Sexual orientation, sense of belonging and depression in Australian men.
Keywords: sexual orientation, gay men, depression
Sexual orientation has been identified as a risk factor for depression among men. For example, data from the National Survey of Midlife Development in the United States suggested that gay and bisexual men were 3.0 times more likely to meet the criteria for major depression compared with heterosexual men (Cochran, Sullivan, & Mays, 2003). Results from the Urban Men's Mental Health Study indicated that men who have sex with men had a higher seven-day prevalence of depression than adult U.S. men in general (Mills et al., 2004). Depression among gay men is of further concern owing to the strong relationship between depression and suicidal behavior (Goldney, 2003). Research shows that gay men are at elevated risk for suicide attempts (Paul et al., 2002). Data from the National Health and Nutrition Examination Survey III revealed that 19% of men who have sex with men had attempted suicide, compared with 3.6% of men who had sex with female partners only and 0.5 percent of men who had not had sexual intercourse at all (Cochran & Mays, 2000).
Higher rates of depression among gay men have been linked, at least in part, to the general community's negative attitudes toward homosexuality. Historically, homosexuality has been conceptualised as immoral and indicative of mental illness (Silverstein, 1991). The idea of homosexuality often generates hostility and contempt from the heterosexual community (Fontaine & Hammond, 1997) and is expressed as homophobia or sexual prejudice. "Externalised" homophobia describes behaviour or attitudes of people that affect the gay individual, such as refusing the individual service or abusing him verbally or physically because of his perceived or self-identified sexual orientation (Hetrick & Martin, 1984). External homophobia is commonly experienced by gay men. For example, in a study of 3,039 Australian gay men, 13.9% reported HIV-related abuse and 39.0% reported homophobic abuse in the previous twelve months (van de Ven, Kippax, Crawford, Race, & Rodden, 1998). In addition, experiencing multiple episodes of anti-gay violence has been shown to be associated with high levels of depression (Mills et al., 2004).
"Internalized" homophobia, a gay person's own negative perceptions of same-sex attracted people or same-sex relationships (Shidlo, 1994), has been seen as the most important barrier to the adoption of a positive homosexual identity (Cass, 1979; Troiden, 1989). Nonacceptance of one's sexual orientation can create conflicts about a man's identity as gay and result in his delaying or denying the expression of his homosexuality in order to establish heterosexual relationships (Taylor & Robertson, 1994). There is evidence that internalized homophobia is related to depression among gay men. Internalized homophobia accounted for 18% of the variance in scores on the Beck Depression Inventory among a sample of gay males and lesbians (Igartua, 2003).
Perhaps, not surprisingly, gay men report higher levels of loneliness than heterosexual males (Westefeld, Maples, Buford, & Taylor, 2001). Research suggests that gay men not in a committed relationship or living alone experience higher levels of loneliness than gay men in a committed relationship or living with others (Berger & Mallon, 1993).
The experience of homophobia and loneliness by gay men is likely to result in a sense of social isolation and a lessened sense of belonging. Sense of belonging has been defined from a psychological perspective as the experience of personal involvement and integration within a system or environment, to the extent that a person feels valued and that he or she plays a special role in that system or environment (Hagerty, Lynch-Sauer, Patusky, Bouwsema, & Collier, 1992). This definition of belonging acknowledges that individuals are part of many different communities, although the current study focuses on the general community in which we live, a community that is predominantly heterosexual. It is likely that, because of the general community's prevailing heterosexual character, gay men experience considerable externalized and internalized homophobia and loneliness, with the result that they feel a lessened sense of belonging to the general community as compared to heterosexual men. This proposition has yet to be empirically tested, but if proved correct it could account for the poor physical and mental health often experienced by gay men.
Sense of belonging has been proposed as a basic human need (Maslow, 1954), necessary for psychological well-being and self-actualization (Chubb & Fertman, 1992). Weak feelings of belonging are likely to be associated with loss of psychological sense of well-being (Thompson-Fullilove, 1996). Individuals who report diminished sense of belonging are also more likely to report higher levels of anxiety disorders (Lee & Robbins, 1998), depression (Bailey & McLaren, 2005; Hagerty, Williams, Coyne, & Early, 1996; McLaren, Jude, Hopes, & Sherritt, 2001), suicidal ideation (Bailey & McLaren, 2005; Lewinsohn, Rohde, & Seeley, 1993), and identify fewer reasons for wanting to live (Kissane & McLaren, 2006).
