Health and relationship quality of sexual minorities in Europe

Be lingie i, F ancesco; Ko acic, Ma ija
A icle — Published Ve sion
Heal h and ela ionship quali y o sexual mino i ies in
Eu ope
Jou nal o Popula ion Economics
P o ided in Coope a ion wi h:
Sp inge Na u e
Sugges ed Ci a ion: Be lingie i, F ancesco; Ko acic, Ma ija (2025) : Heal h and ela ionship quali y
o sexual mino i ies in Eu ope, Jou nal o Popula ion Economics, ISSN 1432-1475, Sp inge , Be lin,
Heidelbe g, Vol. 38, Iss. 1,
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Jou nal o Popula ion Economics (2025) 38:15
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ORIGINAL PAPER
Heal h and ela ionship quali y o sexual mino i ies
in Eu ope
F ancesco Be lingie i1·Ma ija Ko acic1,2,3
Recei ed: 27 No embe 2023 / Accep ed: 3 Janua y 2025
© Eu opean Commissions 2025
Abs ac
A g owing body o li e a u e in es iga es inequali ies be ween sexual mino i ies and
hei he e osexual pee s. This pape deals wi h dispa i ies in heal h, heal h- ela ed
beha iou s, and ela ionship quali y among LGB+ indi iduals. We use a no el da a
se ha allows o a wide c oss-na ional analysis (27 EU membe s a es) o dispa i ies
be ween sexual mino i ies and he es o he popula ion, as well as di e ences in
epo ing sexual o ien a ion. We conside a ich se o social s esso s, indi idual-
speci ic beha iou al ac o s, and heal h ou comes, as well as no el pa a-da a (i.e.,
indi iduals’ esponse imes) ha a e no a ailable in o he la ge su eys. The esul s
indica e ha sexual mino i ies a e mo e exposed o s igma- ela ed social s esso s (bo h
in childhood and adul hood), epo wo se physical and men al heal h condi ions, eel
mo e lonely, and a e mo e likely o engage in coping s a egies aimed a educing o
adap ing o s ess ul condi ions. Some o hese indings signi ican ly di e ac oss gay,
lesbian, and bisexual indi iduals and wi h espec o household income, he coun y’s
en o cemen o sexual mino i ies’ igh s, and ela ionship s a us.
Keywo ds LGB+ ·Social s esso s ·Beha iou al isks ·Heal h ·Loneliness
JEL Classi ica ion J12 ·J16 ·K38
Responsible edi o : Milena Nikolo a
BMa ija Ko acic
Ma ija.KOVA[email p o ec ed]; ma ija.ko acic@uni e.i
F ancesco Be lingie i
[email p o ec ed]
1Eu opean Commission, Join Resea ch Cen e (JRC), Isp a, I aly
2Ca’ Fosca i Uni e si y o Venice, Venice, I aly
3Global Labo O ganiza ion (GLO), Essen, Ge many
0123456789().: V,- ol 123
15 Page 2 o 39 F. Be lingie i and M. Ko acic
1 In oduc ion
Imp o ing he inclusion o sexual and gende mino i ies is high on he poli ical agenda
o mos OECD and EU coun ies (see, e.g., Eu opean Commission 2020). Se e al
ad ancemen s in non-disc imina ion policies and in he legal ecogni ion o same-sex
pa ne ships ha e been made o e he pas decades (OECD 2020). Howe e , acco ding
o a ecen su ey, mo e han 40% o LGBTQIA+ people in Eu ope s ill epo ha ing
expe ienced disc imina ion in some a ea o li e, such as a wo k, in housing, heal hca e,
o social se ices (see, e.g., D ydakis 2009; Ahmed and Hamma s ed 2009; Pa acchini
e al. 2015;FRA2020).1Fu he mo e, s igma- ela ed social exclusion, p ejudice, and
disc imina ion agains sexual mino i ies may inc ease he likelihood o expe iencing
ad e se heal h condi ions and make indi iduals engage mo e equen ly in cogni i e
and beha iou al coping s a egies aimed a educing o adap ing o s ess ul condi ions
and associa ed emo ional dis ess, such as smoking, d inking, unheal hy li es yles, and
high- isk sexual ela ionships (see, e.g., Lick e al. 2013; Meads 2020; F iedman 2020;
Williams e al. 2021).
Despi e he ele ance o he opic, he e is s ill li le compa able e idence on how
sexual mino i ies a e compa ed o he e osexual indi iduals. This is mainly because
ques ions abou sexual o ien a ion a e ypically no included in la ge c oss-coun y
su eys. Acco ding o su ey da a om selec ed coun ies, howe e , impo an di -
e ences in socio-economic ou comes pe sis , wi h LGBTQIA+ indi iduals ha ing on
a e age less a ou able labou ma ke ou comes, poo e heal h, and lowe li e sa is ac-
ion han he e osexual indi iduals (Val o 2017). The economics li e a u e has widely
documen ed he exis ence o di e ences in ea nings and o he labou ma ke ou comes
(see, e.g., Ahmed and Hamma s ed 2010; Aksoy e al. 2018;Bu n2020; D ydakis
2022b; Plug and Be khou 2004), bu much less is known abou sys ema ic di e ences
in heal h ou comes, heal h- ela ed beha iou s, and he quali y o social ela ionships.
Mo eo e , mos o he e idence so a s ems om single-coun y s udies ocusing on
he US and he UK (OECD 2019).
This pape exploi s he i s la ge EU-wide su ey (EU-LS, hence o h) ha includes
a de ailed ques ion on sexual o ien a ion, co e ing mo e han 25,000 indi iduals esid-
ing in all 27 Eu opean Union membe s a es. While he su ey does no consis en ly
iden i y all gende mino i ies, and in pa icula ansgende indi iduals, i allows us
o conside LGB+ indi iduals, namely hose ha iden i y as gay, lesbian, bisexual, o
ha ing ano he sexual o ien a ion di e en om he e osexual o s aigh . The da a se
con ains a ich se o in o ma ion on indi iduals’ childhood expe iences, heal h condi-
ions, heal h- ela ed beha iou s, ela ionship quali y, loneliness, and social media use.
In addi ion, he a ailabili y o no el pa a-da a, including indi idual-speci ic esponse
imes, ep esen s an addi ional added alue, allowing o he co ec ion o he epo ing
bias on he sexual o ien a ion ques ion as well as on all he o he a iables conside ed
in he analysis. Ano he o iginal aspec o EU-LS da a conce ns he possibili y o
1The LGBTQIA+ ac onym is used o ep esen a ange o sexual o ien a ions and gende iden i ies. I
s ands o lesbian, gay, bisexual, ansgende , quee (o some imes ques ioning), in e sex, asexual, and
o he s. The “+” ep esen s o he sexual o ien a ions (including “pansexual” and “ wo-spi i ”).
123
Heal h and ela ionship quali y... Page 3 o 39 15
analysing ac oss-g oup p ocesses and hei associa ions wi h ou comes, which ep-
esen s an ad an age o e many o he exis ing s udies ocusing on wi hin-g oup
di e ences. In addi ion o he non-p obabilis ic su ey co e ing all he EU membe
s a es, we also ely on a companion online su ey based on p obabili y sampling ha
was ca ied ou in pa allel in ou Eu opean coun ies, which includes also indi iduals
wi hou in e ne access. The main esul s, howe e , do no change signi ican ly.
On a e age, 91% o esponden s in ou sample iden i y as he e osexual and 6.1% as
lesbian, gay, bisexual, o ha ing ano he sexual o ien a ion (LGB+). These sha es a e
sligh ly la ge han wha was ound in a ecen la ge su ey in he US (Badge e al.
2021) and in o he su eys om OECD coun ies (OECD 2019), bu a e somewha
lowe han es ima es om some o he coun y-speci ic online su eys, such as he
LGBT+ P ide 2021 su ey.
E en hough he su ey was ca ied ou online o minimise a possible unde epo ing
o he sexual o ien a ion due o p i acy issues, i is s ill likely ha he ue sha e
o sexual mino i ies is unde es ima ed in he da a. Di e en epo ing a es may be
coun y-speci ic and signi ican ly in luenced by cul u al no ms and belie s. We i s
p esen de ailed e idence showing ha mo e people iden i y hemsel es as LGB+ in
mo e open and inclusi e coun ies, as well as in cul u es cha ac e ised by less s ingen
social no ms and es ic ions. Mo eo e , we show ha esponden s in coun ies wi h
s onge p o ec ion o sexual mino i ies ake signi ican ly less ime on a e age o
answe he ques ion on hei sexual o ien a ion. This indica es ha he deg ee o
con idence in decla ing he “ac ual” sexual o ien a ion may depend on he deg ee
o inclusi eness o he na ional legisla ion. An in e es ing pic u e eme ges om a
mul i a ia e analysis o he ac o s ela ed o indi idual decisions o e use o answe
he ques ion on sexual o ien a ion. Mo e p ecisely, lowe -educa ed, less weal hy, mo e
eligious, and/o hose li ing in u al a eas a e signi ican ly mo e likely no o epo
hei sexual o ien a ion.
We hen documen subs an ial di e ences be ween LGB+ indi iduals and he es
o he popula ion in e ms o exposu e o social s esso s (bo h in childhood and
adul hood), heal h- ela ed beha iou s and social media (ab)use, physical and men al
heal h ou comes, and loneliness. In pa icula , we ind ha sexual mino i ies a e mo e
likely o ha e expe ienced a low ela ionship quali y wi h pa en s in childhood and had
ewe close iends du ing adolescence. They also can coun less on he suppo om
close amily membe s and iends in adul hood. In addi ion, LGB+ indi iduals ha e
a highe p obabili y o smoking mo e han 10 ciga e es pe day and a e less a e se o
aking isks in heal h- ela ed domains. We also documen a mo e in ense use o social
media among LGB+ indi iduals who also epo mo e o en o neglec wo k, school,
o amily- ela ed du ies because o he ime spen on social media. Mo eo e , sexual
mino i ies a e signi ican ly mo e likely han he e osexual indi iduals o epo ad e se
physical and men al heal h condi ions, as well as loneliness expe iences. Rega ding
men al heal h and emo ional diso de s, he di e ences a e mainly d i en by highe
epo ed a es among bisexual indi iduals, while gay men epo signi ican ly highe
smoking habi s. Finally, we ind some he e ogeneous e ec s wi h espec o indi idual
ela ionship s a us, household income, and coun y openness. Single and less weal hy
LGB+ indi iduals su e mo e om dep essi e symp oms and ha e wo se o e all
heal h compa ed o hose belonging o highe income quan iles o in a ela ionship.
