(PS9-86) The Importance of Analyzing by Sex, Gender, Sexual Orientation, Race, and Ethnicity in Psychopathology Research

Psychopathology researchers often conflate sex and gender (Howard et al., 2017), leading to unclear conclusions about the roles of sex/gender in the development of psychopathology. Even when both women and men are included in samples, analyses are rarely conducted to determine whether findings generalize across sex/gender (Hartung & Lefler, 2019). Thus, these studies are sex/gender-neutral and largely ignore the unique experiences of women, men, and sexual and gender minorities (SGM). Additionally, racial and ethnic minorities are at increased risk for psychopathology (Nguyen et al., 2007); thus, it is also important to consider how race/ethnicity influences symptom presentation (Chapman et al., 2018). In the current study, we examined attention-deficit/hyperactivity disorder (ADHD) and internalizing symptoms (INT; i.e., depression, anxiety) to explore this issue.

Participants (N = 8,684; Mage = 35.52; 26.3% SGM, 25.2% non-White) resided in the USA and completed an online survey via Amazon’s Mechanical Turk. Participants reported ADHD (DSM-5; APA, 2013) and INT (DASS-21; Lovibond & Lovibond, 1995) symptoms and were grouped based on sex/gender/sexual orientation (SGSO; cisgender/heterosexual woman = CHW, cisgender/heterosexual men = CHM, SGM) and race/ethnicity (White vs. non-White). Our non-White group included those who self-identified as Black/African American, Latinx/Hispanic, Middle Eastern/North African, Native American, Pacific Islander/Native Hawaiian, and Multiracial. Levels of ADHD and INT in the Asian American group (n = 748) were significantly lower than the White group, whereas other minority groups reported similar (i.e., Latinx/Hispanic) or higher levels than the White group. Thus, Asian Americans were excluded from the current analyses because they do not seem to be impacted by minority stress in the same way as other minority groups. This has been found in other research as well (e.g., Asian Americans score higher on IQ tests than Whites; Reynolds et al., 2021).

Internal consistency was excellent for ADHD (ɑ = 0.95) and INT (ɑ = .096). We conducted two 3 (CHF vs. CHM vs. SGM) x 2 (White vs. non-White) ANOVAs. For ADHD symptoms, there were significant main effects of SGSO (F = 490, p < .001, ηp2 = .11) and race/ethnicity (F = 46.4, p < .001, ηp2 = .01), and a significant interaction (F = 22.7, p < .001, ηp2 = .01). For INT symptoms, there were significant main effects of SGSO (F = 431, p < .001, ηp2 = .10) and race/ethnicity (F = 52.5, p < .001, ηp2 = .01) and a significant interaction (F = 11.9, p < .001, ηp2 = .00). Both interactions indicated the SGM group had higher severity of symptoms and the highest group was the non-White SGM group. 

The large effect of SGSO on ADHD and INT symptoms suggests that SGM strongly impacts psychopathology symptom presentation. Considering past studies have examined sex/gender in a binary fashion, some studies may have attributed differences to sex/gender that SGM status could better explain. The small interaction effects suggest that the role of intersecting identities may further exacerbate symptom presentation. Thus, it is pertinent that researchers analyze sex/gender/sexual orientation and race/ethnicity in studies of psychopathology.