Psychological Distress and Well-Being in Relation to Sexual Minority Status Among Malaysian Undergraduates: Findings from a Multi-Institutional Survey

Abstract

Psychological distress is increasing among university students, especially sexual minority individuals in Malaysia, who face stigma and challenges within a sociocultural and dual legal system. This study examined the relationship between sexual minority status and both negative (psychological strain, distress, suicidality) and positive (self-esteem, purpose in life, social support, religiosity) mental health indicators among Malaysian undergraduates. A cross-sectional, multi-institutional survey was conducted utilizing an existing dataset, yielding a final analytical sample of 2244 participants (1870 heterosexual and 374 sexual minority students). Data were analyzed using Welch’s ANOVA and multiple logistic regression, controlling for demographic variables. Heterosexual students reported significantly lower depressive symptoms, anxiety, stress, and suicidality compared to gay, bisexual, and participants with other sexual orientation. In the fully adjusted model, sexual minority identity remained significantly associated with higher deprivation strain (aOR: 1.043), depression (aOR: 1.025), and suicidality (aOR: 1.117). Conversely, identifying as a sexual minority was linked to lower religious commitment (aOR: 0.961) and lower perceived family support (aOR: 0.943). Self-esteem and purpose in life lost statistical significance in the fully adjusted model. Sexual minority undergraduates in Malaysia face heightened psychological distress and suicidality, underscoring the need for comprehensive campus mental health interventions.

1. Introduction

Globally, there is a rising trend of psychological distress among university students, marking the undergraduate years as a critical developmental period characterized by significant life transitions, newfound independence, and identity development [1,2]. While navigating these academic and personal transitions is challenging for all students, it can be particularly demanding for those identifying as sexual minorities.

Sexual minority (SM) identities encompass individuals who experience same-sex attraction or identify with non-heterosexual orientations. Within the context of this study, this spectrum specifically includes individuals identifying as gay, lesbian, bisexual, demisexual, asexual, pansexual, queer, and questioning orientations. Research consistently demonstrates mental health disparities between sexual minorities and their heterosexual counterparts; for instance, general mental disorders and major depressive disorders are found to be much higher among SM individuals compared to the general population in a Malaysian study [3]. International evidence supports this trend, indicating a strong link between minority sexual identities and an increased risk of psychological distress and suicidality, such as findings from a meta-analysis demonstrating elevated odds of mental disorders (pooled odds ratios between 1.76 and 4.81) [4].

In Malaysia, these vulnerabilities may have been affected by a sociocultural environment which may have hindered frank conversations about sexuality and help-seeking. Data from the Global Acceptance Index rated Malaysia 115 out of 175 countries in 2020, reflecting widespread stigmatization and a lack of social acceptance for SM individuals [5]. A cross-national study in Southeast Asia found that approximately 61% of Malaysians view same-sex desire as morally wrong [6]. Furthermore, SM individuals face a dual legal system that criminalizes their orientations. Secular civil laws, specifically Sections 377A and 377B of the Penal Code, prohibit same-sex behavior for all citizens, while Sharia laws enforce prohibitions against same-sex relations for Malay-Muslims [7].

Malaysian SM individuals report high levels of psychological distress and suicidality. For example, a previous local study focused on community-dwelling lesbian, gay, and bisexual adults found that 44% of participants experienced current suicidal ideation, which was strongly linked to their experiences of victimization and depression [8]. However, data specifically examining these vulnerabilities among the younger, university-attending population remains scarce. Data from another study among gay, lesbian and bisexual adults in Malaysia further revealed that 58.3% of sexual and gender minority participants experienced at least mild anxiety, and 22.5% had attempted suicide [9]. Given the centrality of religion in Malaysian culture, religious commitment introduces a complex dynamic; it can lead to internalized shame, homonegativity, and inner conflict for sexual and gender minority individuals trying to reconcile their faith with their sexual identity [10,11].

However, apart from a focus on psychological distress, assessing well-being is also vital. Social support serves as a prominent protective variable that significantly correlates with lower suicidality, as was found in Malaysian and Dutch samples [10,11]. However, social support and self-esteem may be lower in this population compared to heterosexual young people, as was found in a review of 34 articles globally [12]. Exploring psychosocial variables such as purpose in life alongside psychological distress provides a holistic view of how SM individuals navigate goals, meaning, and direction in their lives, which may be protective against mental health problems. A study among sexual and gender minority youth in Spain has found that higher purpose in life in sexual minorities was associated with greater life satisfaction [13]. However, there is a lack of studies comparing purpose in life in heterosexual and sexual minority participants.

