Sexual Orientation and Social Isolation from Early Adulthood to Early Midlife

Abstract

Although social isolation is a critical public health issue, there is a gap in understanding how it varies by sexual orientation. Using minority stress, minority strength, and life course perspectives, this study investigates how social isolation trajectories differ by sexual orientation from ages 18 to 42 using longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (2001–2018, N = 30,250 observations). Results from growth curve models reveal that sexual minority respondents experience higher levels of isolation than heterosexual respondents from early adulthood to early midlife. Specifically, respondents who identify as lesbian, gay, or bisexual report the highest levels of social isolation; completely heterosexual respondents have the lowest levels; and mostly heterosexual respondents fall in between. Notably, mostly heterosexual respondents experience a more rapid increase in isolation than the other two groups. Analyses conducted separately by sex and each dimension of social isolation reveal important nuances.

Keywords

life course minority stress sexual orientation social isolation

Numerous studies have documented disparities in health and well-being among sexual minority populations (Hatzenbuehler 2009; Hsieh and Shuster 2021; Liu et al. 2019). Gay and bisexual men continue to have the highest rates of HIV acquisition each year, and lesbian and bisexual women face a greater risk of obesity, cancer, and cardiovascular disease compared to their heterosexual counterparts (Institute of Medicine 2011; National Academies of Sciences, Engineering, and Medicine 2020). Research based on the National Health and Nutrition Examination Surveys-linked mortality file (2001–2010) revealed that gay, lesbian, and bisexual adults had over twice the adjusted hazard rate (i.e., a hazard ratio greater than 2.0) of all-cause mortality as heterosexual adults (Cochran, Björkenstam, and Mays 2016). Sexual minority individuals also report higher levels of depression and anxiety and elevated rates of substance use and suicide than their heterosexual peers (Cooley, Zhang, and Denney 2024; Stacey and Wislar 2023). Financial disparities are also evident: Bisexual men and women are more likely than their heterosexual and gay counterparts to report household incomes below the federal poverty line (Badgett, Carpenter, and Sansone 2021).

Despite this wealth of research, the vast majority of studies on sexual minority disparities have focused on physical, mental, and economic well-being. By contrast, our understanding of the social well-being of sexual minority individuals, particularly relative to heterosexual individuals, remains surprisingly limited. Social well-being, recognized by the World Health Organization as a critical component of overall health, is fundamental to human existence (Holt-Lunstad 2022). Social isolation, defined as the absence of social ties and contact, is a major determinant of health and well-being (Yang et al. 2016). Indeed, objective measures of social isolation exhibit stronger associations with morbidity and mortality than subjective assessments, such as loneliness (House, Landis, and Umberson 1988). Among the factors associated with social isolation, sexual orientation remains one of the least comprehensively studied (Umberson and Donnelly 2023). Considering that social marginalization is a key mechanism driving sexual minority disparities in physical, mental, and economic well-being (National Academies of Sciences, Engineering, and Medicine 2020), this omission is particularly concerning.

A growing number of studies have begun to illuminate the social well-being of sexual minority populations using population-based data. However, these studies often focus on specific age groups (e.g., Hsieh and Wong 2020; Ueno 2005) or combine individuals across age groups to enhance statistical power (e.g., Gustafson, Manning, and Kamp Dush 2023; Stacey, Reczek, and Spiker 2022). To our knowledge, only one study addresses how the social well-being of sexual minority individuals varies across age groups or birth cohorts, and it does not include a comparison group of heterosexual individuals (la Roi et al. 2022). Moreover, prior studies on the well-being of sexual minority populations often center exclusively on lesbian, gay, or bisexual (LGB) individuals, overlooking mostly heterosexual individuals, who are increasingly recognized as a distinct and important subgroup in sexual orientation research (Krueger, Meyer, and Upchurch 2018; Kuyper and Bos 2016).

Longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) provide an unprecedented opportunity to examine the social ties of a single birth cohort (those born between 1974 and 1983) across different stages of the life course. These data allow us to investigate heterogeneity within sexual minority identities and include mostly heterosexual individuals alongside LGB individuals. This study extends existing knowledge by examining how trajectories of social isolation differ by sexual orientation. Furthermore, it considers how these patterns vary by gender, an aspect rarely addressed in prior research (Umberson, Lin, and Cha 2022).

Background

Risk Factors for Social Isolation

Studies have paid far more attention to the consequences of social isolation than to the factors that put individuals at risk for it. Extensive research worldwide has consistently demonstrated that social isolation is associated with an elevated risk of morbidity and mortality (Holt-Lunstad 2022). Researchers have typically operationalized the concept of social isolation (or social connectedness) using measures such as social network size, frequency of contact, and participation in social activities. They have also distinguished different types of ties, such as those with family members, romantic partners, friends, and community members, and have demonstrated their varying importance for subjective well-being (Hsieh and Liu 2021; Hsieh and Wong 2020). Studies that consider the risk factors for isolation find that its prevalence differs by gender, race-ethnicity, social class, and sexual orientation (Umberson and Donnelly 2023). These characteristics capture exposure to stressors and life events that have implications for social isolation. We focus here on how and why social isolation differs for men and women given the centrality of gender in structuring social ties.

Studies have long shown differences between men and women in patterns of social isolation, attributing them to gender as a structural system (Umberson et al. 2022). This system encourages women to be attentive to the needs of others and men to be independent. For instance, women often assume the role of kin-keepers in families, which typically fosters stronger social ties (Lin and Chen 2021). Consistent with this gender system, men tend to experience higher levels of isolation than women across most stages of life (Umberson et al. 2022). Girls display a greater tendency than boys to preserve interpersonal relationships, and this pattern persists over time (Gilligan 1982). Yet in later life, women report higher levels of isolation than men (Waite, Duvoisin, and Kotwal 2021). Umberson et al. (2022) examined trajectories of social isolation in the Add Health and the Health and Retirement Study and found evidence that social isolation increases from adolescence through later life for both men and women. Reflecting the fact that the increases are greater for women than for men, the gender gap in isolation reverses around the age of 50. Widowhood and caregiving responsibilities, such as taking care of a grandchild or an elderly partner, appear to increase isolation for older women (Lin and Chen 2021).

