Social relationships, psychological distress, and physical health in sexual minority and heterosexual middle-aged and older adults in the Canadian Longitudinal Study on Aging

Social connections are crucial for healthy aging, and health disparities are particularly pronounced among sexual minorities. This secondary data analysis investigates longitudinal associations between social relationships and physical health in 1,057 participants of whom 26% identified as lesbian, 50% as gay, and 24% as bisexual people (Mage = 59 years, 38% women, 62% men) and a matched heterosexual control group. Participants reported social support, social isolation, and health behaviors 3 times at 3-year intervals; a subset (n = 665) provided information on psychological distress and physiological assessments. Lesbian, gay, and bisexual adults reported lower social support, higher social isolation, higher psychological distress, and lower physical activity (only men), compared to heterosexual controls. Groups did not significantly differ in nutritional risk or allostatic load. Social vulnerabilities were most prominent among gay and bisexual men as well as bisexual women, but not lesbian women. Controlling for autoregressive effects, we found little evidence for longitudinal associations of social support or social isolation with physical health. However, we found indirect associations between lower social support and subsequent worse physical health (nutritional risk, physical activity, allostatic load) mediated by increased psychological distress (both groups). Findings underscore the need for interventions to increase social belonging, and to address the unique social and physical health challenges of aging sexual minority adults.