Adverse Childhood Experiences and Mental Health Outcomes Among Sexual Minority Women: A Population-Based Study

Purpose: We aimed to investigate the association between sexual orientation and multiple types of adverse childhood experiences (ACEs) and to what extent ACEs mediate the association between sexual orientation and symptoms of depression and anxiety among sexual minority women (SMW). Methods: This was a cross-sectional analysis nested within the nationally representative Icelandic Stress-And-Gene-Analysis cohort. Data were collected from March 2018 to June 2019. Participants included 11,007 women, aged 18-69, with data on sexual orientation and ACEs. Self-reported data were obtained on 13 different ACEs, and current symptoms of depression and anxiety. Results: Overall, 724 (6.6%) identified as sexual minority. The mean age of SMW was 34.0 years (standard deviation [SD] 14.0) and 44.7 years (SD 14.0) for heterosexual women. SMW were more likely to report six or more ACEs than heterosexual women (21.7% vs. 11.3%, respectively), yielding an adjusted odds ratio (aOR) of 2.26 (95% confidence interval [CI] 1.76-2.91). SMW were more likely than heterosexual women to report four types of ACEs: specifically bullying, emotional abuse, sexual abuse, and mental illness in the household (aOR ranging from 1.36 to 1.71). SMW reported higher odds of current symptoms of depression (aOR = 2.10, 95% CI 1.77-2.49) and anxiety (aOR = 1.69, 95% CI 1.41-2.02). The total number of ACEs mediated 32.6% of the association between sexual orientation and depression, and 43.2% of the association between sexual orientation and anxiety. Conclusion: These findings suggest that ACEs are a major contributor to the mental health disparities observed among SMW.