"What matters most is how open one can be"

Richard Bränström, researcher in health psychology at Karolinska Institutet’s Department of Clinical Neuroscience, has studied the situation facing LGB individuals in 28 European countries. By reviewing legislation and measuring the population’s acceptance of homosexuality, he has evaluated the level of stigmatisation LGB individuals face in these countries. This has been compared to the results of questionnaires in which LGB individuals have responded to questions about their life-satisfaction.

“We see a clear correlation. The more a country stigmatises LGB individuals, the worse their mental health. It is unusual to see such a strong correlation between a country’s laws and attitudes, and the health of its citizens,” says Richard Bränström.

Vulnerable minorities

Ill-health among members of vulnerable minorities is often explained by the fact that they are exposed to specific stress factors in the form of the society’s attitudes, discrimination, social exclusion, threats and bullying. Individual factors also come into play. Those who expect to be treated badly often internalise the negative attitudes prevalent in their environment and, in so doing, denigrate themselves as much as the society around them does.

“The factor that above all others affects mental health is how open one can be about one’s sexual orientation. Openness explains most of the differences we see in life-satisfaction between European countries.”

Here, there are enormous differences. In countries such as Romania, Latvia and Lithuania, only 20% of lesbians, gay men and bisexuals are open with their sexual orientation. This is the result of discriminatory legislation and negative attitudes to LGB individuals. By hiding their sexual orientation, people reduce the risk of threats and violence – this does however come at the price of poor mental health.

In Sweden, the situation is much better, with 80% of LGB individuals being with their sexual orientation. They also enjoy better health than their counterparts in the majority of EU countries. Sweden has made great strides in creating a tolerant society for the 2-4% of the population that identifies as lesbian, gay or bisexual. We have fewer discriminatory laws, attitudes are becoming ever more positive and, in many parts of society, people receive training in these issues. In parallel with these developments, the health of the group has improved.

“This demonstrates that if we are successful in changing legislation and attitudes and decreasing discrimination within a society, we also have a direct influence on the well-being of people. It is important to understand this as in Sweden we have a clear policy of equality in health,” says Richard Bränström.

Still suffer from worse health

However, LGB individuals still suffer from worse health than heterosexuals. This applies not only to mental health, with surveys showing that LGB individuals also have worse preventable physical health, for example forms of cancers strongly linked to tobacco smoking.

“We must develop preventative measures primarily to combat mental illness, as this is in turn linked to physical health. We need a coordinated strategy,” explains Richard Bränström.

Richard is currently a visiting researcher at Yale University in the United States, where he is continuing his work on European data. Researchers at Yale are working to develop online support for LGB individuals who live in countries where they feel far too vulnerable to visit a clinic.

“A pilot project is underway with a chat-based support network for LGB individuals in Romania. This is aimed at improving physical health and reducing sexual risk-taking.”

Richard Bränström would like to continue his research on the health of gay, lesbian and bisexual individuals from an international perspective. His research group is currently also analyzing the situation of transgender people in Europe.

“How do societal norms get under the skin and influence health? For me, as a health psychologist, this is an exciting question,” he says.