1. A mixed methods approach to
exploring the relationships
between sexual orientation and
mental well-being in an Irish
context.
Nicole Owens
Department of Sociology,
School of Social Sciences and Philosophy
Supervisor: Professor Richard Layte
April 2015

2. Acknowledgements
Thank you to my supervisor, Professor Richard Layte, for the time and effort
he put into this dissertation. The feedback he gave on each section as it
unfolded was invaluable.
Also a huge thank you to my parents for their endless proof-reading and not
always well-received corrections.
ii

3. Declaration
I hereby declare that this is entirely my own work and that it has not been
submitted as an exercise for the award of a degree at this or any other
University. I agree that the Library may lend or copy this dissertation upon
request.
Signature: Date:
iii

4. Abstract
Gay people in Ireland are seven times more likely to attempt suicide than
heterosexuals, according to new research by the Royal College of Surgeons
in Ireland (Cannon et al., 2013). The aim of this study was to gain a deeper
understanding of the risk factors influencing the relationship between sexual
orientation and mental well-being, with a specific emphasis on underlying
factors such as depression, alcohol abuse and unemployment. My findings
were framed under two conceptual approaches; the Minority Stress model
expanded by Meyer (2003) and Durkheim's Social Integration Theory
(1897). A mixed methods sequential explanatory design was used,
consisting of two stages; secondary quantitative data analysis of a
nationally representative survey, followed by qualitative data collection and
analysis. The data collection method used was semi-structured interviews,
carried out with 5 participants identifying as homosexual, who were
purposively sampled. The initial findings demonstrated that there are a
combination of factors affecting the relationship between sexual orientation
and mental well-being and that these are mediated by an overwhelmingly
heteronormative society. This research suggests that political and cultural
marginalisation leads to stigma and discrimination towards non-
heterosexual people in Ireland, which results in a negative mental state,
furthering a sense of isolation and alienation and resulting in alcohol abuse
and increased mental problems, such as the risk of suicide.
iv

5. Table of Contents
Chapter 1: Introduction 1
Problem Statement 1
Research Questions 1
Overview of methodology 2
Rationale/Significance 3
Role of the researcher 3
Organisation of dissertation 4
Chapter 2: Literature Review and Theoretical Framework 5
Social Integration Theory 6
Minority Stress Model 7
Unemployment and Mental well-being 8
Substance abuse and Mental well-being 9
Sexuality and Mental well-being 10
Gender as a factor 10
Methodological Limitations 11
Chapter 3: Methodology 13
Mixed Methods 13
Explanatory design 14
Challenges 14
Quantitative Stage 15
Irish Study of Sexual Health and Relationships (ISSHR) 15
Secondary Analysis 15
Variables 17
Dependent variable 18
Independent variables 18
Qualitative Stage 20
Sampling 20
Semi-structured interviews 20
Data Analysis 21
Methodological Limitations 22
v

6. Chapter 4: Findings 23
Quantitative Section introduction 23
Confounding factors 23
Qualitative Section introduction 23
Coding and Analysis 24
Reminder of Research Questions 24
Question 1: Mental well-being and sexual orientation 25
Question 2 29
Part 1: Mental well-being and alcohol 29
Part 2: Mental Well-being and unemployment 31
Part 3: Unemployment and alcohol 32
Question 2 as a whole 33
Question 3 34
The existence of a heteronormative society 34
Inclusion and exclusion 36
Stereotypes and biases 37
Alienation and Isolation 37
Summary 38
Chapter 5: Discussion/Conclusion 40
Minority Stress Model 41
Social Integration Theory 42
Significance of the study 43
Limitations 44
Avenues for further research 44
Conclusion 46
Bibliography 47
Appendices 52
Appendix A: ISSHR Questionnaire 52
1. Sexual identification
2. Sexual Attraction
3. Employment Status
4. Mental Well-being
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7. 5. Regularity of alcohol consumption
6. Level of alcohol consumption
Appendix B: Interview Guide 55
Appendix C: Qualitative coding scheme 56
Appendix D: Componential analysis 57
vii

8. Chapter 1
Introduction
Problem Statement
A recent psychiatric study conducted by the Royal College of Surgeons in
Ireland found that having a same sex orientation increased young people’s
risk of mental illness by 4 times that of heterosexual young people and
bisexual or homosexual young adults were over 7 times more likely to have
experienced suicidal ideation or engaged in suicidal acts than their
heterosexual peers (Cannon et al., 2013). The study Supporting LGBT Lives
(Mayock et al, 2009) linked society’s negative treatment of Lesbian, Gay,
Bisexual and Transgender (LGBT) people with an increased risk of poor
mental health, self-harm and risk of suicidal thoughts and behaviours. 18%
had attempted suicide and 85% of these saw their first attempt as related
in some way to their LGBT identity. There is a lack of research on LGBT
people in Ireland and the structural and social mechanisms and factors
which increase their incidence of depression and, as a result, their
engagement in risk behaviours such as substance abuse and suicide.
The purpose of this sequential explanatory mixed methods study is to
explore the mechanisms linking people with same sex attraction or
behaviour with an increased propensity to experience depression and a
higher risk of suicide, firstly by carrying out statistical secondary data
analysis on a nationally representative study and following up with a
number of purposefully sampled interviews to explore these results in more
depth.
Research Questions
The questions that shaped my research are;
Q1 Is there a relationship between sexual orientation and mental illness
in Ireland?
Q2 How do underlying factors such as alcohol abuse and
unemployment mediate the relationship between sexual orientation
1

9. and mental well-being?
Q3 What is the effect of a heteronormative society on the mental well-
being of young gay people in Ireland?
The first question, Q1, was answered within the quantitative phrase with
statistical analysis to determine correlation. Q2 was answered using a
combination of qualitative variable analysis and thematic coding on
qualitative data collected during interviews. Q3 was explored through data
analysis of the interviews.
Overview of Methodology
An explanatory mixed methods sequential design was used, involving the
analysis of quantitative data first, and then the extrapolation of the findings
with in-depth qualitative analysis aimed at exploring the intricate social
mechanisms which mediate the relationship between sexuality and mental
illness.
The quantitative phase of the study consisted of data analysis of an existing
dataset, from the Irish Study of Sexual Health and Relationships (2006).
This statistical analysis was conducted using the Statistical Package for
Social Sciences software (SPSS) and focused on the various risk factors
which influence the relationship between minority sexuality and mental
illness. This allowed me to calculate the strength of the relationships
between all the factors involved and determine whether there was any
correlation between them. Quantitative methods allowed me to explore the
relationships between the factors statistically by demonstrating the strength
of different relationships in comparison to others. Quantitative studies are
inadequate to describe and explain the experiences of gay people in Ireland
as little is known about the mechanisms behind the trends, so qualitative
methods allowed me to further map the complexity of these relationships
and to get a sense of the human voices, attitudes, perceptions and feelings
behind the numbers/quantitative data.
The subsequent qualitative phase consisted of in-depth lightly structured
2

10. interviews with participants I identified through purposive sampling
methods. I feel that a qualitative element strongly added to this research
project as qualitative research strategies emphasise human voices e.g.
attitudes, emotions and individual perspectives, rather than simply focusing
on quantification in the collection and analysis of data. This enabled me to
achieve an in-depth understanding of the experiences of homosexual/LGBT
people in Ireland. As this study involves identities and the reaction of
society as a whole to said identities, I believe that it added considerable
merit to my research to have a qualitative element which brought the
quantitative data alive, in a sense. It provided a human voice to the
statistics and allowed me to assess the Minority Stress Model in depth,
including the experience of prejudice events, expectations of rejection,
hiding and concealing, internalized homophobia, and coping processes
unique to LGBT people in Ireland.
Rationale/Significance
This research benefits both LGBT people living in Ireland, aiding their
understanding of the societal causes of their mental health problems, and
the government or policy makers by allowing them to grasp a deeper
understanding of the structural and societal factors which perpetuate and
re-perpetuate minority stress and mental illness.
Role of the researcher
The role of the researcher evolved throughout the study, from a data
analyst confined to SPSS in the initial phase to a more active, participatory
role in the second phase. This more participatory role was as a result of
interacting directly with participants but was also due to a personal
involvement with the research topic. This introduces the possibility for
subjective interpretation of phenomena studied and also a potential for bias
(Locke, Spirduso and Silverman, 2000). However the researcher ensured
personal bias did not influence either phase of the study by following
extensive verification procedures.
3

