Sexual orientation differences in ACEs and internalizing psychopathology: Swedish population study

Abstract Background Sexual minority (SM) populations experience increased risk of mental health problems compared to heterosexuals, yet the role of adverse childhood experiences (ACEs) remains understudied. This study's research questions were: (1) What ACE differences exist based on sexual orientation? (2) Can any elevated ACE exposure be explained by SM groups’ greater gender non-conformity (GNC)? (3) To what extent do ACEs explain SM differences in depression, anxiety, and suicidality? Methods A cross-sectional analysis was conducted of 19,421 individuals ages ≥ 16 randomly selected from the Swedish total population register. Data from 2023 included self-reported measures of ACEs, GNC, suicidality, 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder scale (GAD-7). Pre-registered analyses included regression and mediation models, adjusting for age and gender modality. Results Compared with same-gender heterosexuals, all SM subgroups reported more ACEs (range = 18%-37%, all P < 0.01), with the greatest disparity for bisexual women (AOR of ≥ 5 PHL-ACEs = 3.90, 95% CI [2.89, 5.19]). Odds ratios were >1.50 (all P < 0.05) compared with heterosexuals among SM men for: bullying, foster care, household domestic violence, physical neglect, parental incarceration, and adverse neighbourhood; and among SM women: bullying, emotional abuse, and household mental illness. Gay/lesbian participants reported more SGM-ACEs than bisexual participants. GNC partially accounted for SM disparities in bullying and emotional abuse. Indirect effects were statistically significant (mediation proportion range = 13-35%) among all SM subgroups for depressive symptoms, anxiety symptoms, suicidal ideation, and suicide attempt. Conclusions Findings quantify population-level mental health impacts of ACEs on sexual minority groups, underscoring the importance of future research and interventions mitigating these potentially traumatic events.