123
15 Page 4 o 39 F. Be lingie i and M. Ko acic
Along simila lines, dispa i ies among sexual mino i ies end o be mo e p onounced
in coun ies whe e sexual mino i y igh s a e less en o ced. The esul s a e obus
o he inclusion o a ich se o con ols, co ec ions o po en ial epo ing biases
based on indi idual-speci ic esponse imes, and addi ional mul iple hypo hesis es ing
co ec ions o accoun o e en ual “ alse posi i e” indings.
The es o he a icle is o ganised as ollows. Sec ion2desc ibes he EU-LS
da ase . In Sec ion 3, we show some desc ip i e s a is ics and discuss possible ac o s
unde lying signi ican he e ogenei ies in epo ing sexual o ien a ion, as well as he
co ela es o indi iduals’ a i udes owa ds no e ealing hei sexual o ien a ion. Sec-
ion4p esen s he concep ual amewo k and ela ed hypo heses, a iables used, and
empi ical s a egy. Sec ion 5shows he main esul , ollowed by Sec ion 6in which
we discuss limi a ions o his s udy and p o ide some di ec ions o u u e esea ch.
Sec ion7concludes.
2 The EU loneliness su ey (EU-LS)
Ou main da a sou ce is he EU Loneliness Su ey (EU- LS), an online su ey con-
duc ed in No embe and Decembe 2022 a ge ing he gene al popula ion aged 16 and
abo e in all 27 EU Membe S a es. Da a we e collec ed o a o al o 25,646 esponden s
ec ui ed om es ablished consume panels, wi h app oxima ely 1000 esponden s pe
coun y excep o Cyp us, Luxembou g, and Mal a (503, 370, and 529 esponden s,
espec i ely). While he su ey is no based on p obabili y sampling, quo as we e used
o achie e a sample ha e lec s he popula ion o each coun y in e ms o age, gende ,
educa ional a ainmen , and NUTS egion o esidence.2Mo eo e , we employ ex-pos
weigh s in all es ima ions o accoun o possible u he unde - ep esen a ion o he
abo e-men ioned socio-demog aphic g oups. Pos -s a i ica ion weigh s a e aimed a
educing he sampling e o and po en ial non- esponse bias. They, hence, eplica e
he dis ibu ion o he c oss-classi ica ion o age g oup, gende , and educa ion in he
popula ion and he ma ginal dis ibu ion o egion in he popula ion. The popula ion
dis ibu ions o he adjus ing a iables we e ob ained om Eu os a s a is ics.3
While he main ocus o he EU-LS was o measu e loneliness and social connec -
edness, indi iduals we e also asked abou hei sexual o ien a ion. In pa icula , hey
we e asked he ollowing ques ion: Which o he ollowing bes desc ibes you sex-
ual o ien a ion? The possible answe s we e: He e osexual/s aigh ,Lesbian o gay,
Bisexual,O he sexual o ien a ion,Don’ know and P e e no o say. We conside
wo di e en ca ego isa ions o sexual o ien a ion: one wi h he agg ega e ca ego y
con aining hose iden i ying as gay/lesbian, bisexual, and o he sexual o ien a ions,
and ano he wi h sepa a e ca ego ies o sexual mino i ies.
2Simple, non-in e locking quo as we e used ollowing popula ion sha es om Eu os a s a is ics by
male/ emale gende , 6 age g oups, 3 educa ion g oups, and 2–16 geog aphical egions depending on he
coun y.
3The same dis ibu ions as o quo as we e used. To imp o e weigh ing e iciency, weigh s we e immed
a he alue o 5. Due o his ac , howe e , he low-educa ed popula ion and ha o indi iduals aged 65+
emain unde - ep esen ed in he weigh ed da a in some coun ies.
123

Heal h and ela ionship quali y... Page 5 o 39 15
The su ey also includes a ques ion on gende iden i y, allowing o he ca ego y
in ano he way besides male and emale. Howe e , gi en ha ew esponden s do
no iden i y wi h he male o emale gende iden i y and he su ey does no allow o
include he ull ange o sexual mino i ies and gende iden i ies4, in ou main analysis,
we only ocus on sexual mino i ies and add ess he popula ion o gay, lesbian, bisexual,
and o he sexual o ien a ions as LGB+ ca ego y. Resul s o non-bina y indi iduals
ha do no iden i y wi h he male o emale gende iden i y a e p esen ed in a sepa a e
analysis (Table A.13, in he Supplemen a y ma e ial).
Besides sexual o ien a ion, he EU-LS su ey includes in o ma ion on s anda d
indi idual-speci ic demog aphic and socio-economic cha ac e is ics, as well as a ich
se o social s esso s, such as exposu e o ad e se expe iences du ing childhood
and adolescence, lack o suppo om amily membe s and iends in adul hood, a
ba e y o ques ions on unheal hy beha iou s, indi idual-speci ic p e e ences in se e al
domains, physical and men al heal h ou comes, loneliness, and se e al aspec s ela ed
o social media use. Fu he mo e, he a ailabili y o indi iduals’ esponse imes o he
sexual o ien a ion ques ion and all he o he ele an a iables ep esen s an addi ional
added alue, allowing o co ec ion o he epo ing bias on he sexual o ien a ion
ques ion as well as on all he o he a iables conside ed in he analysis. The plu ali y
o in o ma ion makes he EU-LS su ey unique in he con ex o simila la ge su eys.
To assess he eliabili y o he EU-LS su ey, we emphasise wo impo an consid-
e a ions. Fi s , he su ey mode and he deg ee o p i acy and anonymi y a e gene ally
ound o ma e subs an ially o he likelihood o decla e as sexual mino i y (Robe -
son e al. 2018). Fo ins ance, in he US, he es ima es o sexual mino i ies a e ound
o be 60% highe when he ques ion on sexual sel -iden i ica ion is comple ed anony-
mously by he esponden s a he han by he in e iewe (OECD 2019). This speaks
in a ou o asking abou sexual iden i ica ion h ough online su eys such as he EU-
LS a he han h ough adi ional su eys. Howe e , he e is e idence ha he size o
sexual mino i ies is unde es ima ed also in anonymous online su eys asking a di ec
ques ion on sexual o ien a ion, pe haps because o a “social desi abili y bias”,
i.e.,
he
ac ha indi iduals a e no willing o p o ide hones answe s in o de o adhe e o
social no ms (Co man e al. 2017). Second, gi en he ac ha he sampling o he
su ey was no p obabili y-based, one could ques ion whe he he esul s a e ep e-
sen a i e o he whole popula ion o he 27 EU coun ies. In pa icula , indi iduals
wi hou in e ne access, who a e mo e likely o be lowe -educa ed, olde , and pa o
ma ginalised communi ies, a e no included in he sample.
Rega ding he la e poin , in addi ion o he non-p obabilis ic su ey, we also ely
on a companion online su ey elying on p obabili y sampling ha was ca ied ou
in pa allel in 4 o he 27 EU coun ies (
i.e.,
F ance, I aly, Poland, and Sweden), he
EU 4 loneliness su ey (EU4-LS). Also, his su ey co e ed app oxima ely 1000
esponden s pe coun y, who we e ec ui ed om online andom p obabili y-based
panels pa o he IPSOS KnowledgePanel. P obabilis ic su eys a e ypically ound
o exhibi a highe accu acy han nonp obabili y samples (Co nesse e al. 2020) and
allow o include he digi ally excluded popula ion in online su eys (Blom e al. 2015).
4Only 0.4% o he esponden s in he EU-LS su ey selec he ca ego y in ano he way when answe ing
he gende ques ion. The su ey does no include in o ma ion abou being ansgende .
123
15 Page 6 o 39 F. Be lingie i and M. Ko acic
We can hus es he obus ness o he main esul s p esen ed o he di e en sampling
me hods applying he same ex-pos weigh s as in he main su ey. The sha e o indi-
iduals iden i ying as LGB+ is e y simila in he wo su eys (see Table A.2 in he
Supplemen a y ma e ial).5
Compa ing he es ima es o sexual mino i ies wi h o he su eys ca ied ou in he
27 EU coun ies, we obse e signi ican simila i ies as well as some disc epancies.
In pa icula , an online su ey ca ied ou by IPSOS in 2021 ( he LGBT+ P ide 2021
Global Su ey) asked he ques ion on sexual o ien a ion in 27 coun ies, including
9 EU coun ies. The sha e o people iden i ying as LGB+ is e y simila (
i.e.,
he
di e ence is wi hin 1 pe cen age poin ) o F ance, he Ne he lands, and Sweden. In
he o he coun ies (
i.e.,
Belgium, Ge many, Hunga y, I aly, Poland, and Spain), he
es ima e o he LGB+ popula ion om he EU-LS is lowe han in he IPSOS su ey.
A possible explana ion is ha he IPSOS su ey ocused on LGBTQIA+ equali y, and
esponse a es may ha e been highe among people iden i ying as a sexual mino i y.
