Sexual minority adults exhibit greater inflammation than heterosexual adults in the context of depressive symptoms and anxiety: Pathways to health disparities

Lisa M Christian; Rebecca R Andridge; Juan Peng; Nithya P Kasibhatla; Thomas W McDade; Tessa Blevins; Steve W Cole; Wendy D Manning; Claire M Kamp Dush

doi:10.1016/j.bbi.2025.106202

Sexual minority adults exhibit greater inflammation than heterosexual adults in the context of depressive symptoms and anxiety: Pathways to health disparities

Brain Behav Immun. 2026 Mar:133:106202. doi: 10.1016/j.bbi.2025.106202. Epub 2025 Nov 30.

Authors

Lisa M Christian¹, Rebecca R Andridge², Juan Peng³, Nithya P Kasibhatla⁴, Thomas W McDade⁵, Tessa Blevins⁶, Steve W Cole⁷, Wendy D Manning⁸, Claire M Kamp Dush⁹

Affiliations

¹ Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute of Brain, Behavior, and Immunology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: Lisa.Christian@osumc.edu.
² Division of Biostatistics, College of Public Health, USA College of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
³ Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA.
⁴ The Institute of Brain, Behavior, and Immunology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁵ Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA.
⁶ The Institute of Brain, Behavior, and Immunology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Psychology, The Ohio State University, Columbus, OH, USA.
⁷ Department of Psychiatry & Biobehavioral Sciences and Medicine, UCLA School of Medicine, Los Angeles, CA, USA; Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Sociology, Bowling Green State University, Bowling Green, OH, USA.
⁹ Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA; Department of Sociology, University of Minnesota, Minneapolis, MN, USA.

PMID: 41330456
DOI: 10.1016/j.bbi.2025.106202

Abstract

Background: Sexual minority individuals, including lesbian, gay, bisexual, and other non-heterosexual (LGB + ) adults have significantly greater risk for mental and physical health conditions, disparities linked with minority stress exposure.

Methods: Utilizing a Biopsychosocial Minority Stress Framework, this study examined depressive symptoms, anxiety, and inflammatory markers [interleukin(IL)-6 and C-reactive protein (CRP)] in a diverse sample of 661 adults (388 heterosexual; 273 LGB + ).

Results: LGB + adults reported greater anxiety and depressive symptoms (ps < 0.01). This effect was partially mediated by greater exposure to adverse childhood experiences (ACES) among LGB + respondents. Compared to heterosexual adults, controlling for key potential confounds, LGB + adults exhibited greater elevations in CRP in relation to depressive symptoms (B_SM = 0.029, SE = 0.013 vs. B_HETERO = -0.0050, SE = 0.012; interaction p = 0.042). A similar pattern was observed in relation to IL-6, however the interaction effect was not statistically significant (p = 0.015). LGB + adults also showed greater increases in CRP in the context of anxiety (B_SM = 0.033, SE = 0.016 vs B_HETERO = -0.012, SE = 0.014; interaction p = 0.028). These effects were not accounted for by differences in body mass index (BMI) or tobacco use.

Conclusions: LGB + adults may experience greater inflammatory burden due to both 1) greater prevalence of anxiety and depression, and 2) sensitization to negative inflammatory sequalae in the context of anxiety and depression. Greater ACES contributed to the greater prevalence of anxiety and depressive symptoms among LGB + as compared to heterosexual participants. Ultimately, differential prevalence of, and physiological responses, to anxiety and depressive symptoms may contribute to physical and mental health disparities among sexual minority adults.

Keywords: Anxiety; Bisexual; Depression; Depressive symptoms; Gay; Heterosexual; Inflammation; LGBTQ+; Lesbian; Psychological well-being; Sexual minority; Sexually diverse; Stress.

MeSH terms

Adult
Adverse Childhood Experiences
Anxiety* / metabolism
Anxiety* / psychology
C-Reactive Protein / analysis
C-Reactive Protein / metabolism
Depression* / metabolism
Depression* / psychology
Female
Health Status Disparities*
Heterosexuality* / psychology
Humans
Inflammation* / metabolism
Inflammation* / psychology
Interleukin-6 / blood
Male
Middle Aged
Sexual and Gender Minorities* / psychology
Young Adult

Substances

C-Reactive Protein
Interleukin-6

Grants and funding

R21 MD018158/MD/NIMHD NIH HHS/United States