11. Organisation of the dissertation
The introduction, Chapter 1, has presented the problem to be studied,
identified the research questions guiding the study and given an overview of
the research project as a whole.
In Chapter 2, I will review the literature currently addressing the topic of
sexuality and mental health and discuss the theoretical ideas which shaped
the structure of my research project, namely the theory of minority stress
which proposes that stigma, prejudice and discrimination constitute unique,
chronic, psychosocial stressors that can lead to negative health outcomes. I
will identify the place I feel my research can fill in what is undoubtedly an
already crowded area of research.
In Chapter 3, I will discuss the research design of the study; a mixed
methods explanatory design which combines both quantitative and
qualitative research methods. There are challenges involved in employing
such a design, such as a strain on time resources, which I will discuss fully
in this chapter. I will also discuss my purposive sampling procedures for the
qualitative data collection.
In Chapter 4, I will introduce my findings; the results of my quantitative
data analysis and the thematic analysis of the qualitative phase of this
research project. I will then colligate these findings with the theoretical
aspects and literature outlined in chapter 2.
In Chapter 5, I will evaluate the main findings and outline the results of the
study; particularly highlighting areas that require further research and those
which hold significance for theory and future policy making.
4

12. Chapter 2
Literature Review
This research sets out to explore the mechanisms linking people with same
sex attraction or behaviour with an increased likelihood of experiencing low
levels of mental well-being and a higher risk of suicide. There is a lack of
research on LGBT people in Ireland and the structural and social
mechanisms/factors which increase their likelihood of low mental well-being
and depression and, as a result, their engagement in risk behaviours such
as substance abuse and suicide. It will encompass Durkheim’s idea that
there are certain people who are more predisposed to attempt to commit
suicide, i.e. those who are unemployed, as well as studying the relationship
between sexuality and risk factors such as depression and alcohol abuse
previously empirically linked to suicidality.
Supporting LGBT Lives: A Study of the Mental Health and Well-being of
Lesbian, Gay, Bisexual and Transgender People (Mayock et al, 2009) is the
most comprehensive and recent study carried out in Ireland to date,
focusing especially on LGBT people and their life experiences. It
concentrates mostly on younger people and the structural and social factors
which influence the minority stress experiences of LGBT people in Ireland.
Over 1,100 lesbian, gay, bisexual and transgender (LGBT) people
participated in an on-line survey and 40 of these took part in in-depth
interviews. The report links society’s negative treatment of LGBT people
with an increased risk of poor mental health, self-harm and risk of suicidal
thoughts and behaviours. 18% had attempted suicide and 85% of these
saw their first attempt as related in some way to their LGBT identity. Further
research has demonstrated high levels of suicidality among LGBT people,
with reports that one in five LGBT people have attempted suicide at some
point (Heffernan, 2007).
One of the key findings of the report was that minority stress exposes a
significant percentage of LGBT people to suicidality and, following on from
that, that mental health resilience was linked to developing a positive LGBT
identity, good self-esteem and positive coping strategies. Durkheim’s social
5

13. integration theory, which I will discuss in the following section, highlights a
lack of self-esteem as a key factor in low mental well-being and suicidal
thoughts and acts.
Theoretical framework: Social Integration Theory
This social integration theory is key to highlighting the social and structural
factors which influence suicidal thoughts and behaviour. Durkheim (1897)
defines suicide as ‘all cases of death resulting directly or indirectly from a
positive or negative act of the victim himself, which he knows will produce
this result’. By studying the suicide statistics from several countries he
identified patterns and links within certain groups and demographics in
society which were more vulnerable to the risk of suicide. He developed his
social integration theory based on this data – he theorised that the degree
to which a person feels integrated in society and their social surroundings
are integral social factors which result in suicide and argued that suicide
rates are affected by the different social contexts in which they emerge.
He identified three groups which aid social integration; the religious group,
the family group and the political or national group of which the person is a
member. These groups fulfil several purposes in a person’s life and mental
health; they create ties of obligation and links of dependency, lessen the
ability of a person to withdraw into themselves, impose social duties and
obligations, give individuals a sense of self-purpose and reduce excessive
self-reflection. Crucially these three integral groups are the very ones which
LGBT people often find themselves alienated from. Without these ties of
obligation and sense of purpose a person can become disconnected from
society.
Durkheim introduces the idea of anomie, “a state of societal normlessness
resulting from rapid social change that produces loss of social control and
disconfirmation of expected social contingencies”. Through research into the
lives of LGBT worldwide it has become evident that LGBT people are
marginalised/pushed to the outskirts of society (Meyer, 2003), they have
less of these social ties and are ostracised from the political sphere (Pearlin,
1982) e.g. due to the absence of equal legislation in Ireland (failure to
6

14. legalise gay marriage). If we employ Meyer’s minority stress model we can
see that LGBT people do not feel integrated in society due to a hostile social
environment and isolation from family and political groups and, as a result,
experience anomie which results in increased rates of depression, alcohol
abuse and the eventual risk of suicide.
Theoretical framework: Minority Stress Model
One theoretical/conceptual framework that has been used to understand the
impact of societal attitudes and stigma on LGBT persons is the minority
stress model which proposes that stigma, prejudice and discrimination
constitute unique, chronic, psychosocial stressors that can lead to negative
health outcomes (Meyer, 2003). In one study, gay men who experienced
high levels of minority stress were two to three times more likely to
experience high levels of psychological distress (Meyer, 1995). Among LGBT
youth, research indicates that stigma-related harassment, discrimination
and victimization are associated with increased mental health symptoms
and suicidality (e.g., Huebner, Rebchook & Kegeles, 2004).
Although LGBT identities are becoming more visible in Ireland, they remain
stigmatized and must develop within a heteronormative environment, one
which dictates heterosexuality and clearly defined and static gender
boundaries. Kelleher (2009) found that there was an association between
the minority stress experienced by the LGBT people studied and
psychological stress, the former influencing the latter. The oppressive social
environment results in an internalised sexual-identity crisis which negatively
impacts on the well-being of LGBT youth in Ireland. Homosexuality itself
was only decriminalised in Ireland in 1993, which highlights the self-identity
issues that LGBT people had in the years prior to that.
Evidence suggests that, compared with their heterosexual counterparts, gay
men and lesbians suffer from more mental health problems including
substance abuse, depression and suicide (Cochran, 2001; Gilman et al.,
2001; Herrell et al., 1999). An explanation for the higher prevalence of
mental disorders and risk of suicide among LGBT people is that stigma,
prejudice and discrimination create a stressful social environment that can
7

15. lead to mental health problems in people who belong to stigmatized
minority groups (Friedman, 1999) [Meyer’s concept of minority stress].
Pearlin (1982) sees society itself as a stressor for minority groups as
dominant culture, social structures and norms do not typically reflect those
of the minority group. This leads to social conflict, an example of such being
the lack of social institutions in Ireland akin to heterosexual marriage which
offer legally sanctioned family life to LGBT people.
Eisenberg and Rosnick (2006) found that sexual orientation alone accounts
for only a small portion of variability in suicidality among LGBT youth. This
suggests that it is necessary for researchers to take other risk factors into
account when exploring mechanisms linking people who identify as LGBT
with an increased likelihood to experience depression and a higher risk of
suicide. The risk factors which I will focus on are; Unemployment,
Substance abuse (particularly alcohol abuse) and Mental well-being (as an
indication of depression).
Unemployment and Mental Well-being
Unemployment may contribute to a state of anomie as loss of employment
can lead to the disruption of social roles and relationships. The literature
studied reinforces a link between low levels of mental well-being, suicide
and unemployment. Watkins (1992) details how unemployment causes
stress by “disturbing such important psychological elements as personal
identity, time structuring and sense of self-esteem”. A lack of self-esteem is
a key factor in the level of socialization of young people and in Durkheim’s
theory of suicide he identified the less sociable people as more prone to
suicide. As previously attributed to Mayock et al. (2009), mental health
resilience is linked to good self-esteem.
Platt (2004) establishes that suicide is more frequent among those who are
unemployed, implying that there is a link between unemployment and
suicide. Blakely et al. (2003) affirm that this link is likely to be causal based
on the level of unemployment-suicide association they showed in their
paper. They found that being unemployed was associated with a
twofold/threefold increase in the relative risk of death by suicide compared
8

16. with being employed, although sensitivity analyses found that about half of
this association might be attributable to mental illness. They proposed two
explanations for the unemployment-suicide link; that unemployment
increases vulnerability which in turn increases the impact of stressful life
events or that unemployment increases the risk of factors that precipitate
suicide, for example mental illness or financial difficulties. The latter
explanation is reinforced by longitudinal studies which found that
unemployment predates symptoms of depression and anxiety (Montgomery
et al., 1999). There is a clear relationship here between unemployment,
depression and suicide; with an unemployment-suicide association and
unemployment empirically proven to lead to low mental well-being and
depression.
LGBT people are also discriminated against in the workplace and as a result
engage in identity disclosure and concealment strategies that address fear
of discrimination on one hand and a need for self-integrity on the other.
Waldo (1999) demonstrated a relationship between employers’
organizational climate and the experience of heterosexism in the workplace,
which was subsequently related to adverse psychological, health, and job-
related outcomes in LGBT employees. Badget’s (1995) analysis of national
data showed that gay and bisexual male workers earned from 11% to 27%
less than heterosexual male workers with the same experience, education,
occupation, marital status, and region of residence.
Substance Abuse and Mental Well-being
According to a report published by the National Registry of Self-Harm,
alcohol was a factor in 37% of all cases of self-harm presenting to hospitals
in 2013 (Griffen et. al., 2014). King et al. (2008) found that alcohol and
substance misuse was at least 1.5 times more common in LGBT people and
Drabble et al. (2005) suggest that alcohol dependence differs according to
sexual orientation, especially between heterosexual and homosexual
women. However Bloomfield’s (1993) study found no statistical differences
in alcohol consumption and drinking patterns between lesbians and
heterosexual women and this was echoed in a study of homosexual and
heterosexual men in San Francisco (Stall and Wiley, 1988). The association
9

