The Role of Interpersonal Relationships and Household Socioeconomic Status in the Association Between Sexual Orientation and Health: A Moderated Mediation Analysis.

Purpose: Emerging studies indicate that sexual minority youths experience worse health than their heterosexual peers, but few studies have examined the intervening mechanisms linking sexual orientation and health status. This study hypothesizes that interpersonal relationships, moderated by household socioeconomic status (HSES), are important mediators in the association between sexual orientation and health status. Methods: A total of 49,084 youths, consisting of 9499 youths who identified as sexual minority individuals and 39,585 youths who identified as heterosexual, were sampled from a national study on sexual and reproductive health conducted in China. Logistic regression analyses were performed to estimate the association between sexual orientation and self-rated health. Causal mediation and moderated mediation analyses were performed to analyze the mediating and moderating effects of interpersonal relationships and HSES, respectively. Results: Self-rated health was significantly poorer for sexual minority youths compared with heterosexual youths (p < 0.01). From 7.90% to 25.74% of the association between sexual orientation and self-rated health was mediated through poor interpersonal relationships with both parents and peers. A poor relationship with the father accounted for the highest percentage. HSES was found to moderate the mediation effect of interpersonal relationships, with the greatest effect found for sexual minority youths with lower HSES. Conclusion: HSES moderated the indirect effects of interpersonal relationships on the association between sexual orientation and self-rated health. Interventions focused on improving interpersonal relationships for sexual minority youths, especially those with low HSES, merit attention.