In short, sexual orientation and sense of belonging have been shown to be related to depression and it is likely that sexual orientation is related to sense of belonging. Therefore it is probable that all three variables are interrelated, but precisely how they are related to each other is yet to be established. One possibility is that both sexual orientation and sense of belonging are simultaneously but independently related to depression. Both being gay and experiencing reduced sense of belonging would induce higher levels of depression (additive effect). A second possibility is that as both sexual orientation and sense of belonging are related to depression, and sexual orientation is likely to affect sense of belonging, it is possible that sense of belonging mediates the relation between sexual orientation and depression. Thus, sexual orientation, in and of itself, might not cause depression, unless it first reduces the gay person's sense of belonging. Conversely, a gay person who experiences a high sense of belonging might also experience little depression. A third possibility is that the relation between sense of belonging and depression is stronger for gay men than for heterosexual men. In that case, depression would be related to sense of belonging only if a person was gay and not if the person was heterosexual. This would suggest an interaction between sexual orientation and sense of belonging, and that sexual orientation moderates the relation between sense of belonging and depression.
This study examined the interrelations between sexual orientation, sense of belonging, and depression among men in terms of the three models proposed above: additive, mediation, and moderation. Support for the additive model would be given if both a sense of belonging and self-identifying as heterosexual were negatively and independently associated with depression. If, on the other hand, it was found that sexual orientation predicted a sense of belonging and any relationship between sexual orientation and depression was nullified by the impact on depression of the sense of belonging, then strong support for the mediational model would be inferred. Finally, if it was found that the interaction between sense of belonging and sexual orientation was a predictor of depression, then the moderation model would be supported.
A total of 293 men, aged 18 to 69 years, participated in the study. Twenty men who self-identified as bisexual or transgender were not included due to their small number. There were 136 men who self-identified as heterosexual (M age = 38.76, SD = 11.52) and 137 men who self-identified as gay or homosexual (M age = 39.28, SD = 10.58). The two groups of men did not differ in age (t (271) = 0.39,p > .05). The demographic details of the two groups of men can be seen in Table 1. It was evident that the heterosexual men were more likely to be married or in a committed relationship, whereas the gay men were more likely to be single. In addition, heterosexual men had a higher average income than the gay men. Because of the group differences in relationship status and income, these variables were entered as covariates in subsequent analyses.
A Plain Language Statement described the research and invited the men to volunteer. In addition, the statement provided available resources that could be accessed in the event participants experienced any distress while completing the questionnaire or afterwards. These included contact telephone numbers of the researchers, a general telephone counseling service, and a telephone counseling service specifically for gay men.
The demographic section of the questionnaire asked participants to report their age, relationship status, postal code, highest education level achieved, and annual income. Participants answered the question "Would you consider yourself to be predominantly heterosexual, gay or homosexual, bisexual, transgender, or unsure?".
The 18-item Psychological subscale of the Sense of Belonging Instrument (Hagerty & Patusky, 1995) assessed the men's experience of feeling valued, needed and accepted, and the perception of fit or connectedness within the general community with questions including, "I feel like an outsider in most situations," "I feel like a piece of a jigsaw puzzle that doesn't fit into the puzzle." Respondents gave ratings on a 4-point Likert scale from I (strongly disagree) to 4 (strongly agree). Scores could range from 18 to 72, with the higher scores indicating a greater sense of belonging. Previous research has shown the instrument to be a valid and reliable measure. The test-retest reliability coefficient for the Psychological subscale was r = .84 over an eight-week period (Hagerty & Patusky, 1995). Cronbach's alpha for a sample of Australians was .95 (McLaren et al., 2001). Reliability analysis found that for heterosexual males, the alpha was .95, and for the gay males, the alpha was .96.