Sexual Orientation and Social Isolation

Prior research on the social isolation of sexual minority populations has used a variety of measures to assess isolation, many of which are subjective (e.g., perceived loneliness). This research has focused heavily on adolescents and relied primarily on community samples. Among sexual minority youth, social isolation has been found to be associated with various indicators of psychological well-being, including mental health disorders, suicidal thoughts, and substance use (Garcia et al. 2020). Studies on this topic rarely use repeated measures of isolation. In a recent exception, la Roi et al. (2022) used fixed-effects models to examine how changes in social support were associated with changes in psychological distress and life satisfaction among sexual minority populations. They found evidence suggesting that cross-sectional studies may overestimate the importance of social ties for life satisfaction and psychological distress.

Only a handful of population-based studies have examined how the social networks of sexual minority populations differ from those of heterosexual populations. Focusing on adolescents from Add Health, Ueno (2005) found that respondents who reported same-sex attraction had friendship networks that were comparable in size to those of respondents who did not report such attraction. Using data from the National Social Life, Health, and Aging (NSHAP) project, Hsieh and Wong (2020) compared the social networks of older adults who identified as LGB with those of their counterparts. They found evidence that the composition of their networks differed but that the size and frequency of contact with network members were similar. Most notably, LGB adults were less likely to have a significant other or family member in their network and more likely to have a friend. Hsieh and Liu (2021), using NSHAP data, found that LGB adults participated less frequently than their heterosexual counterparts in community activities, such as volunteering or attending religious services.

Population-based studies have also examined the social networks of sexual minority populations using subjective measures that capture the type and quality of support received. Using data from Add Health, Ueno (2005) found that adolescents with same-sex attraction reported more difficulty getting along with parents, teachers, and peers than their counterparts without same-sex attraction. Using data from the National Couples’ Health and Time Study, Gustafson et al. (2023) examined the sources of emotional support for adults who identified as sexual minority (e.g., gay, bisexual, queer, or same-gender loving) and found that they were less likely than their heterosexual counterparts to rely on family members for emotional support but more likely to rely on friends. Research distinguishing subgroups within sexual minority populations suggests that gay individuals may be less isolated than those with other identities. Stacey et al. (2022), relying on data from Gallup’s National Health and Well-Being Index, found that adults who identified as bisexual, queer, or same-gender loving reported lower levels of social connectedness than those who identified as heterosexual; however, those who identified as gay did not significantly differ in their connectedness from heterosexual adults. However, la Roi et al. (2022), using data from the Generations Study, reported that adults who identified as gay did not differ significantly from their counterparts who identified as bisexual or something else with respect to their perceived support and size of their support networks.

These seemingly inconsistent findings highlight the importance of examining critical within-group differences among sexual minority populations. Therefore, beyond the traditionally considered sexual minority populations—LGB individuals—we also consider individuals who report being mostly heterosexual as a distinct sexual orientation. Mostly heterosexual individuals are defined as those who report being primarily attracted to other-sex partners while also expressing some degree of same-sex attraction (Kuyper and Bos 2016). Based on a systematic review by Savin-Williams and Vrangalova (2013), these individuals tend to trend more toward same-sex orientations compared to heterosexual individuals but less so than bisexual individuals in terms of both attraction and behavior. Compared to LGB groups, the well-being of mostly heterosexual individuals has received significantly less attention, and we suggest that they may have unique experiences of social isolation compared to heterosexual and LGB individuals.

Most studies on the well-being of sexual minority populations rely on the theoretical framework of minority stress to explain health disparities by sexual orientation (Hsieh and Shuster 2021). The minority stress perspective, pioneered by Brooks (1981) and further developed by Meyer (2003), contends that discrimination, stigma, internalized stigma, identity concealment, and restricted access to resources collectively act as stressors for sexual minority populations, leading to poorer health outcomes, including higher levels of social isolation, compared to heterosexual individuals. Empirical evidence supports this perspective, demonstrating that sexual minority populations regularly encounter minority stressors in their everyday lives. Sexual minority youth, in particular, are more likely than their heterosexual counterparts to experience bullying, violence, and familial rejection (Garcia et al. 2020). Sexual minority adults may fear disclosing their sexual orientation at the workplace (Holman, Ogolsky, and Oswald 2022) or encountering rejection from family or friends (Pachankis and Jackson 2023). To avoid expending energy concealing their identity or to save face, sexual minority individuals may withdraw socially as a stigma-management strategy (Peterie et al. 2019). Minority stress also leads to social withdrawal indirectly through its effects on depression and anxiety (Hsieh and Liu 2021).

Although the minority stress model has been widely used to explain the health disadvantages experienced by sexual minority populations, an emerging literature also outlines how personal and collective strengths in minority populations, often referred to as the minority strength or resilience model (Fredriksen-Goldsen et al. 2017; Perrin et al. 2020), can mitigate these effects. Based on this framework, sexual minority individuals may demonstrate resilience through compensatory mechanisms, such as “families of choice” and community support, which could reduce or even eliminate differences in isolation compared to heterosexual individuals. This framework in combination with the classical minority stress model is particularly helpful for understanding the heterogeneities in social isolation in sexual minority populations. As the largest but often understudied sexual minority group, mostly heterosexual individuals may be exposed to minority stress but lack the protective effects of minority strength or resilience because they are often perceived as heterosexual. Thus, there is an emergent need to study the social well-being of this distinct group.

