Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Homophobia, economic precarity and the well-being of sexual and gender diverse people in a 153-country survey

Nature Human Behaviour (2025)Cite this article

Subjects

Abstract

Here we explore the well-being of sexual and gender diverse (LGBTQ+) people using three socioecological dimensions of homophobia, family, community and national and their socioeconomic status via a convenience sample of 82,324 participants. Participants from the Middle East and North Africa reported the lowest subjective well-being (mean 4.78, s.d. of 2.70), followed by Eastern Europe and Central Asia (mean 5.22, s.d. of 2.13). The Structural Homophobic Climate Index (β = −1.68, 95% confidence interval (CI) −2.38 to −0.99) and family-level homophobia (β = −0.84, 95% CI −0.87 to −0.81) were negatively related to LGBTQ+ well-being. Economic precarity significantly interacted with the negative association between homophobia and participants’ well-being. The weight of a country’s homophobic climate on well-being was nearly halved for economically secure participants compared with those economically deprived. Participants unaware of their human immunodeficiency virus status reported the lowest well-being (β = −0.20, 95% CI −0.23 to −0.16) controlling for homophobia. Public health measures should address homophobic stigma and discrimination, focusing on the lowest socioeconomic strata.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Distribution of the LGBTQ+ happiness index worldwide.
Fig. 2: Distribution of individual-level homophobic measures worldwide.
Fig. 3: Strength of the association between homophobia and well-being by sexual identity and region.

Similar content being viewed by others

Data availability

The data supporting the findings of this study are available from the corresponding author (E.L.) to all accredited researchers upon request and signature of a declaration of confidentiality and privacy. Please note that due to the existence of national legislation criminalizing sexual and gender diverse people, the above declaration requests all data related to the LGBTI Global Survey to be treated following the EU Directive 95/46/EC and as amended, replaced or superseded from time to time, including by the EU General Data Protection Regulation 2016/679 (GDPR).

References

  1. Allardt, E. Dimensions of welfare in a comparative Scandinavian study. Acta Sociol. 19, 227–239 (1976).

    Article  Google Scholar 

  2. King, M. F., Renó, V. F. & Novo, E. M. L. M. The concept, dimensions and methods of assessment of human well-being within a socioecological context: a literature review. Soc. Indic. Res. 116, 681–698 (2014).

    Article  Google Scholar 

  3. Stiglitz, J. E., Sen, A. & Fitoussi, J.-P. Report by the Commission on the Measurement of Economic Performance and Social Progress (Commission on the Measurement of Economic Performance and Social Progress Paris, 2009).

  4. Diener, E. Subjective well-being. Psychol. Bull. 95, 542–575 (1984).

    Article  CAS  PubMed  Google Scholar 

  5. Diener, E., Oishi, S. & Tay, L. Advances in subjective well-being research.Nat. Hum. Behav. 2, 253–260 (2018).

    Article  PubMed  Google Scholar 

  6. Helliwell, J. F. et al. World Happiness Report 2022 (Sustainable Development Solutions Network, 2022).

  7. Ngoo, Y. T., Tey, N. P. & Tan, E. C. Determinants of life satisfaction in Asia. Soc. Indic. Res. 124, 141–156 (2015).

    Article  Google Scholar 

  8. Adger, W. N. Vulnerability. Glob. Environ. Change 16, 268–281 (2006).

    Article  Google Scholar 

  9. Stavrova, O. How much do sources of happiness vary across countries? A review of the empirical literature. Kölner Z. für Soziologie und Sozialpsychologie 71, 429–464 (2019).

    Article  Google Scholar 

  10. Bartram, D. Age and life satisfaction: getting control variables under control. Sociology 55, 421–437 (2021).

    Article  Google Scholar 

  11. Rothblum, E. D. The Oxford Handbook of Sexual and Gender Minority Mental Health (Oxford Univ. Press, 2020).

  12. Sexual and Gender Minority Research Office (NIH). NIH definition of SGM. National Institutes of Health https://grants.nih.gov/grants/guide/notice-files/NOT-OD-19-139.html (2022).

  13. Terminology. Centers for Disease Control and Prevention https://www.cdc.gov/reproductive-health/glossary/index.html (2022).

  14. Powdthavee, N. & Wooden, M. Life satisfaction and sexual minorities: evidence from Australia and the United Kingdom. J. Econ. Behav. Organ. 116, 107–126 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Stanton, M. C., Ali, S. & Chaudhuri, S. Individual, social and community-level predictors of wellbeing in a US sample of transgender and gender non-conforming individuals. Cult. Health Sex. 19, 32–49 (2017).

    Article  PubMed  Google Scholar 

  16. Simons, L., Schrager, S. M., Clark, L. F., Belzer, M. & Olson, J. Parental support and mental health among transgender adolescents. J. Adolesc. Health 53, 791–793 (2013).

    Article  PubMed  Google Scholar 

  17. Hutton, V. E., Misajon, R. & Collins, F. E. Subjective wellbeing and ‘felt’ stigma when living with HIV. Qual. Life Res. 22, 65–73 (2013).

    Article  PubMed  Google Scholar 

  18. Detrie, P. M. & Lease, S. H. The relation of social support, connectedness, and collective self-esteem to the psychological well-being of lesbian, gay, and bisexual youth. J. Homosex. 53, 173–199 (2007).

    Article  PubMed  Google Scholar 

  19. Meyer, I. H. Resilience in the study of minority stress and health of sexual and gender minorities. Psychol. Sex. Orientat. Gend. Divers 2, 209–213 (2015).