Conceptually, the interplay of these variables can be understood through the lens of psychological strain models. Specifically, the Strains Theory of Suicide states that psychological strains produced by conflicting pressures or unmet expectations in a person’s life may generate psychological distress and suicidal behaviors [14]. The unique sociocultural stigmatization faced by SM undergraduates in Malaysia generates chronic, systemic stressors, leading to heightened psychological strains (such as deprivation and aspiration strains). These strains, in turn, act as primary drivers for elevated psychological distress and suicidality. Within this explanatory framework, psychosocial resources such as perceived social support, self-esteem, and a strong purpose in life traditionally serve as stress buffers that mitigate the impact of distress. However, the Malaysian context introduces a critical complication: while religiosity and familial structures are typically protective variables in the general population, they can act as paradoxical sources of internal conflict and social rejection for SM individuals. Therefore, to more comprehensively understand the mental health of SM undergraduates, it is necessary to concurrently evaluate these intersecting psychosocial correlates.

Despite pronounced health disparities between heterosexuals and sexual minorities, research on the SM population in Malaysia is still in its infancy. Most existing studies rely on convenience or snowball sampling, resulting in a critical lack of large-scale quantitative data [15,16]. Furthermore, while university campuses are crucial environments for identity development and mental health intervention, there is limited literature specifically examining how these unique Malaysian sociocultural dynamics relate to the experiences of undergraduate students. Addressing this significant gap in the literature, the primary objective of this study is to compare the proportion and severity of psychological distress (specifically depressive symptoms, anxiety, stress, suicidality, and psychological strains) and protective well-being indicators (purpose in life, social support, self-esteem, and religious commitment) between heterosexual and sexual minority undergraduates in Malaysia. The secondary objective is to examine which of these specific psychosocial correlates remain significantly associated with sexual minority status after adjusting for sociodemographic covariates.

2. Materials and Methods

2.1. Study Design and Setting

Guided by the Strains Theory of Suicide by Zhang [14], this study utilized a retrospective analysis of an existing cross-sectional dataset to examine the relationship between sexual minority status and both negative (psychological strain, distress, suicidality) and positive (self-esteem, purpose in life, social support, religiosity) mental health correlates among Malaysian undergraduates. The existing dataset was collected between November 2023 and March 2025, covering four academic semesters. To ensure broad geographical representation, participants were recruited via convenience sampling from 32 public and private higher education institutions across 13 states and three federal territories in Malaysia.

2.2. Participants and Eligibility

This study used an existing dataset of 4514 participants. Inclusion criteria required participants to be:

• Malaysian citizens.
• Currently enrolled undergraduate students at a Malaysian public or private university/college.
• Between 18 and 30 years of age. This upper age limit was implemented to ensure developmental homogeneity, restricting the sample to ‘emerging adults’ and limiting potential confounding psychosocial variables associated with older, non-traditional students.

International students were excluded. Data of 374 individuals identifying as a sexual minority (lesbian, gay, bisexual and other sexual orientations) were first extracted. A simple random sample of heterosexual participants (n = 1870) was selected from the full dataset to achieve an approximate 5:1 control-to-case ratio of heterosexuals and sexual minorities [17,18]. This specific ratio was utilized to maximize statistical power for comparative analyses, as the marginal gains in statistical power diminish substantially beyond a 4:1 or 5:1 ratio. While this analytical balancing strategy strengthens the validity of our group comparisons and associative models, it artificially alters the proportion of sexual minorities in the analytical sample. Consequently, while comparative differences are robust, the overall pooled prevalences (e.g., total sample suicide risk) reflect this constructed dataset and should not be interpreted as representative population-level epidemiological rates.

2.3. Instrumentation

Data were collected using a single, comprehensive survey battery comprising multiple established and validated psychometric instruments. To ensure proper attribution, the original developers of each specific scale are cited within their respective subsections below. The research instrument was provided in both English and Malay to ensure linguistic accessibility for the Malaysian undergraduate population.

2.3.1. Demographic Information

Socio-demographic data were collected through a demographic sheet, which captured the following information: age, sex, ethnicity, religion, university affiliation and attendance of religious services. To account for socioeconomic influences, the researchers also collected monthly household income in Malaysian Ringgit (MYR).

