"One never dropped a hat pin!": a mixed methods analysis of the factors influencing mental health and wellbeing in middle-aged and older LGBTI+ people in the UK

This thesis explores the factors which influence mental health and wellbeing in middle-aged (MA) and older LGBTI+ people living in the UK. Current research on this topic is limited and the study aims to provide new insights which policy makers, local authorities, community organisations and scientists can consider in their commissioning intentions, policy making and research in the fields of economics and healthcare through the lens of theories relating to minority stress and health equity in ageing. Initial questions were formulated into five thematic hypotheses for testing and analysis. The first three investigate the relationship between wellbeing and discrimination, stigma, social support and identity, the fourth investigates specific effects relating to race and ethnicity and wellbeing, and the final thematic hypothesis investigates factors affecting access to health services from this population group. A mixed methods approach was chosen and an exploratory sequential design model adopted, providing the opportunity for an initial qualitative enquiry to take place, in order to (i) identify topics specific to the UK context and test elements of the international literature; and (ii) to validate the conceptual framework and instruments for wider application, via interviews with 24 participants. The second phase took the format of a national online survey which yielded data from 248 respondents.

Findings from the qualitative phase identified eight major themes for further exploration: identity, ‘coming out’, opinions of others, social support, stigma and discrimination, positive moderators, mental health aspects, and ‘new’ information not identified in the literature – this final area included early insights into the effect of the COVID-19 pandemic on the wellbeing of LGBTI+ people. The survey offered a sense of magnitude of these phenomena through statistical testing, and yielded further insights on age group differences. The outcomes indicate that, even today, there exists significant stigmatization in being LGBTI+, demonstrated through types and levels of discrimination, further compounded when intersections of age and in some cases, race, are included. Positive associations between social support mechanisms offer a strong mitigating effect, both on the wellbeing of older LGBTI+ people, and on how they access healthcare services.

Combining both sets of findings yielded new insights into the wellbeing of LGBTI+ MA/older people, for example, that in some cases, people have better wellbeing as they age. This enabled the conceptual framework to be adapted and a new model to be proposed which contributes to the current knowledge in this field: the Wellbeing Promotion Model. The study also adds to and extends the current academic literature by providing new insights and theoretical perspectives, including the negative associations of economic condition and the COVID-19 pandemic on wellbeing.