Mental Health, Resilience, and Well-Being Among Sexual Minority College Students: A Study Framed by the Minority Stress and Minority Resilience Models

Abstract

This study contributes to the understanding and promotion of mental health among sexual minority college students by examining a comprehensive range of mental health outcomes, including psychological distress and indicators of well-being. Using survey data from 521 students at a US state university, we applied the minority stress model and the minority resilience model, while also considering the minority mental health paradox, to compare mental health outcomes between sexual minority and heterosexual students. Our findings indicate that sexual minority students report higher levels of depression, anxiety, and self-harming behaviors compared to their heterosexual peers. Additionally, they score lower on measures of positive mental health and well-being, including inner peace, environmental mastery, happiness, life satisfaction, life purpose, self-perceived health, and fulfilling relationships. We further found that sexual minority students exhibit lower resilience, largely due to insecurities related to safety, food, and housing. These findings underscore the need for targeted programs and services to support the well-being of sexual minority students and foster healthier college environments.

1. Introduction

Mental health challenges are widespread and well documented among university students. This social phenomenon has been reported in the US and worldwide (Auerbach et al. 2016; Keyes et al. 2012) and was worsened during the COVID-19 pandemic (Salerno et al. 2020). Sexual minority students, students whose sexual orientation differs from the heterosexual majority, including but not limited to lesbian, gay, bisexual, pansexual, and asexual people (Mandatori et al. 2025), face higher rates of mental health disorders than their heterosexual peers, making this group one of the most vulnerable college student sub-populations (Fruehwirth et al. 2021; Rankin et al. 2010).

Investigations on the mental health of sexual minorities have been predominantly focused on mental health disorders, with limited attention to positive mental functioning and well-being. As argued by the Dual Continua Model of mental health, the absence of disorder does not automatically imply mental health, which is a positive state with positive mental functioning and experiences (Keyes 2003). On the other hand, high levels of disorders have been found to coexist with high levels of mental well-being (Suldo and Shaffer 2008). Positive mental health is not just an end in itself. Many of its components have been found to buffer or mediate harmful life events and prevent mental illness (Provencher and Keyes 2011; Schotanus-Dijkstra et al. 2016).

To understand sexual minority students’ mental health, researchers need to see a broader mental health profile including both symptoms of disorders and indicators of positive psychological functioning, mental states, and experiences. Using a cross-sectional survey of students attending a state university in the Midwestern United States, the current study contributes to a fuller account of sexual minority students’ mental health in contrast to heterosexual college student mental health.

1.1. The Minority Stress Model

It has been well documented that sexual minorities report more mental health symptoms, such as depressive and anxiety symptoms, than their heterosexual peers (Borgogna et al. 2018; Fruehwirth et al. 2021; Grant et al. 2014; Johns et al. 2013; Lourie and Needham 2017; Meyer 2013; Pakula et al. 2016; Ross et al. 2018). To explain the excess prevalence of mental health problems among sexual minorities, researchers have developed the minority stress model (Meyer 2013), an extension of the general Stress Process Model, which has been one of the primary guiding theoretical frameworks in understanding the socio-psychological processes of mental health (Pearlin et al. 1981; Thoits 2010). The Stress Process Model analyzes the mental health experiences from three aspects: (1) stressors, (2) stress mediators/moderators, including social and psychological resources and coping strategies, and (3) the mental health outcomes (Pearlin 1989; Thoits 2010). The research on sexual minorities’ mental health over recent decades has utilized the minority stress model, an adaptation of the Stress Process Model. This framework has helped researchers examine multiple aspects of sexual minorities’ experiences: the various stressors they face, the factors that influence how these stressors affect their mental health (including social support, socioeconomic status, psychological traits, and coping mechanisms, etc.), and mental health outcomes such as depression, anxiety, and suicidal thoughts (Goulet and Villatte 2020; Meyer 2013, 2015).

The minority stress model emphasizes the importance of minority identity in the stress process (Meyer 2015). Whether or not, and to what extent, one identifies with a sexual or gender minority identity impacts both exposure to general and sexual minority-specific stressors and the coping and resilience opportunities one will have (Meyer 2015). Studies have examined various stressors that affect sexual minorities, including proximal subjective stressors such as internalized homophobia, identity concealment, and expectations of rejection (Meyer 2003; Newcomb and Mustanski 2010; Pachankis 2007) to distal objective stressors including homophobic stigma and bullying, workplace discrimination, economic hardship, and relationship difficulties (Peralta 2008; Meyer and Dean 1998; Meyer 2003; Newcomb et al. 2019). Though everyone faces general stressors such as economic hardship and relationship difficulties, sexual minorities experience heightened challenges, especially socioeconomic challenges, vis-à-vis systematic discrimination. Such discrimination is associated with employment challenges, housing and food instability, and limited access to healthcare—factors that contribute to increased rates of mental illness within these communities (Meyer 2003).

1.2. The Minority Mental Health Paradox

Although minority groups often encounter greater socioeconomic challenges, elevated stress levels, and higher rates of discrimination, an expanding body of research suggests that a minority status does not always correlate with poorer mental health outcomes, particularly concerning racial minorities. For instance, Black Americans frequently report similar or lower rates of psychiatric disorder compared to those of White Americans, a phenomenon known as the minority mental health paradox (Keyes 2009; Louie et al. 2022; Thomas Tobin et al. 2020). While this paradox was initially documented between Black and White populations (Keyes 2009), more recent studies have identified similar patterns among other groups, including Asians and Latinos (John et al. 2012; Lau et al. 2013).

Conversely, evidence indicates that White Americans may be more susceptible to certain psychosocial risk factors that negatively impact both physical and mental health when compared to minority populations (Assari and Lankarani 2016; Case and Deaton 2015; Kessler 1979). Scholars suggest that the adversities faced by racial minorities may contribute to the development of protective mechanisms and coping strategies, aiding these groups in managing stressful life circumstances (Assari and Lankarani 2016; Breslau et al. 2006; Malat et al. 2018). For example, the literature on resilience among minority youth in the U.S. highlights their capacity to navigate and overcome persistent, severe hardships (Marks et al. 2020). Such challenges foster resilience by promoting emotional regulation, perspective-taking, and the establishment of strong social support systems (Marks et al. 2020).

