What you need to know
Throughout the COVID-19 pandemic, older adults have been more vulnerable to serious illness and death from the COVID-19 virus, while older adults from disadvantaged groups such as racial minorities and low socioeconomic status are at a greater risk of worsening mental health during the pandemic. In the United States, 25% of self-identified sexual minority individuals are 65 years or older, yet there is little known about the effects of the COVID-19 pandemic on the mental health and well-being of sexual minority older adults. This research set out to understand the effects of the COVID-19 pandemic on the health and well-being of sexual minority older adults and proposed that the pre-existing inequalities that affect the mental health and well-being of sexual minorities may be intensified by the pandemic.
The researcher found that compared to heterosexual older adults in the United States, sexual minority older adults reported poorer mental health and well-being during the pandemic as well as more difficulty socially due to a decline in in-person contact.
What is this research about?
Sexual minority individuals are people from diverse populations including, but not limited to, lesbian, gay, bisexual, pansexual, queer, fluid, and asexual sexual orientation. This research takes a social ecological perspective in understanding how the well-being of sexual minority older adults has been affected by the COVID-19 pandemic by recognizing the multiple elements that can influence an individuals’ opportunities and outcomes. From this perspective, the researcher proposed that sexual minority older adults are likely to experience worse social and mental health impact during the pandemic than heterosexual older adults.
Prior to the COVID-19 pandemic research has shown that sexual minority older adults are more vulnerable to mental distress and poor health than heterosexual older adults due to interpersonal and institutional oppression and discrimination. The research proposes that the existing inequalities that affect the health and well-being of sexual minority older adults and make them more vulnerable may be exacerbated by the pandemic based on three potential factors:
- sexual minority individuals are more likely to have pre-existing health conditions which could increase vulnerability to severe infection or death from COVID-19 and this increased health risk may lead to greater mental distress;
- pandemic public health measures may disrupt networks of support and specialized health care services that sexual minority adults rely on (i.e. chosen families who live in different households or closures of and limited access to health care services and providers that are safe and known to sexual minority individuals);
- although sexual minority older adults in the United States live in many different settings, a large majority of sexual minority individuals are concentrated in the cities that have seen the highest COVID-19 case counts and death related to COVID-19. This includes California, Florida, Texas, New York and other major cities within these states.
What did the researchers do?
The data for this study was taken from the June 2020 COVID-19 module of the Health Retirement Study (HRS). The HRS is a longitudinal panel study that surveys a representative sample of adults, 50 years and older, in the United States. In June 2020, a subsample of HRS respondents completed a COVID-19 module that gathered data about their experiences during the pandemic. The study used baseline enrolment questions regarding sexual orientation and relationship status to identify sexual minority older adults. Seven indicators from the COVID-19 module were identified by the researcher to explore mental health and well-being and those included 1) depression, 2) concern about COVID-19 3) pandemic emotional stress, 4) change in loneliness, 5) change in in-person contacts, 6) change in income and 7) change in work.
What did the researchers find?
The results of the study indicate that sexual minority older adults had poorer mental health outcomes and had greater disruption in their lives than heterosexual older adults. With sexual minority older adults reporting greater concern about COVID-19, an increase in loneliness, a higher level of emotional stress and greater effects on work, such as a decrease in income, than their heterosexual counterparts. With this, the research identified three key findings:
- On average, sexual minority older adults reported poorer mental health and well-being during the pandemic than heterosexual older adults. Differences were not explained by sociodemographic characteristics;
- A decline in in-person contact resulted in sexual minority older adults having more difficulty socially than heterosexual older adults;
- The differences in mental health and well-being between sexual minority older adults and their heterosexual counterparts cannot be fully explained by differences in age, marital status, racial or ethnic background, household composition and/or self-rated health. However, levels of depression were no different between sexual minority and heterosexual older adults.
The researcher noted several limitations. Firstly, because a cross-sectional analysis was used the results cannot be interpreted as causal. Secondly, due to the relatively small sample size of sexual minority older adults in the HRS sample, the study does not have enough statistical power to include an intersectional framework to analyze disparities in the data. An issue that is common amongst publicly funded, nationally representative datasets. Thirdly, the empirical analysis was not able to directly assess experiences such as exposure to structural stigma that may also affect the health and well-being of sexual minority older adults. These experiences may be captured in the future through qualitative measures.
Lastly, the HRS’s COVID-19 related measures have not been validated and many are single-item measures. Due to the quickly changing nature of the COVID-19 pandemic the study team was unable to undertake the usual validation process without delaying the study and suggest that future studies should validate these measures to generate a clearer understanding of the effects of the COVID-19 pandemic on the mental health and well-being of sexual minority older adults.
How you can use this research?
The findings of this research indicate several implications for policy and practice. The findings highlight the crucial importance of including questions about sexual orientation and gender identify in government data collection efforts. Researchers and advocates have long been calling for these inclusions to generate data with sufficient sample sizes to better understand the mental health and well-being of sexual minority individuals. Furthermore, the study found that sexual minority older adults experienced a larger reduction in in-person contact during the COVID-19 pandemic, which highlights the need for policy makers to give attention to the specific social support needs of sexual minority individuals. Sexual minority older adults may not be comfortable accessing the existing support services in place due to historical and current experiences of discrimination and thus specialized programs and services should be created to support this population.
The researcher suggests that these programs can be created in collaboration with local community organizations. Lastly, the finding that sexual minority older adults were more concerned about COVID-19 and its impact on their lives, compared to their heterosexual counterparts, highlights a need for governments, social service organizations and healthcare providers to provide current and relevant information on services and support to sexual minority older adults.
About the researchers
Jen-Hao Chen, PhD1
- Department of Sociology & Department of Psychology, National Chengchi University, Taipei, Taiwan