On he o he hand, he popula ion es ima es o sexual mino i ies om na ional su eys
ca ied ou ei he ace- o- ace o h ough elephone in e iews end o be subs an ially
lowe han in he EU-LS in F ance, Ge many, I eland, and Sweden (see Table A.2 in
he Supplemen a y ma e ial and OECD 2019). Besides he su ey mode, he di e -
ence may also come om he la ge ime gap be ween he su eys gi en ha younge
gene a ions a e mo e likely o decla e as LGB+ and ha he a es o epo ing a non-
he e osexual o ien a ion ha e inc eased o e ime, possibly due o imp o ed a i udes
owa d sexual mino i ies (Badge e al. 2021).
3 LGB+ popula ion in Eu ope
3.1 Pa e ns based on he EU-LS su ey
The EU-LS is he i s EU-wide su ey on he o e all popula ion asking abou sex-
ual o ien a ion. On a e age, 6.1% o people iden i y hemsel es as LGB+, 90.6% as
he e osexual/s aigh , 1% don’ know, and 2.3% p e e no o disclose hei sexual
o ien a ion. Panel (a) o Fig.1shows ha mo e men han women decla e as LGB+
in he EU (7.2% s. 4.7%). The di e ence is mainly due o a highe sha e o men
iden i ying as gay (3.1%) han women iden i ying as lesbian (1.2%). Howe e , he
sha e o women e using o answe his ques ion is highe han hose o men (3% s.
1.5%), so ha he sha e o hose iden i ying as he e osexual is 91% o bo h sexes.
Mo eo e , panel (b) o Fig.1shows ha younge indi iduals a e mo e likely o decla e
hemsel es as LGB+ han olde ones: almos 13% o indi iduals be ween 16 and 30
do so, compa ed o 6% o hose aged be ween 30 and 59 and jus 3% o hose aged 60
o olde . The sha e o hose answe ing don’ know is also highe among hose below
he age o 30, consis en wi h he ac ha especially younge people migh s ill be
explo ing o ques ioning hei sexual o ien a ion. On he con a y, he sha e o hose
e using o answe he ques ion is highe among indi iduals abo e he age o 60.
5The la ges di e ence is ound o F ance, whe e he sha e o hose decla ing as LGB+ is ci ca 20% la ge
(7% s. 6%) in he EU4-LS compa ed o he main su ey.
123
Heal h and ela ionship quali y... Page 7 o 39 15
Fig. 1 Popula ion decla ing as LGB+ (%), by gende . No es: EU-LS 2022 a e ages using EU27 sampling
weigh s. The ca ego y “He e osexual/s aigh ” is no epo ed
Fu he mo e, se e al in e es ing pa e ns eme ge when looking a he esponse o he
sexual o ien a ion ques ion by o he socio-demog aphic cha ac e is ics o esponden s
besides age and gende . In pa icula , co ela es o non- esponse o his ques ion a e
wo h explo ing. Less-educa ed indi iduals and hose li ing in poo e households
123
15 Page 8 o 39 F. Be lingie i and M. Ko acic
a e mo e likely o e use o answe he ques ion on sexual o ien a ion, while hose
in a ela ionship a e mo e likely o answe i (see Table A.3 in he Supplemen a y
ma e ial). Mo eo e , hose egula ly a ending eligious se ices a e 2 pe cen age
poin s mo e likely o e use answe ing he ques ion and 1 pe cen age poin mo e
likely o s a e ha hey don’ know hei sexual o ien a ion. Non- esponse o he sexual
o ien a ion ques ion is also co ela ed o non- esponse o he income and ela ionship
s a us ques ion, indica ing ha some indi iduals p e e no o answe se e al pe sonal
ques ions join ly. This ac does no seem o be due o esponden s speeding h ough
he ques ionnai e, gi en he e is a posi i e co ela ion be ween esponse ime o he
sexual o ien a ion ques ion and answe ing p e e no o say o don’ know.6
Figu e2shows ha he e a e la ge di e ences ac oss coun ies in he sha e o
indi iduals decla ing as LGB+, anging om 4% in Cyp us, Czechia, Hunga y, and
I aly o o e 10% in I eland, Luxembou g, and Slo enia.7In gene al, sha es end o be
high in No he n Eu ope and low in Sou he n and Eas e n Eu ope (wi h he excep ion
o Mal a, Spain, Slo enia, and he Bal ic coun ies). The e a e also di e ences be ween
coun ies in he sha e o people ha iden i y hemsel es wi h di e en LGB+ mino i y
g oups. Fo ins ance, in C oa ia, Es onia, La ia, Finland, and Sweden, he sha e o
hose iden i ying as lesbian o gay is below he EU a e age, while he sha e o hose
iden i ying as bisexual is abo e a e age. Mo eo e , he sha e o people p e e ing no
o answe he ques ion on sexual o ien a ion is o en ela i ely high in coun ies wi h
an o e all low sha e o people iden i ying as LGB+, such as Bulga ia, Hunga y, and
Romania.
3.2 Inclusion o sexual mino i ies and con ex ual ac o s: coun y-le el analysis
The p e ious discussion has shown ha he e a e signi ican di e ences be ween EU
coun ies in he sha e o esponden s decla ing hemsel es as LGB+. The ques ion
a ises whe he hese di e ences a e due o a di e en sha e o he popula ion being
non-he e osexual o a he o di e ences in openness abou sexual o ien a ion. The
i s case may a ise, o ins ance, i sexual mino i ies a e mo e likely o mo e o
high-ameni y loca ions (Black e al. 2002) o o places wi h less disc imina ion and
mo e legal igh s (Ma cén and Mo ales 2022). Howe e , geog aphic mobili y ac oss
coun ies in he EU is no la ge enough o ully explain he c oss-coun y di e ences
in he epo ing o sexual o ien a ion.8
6We a e awa e o he ac ha he op ion p e e no o say o don’ know could be indica i e o a ious ac o s,
including discom o wi h he a ailable ca ego ies such as o he sexual o ien a ion o eluc ance o sel -
iden i y wi hin he cons ained op ions p o ided, a he han a s ic e usal o disclose sexual o ien a ion.
This is ce ainly a limi a ion o he EU-LS su ey design.
7The high sha e o LGB+ people in Luxembou g (17%) may be due o he ac ha he coun y has a
ela i ely young and highly educa ed popula ion. Howe e , he su ey ailed o each he a ge ed sample
size o he olde and less-educa ed popula ion in he coun y, which could also con ibu e o he ela i ely
high sha e o he LGB+ popula ion. Gi en he small sample size o Luxembou g (1.4% o he o al sample),
esul s a e no a ec ed when excluding om he analysis indi iduals esiding in he coun y.
8While he sha e o o eign-bo n indi iduals is highe among hose iden i ying as LGB+ han he e osexual
people (18% s 8%), i is s ill no la ge enough o explain he di e ences in he sha e o people iden i ying
as sexual mino i ies, which a e la ge han 200% be ween se e al EU coun ies.
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Heal h and ela ionship quali y... Page 15 o 39 15
Hypo hesis 3 Highe exposu e o ch onic s esso s ela ed o s igma, disc imina ion,
and social exclusion o sexual mino i ies is associa ed wi h a highe likelihood o emo-
ional diso de s, loneliness, ad e se physical heal h- ela ed ou comes, and unc ional
decline compa ed o he gene al popula ion.
4.2 Da a
Social s esso s
The exposu e o social s esso s in childhood and adul hood is measu ed by he
ollowing a iables: indi iduals’ ea ly li e condi ions,
i.e.,
quali y o ela ionship wi h
pa en s du ing childhood, ha ing had a ew close iends in childhood, and suppo
om amily membe s and ela i es in adul hood,
i.e.,
he numbe o close amily
membe s ( wo o less close amily membe s), and equency o mee ing amily mem-
be s (less han once pe week). The pa en -child ela ionship quali y is measu ed on
a 10-poin scale, anging om 1 (“no close a all”) o 10 (“ e y close”). We ollow
B ugia ini e al. (2022) and Ko acic and O so (2022), and ecode he answe s in o
a dicho omous a iable, whe e a alue o 1 indica es ha he indi idual has a low-
quali y ela ionship wi h ei he o bo h pa en s (answe ca ego ies 1–4). Ha ing ew
close iends in childhood is measu ed wi h a bina y a iable indica ing ha indi id-
uals had a ely o ne e a g oup o iends ha hey el com o able spending ime
wi h. In addi ion, we conside he ollowing social suppo ac o s: he numbe o
close iends ( wo o ewe close iends), equency o mee ing close iends (less
han once pe week), a ailabili y o suppo in he case o wo ies o ea s (yes o
no), and ha ing people o coun on o doing some hing enjoyable mos o he ime
(yes o no). As addi ional con ols, we include a bina y a iable cap u ing whe he he
esponden g ew up in he absence o one o bo h pa en s, has li ed wi h close ela i es
wi h men al heal h issues, and/o has had d inking p oblems, as well as ha ing had
poo heal h in childhood.
Beha iou al coping s a egies
Indi iduals’ beha iou al aspec s a e cap u ed by h ee indica o s o unheal hy
beha iou ,
i.e.,
whe he an indi idual smokes mo e han 10 ciga e es pe day, has an
unheal hy die ( ew ui s and ege ables), o is physically inac i e. In addi ion, we con-
side an indica o cap u ing he indi iduals’ isk- aking a i udes in he heal h domain.
Un o una ely, we do no ha e any in o ma ion in ou da a on d ug use and/o abuse.
Finally, o cap u e an excessi e use o social media, we conside a bina y a iable
ha equals one i a esponden spends mo e han 1h pe day on social media (dis in-
guishing be ween social ne wo ks and ins an messaging), ano he a iable cap u ing
whe he esponden s epo o ha e neglec ed wo k o amily du ies due o excessi e
ime spen on social media, as well as he eason o such a beha iou ( eeling be e ).