The 14-item Depression subscale of the Depression Anxiety Stress Scales (Lovibond & Lovibond, 1995) measures symptoms associated with a dysphoric mood (e.g., hopelessness, devaluation of life, lack of interest and involvement, anhedonia, and inertia). Participants used a 4-point Likert scale from 0 (did not apply to me at all) to 3 (applied to me very much, or most of the time) to rate the extent to which they had experienced each symptom over the past week. Scores could range from 0 to 42, with higher scores indicating the presence of more depression. Research indicates that Cronbach's alpha for the Depression subscale is .97 (Antony, Bieling, Cox, Enns, & Swinson, 1998). Concurrent validity has been demonstrated by the correlation of the instrument with a range of scales, including the Beck Depression Inventory (r = .77), the Beck Anxiety Inventory (r = .84), and the State-Trait Anxiety Inventory--Trait Version (r = .59) (Antony et al., 1998). Test-retest reliability was adequate over a two-week period (r = .71) (Brown, Chorpita, Korotitsch, & Barlow, 1997). For the current sample, the internal reliability result for the depression subscale was .95 for both groups of men.
Participants were recruited over a seven-month period using a number of methods. Initially, men were approached through intact friendship groups of the researchers. Many of these men took questionnaires that were then passed on to other family members and work colleagues. Other men were approached at a number of sporting clubs, social events, and community centres and support groups. Men were also approached in shops and on the street and asked to complete the questionnaire.
When collecting data from gay men, the researchers relied initially on being introduced to members of the gay community by gay friends. This established a social network within which people informed other members of their community of the research and took questionnaires to pass on to them. Gay men were also recruited at prominent gay social events and by advertising in gay magazines. Several community groups also assisted in promoting the research and obtaining participants. Interested participants were provided with additional questionnaires so that these could be passed on to friends who were not as involved in these social events or the gay social scene as such. Participation was voluntary and this was explained to potential participants in the plain language statement and during the course of speaking to them.
The questionnaire was also available on the internet. Advertisements in magazines aimed at gay men and flyers distributed at gyms and sporting venues gave readers a web address, as well as a login name and password. Once on the web site, there was an information page that explained the nature of the research and gave contact phone numbers and a link to the current study. Men were able to complete the questionnaire online and send it anonymously via e-mail to the principal researcher. Fifteen percent of men participated in this manner, with significantly more gay men (24 percent) than heterosexual men (6 percent) using the internet ([chi square](1) = 17.72, p < .001).
Data Screening and Analysis
The depression and sense of belonging variables were assessed for skew. Whereas the sense of belonging variable was acceptable, the depression variable was highly skewed. A logarithmic transformation was performed, which reduced the skew to an acceptable level, and the transformed variable was used in all analyses.
Initially, means and standard deviation scores were calculated for the sense of belonging and depression measures for both the heterosexual and gay men. A series of independent sample t-tests were used to test for differences between the two groups of men on sense of belonging and depression. Controlling for relationship status and income, partial correlations between sexual orientation, sense of belonging and depression were also calculated. A probability level of .05 was used for all analyses.
The additive and moderation effects were examined using hierarchical regression analysis. At Step 1, the demographic variables, on which the two groups of men differed, were entered to provide statistical control. Sexual orientation and sense of belonging to the community were entered at Step 2 and the interaction term (sexual orientation x sense of belonging to the community) was introduced at Step 3.
Prior to calculating the interaction term for the hierarchical regression, the sense of belonging term was centered using the mean-deviation method (Tabachnick & Fidell, 1996). These new centered scores and sexual orientation scores (gay or heterosexual) were then multiplied together to create the new interaction term, sexual orientation x sense of belonging. This interaction term has several advantages. Jaccard, Turrisi, and Wan (1990) argued that normal multiplicative interaction terms in regression analyses inflate standard errors of the regression coefficients. In addition, Cronbach (1987) suggests that centering the independent variables prior to forming a multiplicative term addresses the issue of multicollinearity. The variance inflation factor (VIF) was used to test for multicollinearity in the multiple regressions. Francis (2004) suggests that the VIF should be below 3. In our analysis, the VIF for each variable in the regression analyses was below 2, indicating that the variables were not highly correlated.