    Article  Google Scholar 

  20. Diaz, R. M., Ayala, G., Bein, E., Henne, J. & Marin, B. V. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am. J. Public Health 91, 927–932 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Meyer, I. H. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol. Bull. 129, 674–697 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mann, S., Blackaby, D. & O'Leary, N. Sexual identity and wellbeing: a distributional analysis. Econ. Lett. 181, 133–136 (2019).

    Article  Google Scholar 

  23. Thoma, B. C., Eckstrand, K. L., Montano, G. T., Rezeppa, T. L. & Marshal, M. P. Gender nonconformity and minority stress among lesbian, gay, and bisexual individuals: a meta-analytic review. Perspect. Psychol. Sci. 16, 1165–1183 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Danil, L. R. Queerphobic immunopolitics in the case of HIV/AIDS: political economy, the dark legacy of British colonialism, and queerphobia in sub-Saharan Africa. Sex. Culture 25, 377–395 (2021).

    Article  Google Scholar 

  25. Ngidi, N. D., Mkhize, N. & Sibeko, B. B. Queer-Identifying Boys, the School Toilet, and Queerphobia (Oxford Univ. Press, 2021).

  26. Banerjee, S. & Nguyen, H. M. Dataset for identification of queerphobia. J. Student Res. 12, 4405 (2023).

  27. Worthen, M. G. F. Queer identities in the 21st century: reclamation and stigma. Curr. Opin. Psychol. 49, 101512 (2023).

    Article  PubMed  Google Scholar 

  28. Herek, G. M. The context of anti-gay violence: notes on cultural and psychological heterosexism. J. Interpers. Violence 5, 316–333 (1990).

    Article  Google Scholar 

  29. Fraïssé, C. & Barrientos, J. The concept of homophobia: a psychosocial perspective. Sexologies 25, e65–e69 (2016).

    Article  Google Scholar 

  30. Altman, D. et al. Men who have sex with men: stigma and discrimination. Lancet 380, 439–445 (2012).

    Article  PubMed  Google Scholar 

  31. McLeroy, K. R., Bibeau, D., Steckler, A. & Glanz, K. An ecological perspective on health promotion programs. Health Educ. Q. 15, 351–377 (1988).

    Article  CAS  PubMed  Google Scholar 

  32. Chaudoir, S. R., Wang, K. & Pachankis, J. E. What reduces sexual minority stress? A review of the intervention ‘toolkit’. J. Soc. Issues 73, 586–617 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hatzenbuehler, M. L. in The Oxford Handbook of Stigma, Discrimination, and Health (eds Major, B. et al.) 105–121 (Oxford Univ. Press, 2017).

  34. Lamontagne, E. et al. A socioecological measurement of homophobia for all countries and its public health impact. Eur. J. Public Health 28, 967–972 (2018).

    Article  PubMed  Google Scholar 

  35. Mendos, L. R. et al. in State-Sponsored Homophobia 2020: Global Legislation Overview Update 331 (ILGA, 2020).

  36. Burgess, D., Lee, R., Tran, A. & Van Ryn, M. Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons. J. LGBT Health Res. 3, 1–14 (2007).

    Article  PubMed  Google Scholar 

  37. Burgess, D., Lee, R., Tran, A. & Van Ryn, M. Erratum: effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons. J. LGBT Health Res. 3, 1–14 (2008).

  38. Hatzenbuehler, M. L. et al. Structural stigma and all-cause mortality in sexual minority populations. Soc. Sci. Med. 103, 33–41 (2014d).

    Article  PubMed  Google Scholar 

  39. Williams, A. J., Arcelus, J., Townsend, E. & Michail, M. Understanding the processes underlying self-harm ideation and behaviors within LGBTQ+ young people: a qualitative study. Arch. Suicide Res. 25, 1–17 (2021).

    Google Scholar 

  40. Murchison, G. R. et al. Transgender/nonbinary young adults’ exposure to cissexism-related social stressors: variation across gender groups. Soc. Sci. Med. 329, 116013 (2023).

  41. Human Rights Watch. #outlawed: ‘The love that dare not speak its name’. LGBT Rights https://features.hrw.org/features/features/lgbt_laws/single.html (2019).

  42. Latour, B. One more turn after the social turn: easing science studies into the non-modern world. Soc. Dimens. Sci. 292, 272–294 (1992).

    Google Scholar 

  43. Dopfer, K., Foster, J. & Potts, J. Micro–meso–macro. J. Evol. Econ. 14, 263–279 (2004).

    Article  Google Scholar 

  44. Dopfer, K. Evolutionary economic geography: the role of economics and why consilience matters. Camb. J. Reg. Econ. Soc. 16, 599–606 (2023).

    Article  Google Scholar 

  45. Logie, C. H., Newman, P. A., Chakrapani, V. & Shunmugam, M. Adapting the minority stress model: associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Soc. Sci. Med. 74, 1261–1268 (2012).

    Article  PubMed  Google Scholar 

  46. Logie, C. H., James, L., Tharao, W. & Loutfy, M. R. HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario. Canada. PLoS Med. 8, e1001124 (2011).

    Article  PubMed  Google Scholar 

  47. Krupchanka, D. et al. Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic. Soc. Sci. Med. 212, 129–135 (2018).

    Article  CAS  PubMed  Google Scholar 

  48. Farber, R. Discrimination, health, and resistance for Thai transgender women. J. Racial Ethn. Health Dispar. 11, 1124–1138 (2024).

