Can Support for Homosexuality Reduce the Prevalence of Mental Health Problems among LGBTQ+ Individuals to Levels Comparable to the General Population? A Second-Order Systematic Review with Thematic Analysis
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Abstract
Objective: This article addresses whether extensive support for homosexuality—accompanying its increased prevalence—has been able to reduce the prevalence of mental disorders among homosexuals in supportive countries to normal population levels.
Method: This study was conducted in two phases. The first phase employed a secondary systematic review method and examined 68 reviews on the public health and mental health of homosexuals in supportive countries. In the second phase, using the thematic content analysis method, the semantic units extracted from the articles were condensed under sub-themes, which then formed themes at a higher level.
Results: Supporting homosexuality has not reduced mental health issues in this group to levels observed in the general population, even in supportive countries. In addition to minority stress, other stressors (such as infectious diseases, cancer, childlessness, and the pathologic nature of homosexuality) are the main barriers to reducing the prevalence of mental disorders among homosexuals.
Conclusion: Based on these findings, this study suggests revisiting the policy of extreme support for homosexuality and preventing scientific research concerning the correlation between this behavior and criminality and other mental disorders—under the pretext of homophobia.
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2. Marashi SA. Review of Removing Homosexuality and Masturbation from the List of Sexual Dysfunctions in DSM. Clin Schizophr Relat Psychoses. 2021;15.
3. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-97.
4. Sun S, Guy AA, Murphy MJ, Zelaya DG, Fernandez Y, Operario D. Minority Stress, Mental Health, and Mindfulness and Self-Compassion as Moderators among Young Sexual Minority Men: A Moderated Structural Equation Analysis. J Contextual Behav Sci. 2024;33:100804.
5. Botha M, Frost DM. Extending the minority stress model to understand mental health problems experienced by the autistic population. Society and mental health. 2020;10(1):20-34.
6. Satpathy M. 007.6 Role of minority stress in health-risk behaviours among young msm and tgs in India. BMJ Publishing Group Ltd; 2015.
7. Bruce D, Harper GW, Bauermeister JA. Minority stress, positive identity development, and depressive symptoms: Implications for resilience among sexual minority male youth. Psychol Sex Orientat Gend Divers. 2015;2(3):287.
8. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79(2):159-70.
9. Amestoy ME, Best MW, Ruocco AC, Uliaszek AA. Borderline personality disorder stigma: Examining the effects of diagnostic disclosure, behavior, and gender as sources of stigma in the general population. Personal Disord. 2024;15(4):254-63.
10. Schmidt FL, Oh I-S. Methods for second order meta-analysis and illustrative applications. Organ Behav Hum Decis Process. 2013;121(2):204-18.
11. Valencia R, Wang LY, Dunville R, Sharma A, Sanchez T, Rosenberg E. Sexual Risk Behaviors in Adolescent Sexual Minority Males: A Systematic Review and Meta-Analysis. J Prim Prev. 2018;39(6):619-45.
12. Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, et al. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis. 2022;22(1):850.
13. Chan A, Jamieson C, Draper H, O'Callaghan S, Guinn BA. Cancer screening attendance rates in transgender and gender-diverse patients: a systematic review and meta-analysis. BMJ Evid Based Med. 2024;29(6):385-93.
14. Andani A, Bunge E, Kassianos G, Eeuwijk J, Mellou K, Van Damme P, et al. Hepatitis A occurrence and outbreaks in Europe over the past two decades: A systematic review. J Viral Hepat. 2023;30(6):497-511.
15. Jordan AE, Perlman DC, Neurer J, Smith DJ, Des Jarlais DC, Hagan H. Prevalence of hepatitis C virus infection among HIV+ men who have sex with men: a systematic review and meta-analysis. Int J STD AIDS. 2017;28(2):145-59.
16. Stockdale AJ, Kreuels B, Henrion MYR, Giorgi E, Kyomuhangi I, de Martel C, et al. The global prevalence of hepatitis D virus infection: Systematic review and meta-analysis. J Hepatol. 2020;73(3):523-32.
17. Falla AM, Hofstraat SHI, Duffell E, Hahné SJM, Tavoschi L, Veldhuijzen IK. Hepatitis B/C in the countries of the EU/EEA: a systematic review of the prevalence among at-risk groups. BMC Infect Dis. 2018;18(1):79.
18. Steffen G, Sperle I, Leendertz SA, Sarma N, Beermann S, Thamm R, et al. The epidemiology of Hepatitis B, C and D in Germany: A scoping review. PLoS One. 2020;15(3):e0229166.