17. between sexual orientation and alcohol abuse is a particular factor which I
will be concentrating on in this study.
Sexuality and Mental Well-being
Cochran et al. (2001) and Fergusson et al. (1999) found that homosexual
orientation is associated with a general elevation of risk for anxiety, mood
and substance abuse disorders and suicidal ideation. Herrell et al.’s (1999)
‘twin’ study found that, on average, male homosexuals were 5.1 times more
likely to exhibit suicide-related behaviour or thoughts than their
heterosexual counterparts, although they associated some of this factor to
depression and substance abuse – demonstrating the complex and intricate
relations between sexuality and mental well-being. Thus further research is
needed to replicate and explore the causal mechanisms underlying this
association.
Gender as a factor
There is a significant gender element with regard to those LGBT people who
succeed in committing suicide. A report prepared by the Men’s Health Forum
in Ireland (2013) identified the key factors which mediate the relationship
between gender and suicide. Firstly, men use more violent methods which
result in a higher completed suicide rate for men than women. Secondly,
men are less likely to seek out help for mental illness.
The literature reveals significant gender differences with regard to mental
health and patterns of health seeking. Studies have shown that men are
more likely to suppress feelings of depression which then manifest
themselves in other ways i.e. through alcohol and substance abuse (Brooks,
2001). Ryan (2003) linked increasing male suicide rates to a lack of
connectedness to the social fabric of life. One of the key challenges is
overcoming the cultural taboos and presence of a traditional masculine
ideology, “laddish” culture, which is contributing to the male suicide
epidemic in Ireland. Reinforcement of traditional gender roles often
prevents men from seeking help for suicidal feelings and depression (Möller-
Leimkühler, 2003).
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18. Methodological Limitations and Difficulties
The evidence on the mental health of LGBT people is inconclusive partly
because of the difficulty of defining or recruiting samples that are
representative of all non-heterosexual people. Specific methodological
obstacles include variation in the definition of sexual orientation and mental
illness; difficulty in achieving random samples; reliance on participants'
recall; unwillingness of people to be open about their sexual orientation;
lack of information on sexuality in suicide victims who are part of
psychological post mortem studies; the complexity of choosing appropriate
comparison groups and poor or absent adjustment for confounding
influences such as substance use and personality factors.
Meyer (2003) divides the methodological limitations between two types of
studies; non probability and population based samples. Non-probability bias
can result in a participant bias as the type of people who volunteer may not
be representative of the general LGBT population and therefore it is
inappropriate to generalise from them. He also identified that population
based surveys lack a sophisticated measure of sexual orientation, i.e. one
which accesses sexual identity and attraction in addition to sexual
behaviour.
Sexual minority and sexuality researchers have compiled considerable
empirical support linking LGBT populations with mental health problems
such as depression, substance abuse and suicidality (Mayock et. al, 2009).
However little is known in an Irish context about how these factors
intermingle/combine to potentially contribute to worsening mental health
problems among LGBT people.
The review of the literature regarding the issue of sexual orientation and
mental illness has flagged several areas which need further research as well
as highlighting significant differences in the findings of existing studies.
Thus I feel this study is justified and can add to the field of knowledge. This
research will also benefit both LGBT people living in Ireland, aiding their
understanding of the societal causes of their mental health problems, and
the government or policy makers by allowing them to grasp a deeper
11

19. understanding of the structural and societal factors which perpetuate and
re-perpetuate minority stress and consequently, low levels of mental well-
being and mental illness amongst LGBT people in Ireland.
12

20. Chapter 3
Methodology
This study used an explanatory mixed methods sequential design consisting
of two distinct phases; quantitative data analysis followed by qualitative
data collection and analysis, which allowed me to explore the mechanisms
underlying the relationship between same sex orientation and mental illness
in Ireland through the data analysis of an existing quantitative study and
the collection of qualitative data through interviews.
Mixed Methods
Creswell and Plano Clark (2011) advocate the use of a mixed methods
approach when it is likely that results will need to be explained and
expanded on. The definition of mixed methods is the use of two or more
methods in a single research topic. Bryman (2004) and Creswell (2005)
reserve this term for projects with both qualitative and quantitative
methods but Gilbert (2008) sees a mixed method approach as simply
involving two or more different methods of data collection. In the case of
this research project quantitative analysis addressed the risk factors which
mediate the relationship between LGBT people and mental illness.
Quantitative studies are inadequate to describe and explain the experiences
of gay people in Ireland, as little is known about the mechanisms behind the
trends, so qualitative methods provided additional insight into the
complexity of these relationships and allowed me to get a sense of the
human perspectives and voices behind the numbers. A combination of
quantitative and qualitative research methods provides strengths that offset
the weakness of qualitative and qualitative research alone (Jick, 1979).
Quantitative methods are said to be weak in understanding the social
context of the situation and do not allow the voices of participants to be
heard. On the other hand qualitative methods are criticised for having an
element of researcher bias and there is a difficulty in generalising from
individuals [Creswell and Plano Clark, 2011)].
Greene et al. (1989) and Brannen (2005) discuss the complementarity
aspect of mixed method research; it can be used to reveal different
13

21. dimensions of a phenomenon and enrich understanding of the multifaceted
and complex nature of the social world. When used in combination,
quantitative and qualitative methods complement each other, allowing for a
more complete analysis and understanding (Green, Caracelli and Graham,
1989, Tashakkori and Teddlie, 1998).
Explanatory Design
Creswell and Plano Clark (2003) define an explanatory study as a mixed
methods design in which there are two distinct phases, each comprising of
either a qualitative or quantitative element. In the first phase I carried out
quantitative data analysis and then followed it up with a qualitative phase
which fulfilled the purpose of extrapolating the initial results.
The explanatory design was straightforward to implement and the two-
phase design, in which the first phase was done independently to the
second, allowed it to be conducted by a single researcher. The second
qualitative phase was structured based on the findings from the initial
quantitative stage. Brennan (2005) suggests that qualitative data analysis
may exemplify how patterns based on quantitative data analysis apply in
particular cases, while also reflecting the complexity of a phenomenon
(Mason, 2006). Using combined methods is also a more ‘practical’ and
realistic way of understanding the social world; individuals respond to
problems in a multitude of ways, they are not limited to one approach
(Creswell and Plano Clark, 2011).
Challenges of using mixed methods
There are some practical issues involved with implementing a mixed
methods approach. Firstly, there are increased demands associated with
mixed methods; mixed methods may require extensive time, resources and
effort on the part of the researcher, in comparison with research limited to
one approach. Also both quantitative and qualitative research skills must be
present, a potential issue in single researcher works.
Smith (1983) highlights another potential issue with this approach; the idea
that quantitative and qualitative research are separate paradigms and
14

22. therefore they have different, and incompatible, epistemological
implications. But Bryman (2004) argues that, firstly, it is difficult to sustain
the idea that research methods carry with them fixed epistemological and
ontological implications and secondly, that it is by no means clear that
quantitative and qualitative research are in fact paradigms. This stems from
the lack of consistency and clarity of the term ‘paradigm’, indeed Kuhn
(1970), who essentially coined the term, used it in twenty-one different
ways (Masterman, 1970).
Quantitative Stage
The quantitative element of the research was carried out through data
analysis of an existing dataset, from the Irish Study of Sexual Health and
Relationships (2006). This statistical analysis was conducted using the
Statistical Package for Social Sciences software (SPSS) Version 22 and
focused on the various risk factors which influence the relationship between
sexual orientation and mental illness. This allowed me to measure the
association between variables and calculate the strength of the relationships
between all the factors involved.
Irish Study of Sexual Health and Relationships
It would be extremely difficult for a single researcher to carry out a
quantitative survey which would be statistically significant and
representative of both the Irish population and of the LGBT people within
that population group. As a result I used data generated by the Irish Study
of Sexual Health and Relationships (ISSHR) commissioned by the Crisis
Pregnancy Agency in 2003 and carried out by the Economic and Social
Research Institute (ESRI) and the Royal College of Surgeons in Ireland
(RCSI). The ISSHR provides nationally representative statistical data
describing levels of sexual knowledge, attitudes and behaviours of adults
(18 years and over) in Ireland for the first time. I was satisfied that the
study met reliability, validity and generalizability requirements as outlined
by Bryman (2004).
Secondary Analysis
Secondary analysis is the analysis of data by researchers who were not
15

