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    An ANCOVA weighted for group size was computed with mental health of gay and bisexual men versus the population sample as outcomes. Age and educational level were used as covariates. The better educated participants thus reported fewer mental health problems. Furthermore, a step-wise regression analysis was computed for the gay and bisexual sample to analyze possible reasons for the mental health differences that the ANCOVA revealed. Mental health was used as the criterion. This study provides initial data on mental health differences between gay and bisexuals versus a population-based male sample in Germany.

    Furthermore, we noted that minority stressors significantly predict mental health problems in German gay and bisexual men above and beyond sociodemographic variables known to influence mental health such as age and education [ 28 , 29 ].

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    Our investigation revealed that German gay and bisexual men report more mental health problems than a German male population sample. Our first hypothesis, namely that the gay and bisexual men would report more mental health issues than our population sample, was thus confirmed.

    These findings are consistent with those from other Western countries, including a number of meta-analytic data documenting mental health differences between gay and bisexual versus heterosexual men [ 1 — 3 ]. Furthermore, we detected a medium effect size in mental health differences that is in line with meta-analytic data [ 3 ].

    Our study therefore provides additional evidence that mental health differences disfavoring gay and bisexual men seem to be a general issue in Western societies. Furthermore, we found that younger participants and those with lower education levels reported slightly more mental health problems than older participants and those with higher education levels.

    These findings are consistent with previous research reporting better mental health in older individuals and those with higher socioeconomic status [ 28 , 29 ].

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    In addition, we analyzed possible reasons for mental health problems within the gay and bisexual group: These findings are in line with previous studies documenting that minority stress predicts mental health problems in gay and bisexual men [ 11 , 13 , 16 ]. Hypothesis 2, stating that minority stress victimization, rejection sensitivity, and internalized homonegativity would predict mental health problems in gay and bisexual men, was thus confirmed as well.

    In summary, we can assume that minority stress may be a driving factor in producing mental health differences between individuals afflicted by it, such as gay and bisexual men, and those who are not, such as heterosexual men. Accordingly, there is evidence that such mental health differences in German LGBs versus heterosexuals are mediated by sexual identity stress stress based on the true sexual identity [ 30 ].

    Strengths of our study include the recruitment of a large sample of gay and bisexual men. Second, our results probably reflect a rather conservative estimate, since our sample of gay and bisexual men was compared to a population sample that might have included at least some gay and bisexual men who would have probably reported a higher mean of mental health problems than an entirely heterosexual sample.

    Limitations of this study include that the gay and bisexual sample may not have been representative of German gay and bisexual men due to our online sampling method. However, since we controlled for sociodemographics in our analyses, sampling biases should be within reasonable limits.

    Second, we did not assess sexual orientation in the population sample and cannot therefore state how many gay and bisexual men it contained. Due to the low prevalence of a gay or bisexual orientation in men about 2. Third, our measure of mental health problems was rather weak and likely assessed psychological distress more than mental disorders.

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    A number of implications for clinical professionals can be drawn from this study: German gay and bisexual men are likely to suffer from more psychological distress and a greater number of mental health disorders than heterosexual men due to experiences of minority stress. They are therefore probably overrepresented in clinical samples. Future studies should determine how diminishing minority stress and coping with it can be managed in order to reduce minority-stress linked psychological distress in gay and bisexual men.

    Our study indicates that mental health differences among German gay and bisexual men versus the general male population are prevalent. While a road to minority stress coping might be psychotherapy for inflicted individuals, minority stress reduction should also be pursued on a political level through mass media and general education about acceptance towards gay and bisexual orientations. Additional file 1: Table S1. FAS and HC obtained the data on the gay and bisexual sample. GHF obtained the data on the population-based sample. All authors contributed in analyzing and interpreting the data as well as writing the manuscript.

    All authors read and approved the final manuscript. Written informed consent was obtained from all participants online. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


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    4. Electronic supplementary material. Frank A. Sattler, Email: Gabriele H. Franke, Email: Hanna Christiansen, Email: National Center for Biotechnology Information , U. BMC Psychiatry. Published online Jul Sattler , 1 Gabriele H. Franke , 2 and Hanna Christiansen 1. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Mar 14; Accepted Jul Associated Data Data Availability Statement The data generated and analyzed during the current study are available from the corresponding author on reasonable request.

      Abstract Background International studies have revealed that gay and bisexual men present more mental health problems than the general male population. Results As compared to our population sample, gay and bisexual men demonstrated more mental health problems with a moderate effect size. Conclusions We observed pronounced mental health differences between gay and bisexual men versus the population sample. Electronic supplementary material The online version of this article doi: Gay and bisexual men, Population-based controls, Minority stress, Minority health, Germany.

      Background Meta-analyses including data from several countries e. Method Our gay and bisexual sample and population-based male sample were recruited independently. Gay and bisexual participants German gay and bisexual men were recruited online in via mailing lists of Philipps University Marburg PUM , sexual minority associations, news portals, and sexual minority social media.

      Measures Since the project MHGGB used a broad number of variables including variables on minority stress, social support, coping, and mental health all scales used were substantially shortened in order to not overload the participants. Victimization Victimization was assessed with a five-item victimization scale VS in gay and bisexual men that was previously published [ 16 ]. Rejection sensitivity Rejection sensitivity was assessed with a modified version of the Gay-Related Rejection Sensitivity Scale [ 8 ] in our gay and bisexual sample.

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      Internalized homonegativity Internalized homonegativity was assessed with a previously published three-item scale [ 16 ] in our gay and bisexual sample. Results Differences in sociodemographics The levels of the two sociodemographic variables age and educational level were compared between both samples. Table 1 Bivariate correlations of the scales in the gay and bisexual sample.

      Scale 1. Victimization 2. Rejection sensitivity. Another issue most of the quoted opinions are based on is the fact that men and women here are more alike than in other countries. Not in politics perhaps, not in society — as there are still not many women on supervisory boards of companies or in very qualified jobs, and there are many women not working at all, at least compared to other European countries, North America or Australia. Nevertheless their appearance and behaviour tell a different story: Is that fair?

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