The mediating effect of sense of belonging was examined using the regression analyses approach proposed by Baron and Kenny (1986). The criterion variable, depression, was initially regressed on the independent variable, sexual orientation. A second regression analysis was conducted in which the mediator, sense of belonging, was regressed on the independent variable, sexual orientation. This was followed by a third regression analysis in which depression was regressed simultaneously on sexual orientation and sense of belonging. As recommended by Baron and Kenny (1986), mediation was inferred if the sexual orientation variable had an effect on both depression (equation 1) and sense of belonging (equation 2), and if, in equation 3, sense of belonging had an effect on depression, and, secondly, that the effect of sexual orientation on depression was less than that found for this relation in equation 1 but still significant (partial mediation) or less and not significant (full mediation).
Descriptive statistics for the sense of belonging and depression variables for the two groups of men can be seen in Table 2. Results indicated that heterosexual men reported higher levels of sense of belonging and lower levels of depression compared with gay men.
Controlling for relationship status and income, the results of the partial correlation analyses between sexual orientation, sense of belonging and depression indicated that self-identifying as heterosexual was associated with higher levels of belonging (r = -.30, p < .001) and lower levels of depression (r = .21, p < .001). Higher levels of belonging were associated with less depression (r = -.61 ,p < .001).
Additive and Moderation Effects
As shown in Table 3, the demographic variables accounted for eight percent of the variance in depression. Examination of the Beta-values indicated that relationship status contributed significantly to the predictive power of the model. The introduction of sexual orientation and sense of belonging at Step 2 explained an additional 34% of the variance in depression. Sense of belonging, but not sexual orientation, contributed significantly to the predictive power of the model. These results do not support the additive model. The addition of the interaction term at Step 3 did not explain any additional variance in depression; thus, there was no support for the moderation effect either. Relationship status and sense of belonging contributed significantly to the final model. Those who were partnered and showed higher levels of belonging reported lower levels of depression. The final model explained 41% of the variance in depression.
As can be seen in Table 4, the independent variable, sexual orientation, had an effect both on the criterion, depression, and the mediator, sense of belonging. Further, the results from equation 3 indicate that sense of belonging had an effect on depression, and that the effect of sexual orientation was less than in equation 1 and was no longer significant. These results suggest that the sense of belonging mediates the relation between sexual orientation and depression.
The present study examined the interrelations among sexual orientation, sense of belonging, and depression among men in terms of additive, moderation and mediation models. It also investigated differences between heterosexual and gay men on measures of sense of belonging and depression. Results revealed that gay men reported higher levels of depression and lower levels of sense of belonging to their community compared with heterosexual men. The results concerning depression were consistent with previous research that demonstrated that gay men have a higher prevalence of depression compared with heterosexual men (Cochran et al., 2003; Mills et al., 2004).
The higher levels of depression and lower levels of sense of belonging among gay men may be explained by sexual prejudice, or homophobia, within the wider community. Like residents of many countries, Australians tend to be homophobic. Kelley (2001) reported that 48% of Australians believed homosexual behavior was always wrong. Although this figure represents a notable decrease since 1980, when 64% subscribed to that view (Kelley, 2001), it remains a substantial percentage at close to half of Australia's population. It is evident, then, that Australian gay men live in a society that condemns their sexuality. This may lead gay men to deny their sexuality, which may result in internalized homophobia and further contribute to depression and lack of a feeling of belonging to the general community.
The results did not support the additive model, indicating that sexual orientation and sense of belonging were not independently related to depression. Whereas sense of belonging was negatively related to depression, being gay, in and of itself, was not associated with higher levels of depression after the impact of sense of belonging had been taken into account. The former finding is consistent with previous research, showing that feeling valued and that one fits in the community is negatively related to depression (Bailey & McLaren, 2005; Hagerty et al., 1996; McLaren et al., 2001).
The results also failed to support the hypothesis that sexual orientation moderates the relation between sense of belonging and depression. This suggests that the relationship between sense of belonging and depression does not vary according to the sexual orientation of the man.