2.3.2. Psychological Strain (PSS-20)

Psychological strain was operationalized using the 20-item shortened version of the Psychological Strain Scales (PSS), adapted from the original 40-item scale by Zhang and Lyu [19] and later shortened by Siau et al. [20]. This multidimensional instrument assesses four distinct domains—value, aspiration, deprivation, and coping strain—using a 5-point Likert scale ranging from 1 (never, it’s not me) to 5 (yes, it’s exactly me). Total scores range from 20 to 100, with higher scores reflecting greater strain. Sample items include: “I don’t know if women should have the same rights that men do” (value strain) and “I wish I could achieve the highest goal in my life, but I cannot” (aspiration strain). While the PSS-20 demonstrated excellent internal consistency in Chinese university samples (α = 0.92) [19], the internal consistency for the current sample was α = 0.90. Although items assessing value and deprivation strains may appear sensitive, they are conceptually vital for this study. They accurately capture the cognitive dissonance and systemic barriers experienced by marginalized populations navigating restrictive sociocultural environments.

2.3.3. Psychological Distress

The Depression, Anxiety, and Stress Scale–21 (DASS-21) is a 21-item self-report instrument developed by Lovibond and Lovibond [21] to assess negative emotional states via three 7-item subscales: depression, anxiety, and stress. Participants rate their experiences over the past week on a 4-point Likert scale, ranging from 0 (did not apply to me at all) to 3 (applied to me very much), covering symptoms such as dysphoria, autonomic arousal, and non-specific arousal. Sample items include “I felt that I had nothing to look forward to” (depression), “I was aware of dryness of my mouth” (anxiety), and “I found it hard to wind down” (stress). The Malay version, validated by Musa et al. [22], demonstrated strong internal consistency within the Malaysian context, yielding Cronbach’s alpha values of 0.84 for depression, 0.81 for anxiety, and 0.79 for stress. In the current study dataset, the internal consistencies were α = 0.92 for depression, 0.88 for anxiety, and 0.89 for stress.

2.3.4. Suicidality

Finally, suicidal behaviors were screened using the Suicidal Behaviors Questionnaire–Revised (SBQ-R) [23]. This 4-item instrument captures the frequency and severity of suicidal ideation and lifetime history of attempts (e.g., “Have you ever thought about or attempted to kill yourself?”), yielding a total score between 3 and 18. The scale has demonstrated reliability among high school students (α = 0.87) [23] and is validated for Malaysian university students with a Cronbach’s alpha of 0.80 [24]. In the present sample, the internal consistency was α = 0.88. Directly inquiring about suicidal behaviors, while sensitive, is conceptually necessary to accurately estimate their presence. Moreover, the provision of mental health resources upon survey completion allows psychologically distressed participants to contact support services.

2.3.5. Purpose in Life

The 4-item Purpose in Life Test-Short Form (PIL-SF) [25] was employed to evaluate the degree to which participants perceive their lives as goal-oriented and meaningful. A sample item includes the contrast between having “no goals or aims at all” versus “very clear goals and aims.” This 7-point Likert scale, yielding total scores from 4 to 28, has shown excellent consistency in regional studies (α = 0.92) [26] and was validated locally with good internal consistency (α = 0.89, ω = 0.89) and reliable test–retest metrics (ICC = 0.78). The internal consistency for the current study sample was α = 0.91.

2.3.6. Social Support

Perceived social support was quantified using the Multidimensional Scale of Perceived Social Support (MSPSS) [27]. The 12-item scale evaluates support across three dimensions—family, friends, and significant others—on a 7-point scale, with sample items such as “My friends really try to help me.” It has previously demonstrated strong reliability among Malaysian medical students (α = 0.89) [28]. The internal consistency for the current study sample was α = 0.93.

2.3.7. Self-Esteem

Global self-worth was measured via the 10-item Rosenberg Self-Esteem Scale (SES) [29]. This instrument utilizes a 4-point Likert scale and includes five negatively worded items (e.g., “At times I think I am no good at all”) and five positively worded items to control for response bias. Total scores range from 10 to 40, where higher scores represent higher self-esteem. The SES is well-established in Malaysia, with a reported internal consistency of α = 0.80 [30]. The internal consistency for the current study sample was α = 0.85.