23. involved in the collection of those data, for purposes which were in all
likelihood not envisioned by those responsible for the data (Bryman, 2004).
There are significant advantages connected with using previously existing
datasets such as those carried out by large institutions or governmental
bodies with substantial resources. Using the data generated by a study such
as the ISSHR allowed access to a scope of data far beyond that achievable
by a single researcher. The data generated is also of a very high quality –
the study having followed rigorous sampling procedures and having been
carried out by highly experienced researchers, within social research
institutions (ESRI/RCSI) which have developed structural controls to ensure
the quality of data. The ISSHR dataset is nationally representative which
could only be achieved with substantial resources.
Secondary analysis can also allow for sub-group analysis within large
datasets which yield nationally representative samples. Arber and Gilbert
(1989) used the data generated by the 1980 General Household Survey in
Great Britain to isolate the subgroup of elderly people and in doing so
concluded that the “large sample size, high response rate and
representative nature” (ibid: 75) of such nationwide studies could be
utilised in order to test findings and theoretical ideas based on small,
qualitative and localised studies. This strategy is reiterated by Bryman
(2004).
Secondary analysis also allowed the opportunity for re-interpretation of the
data, i.e. exploring relationships between variables that the initial
researchers may not have focused on. It is important to note that there
were limitations to the use of secondary data. There was a necessity to
undergo a period of familiarisation when dealing with data collected by
others; understanding the range of variables, the way in which they have
been coded etc. There was also a risk of the absence of key variables as the
initial study may not have focused specifically on relationships between two
variables that I wished to study.
16

24. Variables
The primary research question; “How do underlying factors such as
depression, alcohol abuse and unemployment mediate the relationship
between sexual orientation and mental well-being”, predetermined a set of
variables for this study. There are several factors which were treated as
independent or predictor variables because they cause, influence or affect
outcomes.
Dependent Variable: Mental well-being:
1a. MentalWellBeingMeasure Interval
1b. GroupedMentalWellBeing Ordinal
Independent Variables: Sexual Identification:
2a. Sexuality [C8] Nominal
2b. RCsexuality Nominal
2c. same_sex_id Dichotomous
Sexual Attraction:
3a. Sexual Attraction [E1] Nominal
3b. Same_Sex_Att Dichotomous
Alcohol:
4a. Alcohol Abuse [RCl10a] Ordinal
4b. GroupedNo.Drinks Ordinal
4c. TotalMeasureAlcohol Ordinal
Unemployment:
5a. RC_job Ordinal
5b. Unemp Dichotomous
17

25. Dependent variable
The dependent variable was MentalWellBeingMeasure (Note: this is a
measure of mental well-being, not mental health). The Ryff scale of
Psychological Well-Being used in the survey measures two of six
theoretically motivated constructs of psychological well-being, Autonomy
and Positive Relations with others (See Appendix A4). I decided to combine
the two dimensions, each comprising of three items, into a single scale
variable as I felt this would provide a more accurate representation of the
overall mental well-being of each person surveyed. Three of the items were
reverse scored and were recoded prior to computing the scale variable.
As this variable had so many values (36) it was re-coded into the grouped
categorical variable GroupedMentalWellBeing, with 3 levels of mental
well-being; low, medium and high. This was done by analysing the scale;
A 1-23 score was deemed to be a low level of mental well-being as it
was under the 'Agree Slight' cut off combined score of 24,
participants answering 3 or below for several questions.
A 24 – 29 score was deemed to be a medium level of mental well-
being as it was under the 'Agree Some' cut off combined score of 30,
participants answering between 4 and 5 for every question.
A 30-36 score was deemed to be a high level of mental well-being as
it would mean that those participants answered 'Agree Some' or
'Strong Agree' (5 or 6) to all the questions, showing very high levels
of autonomy and positive relations with others.
Independent variables
Sexual Identification was a nominal variable and had 6 distinct values which
referred to points on the Kinsey scale of sexual identification (See Appendix
A1). To facilitate data analysis it was recoded into an ordinal variable,
Rcsexuality, with three groups; Straight, Not straight and Refused (to
answer the question). It was also recoded into a dichotomous variable,
same_sex_id, to enable the use of logistic regression.
18

26. Sexual Attraction was also a nominal variable with 7 distinct values which
measured same sex attraction (See Appendix A2). It was also recoded into
a dichotomous variable, same_sex_att, to enable the use of logistic
regression.
Alcohol was measured in several different ways in the survey (See Appendix
A5 and A6). Regularity of alcohol consumption (L10a) was reverse sorted
and was recoded into the variable RCl10a. The level of alcohol consumption
(L10b) was recoded into an ordinal variable in order to facilitate analysis of
the data; GroupedNo.Drinks based on the number of drinks consumed at
once; Four or less, Five to eight and More than eight drinks.
The variable for employment, L7a (See Appendix A3), was re-coded to form
the ordinal variable RC_Job which ranked those in employment
(full/part/self) and those who are unemployed (unemployed, actively
looking for a job). It was also recoded into a dichotomous variable, unemp,
to enable the use of logistic regression.
I employed a combination of bivariate and multivariate analyses in order to
quantify how one variable affected another and to see how an underlying
independent variable could affect the relationship between the dependent
variable and another independent variable. Bivariate analysis uncovered
whether or not two variables were related, i.e. that the variation in one
variable coincides with the variation in another variable. It is important to
note that I was wary of the problem of causal direction when analysing
relationships between variables.
Multivariate analysis was used to establish the existence of spurious
relationships, intervening variables and the presence of moderating
variables. It was an essential part of this research project as there were
various variables present which could modify or intervene in the relationship
between the key variables. The data analysis was performed using rigorous
statistical analysis techniques and the results were interpreted at the
appropriate level of statistical significance.
19

27. Qualitative Stage
The qualitative element followed the data analysis and consisted of five in-
depth semi structured interviews with participants I identified through
purposive sampling methods. I felt that a qualitative element would strongly
add to this research project as qualitative research strategies emphasise
human factors e.g. attitudes, emotions and individual perspectives, rather
than simply focusing on quantification in the collection and analysis of data.
This allowed me to achieve an in-depth understanding of the experiences of
LGBT people in Ireland. In the qualitative stage, data collection and analysis
proceed simultaneously (Merriam, 1998).
Sampling
I used purposive sampling to choose my initial participants, defined as a
sample in which study participants are deliberately targeted based on
certain features or characteristics of interest in order to learn more about
the central phenomenon (Carter & Henderson, 2005, Miles and Huberman,
1994). The criteria was a priori, i.e. those who fit the socio-demographic
description; Gay. The initial participants were chosen from people I know
but I then expanded into other social circles through snowball sampling. As
my participants were sourced through non-probability sampling methods I
was unable to generalise directly from the data produced to the population
as a whole. However authors such as Onnwnegbuzie and Leech (2010) and
Mitchell (1983) state that it is possible to infer an “analytical generalisation”
from qualitative methods based on Yin’s idea (2004) that the purpose of
such research is to expand and generalise theory at a theoretical level and
not for statistical generalisation. The qualitative element is intended here to
extrapolate the findings of the quantitative data analysis and delve into the
relationships, rather than attempting to necessarily qualify or justify the
findings.
Semi-structured interviews
Silverman (1993) highlights the growing use of qualitative methods to test
theories and provide a more textured analysis of the dynamics involved.
Qualitative research methods such as the semi-structured interview allow
for the investigation of feelings, meanings and particular situations (Knight,
20

28. 2002). Qualitative interviewing does not have the same constraints as
quantitative interviewing as the focus is on the participants’ real life
perspectives rather than on the necessity of maximising the reliability and
validity of measurement of key concepts.
I used semi-structured interviews which ensured that specific issues and
topic areas were addressed while still allowing the interviewer to glean the
ways in which the research participants view their social world (Interview
guide – see Appendix B). Due to single-researcher issues such as time and
other resource constraints, as well as a more ‘analytical generalisation’
focus, I kept the number of people I interviewed quite low. Interviews were
recorded and then transcribed in order to ensure that all data was captured.
Data Analysis
The steps in the qualitative analysis, as guided by Creswell (2002),
included;
1. Preliminary exploration of the data by re-listening to voice recordings
of interviews and transcribing
2. In-depth analysis of the transcripts
3. Coding the data
4. Using the codes to develop themes
5. Constructing a narrative
A limitation of qualitative analysis has traditionally been a degree of
uncertainty and lack of clarity as to how the researcher arrived at certain
conclusions and interpretations from the data collected (Mays & Pope,
1995). Thorne (2000) advises a “systematic and auditable procedure” based
on principles being comprehensive, accessible and grounded in the data.
There was a need for an analytical strategy to ensure that these principles
were satisfied.
Thematic analysis was a good method of analysis as it allowed me to move
from a descriptive level to a conceptual level, with the use of the analytic
cycle of coding and categorising proposed by Hennik et al. (2011), which in
turn helped my theory develop while still maintaining a level of accessibility
21

