Abstract
According to the World Health Organization (WHO, 2023), approximately 280 million people experience depression globally. The WHO regards depression as a significant public health problem due to its effects on both individuals and society. Added to personal psychological suffering are social suffering in the form of health and social care costs and a reduction in economic activity. The COVID-19 pandemic not only exacerbated both forms of suffering but also increased the incidence of depression by 25% (WHO, 2023).
There are well-known risk factors for depression based on decades of empirical research. These include socioeconomic and sociodemographic characteristics, the main examples of which are age, biological sex, income and social status. More recently, sexual orientation and gender orientation have been added to the list of risk factors. The WHO (2023) reported that in Western countries, sexual and gender minority (SGM) populations have a rate of depression about three times higher than non-SGM groups. This disparity in the experience of depression and other mental health problems based on sexual orientation and gender orientation has not been researched to the same extent as other risk factors (Rothblum, 2020). However, the paper commented on here adds to the growing number of studies exploring the risk of depression among SGM populations. In this case, the research is based in Thailand, as have been others (e.g. Kittiteerasack, 2021).
The paper explores how different coping styles moderate the relationships between various forms of stress and depression among SGM populations in Thailand. The authors point out that approximately 1.5 million people in Thailand over the age of 15 experience symptoms of depression, and another 14 million adults have a history of depression (Frost and Meyer, 2023).
The research methodology used by the authors was cross-sectional descriptive in-person and online surveys conducted between March and August 2018. Convenience and snowball sampling techniques were adopted, and the Minority Stress Model for standardised measurements. The aim of the Minority Stress Model is a framework aimed at identifying stressors such as violence, prejudice and stigma experienced by members of minority groups that may lead to deterioration in mental health. The theory behind the model Minority attempts to understand the social, psychological and structural influences that may relate to deterioration amongst SGMs. The Minority Stress Model also indicates what coping strategies can be employed to effectively buffer the emotionally deleterious effects of stress on minority groups. Statistical analysis of the data in this study included Hayes’s PROCESS regression-based approach.
The results from the study were: 40% of participants reported symptoms of depression that were associated with multiple stressors; three main methods of attempting to cope with these symptoms by the participants were ‘problem-solving’, social support and avoidance. Problem-solving coping is when direct action is taken to address a problem causing stress. Coping through social support refers to engaging family members and/or friends to assist in relieving stress. Avoidance coping involves avoiding or diminishing stressful situations, but which in the long run can be counterproductive.
In this study, problem-focused coping was reported by nearly all the participants (95.8%) followed closely by social support (83.1%), whereas avoidance was adopted by less than half (49.1%). Significantly, the authors report that problem-focused coping weakened the relationships between stressors and depression, but avoidance coping strengthened the relationships between depression, stress, loneliness and prejudice. Hence, the research concludes that problem-focused coping served to mitigate the influence of stressors on depression, whereas avoidance coping strategies exacerbated the impact.
The paper is well-written and has the substantive benefit of adding to the literature highlighting the relationship between psychological suffering amongst SGM populations. It also has the benefit of promoting effective coping strategies to further emotional well-being that could be encouraged by healthcare professionals in both clinic and community settings. The authors are, however, aware of the study’s limitations (such as using a nonprobability sampling approach limiting the generalisability of the findings, and the cross-sectional descriptive research design only allowing for speculation regarding cause-and-effect connections).