Running head: MENTAL HEALTH STATUS AND AGING

Mental Health Status and Attitude Towards Aging of Self-Identified Lesbian and Gay
Filipino Able-Aged
Nicole Meliza Ann C. Abella
Rizal Michael R. Abello
Roed Vincent C. De Vera
Bennie Kate V. Go
Kathleen Anne C. Morales
Marc Eric S. Reyes, Ph.D., RP
University of Santo Tomas

Abstract
The research study was conducted to determine whether there is a direct or an
inverse relationship between mental health status and attitude towards aging of the
lesbian and gay (LG) participants. The first batch of 9 respondents were selected and
the rest were gathered using the snowball technique. Similar treatment condition was
used in the interview and testing session of the LG elders. Every participant was
instructed to answer the questions of the interviewer as quickly and honestly as
possible. The result of the regression analysis showed that there is a significant
correlation between the mental health status and attitude towards aging of the selected
self-identified LG elders. This study suggests that there is a positive relationship
between mental health status and attitude towards aging.

Mental Health Status and Attitude Towards Aging of Self-Identified Lesbian and Gay
Filipino Able-Aged
The LGBT (lesbian, gay, bisexual, and transgender) community has improved in
addressing issues and concerns on coming-out, AIDS, and even civil rights, the next
wave however has to be aging (Fredriksen-Goldsen, Kim, Emlet, Muraco, Erosheva,
Hoy-Ellis, Goldsen, & Petry, 2011). Older people are considered a hidden section of the
LGBT community in where Blando described them as the most invisible of an invisible
minority and that it seemed that beyond middle age, the LGBT people simply
disappeared (2001; as cited by Clarke, Ellis, Peel, & Riggs, 2010). According to
Fredriksen-Goldsen and her colleagues (2011), aging issues and health concerns of the
LGBT older adults are rarely addressed in social services, policies, and researches
despite diversity as the defining feature of global aging.
The National Association of Chronic Disease Directions (2008) generally
estimated that 20% of people age 55 years old and above experience some type of
mental health concern. To support that the issue on mental health is of growing concern,
researchers expanded the definition of mental health such that it is no longer just the
absence of psychopathology but also the presence of positive feelings and positive
functioning in both individual and social life (Keyes, Dhingra, & Simoes, 2010; Wood
and Joseph, 2009; as cited by Lamers, Westerhof, Bohlmeijer, & Keyes, 2012). In line
with this, French (2013) added that the vast majority of the LGBT older adults have lived
through discrimination, social stigma, and the effects of prejudice such as mental health
issues, social isolation, poverty, chronic illness, delayed care seeking, premature
mortality, anxiousness, and sexlessness. This fear and social stigma has interrupted

their way of living, connections with family and friends, their lifetime earnings, and equal
opportunity for health care. In fact, a local study by Austria, Castillo, and Llave (2001)
found that financial problem, the feeling of being burnout, the fear of growing old alone,
the problem of physical aging and family-related problems are the common issues face
by Filipino middle-aged gay men (as cited by Motilla, 2004).
Furthemore, as cited by Fredriksen-Goldsen and Muraco (2010), LGB adults
poor mental health outcomes are predicted by loneliness, low self-esteem, internalized
homophobia, and victimization based on sexual orientation, which corresponded with
higher rates of attempted suicide, suicidal thoughts, and drug abuse (DAugelli and
Grossman 2001) whereas successful aging among older LGB adults is influenced by
good health (Adelman 1990; Lee 1987; Quam and Whitford 1992), higher social status
and class (Lee 1987), increased social support (Jones and Nystrom 2002; Quam and
Whitford 1992), and community involvement (Quam and Whitford, 1992)
According to Schope (2005), gay men were found to be more ageist, have a
greater fear of negative evaluation by others, and give more importance to their own
physical attractiveness. In addition, results indicated that gay men have more negative
views of how gay society views growing older and how they view their own growing
older as compared to lesbian respondents
Despite the way society treats the older people of the LGBT community, Laura
Carstensen developed Socioemotional Selectivity Theory which states older people
tend to focus on emotion-regulation goals than knowledge-seeking goals during their
early adulthood (Berngtson, Gans, Putney, & Silverstein, 2008). According to Lang,

