Trends in Mental Health and Smoking Disparities Between Sexual Minority and Heterosexual Adults in Canada, 2003-2020
Dublin Core
Title
Trends in Mental Health and Smoking Disparities Between Sexual Minority and Heterosexual Adults in Canada, 2003-2020
Subject
Clinical psychology
Creator
Kristen Walker
Electronic Resource Item Type Metadata
Journal Name
SSM - Population Health
Volume
Vol. 27
Publication Date
2024
Publisher
Elsevier ScienceDirect
Document Type
Journal article
Language
English
Region
Canada
Access
Open Access
View Source
Abstract
Sexual minority populations experience a higher burden of mental health and substance use/misuse conditions
than heterosexual comparators—a health inequality that has predominantly been attributed to forms of minority
stress experienced by the former group. Sexual minority-affirming legislative and policy advances, as well as
improvements in social attitudes toward sexual minorities in recent decades, should presumably reduce experiences of minority stress, thereby attenuating these disparities. We conducted temporal trend analyses of annual
prevalence of anxiety, depression, poor self-rated mental health, and cigarette smoking, stratified by sexual
orientation and gender/sex subgroups using the Canadian Community Health Survey, 2003–2020. Descriptive
analyses were used to display temporal trends; joinpoint regression was used to identify significant changes in
prevalence data during 2003–2020; and prevalence ratios were estimated by year to detect any reduction in
disparities. The prevalence of self-rated mental health and mood and anxiety disorders increased, whereas the
prevalence of smoking decreased, between 2003 and 2020, among both sexual minority and heterosexual people
in Canada. We observed a significant inflection point in 2009 in the self-rated mental health trend among
bisexual women, where rates of poor mental health initially decreased from 2003 but then increased drastically
from 2009 to 2020. Significant inflection points in current smoking trends were observed in 2012 among bisexual
and heterosexual women and in 2013 among heterosexual men; in all three groups, both segments demonstrated
decreasing trends, however, the slope of the trend became more pronounced in the latter period. Consistent with
other North American studies, we found that relative differences between sexual minority and heterosexual
groups for all four outcomes remained the same or increased during this 18-year period. Findings highlight the
need to better understand mechanisms bolstering sexual orientation health disparities.
than heterosexual comparators—a health inequality that has predominantly been attributed to forms of minority
stress experienced by the former group. Sexual minority-affirming legislative and policy advances, as well as
improvements in social attitudes toward sexual minorities in recent decades, should presumably reduce experiences of minority stress, thereby attenuating these disparities. We conducted temporal trend analyses of annual
prevalence of anxiety, depression, poor self-rated mental health, and cigarette smoking, stratified by sexual
orientation and gender/sex subgroups using the Canadian Community Health Survey, 2003–2020. Descriptive
analyses were used to display temporal trends; joinpoint regression was used to identify significant changes in
prevalence data during 2003–2020; and prevalence ratios were estimated by year to detect any reduction in
disparities. The prevalence of self-rated mental health and mood and anxiety disorders increased, whereas the
prevalence of smoking decreased, between 2003 and 2020, among both sexual minority and heterosexual people
in Canada. We observed a significant inflection point in 2009 in the self-rated mental health trend among
bisexual women, where rates of poor mental health initially decreased from 2003 but then increased drastically
from 2009 to 2020. Significant inflection points in current smoking trends were observed in 2012 among bisexual
and heterosexual women and in 2013 among heterosexual men; in all three groups, both segments demonstrated
decreasing trends, however, the slope of the trend became more pronounced in the latter period. Consistent with
other North American studies, we found that relative differences between sexual minority and heterosexual
groups for all four outcomes remained the same or increased during this 18-year period. Findings highlight the
need to better understand mechanisms bolstering sexual orientation health disparities.
Citation
Kristen Walker, “Trends in Mental Health and Smoking Disparities Between Sexual Minority and Heterosexual Adults in Canada, 2003-2020,” ICMGLT Digital Library, accessed June 12, 2026, https://icmglt.org/library/items/show/497.