2.3.8. Religious Commitment

The study assessed religious involvement using the Religious Commitment Inventory-10 (RCI-10) [31], which measures intrapersonal (cognitive) and interpersonal (behavioral) commitment regardless of specific faith content. Sample items include “I often read books and magazines about my faith” (intrapersonal) and “I make financial contributions to my religious organization” (interpersonal). The 10-item scale employs a 5-point Likert scale (range 10–50) and has demonstrated excellent internal consistency within the Malaysian collegiate population (α = 0.95) [32]. The internal consistency for the current study sample was α = 0.96.

2.4. Procedures

Researchers recruited participants during lecture hours, in university common areas, or via digital platforms (Facebook, WhatsApp). Although physical recruitment occurred in shared environments, the surveys were hosted digitally on Google Forms, allowing participants to complete the questionnaire privately on their personal smartphones or laptops to prevent inadvertent disclosure of their responses to peers. This measure also helped to minimize social desirability bias. Participants first reviewed an information sheet and provided electronic informed consent before proceeding. The survey required approximately 45 min to complete. Participation was voluntary. To minimize participant distress regarding sensitive topics, the informed consent explicitly stated that participants could withdraw from the study entirely at any time without penalty. Furthermore, to ensure participant welfare, mental health resources and crisis helpline contacts were provided at the end of the session. Participants did not receive any financial incentives for participating in this study.

2.5. Data Analysis

Data were analyzed using SPSS Statistics version 29.0. Descriptive statistics (mean, SD, frequencies) summarized the sample profile. Inferential analyses included Welch’s analysis of variance tests (due to the violation of the assumption of homogeneity of variance between groups) and multiple logistic regression to compare and identify psychosocial correlates associated with sexual minority status. A post hoc power analysis indicated that our final analytical sample of 2244 participants provided >95% statistical power to detect small-to-medium effect sizes across the statistical models. While Welch’s ANOVA evaluated nuanced differences among specific sexual orientation groups, the multiple logistic regression utilized a dichotomized variable (Heterosexual vs. combined Sexual Minority). This strategy was employed to ensure adequate statistical power for the regression model. The threshold for statistical significance was set at p < 0.05 (two-tailed). There were no missing data.

2.6. Ethical Considerations

Ethical approval was granted by eight institutional review boards, including Universiti Kebangsaan Malaysia Research Ethics Committee (UKM PPI/111/8/JEP-2022-521), Ethics Committee for Research Involving Human Subjects Universiti Putra Malaysia (JKEUPM-2023-1215), Universiti Teknologi MARA Research Ethics Committee (REC/06/2023 [OT/MR/9]), Universiti Sultan Zainal Abidin Human Research Ethics Committee (UniSZA/UHREC/2023/576), International Islamic University Malaysia Research Ethics Committee (IREC 2023-124), Human Research Ethics Committee Universiti Sains Islam Malaysia (USIM/JKEP/2024-293), Human Research Ethics Committee Universiti Sains Malaysia (USM/JEPeM/PP/24070595), and Universiti Tunku Abdul Rahman Scientific and Ethical Review Committee (U-SERC/56(A)-551/2025). Electronic informed consent was obtained from all participants. All participation was voluntary, and digital informed consent was mandatory for inclusion. To safeguard against the risks of indirect identification, strict anonymity was maintained. The digital survey was configured to disable the collection of email addresses and IP tracking. No personally identifiable information, such as names, student matriculation numbers, or specific course details, was collected, and all data were stored in password-protected files accessible only to the core research team.

3. Results

This section presents the empirical findings regarding the psychosocial strengths and vulnerabilities of SM undergraduates in Malaysia. First, we outlined the demographic and mental health characteristics of the sample. Next, we provided a comparative analysis to examine psychosocial differences between heterosexual and sexual minority groups. Finally, we presented fully adjusted regression models that identify the variables significantly associated with sexual minority status.

3.1. Demographic and Mental Health Characteristics

The final analytical sample consisted of 2244 participants. The majority of the respondents identified as heterosexual (83.3%), while sexual minority groups, including bisexual (8.2%), gay (2.5%), lesbian (2.0%), and other orientations (3.9%), accounted for the remainder of the sample. Female students made up 71.5% of the participants, and the average age was 21.34 years (SD = 1.557). In terms of ethnicity and religion, the sample was primarily Malay (40.4%) and Chinese (42.8%), with Islam (43.2%) and Buddhism (33.7%) being the most reported religious affiliations. Nearly half of the participants (47.2%) reported a monthly household income of MYR4,850 or below.

