Relationship between sexual orientation and psychotic experiences in the general population in England

Background: Non-heterosexual individuals are at high risk for a variety of factors associated with the emergence of psychotic experiences (PEs) (e.g., common mental disorders, substance use, stress). However, there is a scarcity of data on the association between sexual orientation and PEs. Therefore, the aim of this study was to examine the sexual orientation-PE relationship, and to identify potential mediators in this relationship. Methods: This study used nationally representative cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey (APMS). Sexual orientation was dichotomized into heterosexual and non-heterosexual. Past 12-month PE was assessed with the Psychosis Screening Questionnaire. Regression and mediation analyses were conducted to analyze the association between sexual orientation and PEs, and to identify potential mediators involved in this relationship. Results: The final sample consisted of 7275 individuals aged ≥16 years. The prevalence of non-heterosexual orientation and any PE was 7.1% and 5.5%, respectively. After adjusting for sex, age, and ethnicity, non-heterosexual orientation was positively associated with any PE (OR=1.99; 95%CI=1.34-2.93). The strongest mediators involved in this relationship were BPD traits (mediated percentage=33.5%), loneliness (29.1%) and stressful life events (25.4%). Conclusions: These findings suggest that there is a positive relationship between sexual orientation and PEs in the general population in England, and that underlying mechanisms may involve BPD traits, loneliness and stressful life events. Future studies with a longitudinal design are warranted to shed more light on how these factors are implicated in the association between sexual orientation and PEs.