Queer people in straight systems: The impact of sexual orientation laws on the health of sexual minorities

Project Details


Theoretical background
Globally, sexual minorities (i.e., people whose sexual identities, behaviors, or attractions differ from the heterosexual majority) face considerable health disparities compared to their sexual majority peers, such as higher levels of depression and anxiety, worse physical health, and higher rates of suicide attempts1,2,3 . Individual and interpersonal drivers involved in the creation of these adverse health outcomes (such as stigma, discrimination and internalized homophobia) are well documented4 , but drivers situated at the structural level (such as laws and policies concerned with sexual orientation) have only recently gained attention in psychological and public health research5,6 . The empirical evidence gathered so far reveals a fairly consistent pattern. The implementation of laws that criminalize same-sex behavior and the absence of protective or recognizant laws (such as marriage equality, access to adoption, or anti-discrimination legislation) are associated with poor mental and physical health7,8,9,10 . Conversely, the implementation of protective and recognizant laws is associated with better health11,12,13 . As this is an emerging field, this evidence is marked by considerable heterogeneity in terms of theoretical and methodological approaches and rigor, as well as in terms of investigated populations, laws, and outcomes. Conceptually, it is an area of research in need of (1) a systematically derived summary of existing empirical evidence on this topic, and (2) an integration of this evidence into existing models on sexual minority health. Methodologically, the field is in need of (3) a systematically derived summary of ways to measure sexual orientation legislation and (4) an empirical investigation on how different ways of measuring sexual orientation legislation affect statistical estimates of their health-related impact.
2. Research aims and methodology
The aim of my cumulative dissertation (three individual studies) is to gain a deeper understanding of how sexual orientation laws affect the health of sexual minorities. By using qualitative, quantitative, and research synthesis methods, I plan to contribute to the four research gaps outlined above, as well as to provide new evidence from German-speaking countries. My research stay at the Institute of Tropical Medicine (ITM) will benefit all three studies of my dissertation, which I summarize briefly below: Study I: The impact of sexual orientation laws on sexual minority health: a mixed-methods systematic review and meta-analysis Study I summarizes existing evidence on the impact of sexual orientation laws on sexual minority health by means of a mixed-methods systematic review and meta-analysis. Accordingly, evidence from both qualitative and quantitative studies on this topic will be gathered via a systematic literature search. This evidence will then be synthesized narratively and statistically and integrated into an overarching theoretical model that extends existing models4 on sexual minority health. The study protocol for this study has been completed and is publicly available on PROSPERO (CRD42019126326) and OSF (https://osf.io/kat8w/). Study II: Structural determinants of sexual minority health: Database development and two multilevel, multiverse analyses with evidence from 28 European countries This study consists of two parts: First, we will derive a systematic collection of ways to measure sexual orientation legislation (i.e., quantitative indices on sexual orientation legislation) via expert consultations and a systematic literature search. Second, we will empirically link all of these indices to two individual-level datasets from sexual minorities (i.e., the EU LGBT Survey 2012) and the general population (i.e., the European Quality of Life Survey 2012) in the European Union. We will do so in a systematic series of multilevel linear regressions (i.e., a multiverse analysis14), that incorporates all possible combinations of (i) indices on sexual orientation legislation and (ii) other confounders at the country level (e.g., income inequality15) as predictors and life satisfaction as the outcome. The aim of this study is twofold: First, it provides a collection of indices on sexual orientation laws, which facilitates future research, policy development, and advocacy. Second, by employing the novel method of multiverse analysis, making use of all possible combinations of indicators and covariates, we will be able to statistically assess the robustness of the impact of sexual orientation legislation on health with regard to different measurement approaches (i.e., indices). Study III: Beyond legislation: How marriage equality affects the lives of sexual minority women in German-speaking countries Using a mixed-methods design, this study provides new evidence on both positive and negative effects of marriage equality on the lives of sexual minority women from German-speaking countries. In an online survey, participants will provide statements and respond to standardized questionnaires on what changed (for Austrian and German participants) or would change (for Swiss participants) for them after the introduction of same-sex marriage. The Ethics Committee of the University of Vienna has approved all study materials (Reference number: 00459, date: 27-06-2019). Data collection was undertaken between 11/2019 and 02/2020 and has been completed.
Effective start/end date17/04/20 → …

IWETO expertise domain

  • B680-public-health


Explore the research topics touched on by this project. These labels are generated based on the underlying awards/grants. Together they form a unique fingerprint.