19. Hagan H, Neurer J, Jordan AE, Des Jarlais DC, Wu J, Dombrowski K, et al. Hepatitis C virus infection among HIV-positive men who have sex with men: protocol for a systematic review and meta-analysis. Syst Rev. 2014;3:31.
20. Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214-22.
21. Harfouche M, Maalmi H, Abu-Raddad LJ. Epidemiology of herpes simplex virus type 2 in Latin America and the Caribbean: systematic review, meta-analyses and metaregressions. Sex Transm Infect. 2021;97(7):490-500.
22. AlMukdad S, Farooqui US, Harfouche M, Aldos L, Abu-Raddad LJ. Epidemiology of Herpes Simplex Virus Type 2 in Canada, Australia, and New Zealand: Systematic Review, Meta-Analyses, and Meta-Regressions. Sex Transm Dis. 2022;49(6):403-13.
23. Malekinejad M, Barker EK, Merai R, Lyles CM, Bernstein KT, Sipe TA, et al. Risk of HIV Acquisition Among Men Who Have Sex With Men Infected With Bacterial Sexually Transmitted Infections: A Systematic Review and Meta-Analysis. Sex Transm Dis. 2021;48(10):e138-e48.
24. Latimer RL, Shilling HS, Vodstrcil LA, Machalek DA, Fairley CK, Chow EPF, et al. Prevalence of Mycoplasma genitalium by anatomical site in men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect. 2020;96(8):563-70.
25. King EM OS, Gilson R, Copas A, Beddows S SK, M J, WJ E, P S. Oral Human Papillomavirus Infection in Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. PloS one. 2016;11(7):e0157976.
26. Machalek DA, Poynten M, Jin F, Fairley CK, Farnsworth A, Garland SM, et al. Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis. Lancet Oncol. 2012;13(5):487-500.
27. Tsuboi M, Evans J, Davies EP, Rowley J, Korenromp EL, Clayton T, et al. Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000-20. Lancet Glob Health. 2021;9(8):e1110-e8.
28. Cantor AG, Pappas M, Daeges M, Nelson HD. Screening for Syphilis: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Jama. 2016;315(21):2328-37.
29. Simon Rosser B, Merengwa E, Capistrant BD, Iantaffi A, Kilian G, Kohli N, et al. Prostate cancer in gay, bisexual, and other men who have sex with men: A review. LGBT health. 2016;3(1):32-41.
30. Robinson K, Galloway KY, Bewley S, Meads C. Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis. Bjog. 2017;124(3):381-92.
31. Chancellor JA, Ioannides SJ, Elwood JM. Oral and oropharyngeal cancer and the role of sexual behaviour: a systematic review. Community Dent Oral Epidemiol. 2017;45(1):20-34.
32. Boehmer U, Cooley TP, Clark MA. Cancer and men who have sex with men: a systematic review. Lancet Oncol. 2012;13(12):e545-53.
33. Moreira Allgayer RMC, Borba GDS, Moraes RS, Ramos RB, Spritzer PM. The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review. Endocr Pract. 2023;29(6):498-507.
34. Turino Miranda K, Kalenga CZ, Saad N, Dumanski SM, Collister D, Rytz CL, et al. Gender-affirming estrogen therapy route of administration and cardiovascular risk: a systematic review and narrative synthesis. Am J Physiol Heart Circ Physiol. 2022;323(5):H861-h8.
35. Quintela-Castro FCA, Pereira TSS, Alves DB, Chiepe L, Nascimento LS, Chiepe K, et al. Lipid profile and risk of cardiovascular disease in adult transgender men receiving cross-sex hormone therapy: a systematic review. Nutr Rev. 2023;81(10):1310-20.
36. Ignacio KHD, Diestro JDB, Espiritu AI, Pineda-Franks MC. Stroke in Male-to-Female Transgenders: A Systematic Review and Meta-Analysis. Can J Neurol Sci. 2022;49(1):76-83.
37. Dominoni M, Scatigno AL, Pasquali MF, Bergante C, Gariboldi F, Gardella B. Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis. J Sex Med. 2025;22(1):184-95.
38. Caceres BA, Brody A, Luscombe RE, Primiano JE, Marusca P, Sitts EM, et al. A Systematic Review of Cardiovascular Disease in Sexual Minorities. Am J Public Health. 2017;107(4):e13-e21.
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| Files | ||
| Issue | Vol 20 No 3 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Homosexuality LGBTQ Mental Health Minority Stress Stigma | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Payami Golhin R, Marashi SA. Can Support for Homosexuality Reduce the Prevalence of Mental Health Problems among LGBTQ+ Individuals to Levels Comparable to the General Population? A Second-Order Systematic Review with Thematic Analysis. Iran J Psychiatry. 2025;20(3):406-424.