Ou comes
Among he ou come a iables, we conside he indi iduals’ sel -assessed o e all
heal h (SAH), whe he hey su e om long-las ing heal h p oblems, and a se o
men al/emo ional diso de s. Sel -assessed heal h is measu ed on a i e-poin scale om
123

15 Page 16 o 39 F. Be lingie i and M. Ko acic
“ e y good” (sco e 1) o “ e y poo ” (sco e 5).14 This indica o has been dicho omised
in o a bina y a iable wi h a alue o 1 i indi iduals decla e ha hei heal h is “ ai ly
poo ” o “ e y poo ”, and 0 o he wise. G ouping he wo wo s op ions in o one single
ca ego y (ins ead o conside ing a lowe cu -o ,
i.e.,
“ e y poo ” only) is mo e sui able
o smalle e e ence g oups (Plan e e al. 2024).15 Limi a ions a e cap u ed by ano he
dicho omous a iable indica ing indi iduals su e ing om long-las ing physical and
men al heal h p oblems. We do no ha e any in o ma ion in ou da a on single physical
heal h issues. As o men al/emo ional dis ess, we conside he ollowing diso de s:
dep essi e symp oms, eelings o wo hlessness, ange , ne ousness, hopelessness,
and being unhappy.
The su ey also includes ich in o ma ion abou loneliness and he quali y o social
con ac s and in e ac ions. Loneliness is gene ally unde s ood as he nega i e subjec i e
expe ience a ising when an indi idual pe cei es a signi ican misma ch be ween ac ual
and desi ed social in e ac ions (Pe lman and Peplau 1981; Peplau e al. 1982; E be
and Gilmou 2013). We conside h ee di e en measu es o loneliness, namely a
di ec ques ion, a educed UCLA scale, and De Jong measu es o emo ional and social
isola ion. The exac wo ding o he i ems in he UCLA loneliness scale is: How o en
do you eel isola ed om o he s?,How o en do you eel you lack companionship?,
How o en do you eel le ou ?. In each case, he a ailable esponses a e: 1. O en, 2,
Some o he ime, 3. Ha dly e e o ne e . A sum sco e was compu ed; he e o e, he
scale anges om 3 (no lonely) o 9 ( e y lonely). A mul i-i em measu e ha does
no men ion loneliness di ec ly can be pa icula ly use ul because people a e o en
eluc an o admi eeling lonely (Qual e e al. 2021), o he e is a ia ion in how
people unde s and he e m “loneliness”. The 6-i em De Jong Gie eld Loneliness
Scale, on he o he hand, cap u es emo ional loneliness (s emming om he absence
o an in ima e ela ionship o a close emo ional a achmen ) and social loneliness
(s emming om he absence o a b oade g oup o con ac s o an engaging social
ne wo k).
Explana o y and con ol a iables
Among explana o y and con ol a iables, we conside a se o indi idual-speci ic
demog aphic and socio-economic cha ac e is ics, such as age, gende , ma i al s a us,
employmen si ua ion, educa ion, numbe o child en, ype o esidence a ea ( u al
o u ban), household income, and indi iduals’ immig a ion s a us ( i s - o second-
gene a ion immig an s). We conside six age ca ego ies (16–25, 26–35, 36–45, 46–55,
56–65, and 65+); o indi iduals’ ela ionship s a us, we dis inguish be ween hose
14 Sel - a ed heal h is widely conside ed a alid and eliable indica o o o e all heal h s a us. The li e a u e
shows a s ong co ela ion be ween SAH and mo ali y o mo bidi y (Idle and Benyamini 1997) and wi h
mo e complex heal h indices, such as unc ional abili y o indica o s de i ed om heal h se ice use (Undén
and Elo sson 2006). Dicho omisa ion is a common p ac ice o simpli y he a iable because he esponses
canno be sco ed on a nume ical scale due o he non-equidis an na u e o he ue scale be ween ca ego ies
(Wags a e al. 2007).
15 We, howe e , pe o med an addi ional obus ness check on he al e na i e lowe cu -o , and he esul s
don’ change signi ican ly. We do no epo hese esul s o he sake o space and cla i y. They a e a ailable
upon eques .
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Heal h and ela ionship quali y... Page 17 o 39 15
in a ela ionship, ma ied o cohabi ing, sepa a ed, and widowed (wi h singles as a
e e ence ca ego y); wo king s a us comp ises unemployed, e i ed, homemake s, and
s ill in educa ion (wi h employed indi iduals as a e e ence ca ego y); o income we
conside i e quin iles o household disposable income and a six h ca ego y comp ising
non- esponse o he income ques ion; immig a ion s a us is cap u ed by wo dummy
a iables indica ing i s - and second-gene a ion immig an s; he child en a iables
con ol o he p esence o kids younge han 5 yea s old and hose aged be ween 6
and 15.
Ou inal sample comp ises 25,123 indi iduals (ou o which 1851 iden i y as
gay/lesbian, bisexual, o o he sexual o ien a ion, and 1034 don’ know o p e e
no o answe ) esiding in 27 EU membe s a es who p o ide consis en in o ma ion
h oughou he su ey.16 Table A.1 (in he Supplemen a y ma e ial) epo s unweigh ed
summa y s a is ics.
4.3 Empi ical s a egy
In o de o empi ically alida e Hypo heses 1-3, we es ima e he ollowing empi ical
model:
DVi=α0+α1Xi+α2(LGB+)+α3FE +i,(1)
whe e DV is a ec o o indica o s e e ing o social s esso s (SST R), beha iou al
aspec s (BEH), and heal h- ela ed ou comes and loneliness (O),
i.e.,
i={SST R,BE
H,O}.DVSST R includes he indica o s o social s esso s ela ed o indi iduals’ child-
hood and adul hood: ew iends in childhood, poo quali y pa en –child ela ionship
du ing adolescence, lack o social suppo in adul hood ( ew close iends, a e con ac
wi h iends, lack o suppo in case o need), and lack o suppo om amily membe s
( ew close ela i es, a e con ac wi h amily membe s). DVBEH con ains smoking,
unheal hy die a y habi s, physical inac i i y, isk- aking a i udes in he heal h domain,
excessi e use o social media, and he ela ed a i udes o neglec wo k, school, o
amily- ela ed du ies. Finally, he se o indica o s in DVOaccoun s o physical and
men al heal h ou comes (sel -assessed heal h, long-las ing limi a ions, and emo ional
diso de s) and expe iences o loneliness.
Xis a se o indi idual cha ac e is ics ha includes (depending on he model): age,
gende , educa ion, ype o he esiden ial a ea ( u al s. u ban), household disposable
income (quin iles), ela ionship s a us, employmen s a us, dummy a iables indica ing
i s - and second-gene a ion immig an s, dummy a iables o he p esence o child en
in he household (any child younge han 5 yea s old and hose be ween 6 and 15 yea s
old), and esponse ime o he sexual o ien a ion ques ion and a e age esponse ime
o o he selec ed ques ions. In eg essions o heal h- ela ed beha iou s and heal h
ou comes, Xalso includes in o ma ion on bad heal h in childhood. In eg essions o
social s esso s in childhood, Xalso includes a se o addi ional childhood expe iences,
i.e.,
absence o one o bo h pa en s, close ela i es wi h men al heal h p oblems, and
16 523 esponden s a e excluded om he analysis because o missing alues in he a iables needed o
calcula e sampling weigh s (age, gende , and educa ion) o because o an inconsis en lack o a ia ion in
he answe s o a se o mul iple ques ions (
i.e.,
s aigh lining).
123
15 Page 18 o 39 F. Be lingie i and M. Ko acic
close ela i es wi h d inking p oblems. FE a e ixed e ec s o he coun y o cu en
esidence.
In o de o show ha he impac o social s esso s (lack o social and amily
suppo ) and o unheal hy beha iou on heal h ou comes is mo e p onounced o
LGB+ indi iduals, we es ima e he ollowing eg ession models:
DVO=β0+β1Xi+β2(LGB+)+β3DVSST R,BEH +β4(LGB+)×DVSST R,BEH +β5FE+i,(2)
We expec ha being exposed o social s esso s in childhood and/o adul hood and
he p obabili y o unheal hy beha iou inc ease ad e se heal h ou comes o a g ea e
ex en o sexual mino i ies compa ed o he es o he popula ion.
Fo each dependen a iable, we also disagg ega e he LGB+ ca ego y in o gay,
lesbian, bisexual, and o he sexual o ien a ions and es ima e he models on he en i e
sample and sepa a ely o men and women. We also include indi iduals who answe ed
“
don’ know
” o he sexual o ien a ion ques ion and hose who e used o answe
his ques ion. The same applies o all independen a iables. We do no show hese
addi ional ca ego ies in ou eg ession esul s ables o he sake o space and cla i y.
Mo eo e , in all model speci ica ions, we con ol o he a e age esponse ime o he
sexual o ien a ion ques ion, as well as o he “ e use o answe ” and “don’ know”
answe s o all independen a iables. Depending on he ype o he dependen a iable,
he es ima ion echnique is ei he OLS, logi , o o de ed logi model. In he case o non-
linea es ima ion, a e age ma ginal e ec s a e epo ed. We employ pos -s a i ica ion
weigh s in all eg ession models as desc ibed in Sec ion 2and clus e he obus
s anda d e o s a he coun y o esidence le el. Fu he mo e, ollowing (Romano
and Wol 2005), we p o ide mul iple hypo hesis es ing co ec ions con olling o
he amily-wise e o a e (FWER) o all dependen a iables. In such a way, we a e
able o add ess po en ially e oneous “signi ican ” indings due o he high numbe o
ou come a iables conside ed. Finally, in all eg ession models, obus s anda d e o s
a e boo s apped and clus e ed a he coun y o esidence le el.17
5 Resul s
In his sec ion, we p esen he e idence documen ing dispa i ies in he exposu e o
social s esso s, beha iou al isks, heal h- ela ed ou comes, and loneliness o sexual
mino i ies. This is a signi ican con ibu ion o he li e a u e since inequali ies in hese
dimensions ep esen an impo an public heal h issue and ha e been widely unde -
s udied, especially in he Eu opean con ex . Mo eo e , di e en om many o he
s udies examining wi hin-g oup p ocesses and hei associa ions wi h ou comes, ou
da a allows us o explo e di e ences be ween sexual mino i ies and he es o he
popula ion. As al eady men ioned in Sec ion 2, since he sha e o non-bina y indi id-
uals ha do no iden i y wi h he male o emale gende iden i y is e y low (0.4%),
we conside only he popula ion o gay, lesbian, bisexual people, and hose wi h o he
17 We apply he wild boo s ap as ecommended by Came on e al. (2008) o es ima es wi h clus e ed
s anda d e o s and ew clus e s.