With respect to sexual minority status, the predominant research findings point to more mental disorder symptoms reported by sexual minority groups. However, it is possible that this population develops more resilience from challenges and adversities specifically associated with their sexual minority identity. For example, recent studies investigating the health of sexual minority midlife and older adults have revealed evidence of resilience in the face of challenges like discrimination and stigma (Fredriksen-Goldsen et al. 2017; Nelson and Andel 2020a, 2020b; Nelson 2024). Among young adults, some sexual minority groups have achieved higher levels of academic performance than their heterosexual peers (Mollborn and Everett 2015).

1.3. The Minority Resilience Model

Despite facing significant adversity and stress associated with their sexual minority identity, many sexual minority individuals do not display mental health problems. Consistent with the development of positive psychology, the recent literature on sexual minority mental health has suggested a shift of research focus from a disease- or deficit-based model to a strengths-based framework to understand the processes mitigating mental disorders and facilitating positive outcomes (Colpitts and Gahagan 2016; Craig et al. 2012; Riggle et al. 2008). Researchers argue that resilience, or the quality of being able to survive and thrive in the face of adversity, is at play among sexual minorities (Colpitts and Gahagan 2016; Meyer 2015). Specifically, the minority resilience model focuses on processes that countervail negative impacts associated with a sexual minority identity, resulting in positive adaptation. Researchers suggest that minority coping and social support at individual and community levels can buffer the effect of stressors faced by sexual minorities so that adverse health outcomes can be avoided or reduced or lead to positive outcomes, indicating the resilience of sexual minorities (Meyer 2015; Nelson 2024). In the literature on sexual minority mental health, the construct of resilience has taken center stage as the research field strives to shift from the disease-based framework and challenge the belief systems that reinforce prejudice and discrimination (Braveman and Gruskin 2003; Herrick et al. 2013; Kwon 2013; Meyer 2013).

Resilience has become a focal point of study within sociology, psychology, and other mental health-related fields (Davydov et al. 2010; Hu et al. 2015; Walker and Peterson 2018). Although definitions may differ slightly across disciplines, resilience generally describes the capacity to recover from adversity, trauma, or stress and adapt positively to such challenges (Fergus and Zimmerman 2005; Hu et al. 2015). It is often characterized as the ability to “bounce back” to the previous state after experiencing negative events (Connor and Davidson 2003). In the literature on sexual minority mental health, resilience has been constructed within the minority stress model, and in most cases, it has been considered as dynamic process, navigating one’s biopsychosocial environment for growth, development, and positive mental health outcomes (Nelson 2024). In empirical research, it has been conceptualized as a blanket of processes such as positive coping and mobilization of social and psychological recourses at individual and community levels (Fredriksen-Goldsen et al. 2017; Nelson and Andel 2020a, 2020b). As such, resilience is often inferred from the effects of positive coping and the mediation or moderation effects of social and psychological resources or from the absence of disorder symptoms without a direct measure (Fredriksen-Goldsen et al. 2017; Nelson and Andel 2020a, 2020b). Although informative, the resilience constructed in this approach is often mingled with or proxied by many other concepts emphasized in the stress process model, such as coping, social support, personal agency, optimism, and locus of control (Mereish and Poteat 2015; Winiker et al. 2019; Nelson 2024). Without a clear definition and direct measurement, it is hard to compare the resilience of sexual minorities with that of other groups.

Besides viewing resilience as a set of dynamic processes, a more conventional definition of resilience considers it as an ability possessed by individuals through previous experiences of adversities (Connor and Davidson 2003). In other words, rather than viewing resilience as the process of coping or resource mobilization when facing stressors, this approach treats resilience as a mental health outcome or personal trait developed through stressful experiences. Treating resilience as an ability or personal trait possessed by individuals has been common in socio-behavioral approaches to mental health research (Connor and Davidson 2003).

In this study, we followed the conventional definition of resilience as the ability to rebound from adverse experiences and directly measured resilience among sexual minority college students and compared it to that of their heterosexual peers. Because resilience implies experiences of adversities, and because sexual minority college students often endure stressors associated with their sexual identity in addition to stressors commonly experienced by college students, we suspect that sexual minority college students will be more resilient than their heterosexual peers.

1.4. Positive Mental Health as Stress Outcomes

A significant body of research suggests that adverse life experiences can enhance mental functioning through increased personal growth, agency and environmental mastery, and sense of meaning and purpose (Erikson 1980; Frankl 1965; Maslow 1954; Meyer 2003; Park et al. 1996; Tedeschi and Calhoun 1996; Ryff and Singer 2003) in addition to subjective mental well-being such as happiness and life satisfaction (Seligman et al. 2005). This aligns with the dual continua model of mental health proposed by Keyes (1995), which posits that mental health disorders and positive mental health are two distinct outcomes resulting from life experiences. Moreover, the absence of disorders does not necessarily imply the presence of positive mental health (Payton 2009). The dual continua model also indicates that stress may provide conditions that facilitate positive mental functioning and develop positive mental health with or without symptoms of mental disorders (Park et al. 1996). Indeed, many studies have found that people can score high on both mental disorder and positive mental well-being continua (Keyes 1995; Park et al. 1996; Payton 2009). Thus, mental health studies on sexual minorities should pay equal attention to both dimensions of mental health.