    Article  Google Scholar 

  49. Reupert, A. A socio-ecological framework for mental health and well-being. Adv. Ment. Health 15, 105–107 (2017).

    Article  Google Scholar 

  50. Cramer, R. J. et al. Social–ecological correlates of social well-being in transgender and gender diverse adults in the USA: implications for policy, theory, and research. Sex. Res. Social Policy 21, 14–33 (2024).

    Google Scholar 

  51. van der Star, A. The socioecology of sexual minority stigma: advancing theory on stigma-based mechanisms underlying sexual orientation-based disparities in health. Soc. Sci. Med. 363, 117484 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Andersen, R. & Fetner, T. Economic inequality and intolerance: attitudes toward homosexuality in 35 democracies. Am. J. Polit. Sci. 52, 942–958 (2008).

    Article  Google Scholar 

  53. Das, K. V. et al. Understanding subjective well-being: perspectives from psychology and public health. Public Health Rev. 41, 25 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  54. Khder, M. A., Sayfi, M. A. & Fujo, S. W. Analysis of world happiness report dataset using machine learning approaches. Int. J. Adv. Soft Comput. Appl. 14, 49–63 (2022).

    Google Scholar 

  55. Wang, B., Zhao, H., Shen, H. & Jiang, Y. Socioeconomic status and subjective well-being: the mediating role of class identity and social activities. PLoS ONE 18, e0291325 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Badgett, M. V. L., Durso, L. E., Mallory, C. & Kastanis, A. The business impact of LGBT-supportive workplace policies. The Williams Institute, UCLA School of Law https://williamsinstitute.law.ucla.edu/publications/impact-lgbt-supportive-workplaces/ (2013).

  57. Badgett, M. V. L., Nezhad, S., Waaldijk, K. & van der Meulen Rodgers, Y. The Relationship Between LGBT Inclusion and Economic Development: An Analysis of Emerging Economies (The Williams Institute, UCLA School of Law, 2014).

  58. Badgett, M. L., Choi, S. K. & Wilson, B. LGBT Poverty in the United States (The Williams Institute and American Foundation for Suicide, 2019).

  59. Gailits, N. et al. Fighting for inclusion across borders: Latin American trans women’s health in Canada. Int. J. Transgend. Health 23, 5–23 (2022).

    PubMed  Google Scholar 

  60. Badgett, M. V. L., Waaldijk, K. & Rodgers, Y. v. d. M. The relationship between LGBT inclusion and economic development: macro-level evidence. World Dev. 120, 1–14 (2019).

    Article  Google Scholar 

  61. Badgett, M. L. The Economic Case for LGBT Equality: Why Fair and Equal Treatment Benefits Us All (Beacon, 2020).

  62. Lorey, I. State of Insecurity: Government of the Precarious (Verso Books, 2015).

  63. Frost, D. M., Fine, M., Torre, M. E. & Cabana, A. Minority stress, activism, and health in the context of economic precarity: results from a national participatory action survey of lesbian, gay, bisexual, transgender, queer, and gender non-conforming youth. Am. J. Community Psychol. 63, 511–526 (2019).

    Article  PubMed  Google Scholar 

  64. Julià, M., Vanroelen, C., Bosmans, K., Van Aerden, K. & Benach, J. Precarious employment and quality of employment in relation to health and well-being in Europe. Int. J. Health Serv. 47, 389–409 (2017).

    Article  PubMed  Google Scholar 

  65. Gray, B. J., Grey, C. N. B., Hookway, A., Homolova, L. & Davies, A. R. Differences in the impact of precarious employment on health across population subgroups: a scoping review. Perspect. Public Health 141, 37–49 (2021).

    Article  CAS  PubMed  Google Scholar 

  66. Marmot, M. Social determinants of health inequalities. Lancet 365, 1099–1104 (2005).

    Article  PubMed  Google Scholar 

  67. Allen, J., Balfour, R., Bell, R. & Marmot, M. Social determinants of mental health. Int. Rev. Psychiatry 26, 392–407 (2014).

    Article  PubMed  Google Scholar 

  68. Hatzenbuehler, M. L., Lattanner, M. R., McKetta, S. & Pachankis, J. E. Structural stigma and LGBTQ+ health: a narrative review of quantitative studies. Lancet Public Health 9, e109–e127 (2024).

    Article  PubMed  Google Scholar 

  69. Lesbian, Gay, and Bisexual People Say They Experience a Lower Quality of Life (Office for National Statistics, 2017).

  70. Anderssen, N., Sivertsen, B., Lønning, K. J. & Malterud, K. Life satisfaction and mental health among transgender students in Norway. BMC Public Health 20, 138 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Bartram, D. Sexual orientation and life satisfaction. J. Sociol. 59, 20–35 (2023).

    Article  Google Scholar 

  72. Gillespie, B. J., Frederick, D., Harari, L. & Grov, C. Homophily, close friendship, and life satisfaction among gay, lesbian, heterosexual, and bisexual men and women. PLoS ONE 10, e0128900 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  73. Bränström, R. & Pachankis, J. E. Country-level structural stigma, identity concealment, and day-to-day discrimination as determinants of transgender people’s life satisfaction. Soc. Psychiatry Psychiatr. Epidemiol. 56, 1537–1545 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  74. Ummak, E., Toplu-Demirtaş, E., Pope, A. L. & Moe, J. The influence of internalized heterosexism on life satisfaction: comparing sexual minority women in Belgium and Turkey. Curr. Psychol. 42, 7421–7432 (2023).

    Article  Google Scholar 

  75. Jebb, A. T., Tay, L., Diener, E. & Oishi, S. Happiness, income satiation and turning points around the world. Nat. Hum. Behav. 2, 33–38 (2018).