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Heal h and ela ionship quali y... Page 19 o 39 15
sexual o ien a ions (LGB+) as a e e ence ca ego y o sexual mino i ies. Resul s o
non-bina y indi iduals a e p esen ed in a sepa a e analysis. In all eg ession esul s
ables, he epo ed coe icien s a e a e age ma ginal e ec s exp essed as pe cen age
poin di e ences o , in he case o non-bina y ou come a iables, a e age a ia ions
in le els. Fo he sake o cla i y, when discussing he esul s, in some cases we also
e e o he size e ec s.18
5.1 Exposu e o social s esso s o LGB+ indi iduals
Acco ding o ou concep ual amewo k (Fig.6), social s esso s can be g ouped in o
wo b oad ca ego ies: ac o s ela ed o indi iduals’ childhood and hose expe ienced
du ing adul hood. Lowe suppo om amily membe s and iends in childhood is
cap u ed by an ad e se pa en -child ela ionship and ha ing a ely o ne e had a g oup
o iends ha he esponden s el com o able spending ime wi h du ing adolescence.
The e idence in Table 1sugges s ha LGB+ indi iduals a e signi ican ly mo e likely
o ha e expe ienced a low ela ionship quali y wi h pa en s as well as ha ing had
ew close iends. This e ec is mainly d i en by LGB+ males, while he di e ence
be ween LGB+ women and hei he e osexual pee s is smalle and ma ginally signi -
ican . The disad an age in e ms o ad e se ela ionships wi h pa en s is pa icula ly
p onounced o bisexual men, who ha e a 7 pe cen age poin s highe p obabili y o
epo ing his issue compa ed o hei he e osexual pee s, which ep esen s a di e -
ence o 35%.19 Gay men, on he o he hand, a e 7.5 pe cen age poin s mo e likely o
ha e had smalle social ne wo ks in childhood compa ed o he e osexual men, which
ep esen s a di e ence o ci ca 90%. Finally, males decla ing ha ing sexual o ien a ion
o he han gay o bisexual a e e en mo e disad an aged, wi h a 11.7 highe likelihood
o ha ing had ew close iendships in childhood compa ed o he e osexual indi idu-
als, while, a he same ime, hey do no di e in e ms o ad e se ela ionships wi h
pa en s. These esul s ep esen a undamen al isk ac o o sexual mino i ies, which
may inc ease he likelihood o emo ional diso de s and physical heal h como bidi y
la e in li e (B ugia ini e al. 2022; Ko acic and O so 2022; Ko acic and Schnep
2023).
Simila e idence is obse ed when conside ing he p e alence o social s esso s in
adul hood (Table 2). Sexual mino i ies a e signi ican ly mo e likely o ha e less han
h ee close amily membe s and/o iends, o mee amily membe s and iends less
han once a week, and o no ha e someone o coun on in case o need. The dispa i y
in e ms o he numbe o close amily membe s is pa icula ly la ge o bo h LGB+
men (10 pe cen age poin s) and LGB+ women (7 pe cen age poin s), ep esen ing a
18 The eg ession esul s ables epo ing size e ec s a e no included in he manusc ip bu a e a ailable
upon easonable eques .
19 This is calcula ed by ela ing he p obabili y o epo ing ad e se ela ionships o bisexual men (27%)
o he espec i e p obabili y o he e osexual men (20%). The eg ession ables epo ing p obabili ies in
pe cen a e no included in he manusc ip and a e a ailable upon eques .
123
15 Page 20 o 39 F. Be lingie i and M. Ko acic
Table 1 Social s esso s in childhood o LGB+ indi iduals
Ad e se ela ionship pa en s Few close iends
All Male Female All Male Female
LGB+ 0.047*** 0.063*** 0.028* 0.033*** 0.055*** 0.005
(0.013) (0.017) (0.015) (0.010) (0.011) (0.006)
Lesbian/gay 0.047*** 0.035** 0.077** 0.065*** 0.075*** 0.013
(0.014) (0.013) (0.032) (0.015) (0.016) (0.015)
Bisexual 0.045** 0.069** 0.026 0.009 0.021 0.002
(0.020) (0.029) (0.020) (0.009) (0.014) (0.005)
O he SO 0.056 0.163 −0.026 0.055*** 0.117*** 0.009
(0.061) (0.097) (0.053) (0.017) (0.034) (0.012)
No. o obse a ions 24,528 11,745 12,783 24,854 11,904 12,950
No es: The able shows he pe cen age poin s di e ences in epo ing poo ela ionships wi h pa en s in
childhood and a ely o ne e ha ing a close g oup o iends du ing school yea s. Fo each dependen
a iable, wo sepa a e eg ession models a e es ima ed: one wi h he agg ega e LGB+ ca ego y con aining
lesbian, gay, bisexual people, and hose wi h o he sexual o ien a ions, and ano he wi h sepa a e ca ego ies
o LGB+ indi iduals. The e e ence ca ego y is he e osexuals.All models con ain he ull se o demog aphic
and socio-economic cha ac e is ics, as well as a bina y a iable cap u ing whe he he esponden g ew up
in he absence o one o bo h pa en s, has li ed wi h close ela i es wi h men al heal h issues and/o hose
wi h d inking p oblems, and ha ing had poo heal h in childhood. The ull se o explana o y and con ol
a iables includes: age, gende , educa ion, wo king s a us, kids unde 5 yea s old, kids aged be ween 6
and 15 yea s, u al e sus u ban a ea, i s - and second-gene a ion immig an s dummy, household income
quin iles, and esponse ime o he sexual o ien a ion ques ion and a e age esponse ime o o he selec ed
ques ions. The me hod o es ima ion is Logi . Robus s anda d e o s boo s apped and clus e ed a he
coun y o esidence le el a e epo ed in pa en heses. Signi icance le els: *p<0.1; **p<0.05; ***p<
0.01
di e ence o ci ca 32% and 24%, espec i ely, compa ed o hei he e osexual coun-
e pa s. Wi hin gende s, his disc epancy is highes o gay men (14.5 pe cen age
poin s) and bisexual women (8.5 pe cen age poin s). On he con a y, he dispa i y in
e ms o he numbe o close iends and equency o in e ac ions wi h hem is la ge
and signi ican only o LGB+ men and no o LGB+ women.20
In e es ingly, bisexual indi iduals seem pa icula ly s essed compa ed o he es
o he popula ion ega ding he lack o suppo wi h p i a e wo ies o ea s, while
gay and lesbian indi iduals ha e, on a e age, ewe close iends and amily membe s.
Fu he mo e, social con ac s o sexual mino i ies a e gene ally less equen , bo h wi h
iends and hei amilies. Bisexual and lesbian women, on he o he hand, do no di e
signi ican ly om hei he e osexual pee s conce ning he numbe o close iends and
equency o con ac , while hey egis e some dispa i y in he amily con ex . Gay
and lesbian indi iduals, unlike bisexual indi iduals, do no di e signi ican ly om
hei he e osexual coun e pa s in cases o a need o suppo wi h p i a e wo ies o
ea s and in e ms o ha ing company.
20 The di e ence be ween he coe icien s o LGB+ men and LGB+ women is s a is ically signi ican a
he 95% con idence le el o bo h ha ing ew close iends and in equen con ac s wi h hem. Signi icance
es s o di e ences by gende a e no included in he manusc ip and a e a ailable upon eques .