29. and transparency. Tesch (1990) sees coding as a process of deconstruction
and reconstruction. I firstly carried out data reduction by categorizing by
thematic content – colour coding sections of the text and developing
categories. This stage involved use of componential analysis, which helped
identify major components or features, which were used to differentiate
cultural items and terms.
This initial level of coding was followed by a second level, which involved
more detailed coding within these initial categories. The coded data was
than transformed into meaningful data through the analysis of patterns,
themes and regularities as well as contrasts, paradoxes and irregularities
(Delamont, 1992).
Methodological Limitations
Specific methodological obstacles that presented themselves in this study
include variation in the definition of sexual orientation and mental illness;
difficulty in achieving random samples; reliance on participants' recall;
unwillingness of people to be open about their sexual orientation; the
complexity of choosing appropriate comparison groups and poor or absent
adjustment for confounding influences such as substance use and
personality factors.
Meyer (2003) divides the methodological limitations between two types of
studies; non-probability and population based samples. Non-probability bias
can result in a participant bias as the type of people who volunteer may not
be representative of the general LGBT population and therefore it is
inappropriate to generalise from them. He also identified that population
based surveys lack a sophisticated measure of sexual orientation, i.e. one
which accesses sexual identity and attraction in addition to sexual
behaviour. The ISSHR study however avoids this participant bias as people
were randomly selected and did not volunteer. Indeed the initial purpose of
the study was not to specifically on homosexual attraction and behaviour.
22

30. Chapter 4
Findings
This chapter presents the results of the data analysis. The data analysis was
carried out in two separate distinct stages and the aim of the research was
to explore the relationship between sexual orientation and mental well-
being.
Quantitative section introduction
The primary research question; How do underlying factors such as
depression, alcohol abuse and unemployment mediate the relationship
between sexual orientation and mental well-being?, predetermined a set of
variables for this study. There are several factors which were treated as
independent or predictor variables because they cause, influence or affect
outcomes. The variables are as presented in Chapter 3.
Confounding Factors
However there are potential confounding factors which must be taken into
account; Age, Gender and Social class. Controlling for these variables was
carried out through logistic regression – which allowed me to calculate the
probability of an event occurring based on a one unit change in an
independent variable when all other variables were held constant.
Qualitative section introduction
The qualitative phase focused on exploring and extrapolating the Minority
Stress Model theorised in Chapter 2. The aim of the interviews was to
capture personal stories and individual perspectives which would illustrate
the data generated in the quantitative phase. The purpose of the inclusion
of the qualitative stage was to explore societal trends on a more individual
level and qualify the experiences, attitudes and voices of the participants. It
is essentially an effort to impart voices to what could be described as 'mute'
data.
23

31. Coding + Analysis
Thematic analysis was used to analyse the interview data via a bi-level
code-and-retrieve coding system (See Appendix C) which allowed the
identification of key themes and patterns, the assignation of labels and the
identification of analysable units. The first level consisted of categorisation
of the data by thematic content, i.e. the labelling of certain words of
phrases using a colour coding scheme. The second level involved more
detailed coding within these initial categories. Initial coding using
componential analysis (See Appendix D) revealed that there were five
themes/features which cropped up in all the conducted interviews:
School struggles, 'Not normal' conception of gay people, Mental
issues, Alienation and Isolation and Relationship worries.
There were also three other themes/features which were common to most
of the interviews;
Alcohol abuse, stereotypes based on appearance and the use of the
'Bi route'.
The next step involved re-categorising and re-coding within the initial
categories, allowing the systematic ordering of data in order to generate
meaningful data and enable interpretation.
Reminder of Research Questions
Q1 Is there a relationship between sexual orientation and mental illness
in Ireland?
Q2 How do underlying factors such as alcohol abuse and
unemployment mediate the relationship between sexual orientation
and mental well-being?
Q3 What is the effect of a heteronormative society on the mental well-
being of young gay people in Ireland?
The first two questions were explored through both the quantitative and
qualitative phases. The third question was explored through the interviews
with the participants.
24

32. Question 1: Mental Well-being and Sexual Orientation
Sexual orientation is used as an umbrella term for same sex attraction and
sexual identification. There is a clear distinction between being attracted to
the opposite sex and identifying as homosexual or bisexual. Using
Durkheim's notion of anomie within his Social Integration theory we can
theorise that those who do not integrate into a heteronormative society will
have lower levels of mental well-being. However perhaps those who do
identify as homosexual might then become part of a new 'community',
meaning that it is those who have same sex attraction but do not identify as
homosexual who suffer worse mental well-being. This establishes two
hypotheses for the quantitative data analysis phase;
H1: Mental Well-being will be significantly worse among those who
identify as homosexual compared to those who identify as
heterosexual.
H2: Mental Well-being will be significantly worse among those who
have a same sex attraction but do not identify as homosexual.
In a cross-tabulation of the relationship between Level of Mental Well-being
and the recoded sexual identification variable RCsexuality, People identifying
as 'not straight' were twice as likely to have a low level of mental well-being
as 'straight' people, 12.9% compared to 6.9%. They were also more likely
to have a medium level of mental well-being; 38.1% in comparison to
24.7%.
Table 1: RCsexuality x GroupedMentalWellBeing
Level of Mental
Well-being
Straight Not Straight Not
sure/Undecided
Low 6.9% (491) 12.9% (19) 16.7% (2)
Medium 24.7% (1763) 38.1% (56) 58.3% (7)
High 68.5% (4893) 49.0% (72) 25% (3)
P value =.000
25

33. However they were considerably less likely to have a high level of mental
well-being, only 49% of the 'not straight' group fell within the high level of
mental well-being while 68.5% of the 'straight' group did. There is
undoubtedly a relationship between sexual identification and mental well-
being – the Likelihood Ratio (39.149 at p<.000) confirms a statistically
significant association between the two variables and the Gamma coefficient
of -.358 suggests that it is a strong positive relationship.
However the participants who did not identify as heterosexual, homosexual
or bisexual had the lowest levels of mental well-being. This trend was also
visible in the comparisons of the mean of the mental well-being measure for
each sexual identity group;
Table 2: Sexual Identification [C8] x MentalWellBeingMeasure
Sexual Identity Mean
Heterosexual 30.9
Homosexual 28.9
Bisexual 30.3
Not sure/Undecided 26.5
P value =.000
Those who were “not sure/undecided” had a considerably lower mean than
those who identified as homosexual; 26.5 : 28.9. This would support the
hypothesis that those who have same sex attraction but who do not identify
as homosexual/bisexual suffer lower levels of mental well-being. However,
when comparing the cross tabulation of those with same sex identification
and those with same sex attraction at each level of mental well-being, those
with same sex identification had a higher percentage at the low level and a
lower percentage at the high level.
26

34. Table 3: GroupedMentalWellBeing x same_sex_id x same_sex_att
Level of
Mental Health
Same sex
attraction
Same sex
identification
Low 13.8% 18.9%
Medium 32.2% 32.7%
High 54.0% 48.4%
P value =.000
The logistic regression analysis confirmed this pattern; those with same sex
identification are 1.91 times more likely to have low mental health than
those with no same sex identification, while those with same sex attraction
are only 1.43 times more likely to have low mental health. This supports
Hypothesis 1, that mental well-being will be significantly worse among
those who identify as homosexual compared to those who identify as
heterosexual. Hypothesis 2 is also supported by the comparison of the
means in Table 2.
The results of the qualitative data analysis suggest that a lot of the mental
well-being issues stem from the coming to terms and coming out periods –
individuals struggle to accept themselves as they have subconsciously
internalised social norms and stigmas and these negatively affect their
mental well-being and feelings of self-esteem and self-worth. The fear of
relationships changing was a big factor in revealing sexuality to parents and
family and indeed, when relationships were negatively affected, there was
then more stress placed on the participants. Jack's parents reacted hugely
negatively to his “choice” and made him feel “guilty and depressed”. In the
end they only accepted his sexuality when a psychologist he was forced to
see justified it, something which still grates although they accept him
completely now. Hope also experienced initial resistance from her parents,
her mother would try to prevent her from seeing girls and this resulted in
family fights which affected her general well-being.
While not all of the interviewees experienced diagnosable mental illnesses
they all spoke at length about the stress and negative impact on their
mental well-being as a result of the coming to terms and coming out period.
27