    Article  PubMed  Google Scholar 

  76. Cantril, H. The Pattern of Human Concerns (Rutgers Univ. Press, 1965).

  77. The EMIS Network. EMIS-2017—The European Men-Who-Have-Sex-with-Men Internet Survey. Key Findings from 50 Countries Report no. 978-92-9498-341-1 (European Centre for Disease Prevention and Control, 2019).

  78. The EMIS Network. EMIS 2010: The European Men-Who-Have-Sex-with-Men Internet Survey. Findings from 38 Countries (European Centre for Disease Prevention and Control, 2013).

  79. Helliwell, J. F., Layard, R., Sachs, J. & De Neve, J. E. World Happiness Report 2020 (Sustainable Development Solutions Network, 2020).

  80. Blanchflower, D. G. Is happiness U-shaped everywhere? Age and subjective well-being in 145 countries. J. Popul. Econ. 34, 575–624 (2021).

    Article  PubMed  Google Scholar 

  81. Blanchflower, D. G. & Oswald, A. J. Is well-being U-shaped over the life cycle?. Soc. Sci. Med. (1982) 66, 1733–1749 (2008).

    Article  Google Scholar 

  82. Steptoe, A. P., Deaton, A. P. & Stone, A. A. P. Subjective wellbeing, health, and ageing. Lancet 385, 640–648 (2015).

    Article  PubMed  Google Scholar 

  83. Graham, C. & Pozuelo, J. R. Happiness, stress, and age: how the U curve varies across people and places. J. Popul. Econ. 30, 225–264 (2017).

    Article  Google Scholar 

  84. Budescu, D. V. Dominance analysis: a new approach to the problem of relative importance of predictors in multiple regression. Psychol. Bull. 114, 542–551 (1993).

    Article  Google Scholar 

  85. Azen, R. & Budescu, D. V. The dominance analysis approach for comparing predictors in multiple regression. Psychol. Methods 8, 129–148 (2003).

    Article  PubMed  Google Scholar 

  86. Gelman, A. & Hill, J. Data Analysis Using Regression and Multilevel/Hierarchical Models (Cambridge Univ. Press, 2007).

  87. Schröder, C. & Yitzhaki, S. Revisiting the evidence for cardinal treatment of ordinal variables. Eur. Econ. Rev. 92, 337–358 (2017).

    Article  Google Scholar 

  88. Bond, T. N. & Lang, K. The sad truth about happiness scales. J. Polit. Econ. 127, 1629–1640 (2019).

    Article  Google Scholar 

  89. Bloem, J. R. & Oswald, A. J. The analysis of human feelings: a practical suggestion for a robustness test. Rev. Income Wealth 68, 689–710 (2022).

    Article  Google Scholar 

  90. Hatzenbuehler, M. L., Keyes, K. M. & Hasin, D. S. State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. Am. J. Public Health 99, 2275–2281 (2009).

  91. Hatzenbuehler, M. L. Structural stigma: research evidence and implications for psychological science. Am. Psychol. 71, 742–751 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Pachankis, J. E. et al. The geography of sexual orientation: structural stigma and sexual attraction, behavior, and identity among men who have sex with men across 38 European countries. Arch. Sex. Behav. 46, 1491–1502 (2017).

    Article  PubMed  Google Scholar 

  93. Ryan, C., Russell, S. T., Huebner, D., Diaz, R. & Sanchez, J. Family acceptance in adolescence and the health of LGBT young adults. J. Child Adolesc. Psychiatr. Nurs. 23, 205–213 (2010).

    Article  PubMed  Google Scholar 

  94. Shilo, G. & Savaya, R. Effects of family and friend support on LGB youths’ mental health and sexual orientation milestones. Fam. Relat. 60, 318–330 (2011).

    Article  Google Scholar 

  95. Wang, Y. C., Miao, N. F. & Chang, S. R. Internalized homophobia, self-esteem, social support and depressive symptoms among sexual and gender minority women in Taiwan: an online survey. J. Psychiatr. Ment. Health Nurs. 28, 601–610 (2021).

    Article  PubMed  Google Scholar 

  96. Ryan, C., Huebner, D., Diaz, R. M. & Sanchez, J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 123, 346–352 (2009).

    Article  PubMed  Google Scholar 

  97. Wong, J. Y.-H. et al. Dating violence, quality of life and mental health in sexual minority populations: a path analysis. Qual. Life Res. 26, 959–968 (2017).

    Article  PubMed  Google Scholar 

  98. Therborn, G. African Families in a Global Context (Nordic Africa Institute, 2004).

  99. Schrimshaw, E. W., Siegel, K., Downing, M. J. & Parsons, J. T. Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men. J. Consult. Clin. Psychol. 81, 141–153 (2013).

    Article  PubMed  Google Scholar 

  100. Gyamerah, A. O., Collier, K. L., Reddy, V. & Sandfort, T. G. Sexuality disclosure among Black South African MSM and responses by family. J. Sex. Res. 56, 1203–1218 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  101. Mayeza, E. South African LGBTPQ youth: the perceptions and realities of coming out and parental reactions. J. GLBT Fam. Stud. 17, 292–303 (2021).