Regarding mental health status, 33.7% of the students were identified as being at risk for suicide. A significant portion of the sample experienced varying levels of psychological distress; specifically, 39% reported moderate to very severe depressive symptoms, 54.9% reported moderate to very severe anxiety, and 24.6% reported moderate to very severe stress, as shown in

Table 1. Demographic and mental health characteristics of participants (N = 2244).

Variable	Frequency (%)
Sexual orientation
Heterosexual	1870 (83.3)
Bisexual	185 (8.2)
Gay	55 (2.5)
Lesbian	46 (2.0)
Others	88 (3.9)
Sex
Male	639 (28.5)
Female	1605 (71.5)
Age (Mean, SD)	21.34 (1.56)
Ethnicity
Malay	907 (40.4)
Chinese	961 (42.8)
Indian	206 (9.2)
Bumiputera Sarawak	62 (2.8)
Bumiputera Sabah	92 (4.1)
Others	16 (0.7)
Religion
Islam	970 (43.2)
Buddhism	757 (33.7)
Hinduism	160 (7.1)
Christianity	245 (10.9)
Others	112 (5.0)
Monthly household income (MYR)
RM4850 and below	1060 (47.2)
RM4851-RM10970	782 (34.8)
RM10971 and above	402 (17.9)
Attendance in religious services
Yes	1478 (65.9)
No	766 (34.1)
Suicide risk
No	1487 (66.3)
Yes	757 (33.7)
Depressive Symptoms
None	1108 (49.4)
Mild	260 (11.6)
Moderate	485 (21.6)
Severe	180 (8.0)
Very severe	211 (9.4)
Anxiety
None	837 (37.3)
Mild	175 (7.8)
Moderate	490 (21.8)
Severe	253 (11.3)
Very severe	489 (21.8)
Stress
None	1377 (61.4)
Mild	314 (14.0)
Moderate	267 (11.9)
Severe	200 (8.9)
Very severe	86 (3.8)

.

3.2. Comparison of Psychosocial Variables Across Sexual Orientations

Welch’s ANOVA was conducted to compare psychosocial variables between heterosexual students and sexual minority groups (

Table 2. Comparison of psychosocial variables across sexual orientation groups using Welch’s ANOVA.

Variable	Sexual Orientation Category Mean (SD)					F Statistics (df)	Post Hoc (Games–Howell) Significant Comparisons
	Hetero-Sexual	Lesbian	Gay	Bisexual	Others
Psychological strains
Value	11.18 (3.42)	11.43 (3.95)	11.89 (4.55)	11.65 (3.21)	12.27 (4.13)	2.51 (4, 145.81) *	No significant differences
Aspiration	14.40 (4.76)	15.24 (5.74)	15.96 (5.40)	16.15 (4.89)	16.66 (5.31)	9.60 (4, 146.09) ***	Heterosexual < bisexual, others
Deprivation	10.60 (3.56)	11.11 (4.16)	12.11 (5.17)	11.46 (3.57)	12.82 (4.33)	8.64 (4, 145.30) ***	Heterosexual < bisexual, others
Coping	13.94 (4.70)	14.13 (5.23)	14.69 (5.68)	16.16 (4.67)	15.72 (5.11)	11.41 (4, 146.35) ***	Heterosexual < bisexual, others
Depressive Symptoms	10.26 (9.64)	13.74 (11.00)	17.89 (12.38)	16.15 (11.13)	17.02 (10.97)	23.96 (4, 145.49) ***	Heterosexual < gay, bisexual, others
Anxiety	11.16 (9.31)	14.09 (9.47)	17.20 (10.62)	16.02 (10.23)	15.95 (10.03)	17.84 (4, 146.62) ***	Heterosexual < gay, bisexual, others
Stress	12.29 (9.27)	15.00 (8.70)	19.16 (10.55)	18.56 (10.01)	17.66 (10.39)	26.29 (4, 146.93) ***	Heterosexual < gay, bisexual, others
Suicidality	5.48 (3.37)	6.67 (3.69)	9.00 (4.60)	8.38 (4.13)	8.00 (4.44)	34.38 (4, 144.91) ***	Heterosexual < gay, bisexual, others Gay > lesbian
Self-esteem	27.12 (5.46)	26.72 (5.44)	25.60 (5.66)	24.74 (5.13)	23.98 (5.44)	15.37 (4, 147.84) ***	Heterosexual > bisexual, others
Purpose in life	20.21 (5.51)	18.52 (4.74)	18.76 (5.59)	17.65 (4.87)	16.30 (5.74)	20.69 (4, 148.70) ***	Heterosexual > bisexual, others
Religiosity	30.87 (11.44)	23.67 (11.40)	22.24 (11.56)	21.97 (9.65)	23.58 (11.01)	48.68 (4, 148.42) ***	Heterosexual > lesbian, gay, bisexual, others
Social Support
Family	20.32 (5.82)	16.96 (5.72)	16.42 (6.26)	16.24 (6.16)	17.20 (6.44)	29.15 (4, 147.02) ***	Heterosexual > lesbian, gay, bisexual, others
Friends	20.60 (5.37)	19.11 (5.15)	19.80 (6.15)	19.30 (5.85)	18.73 (5.90)	4.81 (4, 146.83) **	Heterosexual > lesbian, gay, bisexual, others
Significant others	20.34 (6.28)	18.80 (6.46)	15.91 (7.76)	18.79 (6.81)	17.38 (6.85)	10.10 (4, 146.32) ***	Heterosexual > bisexual, others