123

Heal h and ela ionship quali y... Page 21 o 39 15
Table 2 Social s esso s in adul hood o LGB+ indi iduals
Close amily membe s (<3) Few mee ings: amily
All Male Female All Male Female
LGB+ 0.090*** 0.103*** 0.069*** 0.073*** 0.101*** 0.039**
(0.015) (0.024) (0.022) (0.017) (0.026) (0.016)
Lesbian/gay 0.122*** 0.145*** 0.073** 0.092*** 0.113*** 0.046
(0.023) (0.031) (0.028) (0.029) (0.034) (0.027)
Bisexual 0.087*** 0.079** 0.085** 0.060*** 0.088*** 0.033**
(0.024) (0.029) (0.036) (0.015) (0.028) (0.014)
O he SO 0.024 0.035 0.011 0.082 0.112 0.056
(0.016) (0.039) (0.010) (0.106) (0.156) (0.132)
No. o obse a ions 23,513 11,181 12,332 24,792 11,887 12,905
Close iends (<3) Few mee ings: iends
All Male Female All Male Female
LGB+ 0.048** 0.064*** 0.021 0.048** 0.096*** −0.008
(0.016) (0.021) (0.029) (0.022) (0.037) (0.043)
Lesbian/gay 0.067*** 0.086*** 0.003 0.068** 0.098*** 0.010
(0.020) (0.027) (0.002) (0.035) (0.041) (0.061)
Bisexual 0.053** 0.071** 0.035 0.047** 0.085 0.014
(0.023) (0.025) (0.067) (0.021) (0.059) (0.013)
O he SO −0.016 −0.055 0.003 0.001 0.145 −0.107
(0.019) (0.061) (0.007) (0.001) (0.170) (0.062)
No. o obse a ions 23,303 11,122 12,181 24,748 11,859 12,889
Low suppo : wo ies Low suppo : company
All Male Female All Male Female
LGB+ 0.068** 0.062 0.072*** 0.044** 0.076** 0.010
(0.030) (0.088) (0.025) (0.018) (0.035) (0.010)
Lesbian/gay 0.034 0.010 0.066 0.017 0.040 −0.028
(0.283) (0.012) (0.048) (0.064) (0.263) (0.119)
Bisexual 0.082** 0.093* 0.075** 0.072*** 0.110*** 0.043
(0.033) (0.055) (0.032) (0.020) (0.032) (0.043)
O he SO 0.097** 0.140 0.072* 0.001 0.073 −0.043
(0.037) (0.100) (0.036) (0.004) (0.803) (0.099)
No. o obse a ions 24,014 11,445 12,569 24,210 11,545 12,665
No es: The able shows dispa i ies be ween LGB+ and he e osexual indi iduals o se e al social s esso s
in adul hood. Fo each dependen a iable, wo sepa a e eg ession models a e es ima ed: one wi h he
agg ega e LGB+ ca ego y con aining lesbian, gay, bisexual people, and hose wi h o he sexual o ien a ions,
and ano he wi h sepa a e ca ego ies o LGB+ indi iduals. The e e ence ca ego y is he e osexuals. All
models con ain he ull se o demog aphic and socio-economic cha ac e is ics which includes: age, gende ,
educa ion, wo king s a us, kids unde 5 yea s old, kids aged be ween 6 and 15 yea s, u al e sus u ban
a ea, i s - and second-gene a ion immig an s dummy, household income quin iles and esponse ime o he
sexual o ien a ion ques ion and a e age esponse ime o o he selec ed ques ions. The me hod o es ima ion
is Logi . Robus s anda d e o s boo s apped and clus e ed a he coun y o esidence le el a e epo ed in
pa en heses. Signi icance le els: *p<0.1; **p<0.05; ***p<0.01
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15 Page 22 o 39 F. Be lingie i and M. Ko acic
5.2 A i udes and isky beha iou s o LGB+ indi iduals
P e iously documen ed dispa i ies in exposu e o social s esso s in childhood and
adul hood may ansla e in o a highe p obabili y o ulne able g oups engaging in cop-
ing s a egies aimed a educing s ess ul condi ions. These include isky beha iou s
such as smoking, physical inac i i y, unheal hy die s, subs ance use, and, in gene al,
a lowe a e sion o isk- aking in he heal h domain. Mo eo e , he indi idual’s eac-
ion o s ess may also ansla e in o an excessi e use o social ne wo ks, wi h ela ed
consequences in e ms o ela ionship quali y, men al heal h, and loneliness.
The esul s in Table 3sugges ha odds o sco ing highe on he isk- aking scale in
he heal h domain inc ease by 0.21 o LGB+ indi iduals compa ed o hei he e osex-
ual pee s, which is gene ally in line wi h some exis ing esea ch in he ield (Smalley
e al. 2015; Lega e and Rogge 2019). In pa icula , lesbian women and people wi h
o he sexual o ien a ions ha e a signi ican ly highe ole ance o isk aking in he
heal h domain han hei he e osexual coun e pa s (di e ences o 43 and 41 pe cen -
age poin s, espec i ely). This esul seems o be e lec ed by a gene ally highe isk
ole ance in he o he wo domains (
i.e.,
ad en u e and inancial isk aking) as well
as in long- e m p e e ences, whe e lesbian women esul less a e se compa ed o he -
e osexual indi iduals (Table A.4, in he Supplemen a y ma e ial).21 This is impo an
e idence ha u he calls o he a en ion o policymake s. In e es ingly, gay men
and bisexual indi iduals, on a e age, do no signi ican ly di e in e ms o heal h and
o he isk- aking beha iou s compa ed o he e osexuals.
As o he o he unheal hy habi s, lesbian and bisexual women a e gene ally mo e
likely o be hea y smoke s. The esul s do no change signi ican ly when we con ol
o smoking beha iou o pa en s o close ela i es in childhood.22 This e idence is
in line wi h he exis ing li e a u e (Ca pen e and Sansone 2021). Rega ding physical
inac i i y, we ind signi ican di e ences wi h espec o he e osexual indi iduals only
o gay men and no o women and o he sexual ca ego ies. This is no su p ising
since he exis ing e idence is a he mixed. Whyb ow e al. (2012), o ins ance, ind
e y simila le els o physical ac i i y be ween sexual mino i ies and he e osexual
indi iduals, while Calzo e al. (2013) epo signi ican ly ewe hou s o exe cise.
Howe e , di e en ly om some li e a u e in he ield (D ydakis 2022a), we do no
obse e signi ican dispa i ies in unheal hy beha iou s wi hin he LGB+ ca ego y,
i.e.,
be ween gay and lesbian people, bisexual people, and o he sexual o ien a ions
(Table A.5, in he Supplemen a y ma e ial), wi h he excep ion o indi iduals decla ing
sexual o ien a ion o he han LGB who a e less likely o smoke and ollow a die poo
in ui s and ege ables. This la e esul , combined wi h simila e idence o o he
sexual mino i ies om Table 3is in line wi h Booke e al. (2017), who ind ha among
young indi iduals in he UK, sexual mino i ies o he han gay/lesbian and bisexual
people we e signi ican ly less likely o be cu en o o me smoke s.
21 To he bes o ou knowledge, he e is no empi ical s udy ocusing on he economic p e e ences and
a i udes o sexual mino i ies. One excep ion is Buse e al. (2018), who show ha gay men ha e weake
a i udes owa ds compe i ion han s aigh men, while lesbian women compe e as much as he e osexual
women. This e idence, acco ding o he au ho s, explains pa o he ea nings di e en ials be ween gay and
s aigh men bu does no explain he ea nings p emium o lesbian women.
22 We don’ show hese esul s o he sake o space and cla i y. They a e a ailable upon easonable eques .
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Heal h and ela ionship quali y... Page 23 o 39 15
Table 3 Heal h- ela ed beha iou o LGB+ indi iduals
Smoking (>10 sig/day) Die (no ui s and ege)
All Male Female All Male Female
LGB+ 0.030*** 0.032 0.024*** 0.008 −0.004 0.009
(0.011) (0.025) (0.008) (0.015) (0.008) (0.096)
Lesbian/gay 0.071** 0.069 0.064** 0.013 −0.020 0.073
(0.029) (0.043) (0.024) (0.021) (0.073) (0.083)
Bisexual 0.024** 0.027 0.022** 0.021 0.031 −0.003
(0.011) (0.030) (0.009) (0.016) (0.021) (0.188)
O he SO −0.061 −0.114* −0.022 −0.057** −0.104* −0.033
(0.039) (0.059) (0.026) (0.026) (0.051) (0.035)
No. o obse a ions 24,825 11,873 12,952 24,726 11,814 12,912
Physically inac i e Heal h isk aking
All Male Female All Male Female
LGB+ 0.021 0.033** −0.003 0.209*** 0.176 0.234***
(0.020) (0.015) (0.004) (0.075) (0.128) (0.081)
Lesbian/gay 0.013 0.035** −0.029* 0.247** 0.166 0.432**
(0.011) (0.013) (0.017) (0.118) (0.145) (0.186)
Bisexual 0.023 0.020 0.008 0.135 0.125 0.133
(0.039) (0.027) (0.026) (0.140) (1.028) (0.111)
O he SO 0.034 0.083 −0.009 0.413*** 0.456* 0.346**
(0.211) (0.107) (0.045) (0.151) (0.240) (0.143)
No. o obse a ions 23,657 11,437 12,220 24,291 11,639 12,652
No es: The able shows he pe cen age poin s di e ences in engaging in unheal hy beha iou be ween
LGB+ and he e osexual indi iduals. Fo each dependen a iable, wo sepa a e eg ession models a e
es ima ed: one wi h he agg ega e LGB+ ca ego y con aining lesbian, gay, bisexual people and hose wi h
o he sexual o ien a ions, and ano he wi h sepa a e ca ego ies o LGB+ indi iduals. Re e ence ca ego y is
he e osexuals. All models con ain he ull se o demog aphic and socio-economic cha ac e is ics, as well
as a dummy a iable whene e indi iduals expe ienced ad e se heal h condi ions in childhood. The ull se
o explana o y and con ol a iables includes: age, gende , educa ion, wo king s a us, kids unde 5 yea s
old, kids aged be ween 6 and 15 yea s, u al e sus u ban a ea, i s - and second-gene a ion immig an s
dummy, household income quin iles, and esponse ime o he sexual o ien a ion ques ion and a e age
esponse ime o o he selec ed ques ions. The me hod o es ima ion is logi o smoking, die , and physical
inac i i y (bina y dependen a iables) and o de ed logi o isk- aking beha iou (ca ego ical dependen
a iable). Robus s anda d e o s boo s apped and clus e ed a he coun y o esidence le el a e epo ed
in pa en heses. Signi icance le els: *p<0.1; **p<0.05; ***p<0.01
Tu ning o social media use, LGB+ indi iduals esul signi ican ly mo e likely o
spend mo e ime on social ne wo king si es and ins an messaging ools (Table 4). One
o he easons why hey do so is o imp o e hei o e all sa is ac ion and eel be e .