35. Darragh described his initial sexual-identity crisis and how worries about
society and the reaction of his friends and family became internalised..”I
didn't really want to be gay...I did have a lot of internal
struggles...sometimes I would think “ohh if only it was different” “. This
resulted in an explicit denial of his sexual identity, he went out with girls
and ignored the reality of the situation; “I just ignored it...it just wasn't a
thing....I just thought that if I just didn't deal with it it would go away”.
Hope accounted how “it all became very internalised”, her general well-
being was negatively affected by her inner struggles to come to terms with
being gay and this in turn impacted on her existing anxiety disorder. Ellen
equated her mental well-being and previous mental issues, with anxiety and
depression, to her sexuality; “I think there's a huge link between the two...I
mean if I was straight I don't think I would have had half the mental health
issues that I had before”, as did Jack who attributed his depression and low
self-esteem to his struggle with his sexuality. Erica did not equate much of
her mental health issues directly with her sexuality but she did acknowledge
that coming to terms with her sexuality resulted in additional stressors
which in turn impacted negatively on her mental well-being.
All the participants harboured worries at some point about the perceived
reactions of their friends and family and this added to the stress they were
under during the already unduly stress-filled 'coming to terms' period. I
noted a clear distinction between coming out to family and coming out to
friends...these were two different discrete stages viewed almost as separate
challenges. There was a dichotomy between the perceived reception from
the family and the perceived reaction from friends. There is a generational
factor here; both Darragh and Erica are not 'out' to their grandparents
because “you don't wanna shock them before they die...”, whereas their
generation was seen as having grown up in a more accepting society which
seemed to assuage most worries that friends would react negatively. And
indeed this was the situation, there was an overall positive reaction from
the participants' friends; supportive, Jack's friends “did not see my revealed
sexuality as being something that changed their opinions of me” and no
change occurred in relationships with peers, despite Erica's worries that her
friends would “think I was weird or think I fancied them and then they'd get
28

36. all awkward around me”. Indeed a narrative began to develop of a
transition from denial of sexual identity to recognition of that sexual identity
and in the end pride in being gay and an equation of gay with a positive
identity.
The qualitative phase gave added strength to the relationship between
sexual orientation and low mental well-being by highlighting the specific life
stages when the association between sexual orientation and mental well-
being is at its strongest – the 'coming out' and 'coming to terms' stages.
The data generated illustrates the mechanisms underlying this association;
the heteronormative society dictates what is 'normal' and what is not to the
gay youth, who internalises the stigma and shame about being different.
This has a negative impact on his/her mental well-being and when this cycle
repeats itself by the thousand we see this association between sexual
identification and low mental well-being.
Question 2: How do underlying factors such as alcohol abuse and
unemployment mediate the relationship between minority sexuality
and mental well-being?
Part 1: Mental Well-being and Alcohol abuse
I have shown the existence of a relationship between sexual identification
and same sex attraction and mental well-being in the data analysis of
Question 1 . This establishes a causal path: Sexual orientation > Mental
well-being. In order to answer Question 2 I will firstly look at the
relationship between mental well-being and alcohol abuse. I want to show
that Mental well-being > Alcohol abuse. This will establish the causal path;
Sexual orientation > Mental well-being > Alcohol abuse
The mechanisms underlying this are that on a societal level homosexuality
is not normalised and this creates stress and pressure on those who do not
identify as straight. This leads to lower levels of mental well-being and
subsequently higher levels of alcohol abuse. However the qualitative data
analysis found that there was no statistically significant correlation to be
29

37. found between a person's mental well-being and the regularity with which
they consumed alcohol. The Chi-Square test, rank correlation (Spearman's
rho) and ANOVA all failed the level of significance test.
Although people with lower levels of mental well-being do not seem to drink
more often, perhaps when they do drink alcohol they consume more than
those with higher levels of mental well-being. There is a clear association
between the level of mental well-being and the number of alcoholic drinks
consumed. Over 48% of the people with a low level of mental well-being
consume 5 or more drinks on a single occasion compared to 40.4% of the
medium level, while only 33.8% of the high level of mental well-being do
so. The low level of mental well-being are twice as likely to consume more
than eight drinks than the high level of mental well-being, 14.4% compared
to 7.2%. There is an evident trend: as the level of mental well-being
increases, the number of drinks decreases. This is supported by the Gamma
coefficient, -.168, which demonstrates a negative moderate association
between the mental well-being and alcohol. Figure 1 shows this association
(p = .000).
Figure 1: GroupedMentalWellBeing x Mean weekly alcohol units
30

38. However, when taking confounding factors into account, age was shown to
be an extremely significant predictor for alcohol; the under 25 age group
are 1.98 times more likely to consume high units of alcohol than those
above 25 years of age. Similarly under 25s are 1.3 times more likely to
have low mental well-being. As a result, when held constant the relationship
between alcohol and mental well-being is weakened – young people are
more likely to drink more and more likely to have low mental health.
The regression however did show a significant relationship between same
sex attraction and units of alcohol consumed when all other factors were
held constant – those with same sex attraction are 1.32 times more likely to
consume high units of alcohol than those with no same sex attraction. Again
however those with same sex attraction are 1.43 times more likely to have
low mental well-being. This means that the relationship between mental
well-being and alcohol abuse is amplified by the effect of same sex
attraction on both mental well-being and levels of alcohol consumption.
[Note: Neither class or same sex identification were significant predictors of
the number of alcoholic units consumed]
The qualitative phase further supports the hypothesis of increased alcohol
abuse as a result of sexual orientation based stress and low mental well-
being - Alcohol was used to deal with the stress and emotions resulting
from the 'coming to terms' period by several of the interview participants.
Ellen described taking drugs and drinking a “shit-load” every night when
going through the process of dealing with her sexuality, Darragh developed
a reputation as “messy Gav” due to his habit of excessive drinking to deflect
his sexuality and Hope told of years of self-described “binge drinking” as an
avoidance mechanism but also as form of liquid courage, giving her the
confidence to go to 'gay' clubs; “it was easier the first time going to the
George and stuff like”. However Erica claimed that “I didn't drink or smoke
more than I would have if I were straight” and Jack never drank to excess
so there isn't a perfect association of alcohol with sexual orientation or with
mental health. Nevertheless the data analysis of Q1 and the first part of Q2
have established the causal path:
31

39. Sexual orientation > Mental well-being > Alcohol abuse.
Part 2: Mental well-being and Unemployment
The relationship between alcohol and mental well-being was demonstrated
in Q2 Part 1. The aim of Q2 Part 2 was to explore the relationship between
unemployment and mental well-being. In the quantitative analysis 10.5% of
those with low mental well-being were unemployed in comparison to 3.4%
of those who did not have low mental well-being. The Gamma coefficient
suggests a positive strong association between unemployment and low
mental well-being, .545 – those who are unemployed are much more likely
to have low mental well-being, or vice versa.
However age, social class and gender are all confounding or intervening
factors in the relationship. Age is a significant predictor for the likelihood of
being unemployed for all but the 24 to 34 years old age group and the
likelihood of having low mental well-being for the under 25 age group.
Females are half as likely to be unemployed (.46) and less likely (.76) to
have low mental well-being. In terms of class unskilled manual workers are
1.7 times more likely to have low mental well-being and 2.3 times more
likely to be unemployed.
The strength of the association between unemployment and mental well-
being is lessened when taking into account the confounding factors but it is
still significant. But what proportion of poor mental well-being is directly
caused by same sex orientation and what proportion can be attributed to
unemployment?
Those with same sex identification have a higher proportion who are
unemployed than those who identify as straight (Table 4).
Table 4: same_sex_id x unemp
Same sex Identification Unemployed
No 3.7% (271)
Yes 8.8% (12)
P value =.002
32

40. When unemployment was adjusted for, same sex identification still had a
significant effect on low mental well-being (p=.000), those with same sex
identification were 2.3 times more likely to have low mental well-being. This
reasserts the strength of the association between sexual Identification and
unemployment as both contribute to low levels of mental well-being and
sexual identification is associated with higher levels of unemployment.
Part 3: Unemployment and Alcohol
In order to understand the relationship between sexual orientation and
mental well-being fully there must be an understanding of the extent of the
relationship between unemployment and alcohol abuse. Data analysis of the
relationship between unemployment and alcohol consumption establishes
that there is a relationship between alcohol and unemployment.
Table 5: High Units of Alcohol x Employment Status
High units of alcohol Employed Unemployed
No 79.8% 69.6%
Yes 20.2% 30.4%
P value =.000
30.4% of unemployed people consume high units of alcohol compared to
20.2% of employed people. The Chi-Square test is statistically significant,
allowing us to reject the null hypothesis that there is no association
between the two variables. The Gamma coefficient, .265, suggests a
moderate positive relationship between unemployment and alcohol abuse,
i.e. unemployed people are more likely to consume high units of alcohol or
people that consume high units of alcohol are more likely to be
unemployed. However age and gender were found to be confounding factors
in this relationship. The Under 25s age group were 1.99 times more likely to
consume high units of alcohol and 1.81 times more likely to be unemployed.
This age group is also the particular age bracket within which the 'coming to
terms' and 'coming out' periods take place – This would suggest a
strengthened relationship between sexual identification and low mental
well-being for this age group.
33