Staudinger, and Carstensen (1998; as cited by Berngston et al., 2008) when people
view the future as limited, preferences shift increasingly from ones that are directed
toward achieving long-range goals for educational ambitions to more short-term goals
for emotional gratification since they are more easily and reliably obtained in
interactions.
The Socioemotional Selectivity Theory further stressed that older adults have
superior emotion regulation skills compared to their younger counterparts. They are
more conscious of their emotion regulation ability as they are more likely to report
controlling anger, pondering less about negative experiences, and experience less
distress during difficult situations; thus, they have lower rates of subsyndromal
depression, dysthymia, major depression, and anxiety disorders. They also show fewer
physiological reactions when reliving and ruminating negative experiences. (Carstensen
et al., 1999;

Lang & Carstensen, 2002; as cited by Berngtson et al., 2008). The

researchers concluded that older people have greater overall well-being and view of the
aging process. In addition, Sarkisian (as cited by Kavirajan et al., 2011) conducted a
study in where he noted that better mental health and physical health was associated
with the positive aging expectations while advanced age and greater depression
predicts negative aging attributes. The researchers findings associated a more negative
ATOA with older age but Barrett (2003; as cited by Karivajan et al., 2011) contradicted
the study and concluded that older age is associated with more youthful age identity a
more positive ATOA. On another study done by James Reid (1995; as cited by Clarke,
Ellis, Peel, & Riggs, 2010), he supported the mentioned theory and concluded that most
of the LGBT older adults are active and selectively engaging in activities that interests

and benefits them - he contradicted the stereotypes of older lesbians and gay men that
they are miserable and lonely.
To further support the present study, a considerable amount of the literature on
gay men aging can be grouped into two opposing theories: accelerated aging and crisis
competence. According to the accelerated aging theory, gay men consider themselves
an elder at a time when heterosexual men do not. This, as said by Berger (1982; cited
in Schope, 2005), echoes the commonly accepted statement that a gay man is old
when he turns 30. On the contrary, Crisis Competence Theory claims that gay men are
better at coping with aging than their heterosexual counterpart. On the word of Friend
(1990), having reconstructed their social and sexual identities through the coming out
process, older gay men may develop skills that allow them to adjust to the aging
process (as cited in Schope, 2005).
In addition, one study of elder gay men found that 68% of the forty-one
respondents felt being gay helped them accept the aging process (Quam & Whitford,
1992) (as cited in Schope, 2005). What is more is that some older gay men stated that
becoming of age is exhilarating and fulfilling and that they are not only surviving but
also thriving (Kertzner, 1997). As for the case of elder lesbian women, Crisis
competence theory is rarely discussed in the literature on lesbian aging. However,
several authors suggest that poisonous environments have forced lesbians to learn
early how to be more resourceful and to develop stronger coping mechanisms
(MacDonald & Rich, 2001). Most studies have found that lesbians feel positive about
being homosexual and aging (Almvig, 1982; Kehoe, 1989) (as cited in Schope,
2005).

The researchers of this present study intended to explore the mental health and
the attitude towards aging of the LG (lesbian and gay) elders in the Philippines. The
purpose of this study is to correlate and determine if there is an existing relationship
between mental health and attitude towards aging in the Philippines context among
lesbian and gay Filipinos. In addition, it was intended by the researchers to find out if
the mental health was a predictor of the attitude towards aging of the respondents; to
prove or disprove that a less positive mental health leads to a pessimistic attitude
towards aging or the other way around.