Howe e , an in ensi e use o social media b ings hem mo e equen ly o neglec
wo k, school, o amily- ela ed du ies. Fo ins ance, compa ed o hei he e osexual
pee s, who ha e 34.2% p obabili y o spending mo e han one hou pe day on social
ne wo ks, LGB+ indi iduals a e 4.2 pe cen age poin s mo e likely o do so. This
e ec is highes o bisexual men and lesbian women. Mo eo e , bisexual men a e
7.7 pe cen age poin s mo e likely o neglec wo k o amily han hei he e osexual
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15 Page 24 o 39 F. Be lingie i and M. Ko acic
Table 4 Social media use o LGB+ indi iduals
Social ne wo ks: >1 h/day Messaging: >1 h/day
All Male Female All Male Female
LGB+ 0.042*** 0.046*** 0.032 0.016*** 0.026* 0.003
(0.011) (0.015) (0.022) (0.005) (0.014) (0.002)
Lesbian/gay 0.047 0.031 0.084 0.037** 0.025 0.055**
(0.032) (0.023) (0.127) (0.015) (0.020) (0.027)
Bisexual 0.043*** 0.076*** 0.008 0.007 0.027 −0.009
(0.012) (0.026) (0.006) (0.006) (0.022) (0.027)
O he SO 0.023 −0.020 0.048 −0.003 0.026 −0.021
(0.025) (0.043) (0.073) (0.007) (0.027) (0.698)
No. o obse a ions 24,908 11,931 12,977 24,875 11,910 12,965
Social media: neglec Social media: eel be e
All Male Female All Male Female
LGB+ 0.055* 0.070** 0.035 0.076*** 0.093*** 0.049**
(0.031) (0.031) (0.056) (0.014) (0.020) (0.019)
Lesbian/gay 0.060 0.054 0.074 0.078*** 0.099*** 0.011
(0.046) (0.062) (0.047) (0.025) (0.035) (0.011)
Bisexual 0.067** 0.077** 0.055 0.076*** 0.092*** 0.060**
(0.029) (0.031) (0.046) (0.012) (0.021) (0.023)
O he SO −0.006 0.108 −0.072** 0.071 0.073 0.066
(0.005) (0.104) (0.033) (0.108) (0.480) (0.084)
No. o obse a ions 24,657 11,813 12,844 24,645 11,809 12,836
No es: The able shows he pe cen age poin s di e ences in in ense social media use and he mo i es
behind hei use be ween LGB+ and he e osexual indi iduals. Fo each dependen a iable, wo sepa a e
eg ession models a e es ima ed: one wi h he agg ega e LGB+ ca ego y con aining lesbian, gay, bisexual
people and hose wi h o he sexual o ien a ions, and ano he wi h sepa a e ca ego ies o LGB+ indi iduals.
Re e ence ca ego y is he e osexuals. All models con ain he ull se o demog aphic and socio-economic
cha ac e is ics. The ull se o explana o y and con ol a iables includes: age, gende , educa ion, wo king
s a us, kids unde 5 yea s old, kids aged be ween 6 and 15 yea s, u al e sus u ban a ea, i s - and second-
gene a ion immig an s dummy, household income quin iles, and esponse ime o he sexual o ien a ion
ques ion and a e age esponse ime o o he selec ed ques ions. The me hod o es ima ion is Logi . Robus
s anda d e o s boo s apped and clus e ed a he coun y o esidence le el a e epo ed in pa en heses.
Signi icance le els: *p<0.1; **p<0.05; ***p<0.01
coun e pa s due o in ense social media use, which ep esen s a di e ence o almos
20%. On he o he hand, women decla ing ha ing sexual o ien a ion o he han lesbian
o bisexual seem o ha e a lowe likelihood o neglec compa ed o he es .
The eason o he disc epancy be ween gay, lesbian, and bisexual indi iduals
ega ding he nega i e e ec s o social media use in e ms o neglec o amily o
wo k may lie in di e en unde lying mo i a ions. Mo e p ecisely, social media may
ep esen a use ul ool o gay and lesbian indi iduals o disclose hei sexuali y and
become mo e socially in ol ed wi hin hei own communi y since web-based en i on-
men s ep esen sa e spaces o pee connec ion (Be ge e al. 2022). I his is co ec ,
hen he in ensi e use o social media does no necessa ily ha e nega i e epe cussions.
123
Heal h and ela ionship quali y... Page 31 o 39 15
men al o physical heal h condi ions la e in li e o LGB+ indi iduals. Indeed, being
LGB+ inc eases he di e ence in odds o ha ing heal h- ela ed limi a ions om 4.9
o 14.3 pe cen age poin s. Ha ing ewe close iends in adul hood combined wi h a
sexual mino i y s a us ansla es in o a 1.048 highe sco e on he UCLA loneliness
scale compa ed o an a e age sco e o 0.785 poin s o he e osexual indi iduals.24 As
o he beha iou al habi s, he ne e ec o being LGB+ and ollowing an unheal hy
die inc eases he likelihood o dep essi e eelings by 8.7 pe cen age poin s, com-
pa ed o 3.1 pe cen age poin s o he e osexual indi iduals. Simila ly, he o e lap
be ween sexual mino i y s a us and an unheal hy die inc eases he loneliness scale
by 0.674 poin s, compa ed o an a e age inc ease o 0.292 o he e osexuals. Finally,
sexual mino i ies wi h a lowe a e sion o isk- aking in he heal h domain egis e a
signi ican ly highe likelihood o ha ing heal h- ela ed limi a ions compa ed o hei
he e osexual isk-lo ing pee s.
5.4 He e ogeneous e ec s
This sec ion epo s he e ogeneous es ima es o di e ences in he dispa i y be ween
LGB+ indi iduals and hei he e osexual coun e pa s, wi h espec o ela ionship
s a us, age, amily income, and acco ding o he le el o en o cemen o sexual and
gende mino i ies’ igh s in he indi iduals’ coun y o esidence. The objec i e is o
assess whe he he e a e signi ican di e ences in he disad an age ela i e o he e o-
sexual indi iduals be ween single and in- ela ionship non-he e osexual indi iduals,
o olde and younge age g oups, and hose li ing in weal hie and economically
mo e disad an ageous households.
The esul s om Tables A.10 and A.11 (in he Supplemen a y ma e ial) sugges ha
he es ima e o he di e ence be ween LGB+ and he e osexuals expe iencing wo se
heal h condi ions is la ge in size among single indi iduals and hose wi h lowe le els
o household income, e en i hose di e ences a e no s a is ically signi ican wi h he
excep ion o less weal hy bisexual indi iduals and singles decla ing a sexual o ien-
a ion o he han LGB. Simila ly, single and less weal hy LGB+ indi iduals su e
mo e han hei he e osexual pee s om dep essi e symp oms. The di e en ial e ec
o non-he e osexuals is wice as high among single LGB+ people compa ed o hose
in ela ionships. Weal hie LGB+ indi iduals, on he o he hand, do no di e signi i-
can ly om hei he e osexual pee s, while mo e disad an ageous indi iduals ha e a 7
pe cen age poin highe p obabili y o expe iencing emo ional dis ess. We do no ind
signi ican age he e ogenei ies, as bo h younge and olde LGB+ indi iduals appea
o be disad an aged in e ms o heal h and dep essi e symp oms.
As o loneliness (Table A.12, in he Supplemen a y ma e ial), while each ca ego y
o indi iduals de ined by ela ionship s a us, age, o weal h is signi ican ly mo e lonely
han he e osexual indi iduals, we do no obse e any s a is ical di e ence wi hin
ca ego ies, wi h he excep ion o hei economic condi ions, wi h mo e disad an aged
LGB+ indi iduals eeling signi ican ly mo e lonely han hei weal hie pee s when
24 The e ec o 1.048 o LGB+ indi iduals is ob ained as he sum o he coe icien s o he ew close
iends in adul hood a iable and i s in e ac ion wi h he LGB+ dummy.
123

15 Page 32 o 39 F. Be lingie i and M. Ko acic
i comes o he compa ison wi h he es o he popula ion. Signi ican di e ences a e
ound, especially among bisexual indi iduals.
Tu ning o high e sus low-en o cing LGBTQIA+ igh s coun ies, we obse e a
clea he e ogeneous e ec in he incidence o ad e se heal h condi ions (Table A.10,
in he Supplemen a y ma e ial). LGB+ women a e pa icula ly ulne able in socie ies
whe e sexual and gende mino i ies’ igh s a e less en o ced. As o dep ession and
loneliness, we do no obse e any signi ican di e ence be ween indi iduals li ing in
coun ies wi h a di e en deg ee o p o ec ion (Tables A.11 and A.12, in he Supple-
men a y ma e ial). I mus be highligh ed, howe e , ha sexual mino i ies may be less
likely o disclose hei sexual o ien a ion in he su ey in coun ies whe e LGBTQIA+
igh s a e less en o ced. In ac , we show sugges i e e idence in sec ion 3.2 ha espon-
den s a e mo e likely o e use o espond o he sexual o ien a ion ques ion and need
on a e age mo e ime o espond o i compa ed o o he ques ions. I LGB+ indi-
iduals no willing o iden i y as such a e mo e disad an aged in e ms o heal h and
well-being, he esul s epo ed may unde es ima e he bigge disad an age o sexual
mino i ies in coun ies wi h a lowe en o cemen o LGBTQIA+ igh s.
We conclude ou esul s sec ion wi h wo addi ional conside a ions. Fi s , in Table
A.13 (in he Supplemen a y ma e ial) we dis inguish be ween indi iduals decla ing
as LGB+ and hose wi h mo e han one gende o no gende , o ha ing a luc u-
a ing gende iden i y (non-bina y indi iduals). The esul s indica e ha non-bina y
indi iduals a e pa icula ly ulne able ega ding loneliness compa ed o cisgende
he e osexual indi iduals.25 This es ima e, howe e , is no s a is ically di e en om
he one o LGB+ indi iduals. Second, all es ima es o he di e ence be ween LGB+
and he e osexual indi iduals p esen ed so a a e obus o mul iple hypo hesis es ing
co ec ions (see Table A.14, in he Supplemen a y ma e ial). Speci ically, we con ol
o he amily-wise e o a e (FWER) o all dependen a iables wi hin he se o
social s esso s, beha iou al aspec s and a i udes, and heal h/loneliness ou comes,
ollowing he app oach o Romano and Wol (2005).
6 Discussion
Documen ed dispa i ies in he physical and men al heal h and loneliness o LGB+ and
non-bina y indi iduals a e a signi ican public heal h issue, pa icula ly because non-
he e osexuals equen ly ace disc imina ion in access o heal hca e se ices (Hswen
e al. 2018), which may educe hei well-being and ha e nega i e consequences in
o he economic dimensions (Badge e al. 2019). This is ce ainly a nega i e ex e -
nali y a ibu able o ma ginalisa ion and, as such, socially unaccep able.
