Compared with heterosexuals without lifetime same-sex sexual contact (the sexual-orientation reference group), mostly heterosexual men and women, and bisexual and lesbian women, had elevated lifetime probable PTSD (). Across sexual-orientation groups, women had higher prevalence of PTSD than did men. Among women, bisexual women had the highest prevalence of PTSD (26.6% vs 6.6% of the heterosexual reference group), and among men, gay men had the highest prevalence of PTSD (13.6% vs 4.0% of the reference group). Childhood sexual abuse was more prevalent in all sexual minorities compared with the reference group. Physical abuse was more prevalent among heterosexuals with same-sex sexual contact of both sexes and among mostly heterosexual and bisexual women. Psychological abuse was elevated in mostly heterosexuals of both sexes and in heterosexual women with same-sex sexual contact and bisexual women. Sexual minorities, except for heterosexuals with same-sex partners, were more likely to report childhood gender nonconformity than was the reference group ().
Prevalence of Posttraumatic Stress Disorder (PTSD) and Childhood Abuse, by Sexual Orientation in Early Adulthood: United States, Growing Up Today Study, 2007 Wave
In models adjusted for age, race/ethnicity, and gender, risk of each type of abuse was elevated in all sexual minority groups, except that risk of physical abuse was not statistically significantly elevated in lesbians and gay men (). In models for risk of any sexual abuse, gender-by-sexual-orientation interaction terms indicated greater increased risk for sexual minority men versus sexual minority women compared, respectively, with the male and female reference group risk (P < .001). Sexual minority men were not at higher absolute risk for sexual abuse than were women, however. With the exception of heterosexuals with any lifetime same-sex sexual contact, women had higher exposure to sexual abuse than did men in each category of sexual orientation (). Gender-by-sexual-orientation interaction terms were not statistically significant for the 2 other types of abuse. In supplementary models using the 4-symptom PTSD cutoff, risk ratios for minorities remained elevated and statistically significant, though somewhat attenuated.
Sexual Orientation in Early Adulthood and Exposure to Childhood Abuse: United States, Growing Up Today Study, 2007 Wave
In a model adjusted for race/ethnicity, gender, and age, risk of PTSD was 1.7 to 3.7 times greater for sexual minorities than for the heterosexual reference group (, Model 1). Elevated exposure to childhood abuse explained between 32.3% and 48.4% of the elevated risk of PTSD among sexual minorities (, Model 2). A gender-by-sexual-orientation interaction term was not statistically significant in the model for PTSD.
Exposure to Childhood Abuse and Childhood Gender Nonconformity as Mediators of Sexual-Orientation Disparities in Posttraumatic Stress Disorder in Early Adulthood: United States, Growing Up Today Study, 2007 Wave
Gender nonconformity partly explained disparities in childhood physical and sexual abuse exposure before age 11 years for some sexual minority groups (), suggesting that nonconformity may be one cause of higher prevalence of abuse in sexual minorities. For heterosexuals with same-sex partners, gender nonconformity did not mediate elevated risk of abuse, and for mostly heterosexuals and bisexuals the mediation proportion was small (from no mediation to 15%). By contrast, gender nonconformity accounted for one third of the elevated risk of sexual abuse in the lesbian–gay group. Gender nonconformity was not a significant mediator of increased risk of psychological abuse for any sexual minority group. In sensitivity analyses with nonconformity as a continuous variable, mediation estimates were similar or smaller. In models adjusted for childhood abuse, gender nonconformity further mediated sexual-orientation disparities in PTSD for mostly heterosexuals, although very slightly (, Model 3). In supplementary analyses stratified by gender, mediation proportions were similar for men and women.
Gender Nonconformity Before Age 11 Years as a Mediator of Sexual-Orientation Disparities in Exposure to Childhood Abuse Before Age 11 Years: United States, Growing Up Today Study, 2007 Wave