Trajectories of Social Isolation

Because research concerning disparities in social isolation routinely focuses on a single point in time, we know little about how patterns of isolation evolve over the lifetime, particularly among sexual minority populations (Reczek 2020). Much of what we know about sexual minority disparities in isolation is based on studies that focus on a particular period of the life course or combined several age groups (or birth cohorts) of adults. These studies offer important snapshots but overlook how isolation changes over the lifetime for men and women with different sexual identities. A recent study shows that social isolation generally escalates over the life course due to changes in social roles and challenges related to aging (Umberson et al. 2022). This applies to the current study as well, suggesting that social isolation may increase as individuals transition from early adulthood to early midlife due to several life course changes that affect social networks, opportunities for social engagement, and the quality of relationships. The life course perspective posits that advantages and disadvantages accumulate over an individual’s lifetime, starting in childhood (Elder, Johnson, and Crosnoe 2003). The cumulative disadvantage perspective, in particular, suggests that disparities in social isolation between different groups emerge early on and become amplified with age (Dannefer 2020).

Gendered Trajectories by Sexual Orientation

Population-based research on sexual minority disparities in social isolation routinely includes a control variable for sex (or gender) rather than examining its intersection with sexual orientation—a practice likely driven by sample size limitations. Research on trajectories of social isolation from adolescence to midlife demonstrates that men tend to experience higher levels of isolation compared to women (Umberson et al. 2022). As discussed earlier, societal norms encourage women to cultivate and nurture social ties, whereas men are encouraged to prioritize self-sufficiency and emotional restraint. Consequently, a greater proportion of men than women report feeling isolated or lonely (Umberson et al. 2022). To the extent that gay and bisexual men engage in gendered behavior, they may be doubly disadvantaged in connectedness due to both their gender and stigmatized sexual identity. Similarly, lesbian and bisexual women may face heightened disadvantages due to discrimination based on both their sexual orientation and gender (Everett et al. 2022; Stacey and Wislar 2023).

Research suggests that sexual minority men face more challenges in forging and maintaining ties than sexual minority women. People generally hold more positive views of lesbian women than of gay men (Worthen 2013). Gay and bisexual men experience higher rates of victimization, as exemplified by hate crimes, compared to lesbian and bisexual women (Herek 2009). Additionally, the coping strategies of women and men in response to minority stressors may differ, with women more inclined to seek social and emotional support and men more inclined to withdraw from others or avoid certain topics, potentially exacerbating their social isolation (Tamres, Janicki, and Helgeson 2002). Gay and bisexual men are more likely than their female counterparts to dissolve romantic relationships (Joyner, Manning, and Bogle 2017). Women who identify as lesbian are more likely than men who identify as gay to be married or cohabiting (Badgett et al. 2021). Taken together, these findings suggest that sexual minority men experience higher levels of isolation than sexual minority women.

Much of the prior work on exposure to minority stressors highlights variation in the legal and social climate surrounding sexual minority populations and demonstrates its importance in understanding sexual minority disparities. For instance, research indicates that sexual minority populations fare worse if they reside in a state without protective LGB-related policies (e.g., Nelson, Wardecker, and Andel 2023) or in communities with higher levels of prejudice (e.g., Hatzenbuehler et al. 2020). Despite this variation across locations, the social and legal context surrounding sexual minority populations has changed remarkably in recent decades. As of 1997, no state in the United States legally recognized same-sex unions. In 2015, the United States Supreme Court ruled on Obergefell v. Hodges, effectively allowing same-sex marriage in all states. Changes in legal and social climate could lead to smaller disparities by sexual orientation for more recent cohorts. Interestingly, la Roi et al. (2022) compared sexual minority individuals from three different birth cohorts (those born 1956 to 1963, 1974 to 1984, and 1990 to 1997) and found only minor differences in their support networks. Their findings, along with those of others, are consistent with the notion that sexual minority populations are resilient and form families of choice.

Current Investigation

The Add Health data set offers an unparalleled opportunity to examine how trajectories of social connectedness differ by sexual orientation for men and women from a specific birth cohort. Importantly, Add Health has asked respondents about their sexual orientation identity at each interview, starting with Wave 3. We use data from Waves 3 to 5 of Add Health to examine the intersectionality of gender and sexual orientation in shaping trajectories of social isolation from early adulthood to early midlife. Based on the minority stress perspective, we hypothesize that individuals with sexual minority identities will report higher levels of social isolation compared to individuals with heterosexual identities. Drawing on the cumulative disadvantage perspective, we further hypothesize that the disadvantages experienced by sexual minority individuals will intensify over the life course. However, if minority resilience factors take effect over the life course, as suggested by the minority strength model, we hypothesize that the isolation gap between heterosexual and LGB individuals may not widen because these strengths may compensate for stress. Specifically we expect that although mostly heterosexual individuals experience lower levels of minority stress, they are also less open with family, friends, and community (Kuyper and Bos 2016), which may lead to disadvantaged isolation trajectories compared to individuals who identify as heterosexual or LGB. Building on research on gender and social isolation, we also hypothesize that sexual minority men will display the steepest increases over time and the highest levels of social isolation as they enter midlife. This research breaks new ground by illuminating the intricate interplay between sexual orientation and gender in shaping social isolation, thereby enriching our understanding of the distinct challenges faced by sexual minority populations throughout their lives. This study will further our understanding of health and well-being for a population that may be among the most exposed and vulnerable to social isolation.

Data and Methods

Data

The data for this study were sourced from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort study that began in 1994 to 1995 with adolescents in Grades 7 to 12 in the United States. The study has tracked these individuals from adolescence into adulthood, conducting five interview waves: 1995 (Wave 1), 1996 (Wave 2), 2001 to 2002 (Wave 3), 2008 to 2009 (Wave 4), and 2016 to 2018 (Wave 5). The first four waves were conducted in person, and Wave 5 used an online survey format. Our study specifically focused on 13,860 individuals who were ages 18 to 26 at Wave 3 (early adulthood), 24 to 32 at Wave 4 (early to middle adulthood), and 32 to 42 at Wave 5 (midlife). We included only those with valid responses on all variables of interest, resulting in a total of 30,250 person-year observations.

