Experience of Outing and Mental Health Among Sexual and Gender Minorities in Japan: A Web-Based Cross-Sectional Study

Context: Sexual and gender minorities (SGMs) are at higher risk of mental health problems. Minority stress due to SGMs’ marginalized social status and institutional stigma is considered to affect SGMs’ mental health. Outing, the act of disclosing one’s sexual orientation or gender identity without the person’s consent, is considered minority stress. However, there is a lack of quantitative studies on the association between outing experiences and mental health problems.

Objective: To examine how outing experiences and the range of outing are associated with SGMs’ mental health status.

Study Design and Analysis: A cross-sectional study. Participant characteristics were described. Modified Poisson regression analyses were conducted to examine the associations between outing experiences and mental health status, as well as the range of outing and mental health status. The range of outings was counted from 0 to 3, depending on the number of communities where participants experienced outing: family, friends, and school/workplace. Age, sexuality, education, household income, and employment status were included as explanatory variables.

Setting or Dataset: A dataset of an ongoing cohort study, the Japan COVID-19 and Society Internet Survey, targeting about 2.2 million panelists in Japan via an internet research company. Registration was closed after 32,000 respondents completed the survey between September and October 2022.

Population Studied: SGMs (those who do not identify as both cisgender and heterosexual) aged 18–79.

Outcome Measures: The Kessler 6-Item Psychological Distress Scale (K6) categorized as high, moderate, or low, and suicidal ideation in the past year.

Results: Among 2,596 analyzed participants, 9.3% had experienced outing, and 40.5% were aged between 18 to 34 years. With outing experience compared to without, a multivariable modified Poisson regression analysis showed that the prevalence ratios [95% CI] of [high] K6 score, [high + moderate] K6 score, and suicidal ideation within the past year were 1.36 [1.10–1.68], 1.43 [1.33–1.55], 1.39 [1.17–1.66] respectively. The results also showed that the range of outing had a dose-dependent association with [high] and [high + moderate] K6 scores. No dose-dependent association was found between suicidal ideation and the range of outing.

Conclusions: Experiencing outing is associated with poorer mental health status in Japan. Outing prevention measures should be strengthened for the mental health of SGMs.