The association of multi-level anti-LGBTQ+ stigma and hypervigilance with health outcomes among LGBTQ+ cancer caregivers in the United States.

298 Background: Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) identifying individuals in the US experience substantial health inequities—driven by structural forces such as stigma. LGBTQ+ individuals are also more likely to serve as primary caregivers than non-LGBTQ+ individuals—likely exacerbating health inequities. However, the health impacts of exposure to LGBTQ+ stigma and hypervigilance (state of constant high alert) have not been assessed among caregivers. Methods: LGBTQ+ adults in the US who provided unpaid care in the last three years to someone with cancer participated in an online survey. Survey domains included sociodemographics, measures of LGBTQ+ experiences including the Human Rights Campaign State Equality Index, an adapted version of the Sexual Stigma Scale (perceived and enacted), the Riggle Hypervigilance Measure (behavioral and contextual), as well as health outcomes (PROMIS anxiety, depression, sleep disturbance, and fatigue). Latent class analysis (LCA) was used to group participants based on measures of LGBTQ+ experiences. Multivariable linear regression models then tested the association between LCA classes and each PROMIS measure. Results: Among N=332 LGBTQ+ cancer caregivers, most were gay or lesbian (44.0%) or bisexual (46.1%), cisgender men (40.4%) or cisgender women (43.1%), White (63.0%), non-Hispanic or Latine (87.1%), and caring for a parent (39.8%). The best fitting LCA revealed four classes of LGBTQ+ stigma and hypervigilance (1. Low [31.0%]; 2. Moderate stigma and behavioral hypervigilance [21.7%]; 3. Moderate contextual hypervigilance and scanning [19.3%]; and 4. High [28.0%]). Moderate and high stigma and hypervigilance classes (2, 3, 4) were significantly associated with each health outcome in comparison to low stigma and hypervigilance (Table). Conclusions: LGBTQ+ cancer caregivers are exposed to substantial LGBTQ+ stigma and hypervigilance that was associated with worse health outcomes—highlighting the need for health systems to ensure LGBTQ+ inclusivity as well as tailored resources and services. Multivariable linear regression models (N=307). PROMIS Anxiety PROMIS Depression PROMIS Sleep Disturbance PROMIS Fatigue (95%CI) (95%CI) (95%CI) (95%CI) LGBTQ+ Stigma and Hypervigilance LCA 1. Low Stigma and Hypervigilance Ref Ref Ref Ref 2. Moderate Stigma and Behavioral Hypervigilance 9.16 (6.41 – 11.92) 8.16 (5.12 – 11.19 8.01 (5.50 – 10.53) 9.12 (5.81 – 12.43) 3. Moderate Contextual Hypervigilance and Scanning 6.23 (3.37 – 9.09) 5.00 (1.82 – 8.15 7.20 (4.58 – 9.82) 6.87 (3.45 – 10.29) 4. High Stigma and Hypervigilance 10.43 (7.75 – 13.11) 9.61 (6.67 – 12.54 9.50 (7.02 – 11.98) 12.11 (8.88 – 15.35) Controlled for age, sexual orientation, gender, race and ethnicity.