Perceived Social Support as a Protective Factor Against Psychological Distress in the Context of COVID-19-Related Stress and Sexual Minority Status in Nigeria

Sexual minority individuals report higher COVID-19-related stress that may mediate higher psychological distress. However, this relationship and the role of social support have not been investigated in low/middle-income settings like Nigeria. Our study tested independent associations of psychological distress with sexual orientation, COVID-19-related stress, and perceived social support and whether perceived social support moderated these relationships. In an online survey, 966 Nigerians (21.7% sexual minority, n= 210) were assessed for sexual orientation, COVID-19-related stress, and perceived social support, and psychological distress. Sexual minority status was associated with higher COVD-19-related stress (r =.13, 95% CI [0.06, 0.19]), perceived social support (r =.07, [0.01, 0.13]), and psychological distress (r =.09, [0.02, 0.17]). Furthermore, we demonstrated two moderation effects: psychological distress was highest among sexual minority participants with low perceived social support and lowest among heterosexual participants with high perceived social support (beta = 0.09, [0.02, 0.16]). Among sexual minorities, the association between COVID-19-related stress and psychological distress was strongest and weakest among those with low and high perceived social support, respectively, but this effect was absent among heterosexual participants (beta=-0.14, [-0.21, -0.06]). Our finding suggests social support as a protective mechanism against adverse health outcomes among heterosexual and sexual minority individuals in Nigeria. Public Significance Statement We collected data from Nigerian heterosexual and sexual minority (gay, lesbian, and bisexual) men and women using an online survey to investigate the associations between sexual orientation, COVID-19related stress, and psychological stress; and how these relationships varied by perceived social support. We found that perceived social support reduced the impact of COVID-19-related stress in the whole sample (including heterosexual and sexual minority participants). Furthermore, higher levels of perceived social support weakened the association between sexual orientation and psychological distress.