E en hough he e idence epo ed so a is gene ally in line wi h he exis ing li -
e a u e, especially ega ding isky beha iou s, o e all heal h condi ions, emo ional
diso de s, and loneliness, some cau ion is equi ed when in e p e ing he esul s.
Fi s , he COVID-19 pandemic and he ela ed social isola ion and dis ancing ha e
25 The di e ences compa ed o cisgende he e osexuals a e conside able also o some o he cha ac e is ics,
such as long-las ing limi a ions due o physical and/o men al heal h issues, e en i hey a e mos ly no
s a is ically signi ican . The lowe p ecision o he es ima es is mainly due o he small numbe o esponden s
decla ing as non-bina y (a ound 100 indi iduals).
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Heal h and ela ionship quali y... Page 33 o 39 15
c ea ed addi ional s ess, which may ha e u he exace ba ed he exis ing ulne abil-
i y o sexual mino i ies in e ms o emo ional diso de s and physical como bidi ies
(Sachde a e al. 2021). E en hough he da a on he e ec s o he pandemics wi hin
he LGB+ communi y a e gene ally poo and incomple e (Cahill e al. 2020), a highe
be o e-pandemics exposu e o sexual mino i ies o social s esso s as well as a ma ked
p e alence o physical and men al heal h p oblems makes i easonable o suspec ha
his speci ic mino i y g oup may ha e in e nalised he nega i e e ec s o social dis-
ancing and isola ion wi h espec o he e osexual indi iduals (Nowaskie and Roesle
2022). Second, he da a collec ed in he EU-LS su ey a e no longi udinal. The coe i-
cien s, he e o e, can be in e p e ed only as associa ions and no as independen causal
e ec s.
Fu he mo e, u u e esea ch should ocus mo e on how he in e sec ional-
i y be ween sexual mino i ies, ansgende indi iduals, and non-bina y indi iduals
impac s he de e minan s o poo e men al heal h in o de o design sui able policy
in e en ions ac oss a ange o sexual and gende mino i y iden i ies. In gene al, mo e
e o is needed, bo h h ough da a collec ions and esea ch designs, o unde s and
he ela i e pe o mances o di e en subg oups. This is ce ainly a c i ical aspec o
ou s udy and some o he la ge-scale su eys ha ind epo ing on sexual and gen-
de mino i ies e y challenging (Russell e al. 2020). We lack sys ema ic e idence on
ansgende , bisexual, and asexual indi iduals. Mo e e o is needed in disen angling
he mechanisms unde lying he ela i ely wo se pe o mance o bisexual indi iduals,
aside om he well-documen ed “biphobia” channel. Simila ly, he knowledge abou
asexual and in e sex indi iduals is almos absen , which calls o a en ion since hei
iden i y does no i wi hin and ou side he LGBT mino i y. Fu u e su ey designs
some ques ions o elici asexuali y and in e sex condi ions (Na ional Academies o
Sciences and Medicine 2020).
In addi ion o he abo e-men ioned need o include a de ailed ques ion on sexual and
gende iden i y in la ge su eys, we need o lea n be e wha d i es social ela ionships
among sexual and gende mino i ies, as well as he ole played by social media in
shaping hei social beha iou and men al heal h. While he EU-LS su ey ep esen s
an impo an s ep in his di ec ion, mo e esea ch is needed in his ega d. Fu he mo e,
he li e a u e on he social and economic pe o mance o olde indi iduals belonging
o sexual and gende mino i ies is e y sca ce. As sugges ed by B aghie i e al. (2022),
his is an impo an aspec since olde LGBTQ+ couples and indi iduals may make
di e en choices han he e osexuals due o di e ences in e ili y, occupa ion, income
and weal h, heal h, and geog aphy. The same is ue o he o he in e sec ional aspec s,
such as ace, e hnici y, and disabili y.
E en hough he esul s epo ed in his esea ch and in nume ous o he s udies
p o ide signi ican di ec ions o policy ac ion, we s ill lack e idence on o he ele an
aspec s o heal h and heal h- ela ed beha iou , such as he p e alence o d ug use
and polypha macy and speci ic physical heal h condi ions. Mo eo e , longi udinal
and coho s udies a e needed o be e unde s and how expe iences ac oss he li e
cou se a ec he li es o sexual and gende mino i ies, no only by desc ibing he
accumula ion o mino i y s esso s bu also by explo ing iden i y o ma ion, access
o social suppo , adap i e coping s a egies, amily o ma ion, and heal hy ageing.
Finally, mo e esea ch is needed o be e unde s and he ole played by s uc u al
123
15 Page 34 o 39 F. Be lingie i and M. Ko acic
ac o s, including powe s uc u es and legal p o ec ions, as well as social no ms and
a i udes.
Las bu no leas , ano he c i ical issue ela ed o esea ch p ospec s o sexual
and gende mino i ies is he a ailabili y o high-quali y su ey da a and he possibil-
i y o elying on adminis a i e da a sou ces. P obabilis ic su eys ypically exhibi
highe accu acy han non-p obabili y ones and allow o he inclusion o he digi ally
excluded popula ion in online su eys, in pa icula he lowe -educa ed, olde , and
hose belonging o ma ginalised communi ies. Adminis a i e da a, on he o he hand,
may be pa icula ly use ul o analysis o same-sex couples (ma ied o in legal union),
bu is less use ul o unde s anding he disad an ages o single mino i y ca ego ies.
This la e aspec conce ns pa icula ly bisexual indi iduals, who a e pa icula ly ul-
ne able when i comes o emo ional diso de s and loneliness. Finally, he las on ie
o da a collec ion on sexual mino i ies conce ns some ecen a emp s o include a
ques ion on sexual o ien a ion and gende iden i y in na ional censuses. E en hough
hey a e a a e y emb yonic s age and p esen in e y ew coun ies, hese da a may
signi ican ly imp o e he accu acy o he collec ed in o ma ion and analysis.
7 Concluding ema ks
This pape deals wi h dispa i ies in heal h, heal h- ela ed beha iou , and ela ionship
quali y among LGB+ indi iduals and ep esen s he i s wide and comp ehensi e
s udy on disad an ages o sexual mino i ies in Eu ope. We ely on a no el da a se ha
allows o a wide c oss-na ional analysis o di e ences in epo ing sexual o ien a ion
and inequali ies in exposu e o a ich se o indi idual-speci ic ou comes ha go beyond
commonly conside ed economic ou comes such as educa ion and ea nings po en ial.
We ind la ge di e ences ac oss coun ies in he sha e o indi iduals decla ing
hemsel es LGB+. In gene al, sha es end o be high in No he n Eu ope and lowe in
Sou he n and Eas e n Eu ope. We show ha di e ences in he willingness o disclose
one’s own sexual o ien a ion a e associa ed wi h he o e all le el o openness o socie y
as well as wi h he impo ance o social no ms and es ic ions ha i indi iduals
in o p ede ined beha iou al s anda ds. The esul s sugges ha indi iduals o igina ing
om es ain socie ies a e, on a e age, less inclined o openly decla e hei sexual
o ien a ion.
As o socio-economic dispa i ies, he esul s indica e ha LGB+ indi iduals a e
signi ican ly mo e exposed o social s esso s, bo h in childhood and adul hood. As a
esul , hey ha e a highe p obabili y o epo ing ad e se physical and men al heal h
condi ions and a e mo e likely o ake heal h- ela ed isks, including smoking and
excessi e use o social ne wo ks, which is one o he easons why hey equen ly
neglec wo k and amily du ies. Compa ed o hei he e osexual pee s, hey also ha e
lowe -quali y social ela ionships and a e mo e likely o expe ience eelings o lone-
liness. Some o hese e ec s signi ican ly di e ac oss gay men, lesbian women,
bisexual indi iduals, and hose wi h o he sexual o ien a ions, wi h bisexual people
being e en mo e disad an aged han o he sexual mino i ies in e ms o men al heal h
and loneliness. Finally, we ind some he e ogeneous e ec s wi h espec o indi idual
ela ionship s a us, household income, and coun y openness. Single and less weal hy
123
Heal h and ela ionship quali y... Page 35 o 39 15
LGB+ indi iduals su e mo e om dep essi e symp oms and ha e wo se o e all
heal h compa ed o hose belonging o highe income quan iles o in a ela ionship.
Along simila lines, dispa i ies among sexual mino i ies end o be mo e p onounced
in coun ies whe e sexual mino i y igh s a e less en o ced. The esul s a e obus o
he inclusion o a ich se o con ols, co ec ions o po en ial epo ing biases based
on indi idual-speci ic esponse imes, and addi ional mul iple hypo hesis es ing co -
ec ions.
The documen ed dispa i ies o sexual mino i ies ep esen a signi ican con ibu ion
o he li e a u e since hey a e an impo an public heal h issue and ha e been widely
unde s udied, especially in he Eu opean con ex . S ill, he inclusion o in o ma ion
on sexual o ien a ion and gende iden i y in la ge ep esen a i e su eys wi h possibly
a longi udinal dimension is s ongly encou aged o be e unde s and he causes o
hese dispa i ies, including he po en ial ole o s igma isa ion, disc imina ion, and
ha assmen o sexual and gende mino i ies.
Supplemen a y In o ma ion The online e sion con ains supplemen a y ma e ial a ailable a h ps://doi.
o g/10.1007/s00148-025-01077-4.
Acknowledgemen s The au ho s would like o hank edi o Milena Nikolo a and h ee anonymous e e ees
o hei aluable commen s and sugges ions. Au ho s names a e in alphabe ical o de .
Funding Open access unding is p o ided by Eu opean Commission unde a C ea i e Commons License
(CC BY 4.0).
Code a ailabili y A ailable upon easonable eques .
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Nei he he Eu opean Commission no any pe son ac ing on behal o he Commission is esponsible o
he use which migh be made o his publica ion.
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