With an emphasis on coping and social and psychological resources in the stress process, the minority resilience model has paid less attention to broadening mental health outcomes aside from disorders and negative symptoms. Kwon (2013) proposed a resilience model for psychological well-being among sexual minority populations which inspired researchers to assess the positive mental functioning experienced by sexual minority individuals. A recent systematic review covering 17 empirical studies found sexual minority stress is associated with inauthenticity (i.e., pretending to be something one is not), which in turn led to worse mental functioning and lower mental well-being (Roberts et al. 2024). Several studies have examined the relationship between specific stressors such as discrimination and purpose of life, which is another dimension of well-being (Allan et al. 2015; Bos et al. 2021; Douglass et al. 2020). For example, with both cross-sectional data (n = 76) and longitudinal data (n = 72) on young adult offspring of lesbian parents, Bos et al. examined the negative relationship between homophobia discrimination and meaning of life. Also, a recent qualitative study explored positive mental experiences such joy, growth, and peace associated with sexual and gender minority statuses (Wurm et al. 2024). Overall, however, research focusing on positive mental health among sexual minority populations is sparse.

Previous studies examining resilience and positive mental health outcomes have mostly only focused on sexual minority populations without comparing the results to those of heterosexual populations. As a result, we do not have a good understanding of whether sexual minority populations score higher or lower on different measures of positive mental health compared to heterosexual individuals. Previous studies employing Kwon’s (2013) resilience model primarily sought to identify protective factors and mechanisms possessed by certain sexual minorities that contribute to their resilience or enhanced mental well-being compared to others who encounter similar sexual minority stressors. Although informative, this within-group research needs to be balanced with comparisons between sexual minority and heterosexual groups to avoid the over-emphasizing of internal and proximate factors while making the external systemic health disparities less visible.

There are a limited number of studies comparing the levels of positive mental health and well-being between sexual minority and heterosexual college students. For example, a recent study analyzed data from the 2020–2021 Healthy Minds Study (n = 373,301) and reported that sexual minority college students experienced a lower level of flourishing compared to their heterosexual counterparts (Oh 2022). A few public health studies found that sexual minority individuals experienced lower levels of happiness and life satisfaction (Center for American Progress 2021; Statistics Canada 2021) and lower levels of social connectedness and self-esteem. All these results are concerning. Since scholars have advocated for the use of a diverse array of measures to assess positive mental health and well-being (Ryff 1989; Seligman 2011), there is a pressing need to allocate more research resources to investigating the diverse positive mental health outcomes among college students. Besides happiness, life satisfaction, social connectedness, and self-esteem, the well-being literature has emphasized other dimensions of positive mental health such as purpose of life (Ryff 1989; Xi et al. 2017), mastery over one’s life circumstances (Ryff 1989), and inner peace (Xi and Lee 2021). Little research attention has focused on these various aspects of positive mental health among sexual minority populations. Overall, there is a need to investigate a broad range of positive outcomes, including resilience, as part of the strengths-based framework for sexual minority college students’ mental health (Meyer 2015).

In this study, we investigated a set of positive mental health outcomes, including resilience, mastery, inner peace, overall well-being, and different aspects of well-being such as life purpose, development of virtue and character, happiness, life satisfaction, and satisfying close relationships. If the minority resilience model is applicable, we would expect that sexual minority college students report better positive mental health and well-being than heterosexual students. Important socio-economic variables were included in our analysis to account for intersectional aspects of oppression that previous work has highlighted.

1.5. The Current Study

This current study addresses the above-mentioned gaps. We asked, Do sexual minority students report higher rates of depressive and anxiety symptoms as well as self-hurting behaviors compared to their heterosexual peers? Are sexual minority students more resilient? Do sexual minority students score higher or lower on a broad range of positive mental health outcomes compared to heterosexual college students? Based on the minority stress model, we hypothesized that sexual minority college students report more mental disorder symptoms compared to their heterosexual peers. According to the minority resilience model, we expected sexual minority students to evidence more resiliency and to report higher rates of positive mental health and well-being compared to their heterosexual counterparts.

2. Materials and Methods

2.1. Data

The data for this study were collected through a cross-sectional survey carried out in November 2022, focusing on the mental health of undergraduate students at a public university in the midwestern portions of the United States. The study received approval from the university’s Institutional Review Board (IRB#20191007). The anonymous survey was distributed via the Qualtrics platform to students enrolled in Introduction to Sociology and Introduction to Anthropology courses, which attract students from a diverse range of majors. The survey was also distributed to students enrolled in other sociology and anthropology courses. The sampling strategy was based on convenience and availability rather than probability. Eligibility criteria included being at least 18 years old. Participation was entirely voluntary, with most instructors offering extra credit as an incentive. After excluding 30 incomplete surveys, the final sample consisted of 521 fully completed responses, with no missing data. Descriptive statistics for the sample are provided in

Table 1. Sample Descriptive Statistics.

	n	%	Mean	SD	Min.	Max.
Sexual Minority Identity	521
Yes	122	23.42
No	399	76.58
Sexual Orientation Details	521
Asexual	3	0.58
Bisexual	51	9.79
Fluid	1	0.19
Gay	5	0.96
Lesbian	7	1.34
Minoritized Sexuality Combinations	14	2.68
Pansexual	3	0.58
Prefer not to disclose	9	1.73
Queer	5	0.96
Questioning or unsure	12	2.30
Straight	399	76.58
Straight and Minoritized Sexuality Combinations	12	2.50
Gender	521
Females	333	63.92
Male	181	34.74
Non-binary/Prefer no to disclose	7	1.34
Age	521		21.42	5.50	18	60
Race	521
Asian	23	4.40
Black	81	15.68
Other/multirace	29	5.54
White	388	74.38
Hispanic	521
Yes	18	3.44
No	503	96.56
Rank of Student	521
Freshman	135	25.91
Sophomore	133	25.53
Junior	96	18.43
Senior	157	30.13
First Generation College Student	521
Yes	156	29.94
No	365	70.06
Commuter	521
Yes	264	50.67
No	257	49.33
Hours of Paid Employment	521
0 h	140	26.87
1–10 h	63	12.09
11–20 h	128	24.57
21–30 h	109	20.92
31–40 h	50	9.60
>40 h	31	5.95
Worrying about Normal Living Expenses	521		4.67	3.51	0 (no worry)	10 (Worry all the time)
Worrying about Safety, Food or Housing	521		3.37	3.21	0 (no worry)	10 (Worry all the time)
Mental Disorder Symptoms a
CES-D (Mean/SD/Min.-Max.)	521		23.41	13.66	0	60
GAD (Mean/SD/Min.-Max.)	521		9.82	6.58	0	21
Self-hurting Behavior past 3 months	521		0.20	0.78	0	5
Never	476	91.36
Once	18	3.45
2–3 times	16	3.07
4–5 times	2	0.38
>5 times	9	1.73
Positive Mental Health and Well-Being b
Resilience	521		2.79	0.86	0	4
Inner Peace	521		2.38	0.66	1	5
Mastery	521		3.19	0.72	1	7
Overall Well-Being	521		6.11	1.74	0	10
Happiness and Life Satisfaction	521		5.69	2.09	0	10
Self-Rated Mental and Physical Health	521		5.73	2.07	0	10
Life Purpose and Self-Worth	521		5.90	2.39	0	10
Virtue and Character	521		6.62	1.94	0	10
Satisfying Relationships	521		6.59	2.44	0	10