Measures

The dependent variable, social isolation, was a multidimensional concept and was assessed across four domains: intimate relationship status, friendship, religious attendance, and volunteer activities. We adopted criteria established in previous studies using Add Health data (Umberson et al. 2022; Yang et al. 2016) to measure isolation in each domain. Respondents were assigned 1 point for each domain in which they met the isolation criteria. Relationship status was coded as 1 for those not currently partnered (i.e., not married, cohabiting, or in other types of serious romantic relationships for more than six months) and 0 otherwise. Participants were considered isolated if they fell into the bottom quartile for the friendship variable, had less than monthly religious attendance, and had not volunteered in the past 12 months. The sum of nonmissing values across all domains constituted each individual’s social isolation score (0– 4), and isolation scores were standardized (0, 1) for the present study. We also considered each domain separately in our analyses to address the concern that social isolation differences by sexual orientation might be due to particular dimension(s) of social isolation.

The primary independent variables encompassed sexual orientation, age (continuous, 18–42), and gender (1 = women, 0 = men). Sexual orientation/identity was a time-varying variable that corresponded to the wave when isolation was measured.¹ Although other operationalizations of sexual minority status, such as sexual attraction and sexual contact, have been considered, Add Health’s sexual identity measure has been widely employed to investigate disparities across a range of health outcomes (Liu et al. 2019; Mize 2016; Mollborn and Everett 2015). The measure of sexual identity allowed respondents to identify as completely heterosexual, mostly heterosexual, bisexual, mostly homosexual, or completely homosexual. Analyses using specific categories (e.g., bisexual) revealed similar patterns (see Appendix Table A1 in the online version of the article) to those we report, but some cell sizes were too small for reliable conclusions, especially when conducting sexual minority subgroup analyses by gender. Our final analyses thus combined the categories of bisexual, mostly homosexual, and completely homosexual into a single category, resulting in a three-category sexual orientation variable: heterosexual, mostly heterosexual, and LGB individuals. This categorization has been employed in prior work using the Add Health data (Hsieh and Liu 2021; Li, Pollitt, and Russell 2016; Mollborn and Everett 2015).

Consistent with prior work on social isolation (Umberson et al. 2022), all analyses adjusted for parental educational attainment (categorized as less than high school, high school graduate, some college, and college) and self-identified race-ethnicity (categorized as White, Black, U.S.-born Hispanic, and foreign-born Hispanic). Respondents were coded as either Black or White if they did not indicate Hispanic ethnicity; those who selected Hispanic were categorized as Hispanic. If respondents chose more than one race, they were asked to identify the race that best described their racial background, and they were assigned to that category. This approach is consistent with other studies using the Add Health data (Hargrove 2024; Umberson et al. 2022).

Analytic Approach

We employed growth curve models to investigate social isolation trajectories by sexual orientation from early adulthood to early midlife. Growth curve modeling allowed us to distinguish within-individual (Level 1) and between-individual (Level 2) variations in estimating social isolation trajectories using the longitudinal structure of the data (Fitzmaurice, Laird, and Ware 2011). The analysis began with a change trajectory model of social isolation using age as the analysis time metric. Age was centered by the mean so that the intercept reflects the level of isolation at the average age of 29. We incorporated the interaction of sexual orientation with age at Level 1 to examine how the rate of change in isolation differs across sexual orientation groups. The Level 1 model can be specified as follows:

\begin{array}{l} Y_{i j} = β_{0 i} + β_{1 i} A g e_{i j} + β_{2 i} S e x u a l O r i e n t a t i o n_{i j} \\ + β_{3 i} A g e_{i j} \times S e x u a l O r i e n t a t i o n_{i j} + Z_{i j} + e_{i j}, \end{array}

(1)

where Y_ij represents the dependent variable (i.e., social isolation index of individual i at wave j). Timing-varying covariates indicated by Z_ij were included at Level 1 model. Level 2 submodels were estimated for between-individual differences in isolation trajectories, where the intercept and age coefficient in Level 1 were further modeled as dependent variables using time-constant covariates as predictors. The level 2 model can be specified as follows:

β_{0 i} = γ_{00} + X_{0} B_{0} + μ_{0 i}

(2)

β_{0 i} = γ_{10} + X_{1} B_{1} + μ_{1 i} .

(3)

The growth curve models in this study involved two steps. First, we examined whether there were overall differences in social isolation by sexual orientation (i.e., intercept) and the rate of change in social isolation (i.e., slope). Subsequently, we assessed whether and how social isolation trajectories by sexual orientation differed between women and men. Thus, we stratified the sample by gender to repeat the analyses conducted in the first step. For models predicting each dimension of isolation, we estimated a series of mixed-effects logistic regression models to examine isolation trajectories by sexual orientation across four different domains. To account for potential attrition bias, we included wave-specific indicators (coded as 1 for dropout at a given follow-up) in our analyses (Muthén et al. 2011).

Results

Descriptive Results

Table 1 presents weighted descriptive statistics for all analytical variables from the combined data of Waves 3 to 5 of the Add Health study, categorized by gender and sexual orientation. Notably, at the bivariate level, individuals identifying as sexual minority (mostly heterosexual and LGB) consistently report significantly higher levels of social isolation compared to their heterosexual counterparts from early adulthood to early midlife. In specific domains of isolation, sexual minority individuals (both mostly heterosexual and LGB) exhibit higher probabilities of being isolated in intimate relationships and religious attendance compared to heterosexual individuals, but they do not differ or are less isolated in friendship ties and volunteering activities. There are more mostly heterosexual individuals than LGB individuals included in the analyses, particularly among women. In terms of education and race-ethnicity, we generally observe the expected distribution by gender and sexual orientation.