The hypothesis that sense of belonging would mediate the relation between sexual orientation and depression was supported. Thus, the higher levels of depression associated with being gay were largely attributable to the reduced sense of belonging felt by gay men. Sexual orientation was associated with a reduced sense of belonging to the community, which, in turn, was associated with depression. Future research needs to address whether there are any other variables that affect these relationships.
The demographic variable, relationship status, was identified as a predictor of depression, over and above the other variables of interest, including sense of belonging and sexual orientation. This is consistent with previous research that indicates that being unpartnered is associated with higher levels of mental ill-health among men (Aasland, Ekeberg, & Schweder, 2001; Smith, Mercy, & Conn, 1998). Intervention programs need to target such at-risk men.
Implications of Research
On the basis of this study, increasing the extent to which they feel they belong in the community should enhance the mental health of the gay men in this sample. Given that gay men in particular are more likely to report a reduced sense of belonging, particular attention should be paid to increasing their experience of belonging. It is important to educate the gay community about the risks gay men face if they do not feel that they belong to the broader community, and about the resulting impact this has on their mental health. This could lead to the development of a skills-based program with a two-part approach: to provide and empower gay men with the personal skills required to integrate into the general community, and, second, to facilitate the general community's acceptance of gay men. The results indicate that, by assisting gay men to become active participants within the broader community, reduced feelings of depression should follow.
Despite the general health advantages of feeling that one belongs and the apparent need to belong to the broader community, gay men still face the difficulty of integration, given the homophobia and stigmatization of gay men that pervades the general community. Clearly, it is necessary to educate members of the broader community and encourage them to accept and welcome people of diverse backgrounds and sexual orientations. This might be achieved through education programs in schools, interventions by health professionals, and amendments to government policy.
The results also suggested that heterosexual men also need assistance to increase their perceived level of belonging to the community. It would appear that these men would also benefit from a program that empowers them to become a part of the community. This raises the interesting question of whether men, both gay and heterosexual, need to be encouraged to include all men in the community, if as the results of this study suggest, all men, regardless of sexual orientation, need to feel that they have a place in the community and are valued members of it.
It is important to note that this study assessed only the sense of belonging to the general community. Research has indicated that gay men often form strong social relationships with other gay men and constitute an independent gay community. Woolwine (2000), for example, demonstrated that gay friendships were very important to gay men, and that such friendships helped to define a clear sense of a gay community. The perceived homophobia of much of society was cited as a reason for such friendships with other gay men, who readily accepted and affirmed gay sexuality. Hart and Fitzpatrick's (1990) study indicated that the majority (66%) of gay men reported that half or more of their friends were other gay men, 75% reported that a half or more of their social life was spent with other gay men, and 35% reported that proximity to the "gay scene" was a factor in their decision about where to reside. Other research has also highlighted the predominance of gay men among the friendship networks of gay men (Frable, Wortman, & Joseph, 1997). It is likely that a sense of belonging to the gay community is a protective factor against the development of depression derived from a reduced sense of belonging to the general community. We are currently analyzing data to test this proposition.
Limitations of the Research
The results and implications of this study need to be considered in light of some of the study's limitations. The sole use of self-report measures and the non-random selection of participants are methodological issues of concern. It is to be noted, however, that conducting research with a minority group, such as gay men, inevitably leads to sampling issues. If one is to obtain a sample large enough to conduct statistical analyses, non-random sampling methods are often needed. Further, although efforts to recruit men who were not a part of the gay social world were made, it is difficult to know just how successful our methods were. The use of "snowball recruitment" may have resulted in men who are socially supported being over represented in the sample. It is likely that these men would have a greater sense of belonging and better mental health than isolated men.
In light of these limitations, the results indicate that a sense of belonging is indeed a key mental health concept, strongly associated with depression, and that sexual orientation is related to depression via feelings of belonging in the community. Future research aimed at investigating ways to increase a sense of belonging among men, particularly gay men, is clearly needed.
