High burden of depressive symptoms among sexual and gender diverse persons in Brazil: The role of discrimination, internalized homonegativity, and race

Sexual and gender diverse (SGD) populations have historically faced restricted rights and systematic discrimination for deviating from the established hetero-cis-normative norms. This long-standing marginalization has a profound negative impact on health outcomes, including a heightened risk of developing mental health issues, such as depression. Understanding the health-disease process among SGD populations requires recognizing that discriminatory experiences, such as homophobia and transphobia, are not unidimensional, but operate synergistically with layered forms of discrimination, such as racism. We assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) among SGD persons in Brazil using race as a stratification variable. We also evaluated the role of discrimination and internalized homonegativity on depressive symptoms, while adjusting for covariates. This was a cross-sectional online survey recruiting SGD persons aged 18 years or older, living in Brazil, through dating apps and social media. Overall, 6220 participants were included, 3749 (60.3%) White, 1685 (27.1%) Pardo and 786 (12.6%) Black. Mean scores of depressive symptoms was 8.8 (SD7.1), higher among Black (9.6; SD 7.5) and Pardo (9.3; SD 7.2) than White (8.4; SD7.0) (p < 0.0001). Considering a PHQ-9 cut-off of ≥10 points, more Black and Pardo participants reported depressive symptoms than White participants (38.5%, 38.1%; 32.3%, respectively). In multivariable linear regression models, higher discrimination score and younger age were associated with higher scores of depressive symptoms for all races. Additionally, internalized homonegativity and lower income were associated with higher depressive symptoms scores for Pardo and White, but not for Black participants. To effectively address vulnerability to depression among SGD populations, it is essential to establish approaches that consider the intersections between different forms of oppression. This includes policies that tackle racism, homophobia, and transphobia, as well as investment in accessible mental health services.