Note: ^a For all mental disorder measures, higher scores indicate higher levels of mental disorder symptoms. ^b For all positive mental health measures, higher scores indicate higher levels of positive mental health.

.

Our sample includes 122 queer-identified students (23%) and 399 students (77%) who self-identified as heterosexual. Table 1 reports the detailed sexual identification information. For example, our sample contained 7 students (1.34%) who self-identified as lesbian, and 5 students (0.96%) who identified as gay. Fifty-one students (9.79%) self-identified as bisexual. Few students self-identified as fluid (1, 0.19%), pansexual (3, 0.58%), queer (5, 0.96%), or asexual (3, 0.58%). There were 14 students (2.68) who identified with more than one of the minoritized sexual identities. Twelve students (2.30%) were questioning or unsure about their sexual identity, and nine students (1,73%) preferred not to disclose their sexual identity. Among the 521 students in the sample, 399 (76.58%) selected heterosexual as their sole sexual identity. Twelve students (2.5%) self-identified as heterosexual in addition to other minoritized sexual identities.

The survey asked the participants whether they self-identify as female (333; 63.92%), male (181; 34.74%), non-binary (1; 0.2%), or prefer not to disclose their gender identity (6; 1.2%). The average age of the students was 21.42, and most students were White (74.38%) and non-Hispanic (96.56%). About a quarter of the sample were freshmen (25.91%), and 30% of the respondents were first-generation college students. About half of the sample were commuters (50.67%), and most of the sample was employed. About 35% of the sample worked over 20 h a week for pay. We broke down the sample statistics by queer-identified and heterosexual-identified groups. The results are shown in Appendix A.

2.2. Measures

2.2.1. Symptoms of Negative Mental Health and Disorders

We gathered data on two categories of mental health symptoms among the students—depressive symptoms and anxiety symptoms—using the Center for Epidemiological Studies Depression Scale (CES-D) (Radloff 1977) and the Generalized Anxiety Disorder scale (GAD) (Spitzer et al. 2006). Additionally, we assessed self-harming behaviors.

The CES-D is designed to measure depressive symptoms in non-clinical populations (Radloff 1977). It consists of 20 items asking respondents how frequently they experienced specific depressive symptoms over the past week. The responses are rated on a 4-point Likert scale from 0 (not at all in the past 7 days) to 3 (nearly every day in the past 7 days), with higher scores reflecting more severe depressive symptoms. Positively worded items were reverse-coded. The total score was calculated by summing all the item responses, yielding a possible score ranging from 0 to 60. In this study, the CES-D demonstrated high internal consistency with a Cronbach’s alpha exceeding 0.9.

To measure generalized anxiety disorder, we employed the seven-item GAD scale. The participants rated their experiences on a 4-point Likert scale ranging from 0 (no days in the past 7 days) to 3 (5–7 days in the past 7 days), with higher scores indicating greater anxiety symptoms. The total scores ranged from 0 to 21 and was based on the sum of all items. The GAD scale also showed high internal consistency in our sample, with a Cronbach’s alpha of 0.9.

Self-hurting behaviors were measured using the survey question, “During the past three months, how many times have you hurt yourself on purpose in any way (e.g., by taking an overdose of pills, or by cutting yourself)?” The responses were scored from 0 (never) to 5 (five or more times).

2.2.2. Positive Mental Health and Well-Being

In this study, we included a broad range of indicators of positive mental health, including resilience, mastery, inner peace, and overall well-being. We also examined life purpose, happiness and life satisfaction, self-rated physical and mental health, virtue and character, and satisfying close relationships as sub-dimensions of overall well-being.

Resilience was measured by the 2-item short resilience scale (RS) derived from Connor and Davidson’s original resilience scale (Connor and Davidson 2003). The RS captures the capacity to adapt or bounce back when facing changes or hardships. The responses were scored on a 5-point Likert-type scale ranging from 0 (not capable at all) to 4 (capable almost all the time), with higher scores indicating higher levels of resilience. The summary scores were created by averaging the total score over the total number of items. The Cronbach’s alpha coefficients calculated for our samples were around 0.75, again indicating adequate internal consistency between these two items.

Mastery was measured using the 3-item environmental mastery subscale of the Psychological Well-Being measure (Ryff 1989). Mastery captures the capacity to master the demands in one’s life, stay in charge of life’s situations, and manage daily responsibilities. The responses were scored on a 7-point Likert-type scale, with higher scores indicating higher levels of mastery over one’s life. The summary scores were created by averaging the total score over the total number of items. The Cronbach’s alpha coefficients calculated for our samples were around 0.67, indicating borderline internal consistency between these three items.