    Article  Google Scholar 

  102. Gwenzi, G. D. in Family in Southern Africa (eds Rugunanan, P. & Xulu-Gama, N.) 75–88 (Springer, 2023).

  103. Ross, M. W. & Anderson, A. M. in Research in the Social Scientific Study of Religion (eds Village, A. & Hood, R. L. Jr) 160–172 (Brill, 2014); http://booksandjournals.brillonline.com/content/books/b9789004272385s010

  104. Therborn, G. The killing fields of inequality. Int. J. Health Serv. 42, 579–589 (2012).

    Article  PubMed  Google Scholar 

  105. Peterson, E. W. F. Is economic inequality really a problem? A review of the arguments. Soc. Sci. 6, 147 (2017).

    Article  Google Scholar 

  106. Clench-Aas, J. & Holte, A. Measures that increase social equality are effective in improving life satisfaction in times of economic crisis. BMC Public Health 18, 1233 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  107. Topuz, S. G. The relationship between income inequality and economic growth: are transmission channels effective?. Soc. Indic. Res. 162, 1177–1231 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  108. Wang, Z., Jetten, J. & Steffens, N. K. in The Social Psychology of Inequality (eds Jetten, J. & Peters, K.) 289–303 (Springer, 2019).

  109. Macchia, L., Plagnol, A. C. & Powdthavee, N. Buying happiness in an unequal world: rank of income more strongly predicts well-being in more unequal countries. Personal. Soc. Psychol. Bull. 46, 769–780 (2020).

    Article  Google Scholar 

  110. FitzRoy, F. R. & Nolan, M. A. Income status and life satisfaction. J. Happiness Stud. 23, 233–256 (2022).

    Article  PubMed  Google Scholar 

  111. Wirajing, M. A. K., Nchofoung, T. N. & Nanfosso, R. T. Revisiting the Inequality–Well-Being Nexus: The Case of Developing Countries (Global Social Welfare, 2023).

  112. Shangani, S., Gamarel, K. E., Ogunbajo, A., Cai, J. & Operario, D. Intersectional minority stress disparities among sexual minority adults in the USA: the role of race/ethnicity and socioeconomic status. Cult. Health Sex. 22, 398–412 (2020).

    Article  PubMed  Google Scholar 

  113. Bränström, R., Fellman, D. & Pachankis, J. Structural stigma and sexual minority victimization across 28 countries: the moderating role of gender, gender nonconformity, and socioeconomic status. J. Interpers. Violence 38, 3563–3585 (2023).

    Article  PubMed  Google Scholar 

  114. Hatzenbuehler, M. L. How does sexual minority stigma ‘get under the skin’? A psychological mediation framework. Psychol. Bull. 135, 707–730 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  115. Zochniak, K., Lewicka, O., Wybrańska, Z. & Bilewicz, M. Homophobic hate speech affects well-being of highly identified LGBT people. J. Lang. Soc. Psychol. 42, 453–463 (2023).

    Article  Google Scholar 

  116. Alencar Albuquerque, G. et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC Int. Health Hum. Rights 16, 2 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  117. Rees, S. N., Crowe, M. & Harris, S. The lesbian, gay, bisexual and transgender communities’ mental health care needs and experiences of mental health services: an integrative review of qualitative studies. J. Psychiatr. Ment. Health Nurs. 28, 578–589 (2021).

    Article  PubMed  Google Scholar 

  118. Harper, G. W. & Schneider, M. Oppression and discrimination among lesbian, gay, bisexual, and transgendered people and communities: a challenge for community psychology. Am. J. Community Psychol. 31, 243–252 (2003).

    Article  PubMed  Google Scholar 

  119. Coker, T. R., Austin, S. B. & Schuster, M. A. The health and health care of lesbian, gay, and bisexual adolescents. Annu. Rev. Public Health 31, 457–477 (2010).

    Article  PubMed  Google Scholar 

  120. Cooper, V. et al. Which aspects of health care are most valued by people living with HIV in high-income countries? A systematic review. BMC Health Serv. Res. 16, 677 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  121. Moskowitz, J. T. Positive affect predicts lower risk of AIDS mortality. Psychosom. Med. 65, 620–626 (2003).

    Article  PubMed  Google Scholar 

  122. Kraaij, V. et al. Coping, goal adjustment, and psychological well-being in HIV-infected men who have sex with men. AIDS Patient Care STDs 22, 395–402 (2008).

    Article  PubMed  Google Scholar 

  123. Lyons, A., Pitts, M., Grierson, J., Thorpe, R. & Power, J. Ageing with HIV: health and psychosocial well-being of older gay men. AIDS Care 22, 1236–1244 (2010).

    Article  PubMed  Google Scholar 

  124. Saxton, P., Dickson, N. & Hughes, A. Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav. 17, 3133–3144 (2013).

    Article  PubMed  Google Scholar 

  125. Zablotska, I. B. et al. Methodological challenges in collecting social and behavioural data regarding the HIV epidemic among gay and other men who have sex with men in Australia. PloS ONE 9, e113167 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  126. Barros, A. B., Dias, S. F. & Martins, M. R. Hard-to-reach populations of men who have sex with men and sex workers: a systematic review on sampling methods. Syst. Rev. 4, 141 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  127. Baral, S. et al. Population size estimation of gay and bisexual men and other men who have sex with men using social media-based platforms. JMIR Public Health Surveill. 4, e15 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  128. Prah, P. et al. Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys. Sex. Transm. Infect. 92, 455–463 (2016).

    Article  PubMed  Google Scholar 

  129. Chasimpha, S. J. et al. Assessing the validity of and factors that influence accurate self-reporting of HIV status after testing: a population-based study. AIDS 34, 931–941 (2020).

    Article  PubMed  Google Scholar 

  130. Xia, Y. et al. Accuracy of self-reported HIV-testing history and awareness of HIV-positive status in four Sub-Saharan African countries. AIDS 35, 503–510 (2021).