* p < 0.05, ** p < 0.01, *** p < 0.001.

). Significant differences were observed across nearly all measured variables, including psychological strains, mental health indicators, and support systems. Post hoc analyses revealed that heterosexual students generally reported lower levels of aspiration, deprivation, and coping strains compared to bisexual students and those in the “others” category. Additionally, heterosexual students had significantly lower scores for depressive symptoms, anxiety, stress, and suicidality than gay, bisexual, and other sexual minority participants. For suicidality specifically, gay students reported higher levels than lesbian students.

Conversely, heterosexual students reported higher levels of self-esteem, purpose in life, and religiosity compared to most sexual minority groups. Social support also differed significantly; heterosexual students perceived higher levels of support from family and friends than all other groups, and higher support from significant others compared to bisexual and other sexual orientation students.

3.3. Psychosocial Correlates Associated with Sexual Minority Status

A logistic regression model was used to calculate adjusted odds ratios (aOR) of variables associated with sexual minority status, controlling for sex, age, ethnicity, and monthly household income (

Table 3. Adjusted odds ratios of psychosocial characteristics associated with sexual minority status, controlling for demographic variables (Model 1) †.

Variable	aOR ‡	95% CI		p-Value
		LL	UL
Psychological strains
Deprivation	1.043	1.003	1.084	0.034
Coping	0.967	0.934	1.002	0.065
Depressive symptoms	1.025	1.007	1.044	0.007
Suicidality	1.117	1.073	1.163	<0.001
Self-esteem	1.020	0.991	1.050	0.183
Purpose in life	0.996	0.967	1.025	0.778
Religiosity	0.961	0.948	0.974	<0.001
Social Support
Family	0.943	0.919	0.968	<0.001
Friends	1.024	0.995	1.053	0.109
Significant others	1.005	0.981	1.029	0.706

† Demographic variables = sex, age, ethnicity and monthly household income. Chi² (17) = 346.93, p < 0.001, Nagelkerke’s R² = 0.241. Hosmer and Lemeshow test was non-significant (p = 0.080), and the model correctly classified 83.9% of the cases. ‡ Aspiration strain, anxiety and stress were excluded from the model due to multicollinearity with coping strain and depressive symptoms. aOR = adjusted odds ratio. CI = confidence intervals. LL = lower limit. UL = upper limit.

). Despite being significantly associated with SM status in the bivariate analyses, aspiration strain, anxiety, and stress were excluded from the primary model (Model 1) due to multicollinearity with coping strain and depressive symptoms. Specifically, the correlation coefficient between aspiration strain and coping strain was r = 0.703. Depressive symptoms correlated strongly with anxiety (r = 0.787) and stress (r = 0.838), and the correlation between stress and anxiety was also strong (r = 0.851). To further examine the association of these variables with SM status, additional analyses were conducted in Model 2 and Model 3 (Tables S1 and S2).