Table 1.

Weighted Descriptive Statistics of Sample Characteristics by Gender and Sexual Orientation (N = 30,250; 2001–2018 National Longitudinal Study of Adolescent to Adult Health).

	Women			Men
	Heterosexual	Mostly Heterosexual	LGB	Heterosexual	Mostly Heterosexual	LGB
Social ısolation	.45	.52*	.56*	.52	.56*	.58*
Intimate relationship (%)	32.37	33.58	39.95*	38.41	47.67*	61.54*
Friendship ties (%)	30.86	30.41	37.48*	31.29	31.53	33.32
Religious attendance (%)	55.67	78.94*	76.56*	66.84	80.88*	76.51*
Volunteering activities (%)	62.61	64.66	70.47*	69.73	65.57	61.84*
Age	29.19	29.62*	29.34	29.46	30.56*	30.90*
Parental education (%)
Less than high school	11	8*	11	10	10	13
High school graduate	29	22*	31	27	20	23
Some college	30	34	30	32	25*	28
College and more	30	36*	28	31	45*	36
Race-ethnicity (%)
White	71	79*	74	73	81*	69
Black	17	9*	13	15	8*	12
U.S.-born Hispanic	9	11	10	9	10	15*
Foreign-born Hispanic	3	1*	3	3	1*	4
n	13,516	2,321	675	12,778	511	449

Note: LGB = lesbian, gay, and bisexual.

p < .05 compared to heterosexual based on chi-square test or t test.

Social Isolation Trajectories by Sexual Orientation

Table 2 presents the results from growth curve models that predict social isolation trajectories. We divided our findings into two models: Model 1 examines disparities in overall levels of isolation by sexual orientation, and Model 2 explores the rate of change in isolation trajectories with age. Both models include all control variables. In Model 1, our results reveal a clear disadvantage in overall isolation levels among mostly heterosexual (b = .046, p < .001) and LGB (b = .072, p < .001) individuals compared to their heterosexual counterparts. Moving on to Model 2, the main effect of sexual orientation reflects disparities in the average levels of social isolation at age 29 (centered age value). Additionally, the interaction terms of sexual orientation and age shed light on the differential rates of change in social isolation trajectories by sexual orientation. Starting with the main effect, once again, mostly heterosexual (b = .044, p < .001) and LGB (b = .071, p < .001) respondents exhibited higher levels of isolation at age 29 compared to heterosexual respondents. Furthermore, we identified significant interaction effects between sexual orientation and age for mostly heterosexual respondents (b = .002, p < .01), indicating that disparities in social isolation between this group and heterosexual individuals widen from early to middle adulthood.

Table 2.

Coefficients from Growth Curve Models Predicting Social Isolation by Sexual Orientation (N = 30,250; 2001–2018 National Longitudinal Study of Adolescent to Adult Health).

	Model 1		Model 2
	B	(SE)	B	(SE)
Sexual orientation (reference = heterosexual)
Mostly heterosexual	.046***	(.005)	.044***	(.005)
LGB	.072***	(.008)	.071***	(.008)
Age (centered on the mean)	.002***	(.000)	.001***	(.000)
Sexual orientation × age
Mostly heterosexual			.002**	(.001)
LGB			.001	(.001)
Women (reference = men)	−.058***	(.004)	−.058***	(.004)
Parental education (reference = less than high school)
High school graduate	−.017**	(.006)	−.017**	(.006)
Some college	−.053***	(.006)	−.053***	(.006)
College and more	−.096***	(.006)	−.096***	(.006)
Race-ethnicity (reference = White)
Black	.019***	(.004)	.019***	(.004)
U.S.-born Hispanic	.023***	(.005)	.022***	(.005)
Foreign-born Hispanic	.034***	(.010)	.034***	(.010)
Censoring	.005	(.004)	.005	(.004)
Intercept	.552***	(.006)	.552***	(.006)
Random effects-variance components
Level 1: Within-person	.037		.037
Level 2: In intercept	.022		.022
Level 2: In linear growth rate	.000		.000
N persons	13,860		13,860
N person-year observations	30,250		30,250

Note: Social isolation is assessed using a composite measure that encompasses intimate relationships, friendship ties, religious attendance, and participation in volunteering activities. LGB = lesbian, gay, and bisexual.

p < .01, ***p < .001 (two-tailed tests).

To visually represent these results, Figure 1 illustrates the age trajectories of social isolation using predicted values. It employs all the coefficients from Model 2, adjusting for variations in our key predictor variable (sexual orientation) while keeping all control variables at their means (for continuous variables) and modes (for dummy variables). Figure 1 demonstrates that sexual minority individuals not only experience higher levels of isolation compared to heterosexual individuals during our period of observation but also witness a growing disparity over time. At the age of 18, mostly heterosexual respondents have levels of social isolation that are between those of LGB and heterosexual respondents; however, their levels are closer to heterosexual respondents than to LGB respondents. As individuals grow older, all three groups become more isolated. However, the gap between heterosexual and sexual minority groups widens, and by age 42, the isolation scores of the mostly heterosexual respondents are closer to LGB respondents than to heterosexual respondents. Differences between mostly heterosexual and LGB respondents are not statistically significant during early midlife.

Figure 1.

Predicted Social Isolation Trajectories by Sexual Orientation (N = 30,250; 2001–2018 National Longitudinal Study of Adolescent to Adult Health).

