Experiences of conflict, non-acceptance and discrimination are associated with poor mental well-being amongst LGBTQ-identified individuals in Singapore

• Date: 26 January 2023
• Pages: 625-655
• DOI: https://doi.org/10.1108/EDI-10-2021-0270
• Published date: 26 January 2023
• Author: Gerard W. Toh,Wee Ling Koh,Jack Ho,Jackson Chia,Ad Maulod,Irene Tirtajana,Peter Yang,Mathia Lee

Experiences of conflict,

non-acceptance and discrimination

are associated with poor mental

well-being amongst LGBTQ-

identified individuals in Singapore

Gerard W. Toh, Wee Ling Koh, Jack Ho, Jackson Chia, Ad Maulod,

Irene Tirtajana, Peter Yang and Mathia Lee

Independent, Singapore, Singapore

Abstract

Purpose –Health disparities affecting lesbian, gay, bisexual, transgender and queer (LGBTQ)

populations have been reported in many countries. For Singapore,no large quantitative studies on mental

health and well-being in the local LGBTQ community have been published. The authors conducted a

community-based survey (National LGBT Census Singapore, 2013; NLCS2013) that covered a

comprehensive set of demographic, social and health indicators. Here, the authors investigated mental

health status and its correlates in 2,350 LGBTQ individuals within the NLCS2013 sample.

Design/methodology/approach –The NLCS2013 was an anonymous online survey conducted

amongst self-identified LGBTQ adults (aged ≥21 years) residing in Singapore. The survey included

the World Health Organisation Well-being Index (WHO-5) as a measure of mental well-being, with low

WHO 5 scores (<13/25) indicating poor mental well-being. The authors analysed relationships

between low WHO-5 score and a range of respondent characteristics using multivariate logistic

regression.

Findings –Strikingly, 40.9% of 2,350 respondents analysed had low WHO-5 scores, indicating poor mental

well-being. Parental non-acceptance, experience of conflict at home and bullying/discrimination in the

workplace or educational environments were all significantly associated with poor mental well-being.

Conversely, community participation appeared protective for mental well-being, as respondents who

participated in LGBTQ community organisations or events were less likely to have poor mental well-being

than non-participants.

Originality/value –The NLCS2013 represents one of the first broad-based efforts to comprehensively and

quantitatively capture the sociodemographic and health profile, including mental health status, within

Singapore’s resident LGBTQ population. These findings affirm the need to address the mental health needs of

LGBTQ individuals in Singapore and to foster safe spaces and allyship.

Keywords Health disparity, Mental health, Personal health, WHO-5, Sexual and gender minorities, Resilience,

Family conflict, Singapore

Paper type Research paper

Mental

wellbeing of

LGBTQ people

in Singapore

625

© Gerard W. Toh, Wee Ling Koh, Jack Ho, Jackson Chia, Ad Maulod, Irene Tirtajana, Peter Yang and

Mathia Lee. Published by Emerald Publishing Limited. This article is published under the Creative

Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create

derivative works of this article (for both commercial and non-commercial purposes), subject to full

attribution to the original publication and authors. The full terms of this licence may be seen at http://

creativecommons.org/licences/by/4.0/legalcode

The authors would like to thank all the individuals who participated in the research; Pink Dot SG,

OogaChaga, Sayoni and all others who helped to promote the survey; and The Greenhouse and Brahm

Centre for supporting open access for this publication.

Funding: This research received no specific grant from any funding agency in the public,

commercial, or not-for-profit sectors.

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/2040-7149.htm

Received 15 October 2021

Revised 6 June 2022

10 August 2022

17 September 2022

Accepted 7 November 2022

Equality, Diversity and Inclusion:

An International Journal

Vol. 42 No. 5, 2023

pp. 625-655

Emerald Publishing Limited

2040-7149

DOI 10.1108/EDI-10-2021-0270

Introduction

Mental health and mental well-being are widely recognised as integral to public health and

sustainable development,being inextricably linked with physical and overallhealth outcomes

(Prince et al., 2007). In recognition of this, the United Nations 2030 Agenda for Sustainable

Development includes a commitment to promoting both“physical and mental health and well-

being ...”(United Nations DevelopmentProgramme, 2015). Yet, poor mental health remains a

leading cause of morbidity and disability worldwide and was one of the top 10 causes of

disability-adjusted life-yearsfor people aged 10–49 years in 2019 (GBD Diseases and Injuries

Collaborators, 2020). Moreover, since the start of the coronavirus disease 2019 (COVID-19)

pandemic in 2020, studies have documented worsened mental well-being in populations

worldwide (Buspavanich et al., 2021;Covid-19 Mental Disorders Collaborators, 2021).

Mental and physical health disparities affecting lesbian, gay, bisexual, transgender and

queer (LGBTQ) minority populations have been widely documented. Notably, LGBTQ

individuals may be at higher risk of depression and poor mental well-being than the general

population(Baptis te-Roberts et al., 2017;Moagiet al.,2021;Valentine and Shipherd,2018). It is

recognisedthat these mentalhealth disparitiesare closely linked toexperiences of stressacross

multiplelife domains, includingthe family, educationaland workplace environments, wherever

an individual’s identity as a memberof a sexual or genderminority comes into conflictwith the

dominant social environment. The majority of the extant research on minority stress and its

consequencesfor impacton LGBTQ mental healthhas come from studiesin North Americaand

Europe.Little or no publisheddata are available formany Asian countries,including Singapore.

This lack of quantitative information makes it challenging for local LGBTQ communities to

comprehensively articulate theirunmet health needs and hindershealth advocacy efforts.

The National LGBT Census Singapore [NLCS2013 (NLCS Research Network, 2016)] was

an exploratory study conducted in 2013 to address the dearth of quantitative information

about Singapore’s LGBT population. The NLCS2013 sought to survey the needs and status of

self-identified LGBT Singapore citizens and residents in the domains of health, housing,

education, employment and family. To the best of our knowledge, the NLCS2013 was then the

first effort to investigate a comprehensive range of health indicators and sociodemographic

factors in multiple subgroups within the LGBTQ community in a developed Asian country.

The NLCS2013 data thus provided a quantitative and comprehensive description of health

status, including mental health, amongst LGBT-identified individuals in Singapore. In the

present work, we address one key sub-domain within the NLCS2013, that of mental health

and well-being. We characterised the mental health status of individuals in the community

using the WHO-5, a brief, well-validated questionnaire that measures subjective well-being

and risk of depression (Topp et al., 2015;World Health Organization, 1998). We then analysed

this status with respect to sociodemographic, psychosocial and relational characteristics to

better understand determinants of mental health and well-being amongst LGBT-identified

individuals in our local setting.

Literature review

Minority stress and mental health disparities

The minority stress model and related conceptual frameworks (Goldbach and Gibbs, 2017;

Hendricks and Testa, 2012;Meyer, 2003) represent a prominent theoretical orientation that

formulates how stigma, prejudice and discrimination related to an individual’s minority

group status may become a stressor that contributes to poor mental health. These

frameworks broadly characterise stressors as external and internal, or distal and proximal,

with experiences of prejudice and discrimination being examples of the former and identity

concealment/non-disclosure and internalised homophobia being examples of the latter.

Numerous studies have linked experiences of discrimination, stigma, bullying, abuse and

EDI

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