Inner peace was measured using the 9-item inner peace scale (IPS) that was recently developed by Xi and Lee (2021). The IPS measures the three dimensions of inner peace: acceptance of losses, transcendence of materialism, and felt peace and balance. The responses were scored on a 5-point Likert-type scale, with higher scores indicating higher levels of inner peace. The summary scores were created by averaging the total score over the total number of items. The Cronbach’s alpha coefficients calculated for our samples were around 0.81, indicating good internal consistency among these items.

Overall well-being was assessed using the 10-item Flourishing Scale (FS) developed by the Human Flourishing Program at Harvard University (VanderWeele 2017). The FS measures five dimensions of well-being: happiness and life satisfaction, self-evaluated mental and physical health, purpose in life, character and virtue such as postponing gratification and persistence, and satisfying social relationships. For each item, the respondents were asked to evaluate themselves on a 0 to 10 scale. The summary scores were created by averaging the total score over the total number of items. From the FS, we created subscales for each dimension of the construct to measure happiness and life satisfaction, mental and physical health, meaning and purpose, character and virtue, and satisfying social relationships.

2.2.3. Sexual Minority Identity

The students were provided a list of sexual identities (lesbian, gay, straight/heterosexual, asexual, bisexual, fluid, pansexual, queer, questioning or unsure, or prefer not to disclose) and were asked to select as many categories as applicable. Due to the low sample size of students who selected each category except heterosexual, we combined all the students who identified with at least one of the minoritized sexualities into ‘sexual minority identity’. This categorization is consistent with Mandatori et al.’s (2025) definition of sexual minority people, which includes all those whose sexual orientations differ from the heterosexual majority, including but not limited to lesbian, gay, bisexual, pansexual, and asexual people. A dummy variable was created with the sexual minority identity coded as 1 and the heterosexual identity as 0.

2.2.4. Socio-Economic Variables

We considered indicators of social-economic status such as being a first-generation college student (yes = 1), hours of paid employment (in hours), sense of basic security for food, housing, and personal safety (on an 11-point scale), and sense of financial security for monthly expenses (on an 11-point scale).

2.2.5. Control Variables

For demographic control variables, we included age (measured in years). The survey did not contain information on gender based on cis- or trans-gender status. The survey asked the participants whether they self-identify as female, male, non-binary, or prefer not to say. We created a dummy variable (0 = male, 1 = female and non-binary/prefer not to say) to denote gender minority status. Based on the information on race and Hispanic ethnicity, we created a dummy variable for racial minority status (non-Hispanic White = 0, others = 1). Other control variables include being a freshman (yes = 1) and being a commuter (yes = 1) due to their mental health impact on college students that has been documented in the literature (Merlin and Hu 2023; Stolzenberg 2018).

2.3. Statistical Analytic Strategy

Our statistical analyses include bivariate t-tests comparing the means of symptoms of mental health disorders and positive mental health and well-being status between the sexual identity groups. Because dependent variables are measured at the interval level, we used ordinal least square regression analysis to test our hypotheses and control for other minority status, socio-economic status, and demographic variables. We analyze the data using STATA 17.

3. Results

In

Table 2. T-test Comparing Means for Outcome Variables between Sexual Minority and Heterosexual students ^a.

	Sexual Minority Students (n = 122)		Heterosexual Students (n = 399)
	Mean	SD	Mean	SD	Diff.
Mental Disorder Symptoms b
CES-D	31.98	1.18	20.78	0.64	11.20	***
GAD	12.93	0.54	8.87	0.32	4.06	***
Self-hurting Behavior Past 3 Months	0.44	0.1	0.12	0.03	0.32	***
Positive Mental Health and Well-Being c
Resilience	2.55	0.08	2.87	0.04	−0.32	***
Mastery	3.85	0.11	4.46	0.05	−0.61	***
Inner Peace	2.02	0.05	2.47	0.03	−0.47	***
Overall Well-Being	5.24	0.15	6.37	0.08	−1.13	***
Happiness and Life Satisfaction	4.72	0.19	5.99	0.10	−1.27	***
Self-Rated Mental and Physical Health	4.61	0.17	6.07	0.10	−1.45	***
Life Purpose	4.82	0.22	6.23	0.11	−1.41	***
Virtue and Character	6.19	0.18	6.75	0.10	−0.56	**
Satisfying Relationships	5.86	0.25	6.81	0.12	−0.95	***

Note: ** p < 0.01; *** p < 0.001 with two-tailed two independent samples t test. ^a No control variables used in these t-tests. ^b For all mental disorder measures, higher scores indicate higher levels of mental disorder symptoms. ^c For all positive mental health measures, higher scores indicate higher levels of positive mental health.

, we compare the mental health outcomes of sexual minority students with those of heterosexual students using a set of two independent sample t-tests without controlling for other variables. Clear patterns emerged, as shown in Table 2, whereby sexual minority students reported much higher levels of depressive symptoms, anxiety disorder symptoms, and more self-hurting behaviors. Sexual minorities also reported less resilience, inner peace, and overall well-being. The average depressive symptom score was 31.98, which was 11 points higher than that of heterosexual students. Research on mental disorders indicates that a CES-D score of 16 or above serves as the threshold for clinical concern, suggesting that individuals meeting or exceeding this score should pursue further evaluation for depression (Radloff 1977). In light of this benchmark, the notably high average CES-D scores among sexual minority students, coupled with the pronounced disparities across sexual identity groups, raise significant concerns.

A GAD score of 5 signifies mild anxiety, while a score of 10 reflects moderate anxiety levels. The threshold for diagnosing generalized anxiety disorder (GAD) is set at a score of 10, beyond which, further clinical assessment is recommended (Spitzer et al. 2006). In our sample, sexual minority students reported an average GAD score of 12.93, surpassing the clinical cutoff for a GAD diagnosis. Additionally, the 4.06-point difference between sexual minority and heterosexual students highlights a troubling disparity.

