Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 26, 2022
Date Accepted: Jan 18, 2023
Quality of life and mental health in Chinese sexual and gender minority women and cisgender heterosexual women: cross-sectional survey and mediation analysis
ABSTRACT
Background:
Health-related research on sexual minorities in China is lacking, and research on sexual minority women (SMW) is even less. Currently, there are limited surveys related to mental health in Chinese SMW, but there are no studies on their quality of life (QOL), no studies comparing QOL in SMW with heterosexuals, and no studies on the relationship between sexual identity and QOL as well as associated mental health variables.
Objective:
This study aimed to evaluate the QOL and mental health in a diverse sample of Chinese women and make comparisons between SMW and heterosexual ciswomen, and then investigate the relationship between sexual identity and QOL through the role of mental health.
Methods:
A cross-sectional online survey was conducted from July to September 2021. All subjects completed a structured questionnaire containing the World Health Organization Quality of Life- abbreviated short version (WHOQOL-BREF), 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder scale (GAD-7), and Rosenberg Self-Esteem Scale (RSES).
Results:
509 women aged 18–56 years were recruited, including 250 cisgender heterosexual women and 259 SMW. Independent t tests suggested that SMW had lower levels of QOL, higher levels of depressive and anxiety symptoms, and lower self-esteem than heterosexual ciswomen. Person correlations showed that every domain and overall QOL were positively associated with mental health variables with moderate-to-strong correlations (r ranged 0.42-0.75, p<.001). Multiple linear regressions found that sexual minorities, current smokers, and women with no steady partner were associated with worse overall QOL. The mediation analysis found that depression, anxiety, and self-esteem were found to significantly completely mediate the relationship between sexual identity and physical, social, and environment domains of QOL; and the relationship between sexual identity and the overall QOL and psychological QOL were partially mediated by depression and self-esteem.
Conclusions:
Sexual minority women had poorer levels of QOL and worse mental health status than heterosexual women. The study findings affirm the importance of assessing mental health and highlight the need to improve the QOL and mental health of the vulnerable SMW population.
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