High burden of depressive symptoms among sexual and gender diverse persons in Brazil: The role of discrimination, internalized homonegativity, and race
- 1Laboratório de Pesquisa Clínica em IST, hepatites e AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
Abstract
Sexual and gender diverse (SGD) populations have historically faced restricted rights and systematic discrimination for deviating from the established hetero-cis-normative norms. This long-standing marginalization has a profound negative impact on health outcomes, including a heightened risk of developing mental health issues, such as depression. Understanding the health-disease process among SGD populations requires recognizing that discriminatory experiences, such as homophobia and transphobia, are not unidimensional, but operate synergistically with layered forms of discrimination, such as racism. We assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) among SGD persons in Brazil using race as a stratification variable. We also evaluated the role of discrimination and internalized homonegativity on depressive symptoms, while adjusting for covariates. This was a cross-sectional online survey recruiting SGD persons aged 18 years or older, living in Brazil, through dating apps and social media. Overall, 6220 participants were included, 3749 (60.3%) White, 1685 (27.1%) Pardo and 786 (12.6%) Black. Mean scores of depressive symptoms was 8.8 (SD7.1), higher among Black (9.6; SD 7.5) and Pardo (9.3; SD 7.2) than White (8.4; SD7.0) (p < 0.0001). Considering a PHQ-9 cut-off of ≥10 points, more Black and Pardo participants reported depressive symptoms than White participants (38.5%, 38.1%; 32.3%, respectively). In multivariable linear regression models, higher discrimination score and younger age were associated with higher scores of depressive symptoms for all races. Additionally, internalized homonegativity and lower income were associated with higher depressive symptoms scores for Pardo and White, but not for Black participants. To effectively address vulnerability to depression among SGD populations, it is essential to establish approaches that consider the intersections between different forms of oppression. This includes policies that tackle racism, homophobia, and transphobia, as well as investment in accessible mental health services.
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BibTeX
@article{guimaraes2026high,
title = {{High burden of depressive symptoms among sexual and gender diverse persons in Brazil: The role of discrimination, internalized homonegativity, and race}},
author = {Caroline Guimarães and Paula Mendes Luz and Carolina Coutinho and Emilia M. Jalil and Cristina M. Jalil and Beatriz Grinsztejn and Valdilea Gonçalves Veloso and Lucilene Araújo Freitas and Thiago Silva Torres},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0007276},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007276},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - High burden of depressive symptoms among sexual and gender diverse persons in Brazil: The role of discrimination, internalized homonegativity, and race
AU - Caroline Guimarães
AU - Paula Mendes Luz
AU - Carolina Coutinho
AU - Emilia M. Jalil
AU - Cristina M. Jalil
AU - Beatriz Grinsztejn
AU - Valdilea Gonçalves Veloso
AU - Lucilene Araújo Freitas
AU - Thiago Silva Torres
PY - 2026
DA - 2026/09/28
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007276
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007276
AB - Sexual and gender diverse (SGD) populations have historically faced restricted rights and systematic discrimination for deviating from the established hetero-cis-normative norms. This long-standing marginalization has a profound negative impact on health outcomes, including a heightened risk of developing mental health issues, such as depression. Understanding the health-disease process among SGD populations requires recognizing that discriminatory experiences, such as homophobia and transphobia, are not unidimensional, but operate synergistically with layered forms of discrimination, such as racism. We assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) among SGD persons in Brazil using race as a stratification variable. We also evaluated the role of discrimination and internalized homonegativity on depressive symptoms, while adjusting for covariates. This was a cross-sectional online survey recruiting SGD persons aged 18 years or older, living in Brazil, through dating apps and social media. Overall, 6220 participants were included, 3749 (60.3%) White, 1685 (27.1%) Pardo and 786 (12.6%) Black. Mean scores of depressive symptoms was 8.8 (SD7.1), higher among Black (9.6; SD 7.5) and Pardo (9.3; SD 7.2) than White (8.4; SD7.0) (p < 0.0001). Considering a PHQ-9 cut-off of ≥10 points, more Black and Pardo participants reported depressive symptoms than White participants (38.5%, 38.1%; 32.3%, respectively). In multivariable linear regression models, higher discrimination score and younger age were associated with higher scores of depressive symptoms for all races. Additionally, internalized homonegativity and lower income were associated with higher depressive symptoms scores for Pardo and White, but not for Black participants. To effectively address vulnerability to depression among SGD populations, it is essential to establish approaches that consider the intersections between different forms of oppression. This includes policies that tackle racism, homophobia, and transphobia, as well as investment in accessible mental health services.
SN - 2767-3375
ER -