Pre-COVID-19 Sexuality-Based Stigma Predicts Mid-Pandemic Anxiety Increases in a Cohort of Sexual Minority Men in the United States.

BACKGROUND

The COVID-19 pandemic severely impacted mental health, including that of gay, bisexual, and other sexual minority men (SMM). Few studies in the US have assessed stigma's role in shaping the mental health of historically marginalized populations during crises.

METHODS

An online sample of 10,130 SMM completed the 2019 American Men's Internet Survey; of these, 1,051 completed a follow-up survey in April, and 572 completed a second follow-up survey in July 2020, meaning 572 completed all three surveys. Using this analytic sample (N = 572), we examined the association between sexuality-based stigma (stigma from family and friends, anticipated healthcare stigma, general social stigma) in the preceding 6 months and increases in anxiety symptoms from April to July 2020 in linear regression models. Economic insecurity and pre-existing psychological distress were considered potential moderators, and we used stratification to examine differences in associations by age.

RESULTS

Mean age was 42 years; 74% of participants (n = 425) were non-Hispanic white, and 84% (n = 482) identified as gay. Greater pre-pandemic general social stigma predicted an increase in anxiety symptoms among SMM overall (adjusted-beta[95% CI] = 0.65[0.26, 1.04]). This increase was amplified among those with greater pre-pandemic psychological distress (adjusted-beta = 0.08[0.01, 0.16]) and specifically among those aged 25 to 44 (adjusted-beta = 0.11[0.01, 0.22]) and 45 to 64 (adjusted-beta = 0.32[0.13, 0.51]). Among SMM aged 16 to 24, greater pre-pandemic stigma from family and friends augmented increases in anxiety among those with greater pre-pandemic psychological distress (adjusted-beta = 0.13[0.03, 0.23]).

CONCLUSIONS

During the initial COVID-19 lockdown, sexuality-based stigma predicted anxiety increases among SMM, increases that were amplified by pre-existing psychological distress and that varied by age. Linking SMM with these vulnerabilities (recent stigma, current distress, young age) to services now and making preparations to link SMM to services later may help mitigate the adverse mental health effects of future national crises.