The primary model (Model 1) was significant, Chi² (17) = 346.93, p < 0.001, with the predictors accounting for 24.1% of the variance. Hosmer and Lemeshow tests were non-significant, indicating good model fit, and the model correctly classified 83.9% of the cases. Several variables remained significantly associated with identifying as a sexual minority after these adjustments. Sexual minorities reported significantly higher levels of deprivation strain (aOR: 1.043, 95%CI [1.003, 1.084], p = 0.034), depressive symptoms (aOR: 1.025, 95%CI [1.007, 1.044), p = 0.007), and suicidality (aOR: 1.117, 95%CI [1.073, 1.163], p < 0.001).

In contrast, sexual minority status was associated with lower religiosity (aOR: 0.961, 95%CI [0.948, 0.974], p < 0.001) and lower perceived family support (aOR: 0.943, 95%CI [0.919, 0.968], p < 0.001). Variables such as self-esteem, purpose in life, and support from friends or significant others did not show a statistically significant association in this fully adjusted model. Despite being significant in the bivariate analyses, aspiration strain, anxiety, and stress were excluded from this model due to multicollinearity with other variables. In the separate models (Model 2 and Model 3) that were generated (refer to Supplementary Tables S1 and S2), aspiration strain was found to have a non-significant association with sexual minority status, while anxiety (aOR: 1.024, 95%CI [1.008, 1.040], p = 0.003) and stress (aOR: 1.037, 95%CI [1.020, 1.055], p < 0.001) were significantly associated.

4. Discussion

This study aimed to investigate psychosocial correlates of identifying as a sexual minority among Malaysian undergraduates, including negative aspects such as psychological strain, psychological distress, suicidality, and positive aspects such as purpose in life, social support, self-esteem and religious commitment. Synthesizing the results, our data revealed consistent psychosocial disparities: sexual minorities demonstrated significantly higher levels across all measured indices of psychological distress (suicidality, depressive symptoms, anxiety, stress, alongside aspiration, deprivation, and coping strains) while simultaneously reporting significantly lower access to protective correlates such as family support and religious commitment.

Sexual minorities in this study reported lower religious commitment, an association that may align with the prohibitive stance that most major religions have on non-heterosexual orientations [33]. Previous qualitative and quantitative studies conducted specifically within Malaysia have indicated that internal tension exists for sexual minorities as they seek to reconcile their religious beliefs with their sexual identities in a highly conservative society [33,34]. Religious beliefs may be linked to greater stigmatization, internalized shame, and internalized homonegativity [35]. Among SM individuals, cross-cultural research comparing Australian and Malaysian gay individuals has shown that higher levels of internalized shame are associated with weaker engagement in religious practices, suggesting that those experiencing such shame may distance themselves from religion [35]. The same may be true for the participants of this study.

It was interesting to note that family support was perceived to be lower for sexual minorities, a finding that mirrors the conservative stance on sexual orientation among Malaysian family systems. For example, Malaysian Hindus reported feeling the weight of their family’s expectations to fulfill their roles and obligations of getting married to the opposite sex and starting a family [36], while another Malaysian study showed that bisexual individuals may conceal their sexual identity to achieve family harmony [37]. A study further reported that experiencing family denial of one’s coming out was common among sexual minority individuals [38]. In a context where familial ties are deemed to be important and central to a person’s social identity, lower familial support may be associated with poorer mental health [39].

The results of the study showing that suicidality was higher in sexual minorities are consistent with existing studies in the literature (e.g., [4]). This aligns with the concurrent finding that sexual minorities also reported higher odds of depressive symptoms, anxiety, and stress, which are well-established correlates of suicidal ideation and behaviors within frameworks such as the interpersonal–psychological theory of suicide [40] and the Strains Theory of Suicide [14]. The fully adjusted logistic regression models in this study confirmed this vulnerability, demonstrating that identifying as a sexual minority remained significantly associated with elevated depressive symptoms, anxiety, and stress even when controlling for demographic variables. This compounded psychological distress may be contextualized within the Malaysian sociocultural landscape, in which 61% of Malaysians view same-sex desire as morally wrong [6] and secular and Sharia laws criminalize homosexual behaviors.

Furthermore, the associations found in our data align with hypothesized psychological indicators linked to this distress, particularly through the lens of Zhang’s [14] psychological strains. Our findings consistently demonstrated that sexual minorities reported higher levels of aspiration, deprivation, and coping strains. Notably, deprivation strain remained significantly associated with SM status in the fully adjusted model. This indicates that SM students report higher levels of perceived deprivation regarding their life goals and expectations compared to their heterosexual peers, reflecting the dimensions captured by the deprivation strain subscale.

