The Interplay of Anxiety, Stress, and Depressive Symptoms among Sexual Orientations in Asian Populations

Background: Healthcare management in modern society plays a crucial role in addressing both physical and mental health conditions, with depression being a prominent concern. Stress and anxiety were intercorrelated with depression, which is commonly reported among individuals of both genders. However, few studies have presented results on this interlink based on sexual orientation. Methods: This study involved examining the association between stress, anxiety, and depressive symptoms, and the ability of anxiety and stress to predict depressive symptoms in a sample of 21,972 volunteer participants from Asian countries (Open-Source & Open-Source Psychometrics Project), who self-reported their mental health experiences in questionnaires on an online platform using the DASS-42 self-report questionnaire. Simple and multiple regression analyses were used to examine the interaction between the three emotional states across five sexual orientations. Results: Across all five sexual orientations (heterosexual, bisexual, homosexual, asexual, and ‘others’), anxiety has been found to be a significant predictor of stress (R2=0.68-0.73) and depressive symptoms (R2=0.64-0.72). Additionally, stress has been shown to be a significant predictor (R2=0.79-0.84) of depressive symptoms. Furthermore, the combination of stress and anxiety was a statistically significant predictor of depressive symptoms in individuals with all five sexual orientations. (Depressive symptoms = 1.26+0.76 stress+0.22 anxiety, R2= 0.66, p < .001). In other words, people with higher levels of anxiety and stress are more likely to develop depressive symptoms. Conclusions: This study confirms that anxiety and stress predict depression not only in a general population but also across sexual minority groups, suggesting that mental healthcare management should combine universal approaches addressing common risk factors and targeted interventions to respond to the unique determinants of mental health in sextual minority populations, especially stigma, discrimination, and social exclusion which differ from those in the general population.