For positive mental health outcomes, the literature does not yet provide benchmarks for us to compare our results with. We thus focused on comparisons between two sexual orientation groups. As shown in Table 2, sexual minority students scored lower than heterosexual students on resilience, mastery, inner peace, and overall well-being. Sexual minority students also scored lower on all sub-scales of well-being, including purpose in life, happiness and life satisfaction, self-evaluated health, virtue and character (measured with postponing gratification and promoting good even in challenging situations), and satisfaction of close relationships.

Table 3. OLS Regression Analysis of Mental Disorder Symptoms and Self-Hurting Behavior.

	Depressive Symptoms				Anxiety				Self-Hurting Behavior
	Coef.	se		Beta	Coef.	se		Beta	Coef.	se		Beta
Sexual Minority (Straight = 0)	7.74	1.21	***	0.24	2.11	0.58	***	0.14	0.26	0.08	***	0.14
Gender Minority (Male = 0)	4.26	1.10	***	0.15	3.26	0.52	***	0.24	0.10	0.07		0.06
Racial Minority (Non-His. White = 0)	−2.00	1.15		−0.06	−1.63	0.55	**	−0.11	−0.16	0.08	*	−0.09
Age	−0.21	0.10	*	−0.09	−0.12	0.05	**	−0.10	0.00	0.01		0.03
Freshman	−0.33	1.22		−0.01	−0.91	0.58		−0.06	0.03	0.08		−0.02
Commuter	2.34	1.10	*	0.09	1.47	0.52	**	0.11	0.02	0.07		0.01
First Generation Student	1.82	1.14		0.06	0.20	0.54		0.01	0.03	0.08		0.02
Hours Employment	−0.48	0.37		−0.05	−0.11	0.18		−0.03	−0.04	0.02		−0.08
Worry Normal Living Expenses	0.34	0.21		0.09	0.19	0.10		0.10	0.00	0.01		0.02
Worry Safety, Food, or Housing	1.48	0.22	***	0.35	0.72	0.11	***	0.36	0.04	0.02	*	0.15
Intercept	41.04	2.96	***		14.26	1.39	***		0.20	0.20
Adj. R-sq	0.32				0.33				0.04
n	521				521				521

Note: * p < 0.05; ** p < 0.01; *** p < 0.001 two-tailed t test.

reports the OLS regression results for mental disorder symptoms and self-hurting behaviors, considering other demographic variables and socioeconomic variables. As indicated in Table 3, sexual minority identity was associated with higher levels of depressive symptoms, generalized anxiety disorder symptoms, and more self-hurting behaviors even after controlling for other demographic and socioeconomic variables. Comparing the standardized regression coefficients, sexual minority status was consistently among the most important predictors across the models.

Turning to positive outcomes, although sexual minority students reported less resilience according to the bi-variate analysis (Table 2), after controlling for social-economic variables, there was no difference in resilience between sexual minority students and heterosexual students (

Table 4. OLS Regression Analysis of Positive Mental Health Outcomes.

	Resilience				Mastery				Inner Peace				Overall Well-Being
	Coef.	se		Beta	Coef.	se		Beta	Coef.	se		Beta	Coef.	se		Beta
Sexual Minority (Straight = 0)	−0.14	0.09		−0.07	−0.46	0.11	***	−0.18	−0.29	0.06	***	−0.19	−0.87	0.17	***	−0.21
Gender Minority (Male = 0)	−0.49	0.08	***	−0.27	−0.05	0.10		−0.02	−0.29	0.06	***	−0.21	−0.18	0.16		−0.05
Racial Minority (Non-His. White = 0)	0.09	0.08		0.05	0.20	0.10		0.08	0.12	0.06	*	0.08	0.26	0.16		0.07
Age	0.02	0.01	*	0.10	0.02	0.01	*	0.09	0.02	0.00	***	0.19	0.02	0.01		0.06
Freshman	−0.04	0.09		−0.02	0.06	0.11		0.03	−0.04	0.06		−0.02	0.11	0.17		0.03
Commuter	−0.15	0.08		−0.09	−0.31	0.10	**	−0.14	−0.13	0.05	*	−0.10	−0.32	0.16	*	−0.09
First Generation Student	−0.07	0.08		−0.04	0.00	0.10		0.00	0.08	0.06		0.06	−0.21	0.16		−0.05
Hours Employment	0.04	0.03		0.08	0.09	0.03	**	0.12	0.01	0.02		0.02	0.07	0.05		0.06
Worry Normal Living Expenses	0.01	0.02		0.04	−0.03	0.02		−0.09	−0.02	0.01	*	−0.12	−0.02	0.03		−0.05
Worry Safety, Food or Housing	−0.06	0.02	***	−0.23	−0.08	0.02	***	−0.23	−0.05	0.01	***	−0.25	−0.13	0.03	***	−0.25
Constant	2.37	0.21	***		2.96	0.27	***		1.53	0.15	***		5.09	0.41	***
Adj. R-sq	0.14				0.14				0.26				0.15
n	521				521				521				521

Note: * p < 0.05; ** p < 0.01; *** p < 0.001 two-tailed t test.

). However, the disadvantages associated with sexual minority identity were persistent for other positive mental health outcomes, such as mastery and inner peace, even after controlling for other demographic and socioeconomic variables. Regarding overall well-being, the disadvantage associated with a sexual minority identity also persisted.

Examining the five dimensions of well-being measured by the sub-scales of the Flourishing Scale in

Table 5. OLS Regression Analysis of Sub-scales of Flourishing Scale for Well-Being.

