Navigating Inequities in Health Care: Personality Functioning, Health Literacy, and Healthcare-Related Sexual Stigma as Pathways to Psychological Well-Being in LGBTQ+ Individuals

Abstract The present study examined how impairments in personality functioning relate to psychological well-being among LGBTQ+ individuals, with particular attention to the serial mediating roles of health literacy and experienced and anticipated sexual stigma in healthcare services. Two subgroups defined by gender identity, namely lesbian, gay, and bisexual cisgender (LGB cis) and transgender, nonbinary, and queer (TNBQ) individuals, were compared, and LGBTQ+ community connectedness was tested as a moderator. In this cross-sectional study, 360 LGBTQ+ individuals living in Italy (59.44% LGB cis, 40.56% TNBQ) completed validated self-report measures of personality functioning, health literacy, experienced and anticipated sexual stigma in healthcare services, psychological well-being, and community connectedness. Serial moderated mediation analyses (with 5,000 bootstrap samples) were estimated separately for each subgroup, controlling for age, education, chronic disease, and disability. Impairments in personality functioning were negatively associated with psychological well-being in both subgroups. However, the serial indirect pathway linking personality functioning to psychological well-being through health literacy and healthcare-related sexual stigma was significant only among TNBQ individuals. Moreover, community connectedness buffered the negative association between sexual stigma and psychological well-being among TNBQ participants, such that the association became nonsignificant at high levels of connectedness. Strengthening health literacy and fostering community connectedness may represent relevant targets for protecting the well-being of LGBTQ+ individuals, and TNBQ populations in particular, against the joint influence of psychological vulnerabilities and healthcare stigma. Affirmative, inclusive clinical practices and social policies that reduce the experience and anticipation of sexual stigma within healthcare settings are likewise essential.