    Article  PubMed  Google Scholar 

  131. Ibbett, H. et al. Topic sensitivity still affects honest responding, even when specialized questioning techniques are used. Conserv. Sci. Pract. 5, e12927 (2023).

    Article  Google Scholar 

  132. Mullinix, K. J., Leeper, T. J., Druckman, J. N. & Freese, J. The generalizability of survey experiments. J. Exp. Polit. Sci. 2, 109–138 (2015).

    Article  Google Scholar 

  133. Ellis, S. F., Savchenko, O. M. & Messer, K. D. Is a non-representative convenience sample of adults good enough? Insights from an economic experiment. J. Econ. Sci. Assoc. 9, 293–307 (2023).

    Article  Google Scholar 

  134. Winton, B. G. & Sabol, M. A. A multi-group analysis of convenience samples: free, cheap, friendly, and fancy sources. Int. J. Soc. Res. Methodol. 25, 861–876 (2022).

    Article  Google Scholar 

  135. Bowen, A. Internet sexuality research with rural men who have sex with men: can we recruit and retain them? J. Sex. Res. 42, 317–323 (2005).

    Article  PubMed  Google Scholar 

  136. O’Connor, J. Outness, Self-esteem, Stigma, Psychological Health and Mobile Dating Application Use in Gay and Bisexual Men. MSc thesis, Dublin Business School (2016).

  137. Vickery S. Queer Connections: Social Media as a Versatile Tool of the Marginalized Moroccan LGBT. Independent Study Project (ISP) Collection, Paper 2522 (SIT Digital Collections, 2016); https://digitalcollections.sit.edu/isp_collection/2522/

  138. Seidenberg, A. B. et al. A national study of social media, television, radio, and internet usage of adults by sexual orientation and smoking status: implications for campaign design. Int. J. Environ. Res. Public Health 14, 450 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  139. Fearon, E. et al. Online socializing among men who have sex with men and transgender people in Nairobi and Johannesburg and implications for public health-related research and health promotion: an analysis of qualitative and respondent-driven sampling survey data. J. Int. AIDS Soc. 23, e25603 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  140. Craig, S. L., Eaton, A. D., McInroy, L. B., Leung, V. W. & Krishnan, S. Can social media participation enhance LGBTQ+ youth well-being? Development of the social media benefits scale. Soc. Media Soc. https://doi.org/10.1177/2056305121988931 (2021).

  141. Zhang, Y. et al. Transgender sexual health in China: a cross-sectional online survey in China. Sex. Transm. Infect. 92, 515–519 (2016).

    Article  PubMed  Google Scholar 

  142. Pew Research Center, Silver, L. & Johnson, C. Internet Connectivity Seen as Having Positive Impact on Life in Sub-Saharan Africa (Pew Research Center, 2018).

  143. Figueredo, M. A. An Examination of Factors That Catalyze LGBTQ Movements in Middle Eastern and North African Authoritarian Regimes (Portland State Univ. 2015).

  144. Bekker S. An Intersectional Analysis of the Systemic Discrimination Confronting LGBTQ+ Individuals in the Middle East: The Cases of Iran, Turkey, and Egypt (University of the Free State, 2023).

  145. Acconcia, G., Perego, A. & Perini, L. LGBTQ activism in repressive contexts: the struggle for (in)visibility in Egypt, Tunisia and Turkey. Soc. Mov. Stud. 23, 207–225 (2024).

    Google Scholar 

  146. Abomah, P. W. & Agbley, R. F. The influence of social media social support on the flourishing homosexual identity: a case study of the lesbian gay bisexual transgender queer (LGBTQ) community in Accra-Ghana. Texila Int. J. Nursing 8, 73–82 (2022).

    Article  Google Scholar 

  147. Pain P. Global LGBTQ Activism: Social Media, Digital Technologies, and Protest Mechanisms (Taylor & Francis, 2023).

  148. Magued, S. The shift to cause framing in Egyptian LGBT advocacy after the January 25 revolution. Curr. Sociol. 71, 470–488 (2023).

    Article  Google Scholar 

  149. Drabble, L. A. et al. Comparing substance use and mental health outcomes among sexual minority and heterosexual women in probability and non-probability samples. Drug Alcohol Depend. 185, 285–292 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  150. Ross, M. W., Månsson, S.-A., Daneback, K., Cooper, A. & Tikkanen, R. Biases in internet sexual health samples: comparison of an internet sexuality survey and a national sexual health survey in Sweden. Soc. Sci. Med. 61, 245–252 (2005).

    Article  PubMed  Google Scholar 

  151. McInroy, L. B. Pitfalls, potentials, and ethics of online survey research: LGBTQ and other marginalized and hard-to-access youths. Soc. Work Res. 40, 83–94 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  152. Ali, A. & David, M. K. Challenges to data collection: digital divide causing double marginalization of the Bagri community in Sindh, Pakistan. IARS Int. Res. J. 11, 24–34 (2021).

