Discrimination and Distress: A Oaxaca-Blinder Decomposition of Sexual Minority Mental Health Disparities (DSI-SRP)
This DSI-SRP fellowship funded Harrison Stuart to work in the laboratory of Dr. Gilbert Gonzales, PhD, MHA in the Department of Medicine, Health, and Society during the summer of 2022. Harrison is a senior with majors in Economics and Medicine, Health, & Society.
Sexual minority adults (including gay men, lesbian women, and bisexual individuals) are more likely to report psychological distress than their heterosexual counterparts. A proportion of the mental health disparity is likely attributable to the harmful effects of discrimination and stigma, which most population-based surveys do not measure. Using Oaxaca-Blinder decomposition methods, Harrison sought to characterize observed disparities in psychological distress using multivariable logistic regression models accounting for demographic, socioeconomic, and health factors. Oaxaca-Blinder decomposition, developed in the economics literature to study wage gaps, is an econometric technique used to separate an observed disparity into a portion due to differences in two groups’ observed characteristics and due to the groups’ unobserved characteristics, the latter of which may be attributed to discrimination and stigma. Using large and rich data from the 2015-2018 National Health Interview Survey and the Behavioral Risk Factor Surveillance System, Harrison confirmed that sexual minorities experience significantly worse mental health outcomes than heterosexuals, with bisexual adults experiencing worse outcomes than their gay and lesbian peers. The largest contributing factors to these disparities are differences in age, marital status, smoking status, and access to mental health care. However, 47-66% of observed mental health disparities are due to worse returns to characteristics for sexual minority adults. These worse returns may be the result of discrimination in the labor market, stigma in clinical settings, non-disclosure of sexual orientation to family and friends, or fears of violence. His work demonstrates that mental health providers should screen for psychological distress among sexual minority patients, and policymakers should consider the potential mental health benefits of nondiscrimination laws, marriage protections, and anti-discrimination awareness campaigns.
In addition to receiving support through a DSI-SRP fellowship, this project was supported and facilitated by the DSI Data Science Team through their regular summer workshops and demo sessions.