Adverse childhood experiences partially mediate sexual minority disparities in depression, anxiety, and suicidality in a population-based study

Sexual minority individuals experience persistently elevated risks of internalizing psychopathology and suicidality, to which increased exposure to adverse childhood experiences (ACEs; i.e., negative life experiences and circumstances before age 18) might contribute. In a population-based nationally representative sample, this study investigated sexual orientation identity differences in ACEs and whether these differences statistically mediated sexual minority disparities in depression, anxiety, and suicidality. We also explored gender non-conformity as a potential contributor to sexual orientation differences in ACEs. A pre-registered, cross-sectional analysis was conducted with 19,421 participants ages ≥16 years randomly sampled from Sweden's population registry with questionnaire-based exposures and outcomes. Compared to heterosexual participants, all sexual minority subgroups were more likely to experience ≥1 ACE: bisexual women (adjusted odds ratio [aOR] = 2.96, 95 % confidence interval [CI] [2.23, 3.83]), lesbian women (aOR = 2.19, 95 % CI [1.32, 3.63], gay men (aOR = 1.97, 95 % CI [1.38, 2.81]), and bisexual men (aOR = 1.60, 95 % CI [1.18, 2.17]). All sexual minority subgroups experienced higher odds of bullying, domestic violence, adverse neighborhood experiences, and physical neglect. ACEs statistically mediated associations between sexual minority identity and depression, anxiety, suicidal ideation, and suicide attempt; indirect effects were significant for all sexual minority subgroups (aORs = 1.11-1.34), explaining 13-41 % of increased risk, across groups and outcomes. Gender non-conformity partially statistically accounted (10-15 % decrease in regression coefficients) for bullying and emotional abuse disparities. We conclude that disproportionate ACE exposure may partially explain elevated mental health problems among sexual minority individuals, especially bisexual women.