    Article  Google Scholar 

  153. Pequegnat, W. et al. Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation. AIDS Behav. 11, 505–521 (2007).

    Article  PubMed  Google Scholar 

  154. Pachankis, J. E. et al. Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS 29, 1239–1246 (2015).

    Article  PubMed  Google Scholar 

  155. Badgett, M., Choi, S. K. & Wilson, B. D. LGBT Poverty in the United States: A Study of Differences Between Sexual Orientation and Gender Identity Groups (The Williams Institute, UCLA School of Law, 2019); https://williamsinstitute.law.ucla.edu/publications/lgbt-poverty-us/

  156. Badgett, M. V. L., Carpenter, C. S. & Sansone, D. LGBTQ economics. J. Econ. Perspect. 35, 141–170 (2021).

    Article  Google Scholar 

  157. Hickson, F., Schmidt, A., Reid, D., Weatherburn, P., Marcus, U. et al. EMIS-2017—The European Men-Who-Have-Sex-with-Men Internet Survey—Key Findings from 50 Countries (European Centre for Disease Prevention and Control, 2019).

  158. Dockery, A. M. Education and Happiness in the School-to-Work Transition (National Centre for Vocational Education Research, 2010).

  159. López-Ruiz, V.-R., Huete-Alcocer, N., Alfaro-Navarro, J.-L. & Nevado-Peña, D. The relationship between happiness and quality of life: a model for Spanish society. PLoS ONE 16, e0259528 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  160. Steiner, P. M., Cook, T. D., Shadish, W. R. & Clark, M. H. The importance of covariate selection in controlling for selection bias in observational studies. Psychol. Methods 15, 250–267 (2010).

    Article  PubMed  Google Scholar 

  161. Trutschel, D., Palm, R., Holle, B. & Simon, M. Methodological approaches in analysing observational data: a practical example on how to address clustering and selection bias. Int. J. Nurs. Stud. 76, 36–44 (2017).

    Article  PubMed  Google Scholar 

  162. European Union Agency for Fundamental Rights. EU LGBTIQ Survey III. European Union https://fra.europa.eu/en/publications-and-resources/data-and-maps/2024/eu-lgbtiq-survey-iii# (2023).

  163. Reyes-Díaz, M. et al. Latin American internet survey for men who have sex with men (LAMIS-2018): design, methods and implementation. PLoS ONE 17, e0277518 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  164. The Key Populations Atlas. UNAIDS https://kpatlas.unaids.org/dashboard (2024).

  165. Kreuter, F., Presser, S. & Tourangeau, R. Social desirability bias in CATI, IVR, and web surveys: the effects of mode and question sensitivity. Public Opin. Q. 72, 847–865 (2009).

    Article  Google Scholar 

  166. Koivula, A., Räsänen, P. & Sarpila, O. Examining Social Desirability Bias in Online and Offline Surveys (Springer, 2019).

  167. Koivula, A. & Sivonen, J. Different sample sources, different results? A comparison of online panel and mail survey respondents. In Proc. International Conference on Human-Computer Interaction (eds Stephanidis, S. et al.) (Springer, 2022).

  168. Arreola, S. et al. Sexual stigma, criminalization, investment, and access to HIV services among men who have sex with men worldwide. AIDS Behav. 19, 227–234 (2015).

    Article  PubMed  Google Scholar 

  169. Lamontagne, E. et al. The Global Internet Survey on Happiness, Health and Well-Being among Sexual and Gender Minority: Design and Methods Working Paper (UNAIDS, 2023).

  170. Chiasson, M. A. et al. HIV behavioral research online. J. Urban Health 83, 73–85 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  171. Zhang, D., Bi, P., Hiller, J. E. & Lv, F. Web-based HIV/AIDS behavioral surveillance among men who have sex with men: potential and challenges. Int. J. Infect. Dis. 12, 126–131 (2008).

    Article  PubMed  Google Scholar 

  172. Guo, Y. et al. A comparison of four sampling methods among men having sex with men in China: implications for HIV/STD surveillance and prevention. AIDS Care 23, 1400–1409 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  173. Databank. World Bank Group https://databank.worldbank.org/home.aspx (2023).

  174. Human development data. UNDP https://hdr.undp.org/data-center (2023).

  175. AIDSinfo online database. UNAIDS http://aidsinfo.unaids.org/ (2025).

  176. Blanchflower, D. G. & Oswald, A. J. Well-being over time in Britain and the USA. J. Public Econ. 88, 1359–1386 (2004).

    Article  Google Scholar 

  177. Ballas, D. & Tranmer, M. Happy people or happy places? A multilevel modeling approach to the analysis of happiness and well-being. Int. Reg. Sci. Rev. 35, 70–102 (2012).

    Article  Google Scholar 

  178. Cheng, T. C., Kim, S. & Koh, K. The Impact of COVID-19 on Subjective Well-being: Evidence from Singapore IZA Discussion Paper No. 13702 (IZA Institute of Economics, 2020); https://ftp.iza.org/dp13702.pdf

  179. Yin, R., Lepinteur, A., Clark, A. E. & D’ambrosio, C. Life satisfaction and the human development index across the world. J. Cross-Cult. Psychol. 54, 233–252 (2023).

    Article  Google Scholar 

  180. Ferrer-i-Carbonell, A. & Frijters, P. How important is methodology for the estimates of the determinants of happiness?. Econ. J. 114, 641–659 (2004).

    Article  Google Scholar 

  181. Gallup, G. World Poll Methodology Technical Report (Gallup, 2009).

  182. International Lesbian G, Bisexual, Trans and Intersex Association & Carroll, A. State-Sponsored Homophobia: a World Survey of Laws: Criminalisation, Protection and Recognition of Same-Sex Love 11th edn (ILGA, 2016).

  183. World Values Survey Association. World Values Survey, Wave 6 2010–2014. Official Aggregate v.20150418 (Analisis Sociologicos, Economicos y Politicos / JD Systems Institute, 2015).

  184. Dulani, B., Gift, S. & Dionne, K. Y. The pan-African research network. Afrobarometer Round 6 http://www.afrobarometer.org (2016).