Gender Differences in Social Isolation Trajectories by Sexual Orientation

To further investigate potential gender-related differences in social isolation trajectories based on sexual orientation, we conducted separate analyses for women and men, replicating the previously described procedures. The results for each gender are presented in Panels A and B of Table 3. The findings from Panel A of Table 3 indicate that among women, both mostly heterosexual (b = .051, p < .001) and lesbian/bisexual (b = .084, p < .001) individuals consistently report higher levels of isolation from adolescence to early midlife compared to heterosexual women. In Model 4, which considers differential rates of change in isolation across sexual orientation, the gap in isolation levels widens primarily between mostly heterosexual and heterosexual women, but the slopes for these two groups are not significantly different. The results for men are more complex. Panel B of Table 3 suggests that gay/bisexual men have the highest levels of isolation and that heterosexual men have the lowest. Model 4, which accounts for differential changes in social isolation across the life course, shows that gay/bisexual and mostly heterosexual men have significantly different slopes compared to heterosexual men (p < .05 and p < .10, respectively). Heterosexual men do not experience statistically significant changes in isolation between the ages of 18 and 42.

Table 3.

Coefficients from Growth Curve Models Predicting Social Isolation by Sexual Orientation among Women and Men (N = 30,250; 2001–2018 National Longitudinal Study of Adolescent to Adult Health).

	Model 3		Model 4
	B	(SE)	B	(SE)
Panel A: Women
Sexual orientation (reference = heterosexual)
Mostly heterosexual	.051***	(.006)	.050***	(.006)
Lesbian/bisexual	.084***	(.010)	.084***	(.010)
Age (centered on the mean)	.002***	(.000)	.002***	(.000)
Sexual orientation × age
Mostly heterosexual			.001	(.001)
Lesbian/bisexual			−.000	(.001)
Parental education (reference = less than high school)
High school graduate	−.018*	(.009)	−.018*	(.009)
Some college	−.054***	(.009)	−.054***	(.009)
College and more	−.103***	(.009)	−.103***	(.009)
Race-ethnicity (reference = White)
Black	.027***	(.006)	.027***	(.006)
U.S.-born Hispanic	.030***	(.008)	.030***	(.008)
Foreign-born Hispanic	.047***	(.013)	.047***	(.013)
Censoring	−.000	(.006)	−.000	(.006)
Intercept	.493***	(.008)	.493***	(.008)
Random effects variance components
Level 1: Within-person	.037		.037
Level 2: In intercept	.022		.022
Level 2: In linear growth rate	.000		.000
n persons	7,278		7,278
n person-year observations	16,512		16,512
Panel B: Men
Sexual orientation (reference = heterosexual)
Mostly heterosexual	.029*	(.011)	.024*	(.012)
Gay/bisexual	.054***	(.014)	.048**	(.014)
Age (centered on the mean)	.001*	(.000)	.000	(.000)
Sexual orientation × age
Mostly heterosexual			.003*	(.002)
Gay/bisexual			.003	(.002)
Parental education (reference = less than high school)
High school graduate	−.017	(.010)	−.017	(.010)
Some college	−.052***	(.009)	−.052***	(.009)
College and more	−.087***	(.010)	−.087***	(.010)
Race-ethnicity (reference = White)
Black	.009	(.007)	.009	(.007)
U.S.-born Hispanic	.014	(.008)	.014	(.008)
Foreign-born Hispanic	.021	(.014)	.021	(.014)
Censoring	.010	(.005)	.010	(.005)
Intercept	.553***	(.009)	.553***	(.009)
Random effects variance components
Level 1: Within-person	.038		.038
Level 2: In intercept	.021		.021
Level 2: In linear growth rate	.000		.000
n persons	6,582		6,582
n person-year observations	13,738		13,738

Note: Social isolation is assessed using a composite measure that encompasses intimate relationships, friendship ties, religious attendance, and participation in volunteering activities.

p < .05, **p < .01, ***p < .001 (two-tailed tests).

We also illustrate the gender differences in social isolation trajectories by sexual orientation in Figure 2. Among women, those who report sexual minority orientations (mostly heterosexual or lesbian/bisexual) consistently exhibit higher levels of isolation across most observed periods, aligning with the trends observed in the total sample analysis. In the case of men, the trajectories of isolation vary significantly across sexual orientation. Gay/bisexual men experience small differentials in isolation compared to heterosexual men during adolescence. However, as they age, the disparity widens significantly. Similarly, mostly heterosexual men initially experience lower levels of isolation during adolescence than heterosexual men. Nevertheless, they undergo a sharp increase in isolation over their life span, surpassing their heterosexual counterparts after the age of 22.

Figure 2.

Predicted Social Isolation Trajectories by Sexual Orientation among Women and Men (N = 30,250; 2001–2018 National Longitudinal Study of Adolescent to Adult Health). (a) Women. (b) Men.

Sexual Orientation Differences in Each Dimension of Social Isolation

To better understand the extent to which sexual orientation differences in isolation are driven by specific dimensions, Table 4 and Figure 3 present analyses in which each of the four components of the isolation scale is regressed separately on sexual orientation. Results from Model 5 of Table 4 show that both mostly heterosexual and LGB adults have higher probabilities of being isolated in intimate relationships and religious attendance compared to their heterosexual counterparts; no significant differences are observed in friendship ties or volunteering activities by sexual orientation. Model 6, which incorporates different age trajectories, further confirms the previous results using the overall isolation index, showing that mostly heterosexual adults exhibit higher rates of increase in isolation from early adulthood to early midlife compared to heterosexual adults. To aid interpretation, we illustrate the age trajectories of isolation across the four distinct dimensions, revealing clear differences by sexual orientation in intimate relationships and religious attendance. Based on these findings, we suggest that the overall isolation index is primarily driven by isolation in intimate relationships and religious attendance.²

Table 4.

Log Odds from Mixed-Effects Logistic Regression Models Predicting Four Dimensions of Social Isolation by Sexual Orientation (N = 30,250; 2001–2018 National Longitudinal Study of Adolescent to Adult Health).