	Life Purpose				Happiness and Life Satisfaction				Self-Rated Physical and Mental Health				Virtue and Character				Satisfying Relationships
	Coef.	se		Beta	Coef.	se		Beta	Coef.	se		Beta	Coef.	se		Beta	Coef.	se		Beta
Sexual Minority (Straight = 0)	−1.12	0.24	***	−0.20	−0.95	0.21	***	−0.19	−1.06	0.20	***	−0.22	−0.35	0.21		−0.08	−0.87	0.25	***	−0.15
Gender Minority (Male = 0)	0.13	0.22		0.03	−0.20	0.18		−0.05	−0.67	0.18	***	−0.16	−0.37	0.19	*	−0.10	0.20	0.23		0.04
Racial Minority (Non-His. White = 0)	0.25	0.23		0.05	0.56	0.19	**	−0.12	0.52	0.19	***	−0.11	0.06	0.19		0.01	−0.08	0.24		−0.02
Age	0.03	0.02		0.07	0.03	0.02		0.07	0.01	0.02		0.02	0.04	0.02	*	0.10	−0.01	0.02		−0.01
Freshman	0.09	0.24		0.02	0.18	0.21		0.04	0.04	0.20		0.01	−0.01	0.21		0.00	0.25	0.26		0.05
Commuter	−0.41	0.21		−0.09	−0.51	0.19	**	−0.12	−0.29	0.18		−0.07	0.04	0.18		0.01	−0.42	0.23		−0.09
First Generation Student	−0.24	0.22		−0.05	−0.12	0.19		−0.03	−0.23	0.19		−0.05	0.01	0.19		0.00	−0.46	0.24		−0.09
Hours Employment	0.13	0.07		0.08	0.06	0.06		0.04	0.01	0.06		0.00	0.04	0.06		0.03	0.14	0.08		0.08
Worry Normal Living Expenses	−0.04	0.04		−0.06	−0.07	0.04	*	−0.12	−0.05	0.03		−0.08	−0.03	0.03		−0.06	0.07	0.04		0.10
Worry Safety, Food or Housing	−0.18	0.04	***	−0.25	−0.12	0.04	***	−0.19	−0.13	0.04	***	−0.21	−0.04	0.04		−0.07	−0.18	0.05	***	−0.24
Constant	7.86	1.15	***		3.77	0.50	***		4.60	0.49	***		5.27	0.50	***		11.58	1.21	***
Adj. R-sq	0.13				0.15				0.19				0.03				0.06
n	521				521				521				521				521

Note: * p < 0.05; ** p < 0.01; *** p < 0.001 two-tailed t test.

, sexual minority students reported lower levels of purpose in life, happiness and life satisfaction, self-rated physical and mental health, character traits such as delaying gratification and perseverance, and satisfaction of relationships compared to heterosexual students. Comparing the standardized regression coefficients, a sexual minority status was consistently among the most important predictors across the models for lower levels of positive mental health outcomes (Table 4 and Table 5).

4. Discussion

As an effort to provide a fuller picture of sexual minority college students’ mental health, this study examined a wide range of mental health outcomes, including symptoms of mental health disorders and self-hurting behaviors and multiple indicators of positive mental health and well-being among 521 college students surveyed at a mideastern state university in 2022. A quarter of the sample self-identified with at least one of the minoritized sexual orientations, providing us enough analytical power to compare sexual minority students with heterosexual students. Based on the theoretical predictions of the minority stress model and the minority resilience model, we expected that sexual minority students would report more mental disorder symptoms but would evidence more resilience and positive mental health compared to their heterosexual peers.

We found that sexual minority college students reported worse mental health on both disorder and well-being continua of mental health. Specifically, sexual minority students suffered more depressive and anxiety symptoms and reported more self-hurting behaviors. These results support the predictions of the minority stress model. They were also consistent with previous research framed by the minority stress model.

Our research found that sexual minority students reported diminished overall well-being, with lower levels of mastery and inner peace. Sexual minorities reported less purpose in life, happiness and life satisfaction, self-evaluated physical and mental health, and satisfying relationships. Although sexual minority students also reported less resilience, as measured by the capacity to rebound after experiencing adversities, the difference between sexual minorities and their heterosexual peers was explained away by socioeconomic variables. Our findings were thus not consistent with the predictions of the minority resilience model.

Although previous studies have found much evidence for minority resilience (Allan et al. 2015; Bos et al. 2021; Meyer 2015), most of these studies focused on comparisons within the sexual minority population, striving to understand why some sexual minorities fare better than other sexual minorities. Studies comparing resilience and positive mental health between sexual minorities and heterosexual groups are sparse. Our findings support the small number of studies that made these kinds of comparisons and highlight the mental health disparities in positive mental health outcomes between sexual minorities and heterosexual groups (Center for American Progress 2021; Statistics Canada 2021; Oh 2022; Roberts et al. 2024).

Comparing different minority statuses, both sexual and gender minority statuses are associated with worse mental health with more symptoms of disorders and less positive mental health and well-being. On the contrary, racial minority status was a protective factor for anxiety and self-hurting behaviors. Racial minority status is also associated with more happiness and life satisfaction as well as self-evaluated physical and mental health status. Our findings indicate that the minority mental health paradox, which argues that a marginalized social status can facilitate growth and lead to better mental health, was applicable to racial minority status but not to sexual and gender minority status. Although beyond the scope of the current study, it would be helpful for future work to explore the social processes and mechanisms that contribute to the different mental health outcomes across different minority status categories. Viewing the results more critically, we note that it is possible that the very notion of mental health might be a Eurocentric and cis-heteronormative construct which may fail to capture what is truly important and essential to the well-being of sexual minorities when defined in their own terms.

In supplemental analyses, we checked the interactions between sexual minority status and racial minority status for all the mental health outcomes considered in the analysis. We found little evidence for heterogeneous effects associated with sexual minority status among non-Hispanic White vs. racial minority students (results available upon request). We also checked the interaction effects between sexual minority status and gender. We found that being a sexual minority who also identifies as female or non-binary offsets some negative effects of minority stress and thus improves a sexual minority’s sense of environmental mastery, inner peace, and overall well-being (results available upon request). Interestingly, the interaction effects between sexual minority status and gender were not significant for mental disorder outcomes (results available upon request).