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SUZANNE MCLAREN BELINDA JUDE ANGUS J. McLACHLAN
University of Ballarat
Suzanne McLaren, Belinda Jude, and Angus J. McLachlan, School of Behavioural and Social Sciences and Humanities, University of Ballarat.
Correspondence concerning this article should be addressed to Suzanne McLaren, University of Ballarat, University Drive, Mr. Helen, VIC 3353 Australia. Electronic mail: firstname.lastname@example.org
Table 1 Demographic Information for Gay (n = 137) and Heterosexual (n = 136) Men Variable Gay men Hetero- sexual men n % n % [chi square] Relationship status 12.46 * Single 56 41 31 23 Married/Committed rl'ship 67 48 93 68 Separated/Divorced 13 10 12 9 Widow 1 1 0 0 Education level 7.78 Primary school 2 1 0 0 Year 12/Trade certificate 46 34 66 49 Undergraduate degree 49 36 36 26 Postgraduate degree 38 28 34 25 Income 13.30 * $5,000 - $10,000 14 10 8 6 $10,000 - $20,000 16 12 12 9 $20,000 - $30,000 16 12 18 13 $30,000 - $40,000 25 18 9 7 $40,000 - $50,000 18 13 23 17 $50,000+ 48 35 66 48 Place of residence 0.08 Urban 100 73 86 63 Regional/Rural 37 27 50 37 Note. There are 2 missing values for education level for gay men. * p < .05. Table 2 Descriptive Statistics for Key Variables According to Sexual Orientation Variable Gay men Heterosexual men M SD M SD t Sense of belonging 53.32 11.59 60.96 9.74 Depression 8.09 9.59 4.10 6.38 4.06 * Depression (transformed) 0.73 0.47 0.49 0.42 4.44 * * p < .001. Table 3 Summary of Hierarchical Regression Analysis for Sexual Orientation, Sense of Belonging and the Interaction between Sexual Orientation x Sense of Belonging Predicting Depression Variable B SE B [beta] t Step 1 [[R.sup.2] = .08, adjusted [R.sup.2] = .07, F(2, 264) = 11.68, p < .001] Relationship status (a) -0.22 0.06 -0.24 -3.89 * Income -0.03 0.02 -0.11 -1.86 Step 2 [[DELTA][R.sup.2]= .34, adjusted [R.sup.2] = .41, F(2, 262) = 79.91, p < .001] Relationship status (a) -0.16 0.05 -0.17 -3.37 * Income -0.01 0.01 -0.02 -0.36 Sexual orientation (b) 0.03 0.05 0.03 0.60 Sense of belonging -0.02 0.00 -0.59 -11.63 ** Step 3 [[DELTA][R.sup.2]= .00, adjusted [R.sup.2] = .41, F(1, 261) = 0.00,p > .05] Relationship status (a) -0.16 0.05 -0.17 -3.32 * Income -0.01 0.01 -0.02 -0.36 Sexual orientation (b) 0.03 0.05 0.03 0.60 Sense of belonging -0.02 0.01 -0.58 -3.41 * Sexual Orientation (b) x Sense of Belonging 0.00 0.00 -0.01 -0.05 (a) single = 1, partnered = 2. (b) heterosexual = 1, gay male = 2. * p < .01. ** p <.001. Table 4 Mediation Effect of Sense of Belonging on the Relation of Sexual Orientation to Depression [beta] Equation 1: Depression on Relationship status (a) -.20 ** Income -.09 Sexual orientation (b) -.21 ** Equation 2: Sense of belonging on Relationship status (a) .06 Income .13 * Sexual orientation (b) -.30 *** Equation 3: Depression on Relationship status (a) -.17 ** Income -.02 Sexual orientation (b) .03 Sense of Belonging -.59 *** Note: The [beta] values are the standardised beta coefficients. (a) single = 1, partnered = 2. (b) heterosexual = 1, gay male = 2. * p < .05. ** p < .01. *** p < .001.
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|Author:||McLaren, Suzanne; Jude, Belinda; McLachlan, Angus J.|
|Publication:||International Journal of Men's Health|
|Date:||Sep 22, 2007|
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