	Model 5		Model 6
	B	(SE)	B	(SE)
Panel A: Intimate relationship
Sexual orientation (reference = heterosexual)
Mostly heterosexual	.269***	(.056)	.243***	(.057)
LGB	.773***	(.086)	.778***	(.088)
Age (centered on the mean)	−.061***	(.002)	−.063***	(.003)
Sexual orientation × age
Mostly heterosexual			.018*	(.008)
LGB			−.002	(.012)
Panel B: Friendship ties
Sexual orientation (reference = heterosexual)
Mostly heterosexual	−.016	(.056)	−.071	(.061)
LGB	−.012	(.086)	−.070	(.092)
Age (centered on the mean)	.080***	(.002)	.077***	(.003)
Sexual orientation × age
Mostly heterosexual			.020*	(.009)
LGB			.024	(.013)
Panel C: Religious attendance
Sexual orientation (reference = heterosexual)
Mostly heterosexual	1.158***	(.075)	1.123***	(.076)
LGB	1.183***	(.120)	1.185***	(.121)
Age (centered on the mean)	.063***	(.003)	.061***	(.003)
Sexual orientation × age
Mostly heterosexual			.034**	(.011)
LGB			−.005	(.016)
Panel D: Volunteering activities
Sexual orientation (reference = heterosexual)
Mostly heterosexual	.011	(.059)	−.002	(.061)
LGB	.008	(.094)	−.037	(.097)
Age (centered on the mean)	−.035***	(.002)	−.037***	(.003)
Sexual orientation × age
Mostly heterosexual			.006	(.008)
LGB			.026*	(.013)

Note: All models control for all covariates included in Table 2. LGB = lesbian, gay, and bisexual.

p < .05, **p < .01, ***p < .001 (two-tailed tests).

Figure 3.

Predicted Probabilities of Each Dimension of Social Isolation by Sexual Orientation (N = 30,250; 2001–2018 National Longitudinal Study of Adolescent to Adult Health). (a) Intimate Relationship. (b) Friendship Ties. (c) Religious Attendance. (d) Volunteering Activities.

Discussion

Our study contributes to knowledge on the intricate interplay between sexual orientation and social isolation, shedding light on the distinct trajectories experienced by sexual minority individuals from early adulthood to early midlife. Although prior investigations of sexual minority individuals have predominantly concentrated on physical, mental, or economic well-being, our research delves into the understudied domain of social well-being among sexual minority individuals (Stacey et al. 2022; Umberson and Donnelly 2023; Waite et al. 2021). By following a single cohort across two decades of their life, our study offers valuable insights into how trajectories of social isolation differ according to sexual orientation. By identifying and examining the experiences of the relatively new and understudied “mostly heterosexual” group, this study also uncovers that different subgroups of sexual minority populations have distinct experiences, leading to unique isolation trajectories over the life course.

Using growth curve models, our findings demonstrate that sexual minority populations consistently display higher levels of isolation compared to their heterosexual counterparts throughout most ages of early adulthood to early midlife, aligning with the minority stress perspective (Meyer 2003). We also find that individuals who identify as gay, lesbian, or bisexual are more isolated than those who identify as mostly heterosexual until their mid-30s. Consistent with the cumulative disadvantage perspective, our analysis reveals that these disparities tend to magnify with age for mostly heterosexual individuals, starting in young adulthood and persisting into early midlife. This pattern suggests that minority stressors accumulate over the lifetime for this specific sexual minority group (Dannefer 2020).

These findings are not consistent with the minority strength model (Perrin et al. 2020), but this does not mean that resilience is not operating. It is possible that the differentials over the life course may have been wider without minority-specific strengths. The expanding disparity underscores the critical importance of addressing social isolation as individuals navigate various stages of the life course and highlights the potential importance of social isolation among older populations. For example, increases in social isolation among sexual minority populations could impact caregiving dynamics as individuals age (Zhang, Smith-Johnson, and Gorman 2024). Given that caregiving often relies on close social connections, sexual minority populations who experience higher levels of isolation may face additional challenges in accessing informal caregiving support in later life, such as from family or friends. This may also have significant implications for their reliance on formal caregiving services and could potentially exacerbate health disparities in later life.

Prior work focusing on the association between sexual orientation and social isolation typically combined men and women, including gender as a control variable. Our analysis reveals key gender differences in the trajectories of social isolation by sexual orientation. Among women, both mostly heterosexual and lesbian/bisexual individuals consistently reported heightened levels of isolation across the life stages examined. Furthermore, as these women progressed in age, we observed a notable widening of the gap in isolation between mostly heterosexual and heterosexual women. These findings underscore the enduring challenges encountered by sexual minority women in establishing and nurturing social connections, revealing the cumulative nature of isolation over the life span. For instance, bisexual and mostly heterosexual individuals may face specific challenges, including the intersection of binegativity, misogyny, and the effects of intimate partner and sexual violence, potentially contributing to higher levels of isolation (Everett et al. 2022; Porsch et al. 2023). Our findings for men uncover more complex dynamics. Initially, both mostly heterosexual and gay/bisexual men exhibited comparable or even lower levels of isolation than their heterosexual counterparts. However, as these men aged, a significant and widening gap in isolation emerged. This pattern suggests that the factors contributing to isolation among sexual minority men evolve over time. Further investigation is needed to explore the specific mechanisms underlying these shifts, such as changes in social networks, evolving identity dynamics, or the cumulative impact of minority stressors (Herek 2009; Hsieh and Liu 2021). Future research could benefit from using more recent and comprehensive data sets, such as the Sexual Orientation/Gender Identity, Socioeconomic Status, and Health across the Life Course study, an ancillary study of Add Health, to assess social isolation through later midlife.

Further analyses decomposing multiple dimensions of social isolation reveal that disparities by sexual orientation are primarily driven by isolation in intimate relationships and religious attendance, with no significant differences found in friendship ties or volunteering activities. Although examining each dimension of isolation provides valuable insights for targeted policy interventions, previous research consistently shows that aggregate measures of social isolation are stronger predictors of mortality and morbidity compared to single-item measures (Holt-Lunstad and Smith 2012; Umberson and Donnelly 2023). Taken together, we recognize the importance of understanding the multidimensional aspects of isolation for intervention design, but we maintain that the overall isolation index provides a robust assessment of its impact on health and well-being.