  185. Kahan, B. C., Jairath, V., Doré, C. J. & Morris, T. P. The risks and rewards of covariate adjustment in randomized trials: an assessment of 12 outcomes from 8 studies. Trials 15, 139 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  186. Downes, M. & Carlin, J. B. Multilevel regression and poststratification versus survey sample weighting for estimating population quantities in large population health studies. Am. J. Epidemiol. 189, 717–725 (2020).

    Article  PubMed  Google Scholar 

  187. Luchman, J. N. Determining relative importance in Stata using dominance analysis: domin and domme. Stata J. 21, 510–538 (2021).

    Article  Google Scholar 

  188. Mooney, C. Z., Duval, R. D & Duvall, R. Bootstrapping: A Nonparametric Approach to Statistical Inference (Sage, 1993).

  189. Mooney, C. Z. Bootstrap statistical inference: examples and evaluations for political science. Am. J. Political Sci. 40, 570–602 (1996).

    Article  Google Scholar 

  190. Kaiser, C. & Vendrik, M. How Threatening Are Transformations of Reported Happiness to Subjective Wellbeing Research? (Center for Open Science, 2019).

Download references

Acknowledgements

We thank the 115,000 LGBTQ+ individuals who responded to the LGBTQ+ Happiness Survey. We thank all the LGBTQ+ networks, civil society organizations, community-based organizations, UNAIDS regional and country offices and partners who promoted the survey. We also thank community activists and celebrities, as well as social networks and ‘dating’ applications, for promoting the survey. We are grateful for the support and expertise of L. Bouvard, A. Lacombe, M. Mahy, C. Protopospescu, K. Sabin, M. Ufarte and A. Yakusik. E.L. received funding from UNAIDS, Geneva, Switzerland. B.V. received funding from the French government under the France 2030 investment plan managed by the French National Research Agency (reference no. ANR-17-EURE-0020) and the Excellence Initiative of Aix-Marseille University - A*MIDEX. V.L. received funding from the Agence nationale de recherche sur le sida et les hépatites virales: grant 22203 PhD fellowship. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Authors and Affiliations

  1. UNAIDS, Equitable Financing, Johannesburg, South Africa

    Erik Lamontagne

  2. Aix-Marseille University, CNRS, EHESS, Centrale Marseille, Aix-Marseille School of Economics, Marseille, France

    Erik Lamontagne & Bruno Ventelou

  3. Aix Marseille University, Inserm, IRD, Sciences Economiques and Sociales de la Santé and Traitement de l’Information Médicale, ISSPAM, Marseille, France

    Vincent Leroy & Sylvie Boyer

  4. LGBT+ Foundation, San Francisco, CA, USA

    Sean Howell

Authors
  1. Erik Lamontagne
    View author publications

    Search author on:PubMed Google Scholar

  2. Vincent Leroy
    View author publications

    Search author on:PubMed Google Scholar

  3. Sean Howell
    View author publications

    Search author on:PubMed Google Scholar

  4. Sylvie Boyer
    View author publications

    Search author on:PubMed Google Scholar

  5. Bruno Ventelou
    View author publications

    Search author on:PubMed Google Scholar

Contributions

E.L., S.H. and B.V. conceptualized the Global LGBTQ+ Happiness Survey. E.L. and S.H. conducted and implemented the Global LGBTQ+ Happiness Survey. E.L., B.V. and S.H. are exclusively responsible for the survey data used in this study. E.L., B.V., V.L. and S.B. conceptualized the study. E.L., B.V., V.L., S.H. and S.B. drafted the paper. V.L., B.V. and E.L. conducted the data analysis. E.L., B.V., V.L. and S.H. were primarily responsible for the final content of the paper. All authors had full access to all the data in the study. E.L., B.V. and V.L. verified the underlying data of the study. All authors approved the final paper. All authors contributed to this article in their personal capacity. The views expressed are their own and do not necessarily represent the views of their respective institutions.

Corresponding author

Correspondence to Erik Lamontagne.

Ethics declarations

Competing interests

E.L. and S.H. declare they work for UNAIDS and the LGBTQ+ Foundation, respectively. Both organizations are engaged in advocacy on HIV and the reduction of societal barriers, including those applied to sexual and gender diverse communities. The other authors declare no competing interests.

Peer review

Peer review information

Nature Human Behaviour thanks Samuel Mann, Sean Waite and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Peer reviewer reports are available.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary Information

Supplementary Material 1. The distribution of participants per sexual and gender diverse categories per region and per age. Supplementary Material 2. A comparative analysis of LGBTQ+ life satisfaction across regions. Supplementary Material 3. A study of LGBTQ+ participants’ subjective well-being with that of the general population. Supplementary Material 4. The association between the three dimensions of homophobia and subjective well-being by sexual identity and by region. Supplementary Material 5. Regressions clustered by the level of economic precarity of LGBTQ+ participants. Supplementary Material 6. An analysis of the association between well-being and economic precarity, by Gini index. Supplementary Material 7. A sensitivity analysis of the happiness index. Supplementary Material 8. Comparison of a subsample of countries with the European MSM Internet Survey (2017). Supplementary Material 9. Preregression tests.

Reporting Summary

Peer Review File

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lamontagne, E., Leroy, V., Howell, S. et al. Homophobia, economic precarity and the well-being of sexual and gender diverse people in a 153-country survey. Nat Hum Behav (2025). https://doi.org/10.1038/s41562-025-02361-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41562-025-02361-9

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing