A US study says sexual minority stress combined with age-related stress is endangering the mental health of middle-aged and older gay men.

Sexual minority stress was defined as a combination of men feeling the need to hide their sexuality or concern that others avoided them because of it.

Published in the American Journal of Public Health, the survey of 200 seems to confirm findings that legal marriage for same-sex couples may confer a unique protective effect against poor mental health.

Having a same-sex domestic partner or same-sex spouse boosted the emotional health of the studied men, but having a same-sex legal spouse appeared to be the most beneficial relationship arrangement.

Lead author Richard G. Wight of the Williams Institute at UCLA: “This study shines a light on the mental health of a generation of gay men who survived the early years of the AIDS crisis and came of age on the heels of the gay rights movement.

“Whether legal marriage benefits mental health within same-sex couples in the way it has been proven to benefit different-sex couples deserves much more empirical attention, particularly given that same-sex marriage is not available in most states and was only briefly available in California in 2008.”

In addition to sexual orientation stigma, the studied men’s mental health was also negatively affected by having experienced the loss of peers to AIDS.

General aging-related stress, such as concerns over finances and independence, also affected the mental health of these midlife and older gay men.

The study was based on self-administered questionnaires completed in 2009 or 2010 by approximately 200 HIV-negative and HIV-positive gay-identified men between the ages of 44 and 75.

The studied men were a subsample of participants in the UCLA component of the Multicenter AIDS Cohort Study, one of the largest and longest running natural-history studies of HIV/AIDS in the United States.

The Williams Institute is a think tank at UCLA which aims to “advance sexual orientation law and public policy”.