41. Question 2 as a whole
Data analysis testing the second research question, Q2, established this
idea of an almost triangular relationship between Mental well-being,
Unemployment and Alcohol abuse, as seen in Figure 1.
Figure 2: Path diagram showing the relationship between Mental
well-being, Unemployment and Alcohol Abuse
Unemployment and Alcohol abuse do not intervene directly in the
relationship between sexual orientation and mental well-being; there is no
statistically significant link between sexual orientation and either variable.
However both variables are closely associated with low mental health and
thereby worsen the extent of low mental well-being established as a result
of sexual orientation.
Question 3
The purpose of the qualitative section was largely to explore the social
phenomena and mechanisms underlying the relationship between sexual
orientation and mental well-being, which the quantitative phase could not –
i.e. the effect of societal norms, personal fears or worries on the
relationship between sexual orientation and mental well-being. There were
two themes which I felt explored the third research question; the
conceptualization of a heteronormative society and the sense of alienation
or isolation that the interviewees felt at various stages in their lives,
particularly in school.
34

42. The existence of a heteronormative society
A key finding of my research was the conceptualisation of a
heteronormative society consisting of institutions, structures and attitudes
which dictate what is considered 'normal' and condemns that which it
deems 'not normal'. Society and the norms of society was a constant theme
throughout all the interviews. All the participants were aware that there was
nothing wrong with their sexuality, most were content and happy in their
sexual identity, but at the same time asserted that “it's not the normal way”
and that it wasn't “the way it's supposed to be”. There's a sort of internal
dichotomy or contradiction implicit in these interviews, even Hope who
described herself as totally comfortable in her sexuality and was outwardly
gay, “ feather boas, glitter, the whole works”, subconsciously differentiated
between a straight and a gay pub, referring to the straight one as a
“normal” pub. The issue is this equating of straight with normal and gay
with something else, something non-normalised and non-accepted.
The ambiguity in this conception compounds feelings of inadequacy and
isolation, indeed Erica concluded that struggling with her sexuality
“probably compounded stress and feelings of loneliness or like inadequacy”.
It is evident in several interviews that worries about a perverse reaction on
a societal level affected the participants on a personal level and hindered
the process of coming to terms with their sexuality initially; “I just thought
everything would change if I was gay and then I just thought I wouldn't be
a first class citizen in society and I'd have a harder life like that and also I
don't think society looked like greatly upon gay people then”.
Society in general was portrayed by all the interviewees as a somewhat
negative and almost unsafe place when they originally came out (Within the
last five years for most of them). They highlighted the lack of legal status,
“there wasn't civil partnership even … so like there was not protection” and
described initial worries that people would treat them differently as a result
of their sexuality. Hope's mother initially struggled to deal with her
daughter's sexuality due to worries that it would expose her to personal
attacks, “my mom was concerned that I would be the victim of prejudice or
that I might get beaten up or whatever blah blah and my life would be
35

43. harder”. Although several agreed that this was a different time and Irish
society was more prejudiced then, Ellen said that she still did not feel like
she fit in and Darragh recognized that there are “certain groups I wouldn't
really fit in”, using the example of rural Ireland to embody the traditional
Irish society in which being gay was not spoken of or acted upon, at least
publicly. Erica spoke of being lonely as a teenager because “I can't find
anyone because I'm gay and no-one knows” in contrast to her friends who
began to have boyfriends and opportunities that she felt she was denied as
a result of the heteronormative structure of society.
Inclusion and Exclusion
Society is often spoken about in terms of inclusion and exclusion, the
practices by which it manages heterogeneity and creates an artifice of
homogeneity. These practices of inclusion and exclusion manifested
themselves in the interviewing process. Erica talked about being excluded
from activities and conversations “cause of the way you are”; the exclusion
was not prompted by herself or the people present but rather by society as
a social actor which has imposed certain norms and is very effective at
isolating and rejecting those who defy those norms. Examples of this were
being in a conversation but feeling like you don't really belong; “like when
everyone's talking about how hot Channing Tatum is and you're like … ”,
and feeling romantically stifled on a night out as you're in “a straight place
and can't get the shift”. Jack spoke about alienating himself initially in
college, being quite guarded towards people as a result of fears about how
they would react to his sexuality. In a sense he excluded himself from his
peers and the college experience, but society itself was responsible for the
creation of his fears. There is a vicious cycle of institutional related stress
leading to alienation, resulting in the polarisation of 'normal' and being gay,
which in turns leads to more alienation and then cycles back to reinforce the
negative characterisation of homosexuality within schools and other
institutions.
However it is clear that Irish society has become more inclusive in some
areas while exclusive in others. Hope talked about the increasing presence
of gay people on TV and the effect this has had on her; “There's something
36

44. to be said when your pop culture has gay people in it … like … you feel so
much more accepted”. We talked about Pretty Little Liars, a hugely
successful mainstream American TV show, which has a main character who
is openly gay and kisses other girls on the show, and how this prominence
of a functioning gay person who does not embody certain stereotypes about
gay women is having a positive affect on society and the implicit biases of
its largely female teenage audience.
Stereotypes and Biases
Indeed these biases or stereotypes were an enduring feature of almost all of
the interviews, perpetuated even by those who were gay. Ellen described
the lesbian stereotype as “butch and short hair” and was keen to
differentiate herself from it, noting that “everyone thinks I'm straight when
I'm walking down the street”. Indeed Hope saw her sexuality as “fairly
evident by the way I dress” and was guilty of her own implicit biases with
regard to appearance and sexuality; when describing someone that came
up to her in a bar she said “she didn't look gay though”. External biases
were also evident in the interviews, Darragh's school peers identified him as
“the gay one” because he displayed certain characteristics that they
classified as gay. Hope also received taunts such as “awh you have to be a
lesbian” when she was out with her 'straight' friends; there was almost a
suggestion that she did not belong in a 'straight' club because she did not
look a certain way and she was immediately labelled as gay based entirely
on her physical characteristics or mannerisms.
Alienation and isolation
Methods of inclusion and exclusion can perhaps best be linked back to the
school period for all of the participants. School struggles were very much
linked to alienation and an implicit acknowledgement by the participants
that it was not 'normal' to be gay, by being so they were exposing
themselves to negative reactions. There was the belief that “I wouldn't have
fit in in school” and there were negative experiences for those who 'came
out' while still in the school system. Hope experienced homophobia from
teachers in the school; “Yeah like they wanted me to talk about my
boyfriend in my Spanish oral and I was like “Can I talk about my girlfriend,
37

45. I've learnt all about her features?” and all this and they were like “No.”,
Ellen received negative reactions from her peers in school, “everyone's like
“oh my god you're gay, do you fancy me?, not getting changed in front of
you”...all that shit”, and Erica said she only experienced one incident of
peer based homophobia in school, “it wasn't so much exclusionary so much
as it was “oh my god she's gay”...basically homophobia but that was a once
off”. What I found particularly interesting and shocking was that she
followed up this account with a statement that she feels lucky about only
having experienced this one incident. This is indicative of the society and
atmosphere in schools and other institutions in Ireland where negative
reactions and experiences seem to be almost expected.
Hope's experience is an example of institutional discrimination and the
enforcement of societal norms by the school and those in power within the
school system which thus lead to low numbers of gay youth revealing their
sexuality in school and perpetuating that notion that being gay isn't normal,
as well as increasing the isolation for these gay youth. Jack described
feeling alienated and isolated as a result of this...”I did not have any friends
who were queer that I was able to talk and relate to”.
Struggling to come to terms with sexuality was often contextualised by the
school environment. “Cause I was in an all boys school like” was one of the
explanations Darragh used for concealing his sexuality and he knew of at
least two other boys in his year of 90 students that came out after leaving
school, as he described it “not one person was gay before [the end of]
school”. The school atmosphere, particularly in an all boys school, seems to
encourage gay youths to conceal their sexuality in order to fit in and to
conform to the norms. Religion was also a factor in Hope's case...”I went to
a Catholic school and they had religious retreats where they would tell us
kind of like “by the way being gay is not right” so it was hard, I felt isolated
then, by my teachers, or by the institutions.”
Summary
The findings of the data analysis provided answers to my three primary
research questions. The findings were partly covered by the literature
38

46. studied but there were several new themes and areas uncovered which I
feel are lacking in the literature for this field. I will introduce these themes
and expand on the significance of the findings in the discussion chapter.
39

47. Chapter 5
Discussion/Conclusion
This research aimed to explore the structural and social mechanisms which
result in lower levels of mental well-being amongst non-heterosexual
people. The results of the qualitative phase revealed why it is not possible
to identify one solitary explanation for the link between sexual minorities
and mental illness; there is a combination of factors mediated by a society
which is still overwhelmingly heteronormative. The emergence of new
themes from patterns in the data allowed for a more exploratory inductive
approach, which was useful as a complementary process to the primarily
deductive approach.
The main findings of the study are as follows;
• The existence of a link between sexual orientation and mental well-
being, with those who are gay experiencing higher levels of stress
and lower levels of mental well-being. This was supported by both
the quantitative and qualitative research stages.
• The increased stress largely results from a highly heteronormative
society which excludes those who do not fit the norms.
• This exclusion results in feelings of alienation and isolation which
further impact on levels of mental well-being and stress.
• Intervening factors such as alcohol and unemployment combine to
worsen the relationship between mental well-being and sexual
orientation. People identifying as 'not straight' and those with low
levels of mental health drank more alcohol on any one occasion than
those who were heterosexual and who had higher levels of mental
well-being. There was a relationship between alcohol and
unemployment with those who were unemployed more likely to drink
more than those who were employed. There was also a strong
positive association between unemployment and the low level of
40

