UC Berkeley

Background: Research on the wellbeing and resilience of LGBTQ+ people including sexual minority women (SMW; whose who identify as women and have a sexual orientation other than heterosexual) is currently of paramount importance given recent challenges spurred by the global COVID-19 pandemic, increased social and political polarization around race, gender, and sexuality, and rising anti-LGBTQ+ rhetoric and policies in the USA. Even prior to these contemporary stressors, SMW have experienced about twice the rates of depression, anxiety, and alcohol use disorder compared to heterosexual women, and there is concern that the pandemic may have exacerbated these disparities. Given SMW’s elevated pre-pandemic health concerns, there is a need to clearly characterize how SMW enact resilience, receive the support needed to stay well, and maintain wellbeing in this rapidly changing, stressful world.

Methods: The present study examines these topics though a series of three inter-related research manuscripts that build on each other. First is a quantitative analysis of the protective nature of resilience against depression, anxiety, and alcohol use disorder in a racially diverse sample of SMW (N=520) reported in a quantitative public health-style analysis. The second examines the relationship between resilience and a key factor underlying it – social support –using intersectional quantitative methods to determine the most protective types of social support and to elucidate potential within-SMW differences by race, sexual orientation, and their intersections. Lastly, these research foci were applied to the current social context using qualitative phenomenological methodology to characterize shifts in social support, and mental and behavioral health for a sub-set of SMW (n=17) at the onset of the COVID-19 pandemic.

Results: Higher levels of resilience were associated with lower adjusted odds of depression, anxiety, and alcohol use disorder. SMW who were older and those with higher household income reported the highest levels of resilience. When considering the role of social support in resilience, higher levels of social support were associated with higher levels of resilience, which was consistent across SMW of all demographics. Few within-group differences in this relationship were found by race, sexual orientation, and their intersections. Social support from family, friends, significant others, and especially the LGBTQ+ community were each predictive of greater resilience. Participant interviews shed further light on how changes in social support occurred in at the pandemic’s onset and were at times related to changes in mental and behavioral health.

Implications: This work has implications for social work practice, intervention research, and policy advocacy. Since resilience and social support appear protective against the most common mental and behavioral health concerns in SMW, multi-level interventions that increase access to social support and strengthen resources for resilience are needed, as they have the potential to ameliorate persistent health disparities. This could include individual, couple, family, or group therapy; peer support; and case management tailored to SMW’s specific life experiences and needs. Interventions drawing on social ecological and strengths-based approaches that consider how individual-level outcomes are impacted by broader societal factors like sexism, heterosexism, and racism are needed. Policy advocacy is also needed to ensure that LGBTQ+ community spaces and organizations, which facilitate access to protective LGBTQ+ support, can remain open and financially viable ongoing.