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Over the past decades, public health research has started to examine the higher risk of mental health concerns among sexual minorities (e.g., lesbian, gay, or bisexual individuals) when compared with heterosexual individuals. Until more recently, most of this research has been coming from North America and focused on theories of stigma and minority stress in their attempt to explain these elevated rates of mental health problems. Minority stress theory posit stigma to be a root cause of the higher risk of mental health problems among sexual minorities and that stigma results in victimization, discrimination, internalized homonegativity, and identity concealment, which erodes mental health. Exposure to such minority stressors may differ across structural climates, based on population attitudes, discriminatory legislation, and unequal policies. In this way, such structural forms of stigma toward sexual minorities may foster increased exposure to minority stressors and elevated levels of mental health problems among sexual minorities. However, the evidence on these mechanisms remains limited as they have only recently become a topic of research. This workshop includes five empirical presentations from various structural contexts. It focuses on the elevated risk of mental health problems among sexual minorities across these settings, on identifying minority stressors in high-stigma countries, and on linking country-level structural stigma to experiences of minority stressors to explain poor mental health among sexual minorities. First, Michal Pitonak will present results from the first Czech population-based study showing higher rates of substance use, psychological distress, and low life satisfaction among sexual minorities compared to heterosexual individuals. Second, Giuseppina Lo Moro will present results from Italy showing a higher likelihood of depressive symptoms and mental health treatment among sexual minority medical students compared to their heterosexual peers. Next, Guillermo Martínez-Pérez will present findings on experiences of minority stress among Senegalese bisexual men and linkages to mental health. Finally, Arjan van der Star will extend these findings with data showing how the mental health effects of structural stigma and minority stress may be related to time both before and since migrating among migrant sexual minority men in the low-structural-stigma context of Sweden. Key messages Sexual minorities across the globe are at an increased risk for mental health problems and stigma-based minority stress experiences compared with heterosexual individuals. Structural forms of stigma, such as country-specific negative societal attitudes and discriminatory laws, may drive this elevated risk depending on length of exposure.

5.M. Workshop: Sexual minorities' mental health and their experiences of stigma and minority stress across settings