48. mental well-being, with those who were unemployed much more
likely to have low mental well-being.
• Political and cultural marginalisation leads to stigma and
discrimination which results in a negative mental state, furthering a
sense of isolation and alienation and resulting in alcohol abuse and
further mental problems.
Minority Stress Model – Internalisation of sexual-identity crisis
The conceptual framework of the Minority Stress model can be applied to
and supported by the data generated from the interviews. It theorises that
the higher prevalence of mental disorders and risk of suicide among
stigmatized minority groups (such as LGBT people) is as a result of stigma,
prejudice and discrimination which create a stressful social environment.
This oppressive social environment results in an internalised sexual-identity
crisis which negatively impacts on the well-being of LGBT youth in Ireland.
There is a constant narrative of stress and negative mental well-being as a
result of a 'non-normalised' sexual orientation running through all the
interviews. The discourse and language used by the participants themselves
sets them apart from the heterosexual majority; the 'coming to terms' and
'coming out' periods were hugely traumatic and stressful experiences for
them, which resulted in a higher propensity to be stressed and to suffer
mental disorders or be unhappy with life in general. 'Stress' itself is a
keyword which came up in all the interviews – the participants were
emotionally and mentally stressed and in some cases this stress resulted in
more adverse mental problems.
The influence of a heteronormative society on mental well-being is one of
the key findings of this research project. Although Darragh didn't consider
himself to have ever been depressed or have suffered from other mental
disorders as a result of his sexuality he stated explicitly that he was “not
100 percent” happy or secure in his sexual identity today. He attributed this
to “the influence of other people” and a society that he considers hesitant to
fully accept and embrace gay people. Darragh and Ellen embody insecurities
and issues present on a societal level and in national discourse....Ellen
41

49. never thought about her future as a gay woman but being confronted by
'normal' relationships in a heteronormative world caused her to consider the
implications of her sexuality in terms of the social and political structures
she may not have access to, such as marriage and parenthood. When asked
was she completely happy and secure in her sexual identity now Hope said
she was but then qualified that with “much more than I was anyway”.
Although she does not think about it most of the time there are occasions
when being defined by her sexuality bothers her. This suggests that even
after the coming out period there is some link between sexual orientation
and mental health.
In contrast Erica and Jack stressed that they are secure and content in their
sexuality today, despite any adversity they may have faced in the past,
either from individuals or society as a whole. Jack described himself as
being completely open about his sexuality and how this has generally got a
positive reaction from society at large; “overall people have a completely
supportive attitude towards me and other members of the queer
community”. The absence of the perceived stigma or prejudice from society
resulted in a positive state of mind regarding his sexuality and general well-
being; “I have no mental health issues and I am completely happy in the
person I am today”. In terms of reflecting on the literature these findings
echo those of Meyer (2003) and the Minority Stress concept – when there
was no stigma or discrimination the result was that the level of mental well-
being was not adversely affected by sexual orientation.
Social Integration Theory
The level at which a person feels like they belong to or are accepted by a
society is linked to their mental well-being – feelings of alienation/isolation
etc.. Durkheim's theory, which focuses on the increased likelihood of those
who were alienated or outside the social spheres of society to have lower
mental well-being and risk of suicide, was supported by both the qualitative
and quantitative data analysis in this research. Those belonging to minority
groups such as homosexuals were shown to have lower levels of mental
well-being and an increased propensity to engage in risk behaviour such as
excessive alcohol consumption. Low levels of mental well-being and high
42

50. levels of alcohol abuse have previously been empirically linked to an
increased risk of suicide (Burns and Teesson 2002, Ross 1995, Kessler et al.
1996 and Hall et al. 1999). The interviews provided perspectives of those
who are alienated or excluded from certain spheres. The political sphere
was one particular area which was flagged as being the source of a lot of
the alienation and exclusion. The period prior to civil partnership negatively
impacted on the mental health of several of the participants as they were
going through this 'coming out' period into a society which legally
sanctioned exclusion, participants spoke of a lack of “protection” and of
being “isolated as a group” as a result of the refusal of the state to legally
recognise same sex couples.
The research empirically shows that political and cultural marginalisation
lead to stigma and discrimination which results in a negative mental state,
furthering a sense of isolation and alienation and resulting in alcohol abuse
and further mental problems.
Significance of the study/findings
The findings are significant in that they support and answer the research
questions as well as expanding on existing research. This is particularly
evident with regards to the image created of the heteronormative society
and the way in which it both exemplifies and advances the minority stress
model used as a conceptual framework. Similarly Durkheim's social
integration theory/functionalist theory is supported by qualitative results
which illustrate the link between alienation and marginalisation and mental
well-being – the emphasis being on the negative effect it has on levels of
mental well-being. The quantitative section allowed for a statistically
significant analysis of the relationships between variables and also allowed
the conceptual mapping of these relationships which enabled the formatting
of the qualitative section in order to explore the intricacies of these
relationships.
The findings of this research study establish that the Minority Stress Model
and the Social Integration theory both provide legitimate explanations for
the relationship between sexual orientation and mental health and that they
43

51. operate in parallel to heighten feelings of depression, isolation and
alienation from society amongst those who are marginalised within their
social context and situation. The quantitative analysis supports the link
between sexual orientation and lower levels of mental well-being, in
addition to higher levels of alcohol abuse which in turn impacts on mental
health.
Limitations
There were several limitations associated with the data collection methods.
There were constraints on generalisability due to the relatively small
number of interviews carried out. However Ritchie, Lewis and Elam (2003)
argue that there is a diminishing return to a qualitative sample, one
occurrence of a code or theme is enough to add it to the analysis structure,
and therefore once I felt that I had reached saturation in terms of themes
and data generated, I ended the data collection stage. Also, as qualitative
research is concerned with meaning and not making generalised statements
(Crouch and Mckenzie, 2006), I felt that the number of interviews was
adequate and complemented the quantitative analysis.
The evidence on the mental health of LGBT people in Ireland is inconclusive
partly because of the difficulty of defining or recruiting samples that are
representative of all non-heterosexual people. This was especially relevant
in this research project as there were limitations on resources such as time,
access to participants and financial backing.
Avenues for further research
The qualitative interviews opened up new avenues for research in two areas
in particular; Firstly the idea of the “Bi Route” and secondly, the issue of
having to constantly come out for non-heterosexual people who are not
'overtly gay' or who do not fit homosexual stereotypes.
A theme which came up on several occasions with female participants was
the phenomenon of initially coming out as bisexual in order to “soften the
blow” for your friends and family. This could be analysed on a theoretical
level as a manifestation of the minority stress model; an attempt to avoid
44

52. being excluded or isolated from heteronormative society based on the
perceived stigma and discrimination associated with being gay. I found the
gender divide particularly interesting...the boys came out as gay initially
whereas the girls in a sense blurred their sexual identity by slowly
descending the spectrum of sexuality over significant periods of time, they
initially defined themselves as bisexual even though they knew they were in
fact homosexual.
Interestingly, in the quantitative analysis, comparison of means between
the mental well-being variable and each group of the sexual identity
variable (Table #2) the bisexual group had a higher mean than the
homosexual group, 30.2759 : 28.9403, and was almost at the same level as
the heterosexual group, 30.9117. This suggests that the mental well-being
of the bisexuals in the survey was on average higher than that of the
homosexuals – Is there some correlation between this and the female
interviewees coming out as bisexual? A study of the literature within the
field shows a lack of research focused on this phenomenon.
Stereotypes and generalisations about the physical characteristics of a gay
person result in the necessity for those who do not fit these stereotypes to
undergo an almost daily 'coming out' ritual, in a myriad of social settings
where heterosexuality is assumed. The heteronormative society's habit of
attaching overtly feminine characteristics to gay men and overtly masculine
characteristics to gay women enforces these stereotypes. While there is a
lot of literature on sexual orientation based stereotypes, there is an absence
of literature studying the effects of having to constantly 'come out' on the
mental health of gay men and women who do not fit these stereotypes.
The qualitative data generated issues which could be addressed further in
such interviews, for example, the inclusion of a question in the interviews
which addressed the reasons why the female participants originally came
out as bisexual. Future researchers wishing to study this issue/topic should
format their research questions and allow for a more deductive approach
with regard to qualitative and quantitative data – this would allow for the
exploration of relationships or patterns not previously theorised.
45

53. Conclusion
This study supports the majority of the literature which links sexual
orientation with lower levels of mental well-being and demonstrates the
effect of sexual orientation in an Irish context. Social norms play a large
part in the production of a heteronormative society and other social factors
such as alcohol and unemployment combine to worsen the influence of
sexual orientation on mental well-being.
46

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