Although sexual orientation discrimination (SO-discrimination) is associated with an increased risk of psychiatric and substance use disorders (SUD) among sexual minority (SM) adults, these relationships are not well understood, particularly in the context of SUD severity. To address this gap, we assessed the direct and indirect effect of SO-discrimination and sexual identity on psychiatric disorders and SUD severity in the context of stress and resilience among SM adults. We used data from 3,494 adults reporting nonheterosexual identity, attraction, or behavior collected as part of a nationally representative cross-sectional sample of adults in the United States. Structural equation modeling assessed potential pathways between SO-discrimination, psychiatric disorders, and SUD severity. Past-year psychiatric disorders and SUD severity were significantly correlated in the multivariate model. Concordant homosexual orientation was associated with reduced risk of psychiatric disorders, but not with past-year SUD severity. SO-discrimination was significantly associated with increased risk of psychiatric disorders, but was not a significant predictor of SUD severity. Notably, SO-discrimination was not directly associated with SUD severity, but was found to have a significant indirect effect on SUD severity through psychiatric disorders. SO-discrimination was directly associated with increased risk of psychiatric disorders, and psychiatric disorders mediated the pathway between SO-discrimination and SUD severity. Since psychiatric disorders and SUD are often cooccurring, these data indicate integrated assessment strategies and dual interventions for SM populations.