Among the socioeconomic variables considered in the analysis, the lack of a sense of basic security for safety, food, or housing stood out as an important risk factor for poor mental health. SES variables predicted more depressive and anxiety symptoms and self-hurting behaviors. SES was also one of the most salient predictors for lower resilience, environmental mastery, inner peace, and different dimensions of well-being. Worrying about basic security for safety, food, or housing explained away much of the difference in resilience between sexual minority students and their heterosexual peers. This result indicates the importance of programs assisting college students to meet their basic needs for safety, food, and housing.

Our study contributes to the literature by examining a broad range of mental health indicators, including both negative and positive aspects of mental health among sexual minority college students in contrast to heterosexual students. In doing so, our study provides a fuller picture of the mental health profile of sexual minority college students in comparison with heterosexual students. We believe these comparisons are important for revealing the mental health disparities in multiple spectra of mental health. Although this kind of comparison provides fewer opportunities to explore the effects of proximate internal stressors (e.g., internalized homophobia) experienced only by sexual minority students, they highlight the importance of sexual minority status as a distal or structural factor shaping a broad range of mental health outcomes. Our research also enriches the literature of the minority resilience model by directly measuring resilience and considering resilience as a mental health outcome of minority stress. The current literature on minority resilience focuses on within-sexual-minority-group comparisons. This can unintentionally emphasize resilience as internal and individual-oriented without emphasizing external or structural factors. By comparing resilience and positive mental health outcomes between sexual minority and heterosexual students, this study highlights the mental health disparities at the structural level even though some sexual minority students were highly resilient and enjoying high levels of well-being. At the same time, this study adds to the minority stress model by demonstrating that minority stress can affect both the disorder and the well-being aspects of mental health. Finally, our study is strengthened by the fact that we incorporated socio-economic variables in accordance with the extant literature. Taking SES into account helps to contextualize our findings on the impact of intersecting oppression mechanisms on overall mental health and well-being.

It is noteworthy that heterosexual students also reported high levels of depressive and anxiety symptoms even though heterosexuals scored lower than sexual minority students. This is concerning yet consistent with the literature. The timing of the survey can be relevant in interpreting the results. The breakout of the COVID-19 pandemic and the disruptions caused by it impacted mental health writ large (Salerno et al. 2020). In the few years after the full lockdown of most U.S. college campuses in 2020, campus life and class arrangements were constantly changing in many places in accordance with policy responses to the pandemic and the availability of vaccines. The high prevalence of mental health symptoms found in this study in 2022 was thus not surprising.

It has been suspected that the COVID-19 pandemic would impact the sexual and gender minority (SGM) groups more adversely compared to cisgender and heterosexual groups (Salerno et al. 2020). The types of employment for many SGMs, for example, are more susceptible to the economic impacts of the pandemic (Gibb et al. 2020). Lack of a supportive family and a safe home might make life hard and dangerous for sexual and gender minorities under lockdown policies, especially for young SMG persons (Fish et al. 2020). Many SGM communities suffered a sudden and significant loss of safe spaces, including support groups and leisure and entertainment spaces, due to social distancing mandates and closures of businesses and gathering places (Anderson and Knee 2020; Banerjee and Nair 2020). Because social support and meaningful social connections are important protective factors for mental health (Pearlin 1989), the loss of these protective resources can lead to heightened mental health symptoms (Scroggs et al. 2020). Without longitudinal data, it is hard to gauge the impacts of the pandemic on sexual minority students. It is possible that the results reported in this study reflect such impacts.

Our findings highlight the importance of programs and efforts specifically designed to boost positive mental health among sexual minority college students and all college students. Sexual minority college students are particularly vulnerable due to stigma, discrimination, abuse and violence, identity concealment, internalized homophobia, and lack of family support (Meyer 2003; Peralta 2008; Newcomb et al. 2019). Such stigma and discrimination may preclude sexual minority students from seeking health care or accessing health care at all (Macapagal et al. 2016). A supportive campus culture has been found to be critical to sexual minority students’ mental health (Rankin et al. 2010), especially after the disruption caused by the COVID-19 pandemic (Sequeira et al. 2020).

The current federal policy stance against diversity, equity, and inclusion efforts gives us pause in suggesting actionable steps to protect and serve vulnerable populations including the sexual minoritized community. Nevertheless, based on our findings, we offer some actionable suggestions for college health professionals and administrators. Providing help to all students in terms of basic needs for food, safety, and housing would benefit some sexual minority students and help minoritized individuals maintain their resilience. Many existing frameworks, such as retention programs and general mental health and well-being programs that are less politically controversial, can be of great value for students in need, including sexual minority students. We suggest conducting legal reviews to identify protected activities that remain viable even under restrictive policies, which could help to ensure a welcoming campus for all. We recommend continued anonymous data collection on campus climate and student well-being to document the needs of students while protecting privacy. Establishing peer mentoring programs that can operate through student organizations could also be useful. Creating informal faculty, staff, and student ally networks to provide mentorship and support to students in need can not only help students, but also nurture university community building. Staff, faculty, and administrators can develop connections with community organizations to provide students with resources that are unavailable on campus. Finally, it should be recognized that certain protections for sexual minoritized students remain in place regardless of state policies (e.g., Title IX interpretations and institutional non-discrimination policies).

This study has several limitations. The use of a convenience sample from a single university restricts the generalizability of the findings to the broader U.S. college student population. It is also important to note that our sample included a higher proportion of female and African American students compared to the overall student body at the university during the fall 2022 semester. While our analysis accounted for race and gender, reducing the likelihood of significant bias due to these demographic differences, the absence of a randomized sample leaves room for potential misrepresentation. Additionally, characteristics unique to the university may have influenced the results. Another limitation is the small sample sizes within the sexual minority subgroups. The small sample sizes prevented us from examining differences among these groups. Future research should focus on exploring the diverse experiences within sexual minority populations to better understand the specific needs of minoritized students. Such work is important to facilitating human flourishing for all within the nation’s college campuses.