Association of Multi-Level LGBTQ+ Stigma and Hypervigilance With Health Outcomes Among LGBTQ+ Cancer Caregivers

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals in the US face significant health inequities driven by structural stigma. However, the health impacts of LGBTQ+ stigma and hypervigilance among LGBTQ+ individuals who are also a cancer caregiver are understudied.

LGBTQ+ adults in the US who provided unpaid care to a cancer patient ( $\le$  3 years prior) were recruited for an online survey. Survey domains/measures included sociodemographics, State Equality Index, Sexual Stigma Scale (adapted), Riggle Hypervigilance Measure, as well as health outcomes (PROMIS anxiety, depression, sleep disturbance, and fatigue). Latent class analysis (LCA) was used to group participants based on LGBTQ+ stigma and hypervigilance scores. Multivariable linear regression models tested the association between LCA classes and each PROMIS measure.

Among 332 LGBTQ+ cancer caregivers, LCA identified four distinct classes: 1. Low stigma and hypervigilance (31.0%), 2. Moderate stigma and behavioral hypervigilance (21.7%), 3. Moderate contextual hypervigilance and scanning (19.3%), and 4. High stigma and hypervigilance (28.0%). In multivariable linear regression models, class 4 was associated with a 10.43-unit higher anxiety T-score (95% CI: 7.75-13.11), a 9.61 unit higher depression T-score (95% CI: 6.67-12.54), a 9.50-unit higher sleep disturbance T-score (95% CI: 7.02-11.98), and a 12.11-unit higher fatigue T-score (95% CI: 8.88-15.35) in comparison to class 1. Similar, but lower magnitude, trends were seen across the associations of classes 2 and 3.

The findings of this study algin with the LGBTQ+ literature and suggest that among LGBTQ+ cancer caregivers, increased levels of LGBTQ+ stigma and the resulting hypervigilance drive health inequities.