Interestingly, while the initial bivariate analyses indicated that heterosexual students reported higher levels of self-esteem, purpose in life, and perceived support from friends and significant others compared to most sexual minority groups, these associations did not remain statistically significant in the fully adjusted logistic regression model. The loss of significance for self-esteem and purpose in life in the fully adjusted model indicates that these variables do not contribute significant unique variance beyond what is already captured by the demographic and distress covariates. Because these positive psychosocial constructs likely share statistical variance with robust indicators of psychological distress and strain, their independent predictive value diminishes when analyzed concurrently in the multivariate context.

The study findings must be interpreted in light of several limitations. First, the cross-sectional design of this study precludes any causal inferences. The associations found between psychosocial indicators and sexual minority status may reflect shared underlying stress processes or bidirectional relationships rather than direct causality. Related to the first limitation, a conceptual limitation of the present study is that sexual minority status was specified as the outcome variable in the statistical model, whereas suicidality is more commonly conceptualized as the outcome in association with psychosocial stressors. Although this modeling approach enabled the examination of psychosocial variables associated with sexual minority identity within the available dataset, it may create interpretive ambiguity regarding the direction and nature of these relationships. Second, although participants were recruited from all Malaysian states, the reliance on convenience sampling means the sample is not fully nationally representative. Therefore, findings should be interpreted with caution, as they cannot be fully generalized to the entire Malaysian undergraduate population. Furthermore, due to the 5:1 matched sampling strategy utilized to optimize statistical power, the absolute prevalence rates of distress indicators within the pooled sample cannot be used to infer general population prevalence, though the associations and between-group comparisons remain methodologically sound. Moreover, the sensitive nature of assessing sexuality, religiosity, and suicidality within a socially restrictive environment introduces the potential for self-selection and social desirability biases. In such a context, individuals may be hesitant to participate or might underreport psychological distress, suicidality, or their true sexual orientation due to internalized stigma or fear of disclosure. Next, the ‘others’ sexual orientation category represents a highly heterogeneous group (e.g., encompassing pansexual, asexual, and queer individuals). Analytically aggregating these distinct identities into a single group obscures the internal variance and unique psychosocial realities experienced by each specific subgroup. Finally, the sample sizes for specific sexual minority subgroups within the data, such as gay (2.5%) and lesbian (2.0%) participants, were relatively small. Consequently, our logistic regression models utilized a dichotomized sexual minority variable. While this maximized statistical power to detect broad disparities, it inherently obscures the nuance and unique psychosocial realities experienced by distinct subgroups within the SM spectrum.

Building on these limitations and findings, future research should employ longitudinal designs to better establish the temporal relationships between minority stress, psychological strain, and mental health variables among Malaysian youth. Additionally, qualitative studies would be invaluable for exploring the lived experiences of SM students in this region, particularly to understand how they navigate the loss of family support. As religiosity is an important aspect of Malaysian society, research on how religious groups approach the psychosocial issues faced by sexual minorities within their fold is relevant. Ultimately, the psychological distress and elevated suicidality observed in this study underscore the urgent need for inclusive, culturally sensitive mental health interventions, safe spaces, and targeted campus support systems to protect the well-being of sexual minority students in Malaysian higher education institutions.

5. Conclusions

This study underscores the mental health disparities experienced by sexual minority undergraduates in Malaysia. Our findings revealed consistent associations within the analyzed sample, indicating that sexual minority students experienced significantly higher levels of psychological distress, notably depressive symptoms, anxiety, stress, and suicidality, alongside elevated coping and deprivation strain when compared to their heterosexual peers. Concurrently, they report significantly lower levels of perceived family support and religious commitment, which are traditionally recognized as critical protective indicators in Malaysian culture. Certain positive indicators, such as self-esteem and purpose in life, did not remain statistically significant after adjusting for demographic and distress covariates. Given the cross-sectional design and the use of convenience sampling, future longitudinal research is necessary to better understand these dynamics over time. Ultimately, these observed associations highlight the need to establish culturally sensitive mental health interventions and targeted support systems on university campuses to better support sexual minority undergraduates navigating these psychological strains in Malaysia.