Although this study offers novel insights, it is important to acknowledge several limitations. First, the measurement of gender as a binary variable overlooks the experiences of gender-diverse populations, who may face unique challenges in social isolation (Reczek 2020; Stacey et al. 2022). Future research could explore within-gender differences in isolation across sexual orientation to better understand how the intersectionality of sexual and gender identities contributes to inequalities in social well-being. Second, although the terminology used to reference sexual orientation is evolving, this study relies on language used in previous research (National Academies of Sciences, Engineering, and Medicine 2020). A challenge for longitudinal studies is deciding whether to maintain consistent language and measures or adopt new terminology that may not align with older measures. For instance, individuals previously described as “mostly heterosexual” might now identify as plurisexual or heteroflexible. Given that most surveys limit responses to heterosexual/straight, gay/lesbian, or bisexual categories, individuals identifying as mostly heterosexual are often categorized as “something else.” This highlights the growing need for broader and more nuanced measures of sexual identities, encompassing desires, behaviors, identities, and outcomes (Westbrook, Budnick, and Saperstein 2022). Additionally, data limitations prevented us from separating bisexual individuals from lesbian individuals and gay individuals, which may limit our understanding of within-group heterogeneity among sexual minority groups. Future research with larger sample sizes and more detailed characteristics of sexual minority groups would be valuable to better understand heterogeneities in social isolation in the sexual minority population and potential mechanisms, such as health and disability, because disabled sexual minority individuals may face unique challenges that contribute to greater social isolation (Fredriksen-Goldsen, Kim, and Barkan 2012).

Third, the single-cohort design of this study may not capture the evolving dynamics of social isolation experienced by younger cohorts, who navigate different social and policy contexts during early and middle adulthood. With recent changes in legal protections and growing social acceptance of LGB individuals, future research should consider age and cohort variations to examine how these factors influence experiences of social isolation over time (Meyer et al. 2021). Fourth, the measure of social isolation used in this study is based on four domains commonly employed in previous research on social ties (Umberson et al. 2022; Yang et al. 2016). Future studies extending this work into later life stages should investigate additional domains of social relationships, such as parenthood, when studying social isolation and well-being disparities by sexual orientation. Finally, significant social and legal changes have occurred since the data for this study were collected. These include growing acceptance of same-sex marriage and an increase in the share of the population identifying as LGBTQ+ (Brenan 2024; Jones 2024). However, these positive trends are contrasted by a recent surge in anti-LGBTQ+ legislation, which may have exacerbated challenges for LGBTQ+ individuals (ACLU 2024). These shifts could mean that current levels of social isolation among LGBTQ+ populations are higher than those reflected in our data. Future research using more recent data should continue to assess the evolving effects of these societal changes on the well-being of sexual minority populations.

Social isolation is a critical public health issue (Umberson and Donnelly 2023), and our findings highlight the populations most at risk, including sexual minority individuals. Social isolation may operate as a key mechanism explaining disparities in health and well-being. Notably, the widening experiences of isolation across the life course suggest that midlife adults in particular warrant closer attention. Our study underscores the importance of developing targeted interventions to reduce social isolation and improve well-being, especially among sexual minority men, who experience the highest levels of isolation in early midlife. Moving forward, it will be crucial to examine how shifting policy landscapes impact sexual minority health and to leverage emerging resources, such as heterosexism databases, to further understand and address these disparities.

Supplemental Material

sj-docx-1-hsb-10.1177_00221465251340020 – Supplemental material for Sexual Orientation and Social Isolation from Early Adulthood to Early Midlife

Supplemental material, sj-docx-1-hsb-10.1177_00221465251340020 for Sexual Orientation and Social Isolation from Early Adulthood to Early Midlife by Zhiyong Lin, Kara Joyner and Wendy D. Manning in Journal of Health and Social Behavior

Footnotes

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported in part by the Center for Family and Demographic Research (Bowling Green State University) and the Population Research Center (University of Texas at Austin), which have core funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD050959 and P2CHD042849, respectively). This research was also supported by a National Institutes of Health-funded project, “Contextual Determinants of Sexual Minority Health in the United States,” led by Joyner and Manning (1R01MD016417-01A1).

ORCID IDs

Zhiyong Lin

Wendy D. Manning

Supplemental Material

Tables A1 through A3 are available in the online version of the article.

Notes

Author Biographies

Zhiyong Lin is an assistant professor in the Department of Sociology and Demography at the University of Texas at San Antonio and a faculty affiliate in the Population Research Center at the University of Texas at Austin. His research focuses on the social determinants of health and family dynamics across the life course and in diverse social contexts. His work has appeared in Demography, Social Forces, Social Science Research, and The Gerontologist, among others.

Kara Joyner is a professor in the Department of Sociology and Demography and codirector of the Institute for Demographic and Socioeconomic Research at the University of Texas at San Antonio. She served as president of the Southern Demographic Association and editor-in-chief of Population Research and Policy Review and is now serving as the Chair-Elect of the Family Section of the American Sociological Association. She has published research in the American Journal of Public Health, American Sociological Review, Demography, Journal of Marriage and Family, Population and Development Review, and Social Forces. Her current research addresses the dimensionality of structural discrimination and its associations with health and migration for various subgroups in the population.

Wendy D. Manning is the Dr. Howard Aldrich and Penny Daum Aldrich Distinguished Professor of Sociology at Bowling Green State University. She is the codirector for the National Center for Family & Marriage Research and founding director of the Center for Family and Demographic Research and served as the president of the Population Association of America. She led the research for the American Sociological Association’s amicus brief filed to the U.S. Supreme Court in same-sex marriage cases. She is a family demographer studying American families and focusing on sources of disparities in the health and well-being of LGBTQ+ individuals.

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