This doesn't surprise me given certain studies on remaining closeted I've found in the past. Here's some copypasta from a post of mine on another forum.
(TL;DR: Hiding who you are when who you are is devalued by your tribe can make you depressed.)
Research from 2009 suggests that concealing a "stigmatized identity" (such as being a closeted LGBT or keeping a poorly understood mental illness secret) raises scores on a self-assessment called the CES-D on average about 6 points. The CES-D is designed to
measure symptoms of depression. Its clinical cutoff score - the score after which a diagnosis of depression using standard DSM criteria is quite likely - is 16. The average adult scores 9.
Full disclosure: The study population was psych students, who are largely young adults. The 2009 paper says the young adult average score has been sometimes measured near 15. This could be due to many factors, including poor self-care, new independence, school stresses, etc. Still, 6 points higher on a scale where the average is 9 and the clinical cutoff is 16 seems like a huge negative effect.
I went looking for other sources to calibrate my intuition. Here are some things I found, in which I could verify that the research used the same form of the CES-D. (It's commonly abbreviated.)
Full-time care of a family member with dementia was reported in
a 2003 study to raise average CES-D scores by 4 points. The same study found the family member's death to raise it on average another 6 points. CES-D scores tended to fall again to pre-caring levels about a year after that.
This 1990 study reports on the CES-D scores of a homeless population, but also includes a table of percentages of other populations who score at least 16 for comparison. Here are some:
- Homeless - inner-city LA - male: 71%
- Psychiatric inpatient: 70%
- Alcoholic: 62%
- Concealing stigmatized identity - young adult: 59% (as reported in 2009 study)
- Drug addict: 52%
- Death of a spouse - past year: 52%
- Marital separation - past year: 49%
- Unemployed - LA - multi-ethnic: 47%
- General population: 19%
Comparing populations using these numbers requires some care, but applying such care seems to bump concealing a stigmatized identity
upward rather than
downward in ranking. For example, the CES-D questions ask about eating and sleeping habits, which are negatively impacted by drugs, alcohol, and homelessness.
Some other conclusions from the 2009 study:
- Psychological distress is due to anticipated stigma from peers should they ever discover the shameful secret.
- Study participants estimated this anticipated stigma as having a much lower effect on them than their peers did. IMO, this implies that we underestimate the distress that staying closeted causes us.
- The effect on psychological distress was mostly mediated through the centrality of the hidden identity (i.e. how much it was seen as central to overall identity) and its salience (i.e. how often it came up in conscious thought).
- The greater the anticipated stigma, the greater the centrality. There's a correlation, and the authors make a good case by comparing statistical models that greater anticipated stigma causes greater centrality.
Some good news: Closeted exmos can use these conclusions to ease their burden. Reducing centrality (e.g. with "I'm much more than my beliefs" or "I'm still the same person") can help. Reducing salience (e.g. by taking as many breaks from church as possible) can help.
Some bad news: The fact that anticipated stigma drives up centrality makes centrality hard to reduce. And of course, an unrelenting stream of belief tests makes salience hard to reduce.
The study didn't attempt to measure the effect of internalizing negative messages from the surrounding culture.