Method
Participants
The sample of the study consisted of 116 self-identified gay and lesbian adults, 76.72
males and 24.11% females. The participants age ranged from 50-87 years, with an
average age of 62.52. All of them were selected having met the following criteria for the
study: self-identified gay or lesbian Filipino, 50 years old and above, and able-aged.
Approximately 15.52% of them were members of the Home of the Golden Gays,
38.80% were social contacts of the members of the said organization, and 45.69% were
personally scouted by the researchers. The participants were briefly introduced to the
topic and how it could benefit them, and were given tokens of appreciation for their
participation in the study. Materials
A Personal Data Sheet was used to gather the demographic characteristics of
the participants such as: name, age, sexuality, highest educational attainment and
relationship status. Additionally, a consent form was also given to the participant to
inform them about their rights and to obtain the respondents consent.

The study used two tests for data gathering: Mental Health Inventory 5 (MHI-5)
and Attitude towards Aging Scale (ATAS) . The MHI-5 measured the participant's mental
health. This instrument was designed to detect depression and anxiety disorders.
Composed of 5 items, 3 items are determined the depressive symptoms while the
remaining two are for symptoms of anxiety. The MHI-5 required the respondents to
respond to a six-point scale: all of the time, most of the time, a good bit of the time,
some of the time, a little of the time and none of the time.The overall score is calculated
by reversing the answer to items 3 and 5, summing-up the scores , and transforming the
total raw scores to a scale that ranges from zero to 100. A higher score indicates better
mental health.The Cronbach alpha in the study ,done by Cujipers, Smits, Donker, ten
Have and de Graaf(2009), was 0.83.
Another instrument used was the ATAS which assessed the participant's attitude
towards aging specifically their tendency to positively or negatively react to aging and
old people. ATAS is composed of a total of 56 items wherein the first 26 are negative
items and the second half being positive. The scale required the participants to score
items through a 3-point Likert scale wherein 1= Not true at all, 2= Somewhat true and
3= Very true. The total score is calculated by reverse scoring the first 26 items, by using
the original value sequence for items 27 to 56, and summing up all the score. The
lowest score is 56 and the highest 168.n. Evaluated by the alpha coefficient, the alpha
of total scores indicated considerable internal consistency. As for the reliability, ATAS
has r=.882, p<.01. Moreover, the congruent validity of ATAS was obtained through
correlating scores with Refined Aging Semantic Differential by Polizzi, and Reaction to
Ageing Questionnaire, by Gething, wherein correlations were significant.

Design
This study utilized a correlational design which is a method used to determine the
correlation, or degree of relationship, between two traits, behaviors, or events. When
two variables are correlated, a change in one variable could mean a change in the other
variable. However, there is no explicit implication of a cause-and-effect relationship. The
researcher is simply determining if measures go together (Myers & Hansen, 2012). The
correlational design was applied to this study to determine whether a relationship exists
between the mental health and the attitude towards aging of self- identified lesbian and
gay elderly Filipinos.
Procedure
Finding the appropriate and necessary participants in this study was done in
three ways. First, the researchers approached organizations that specifically has LG
members and wrote formal letters to these organizations asking for approval for their
older LG members to be participants of the study. Second, members of the said
organization were asked if they have contact with other members of the elder LG
community who would be willing to participate in the study. Lastly, social connections of
the researchers were contacted for referrals regarding possibles candidates for
participants. The purpose, and the significance of the study were properly discussed to
the participants to build rapport and encourage honest and truthful responses.
Once permission was granted, testing dates were set and scheduled then the
test administration proceeded. All participants were interviewed and given tests
individually. The researchers first requested the participants to sign the Consent form
and complete the Personal Data Sheet. After that the researchers conducted a short

interview regarding the physical health, the psychological state and the general outlook
of the participants towards aging. The researchers then administered the test for mental
health, MHI-5 , followed by the ATAS to determine the attitude towards aging of the
participants.
Results and Discussion
The focus of the present study is to correlate and determine if there is an existing
relationship between mental health and attitude towards aging of selected self-identified
lesbian and gay Filipino able-aged. Also, the researchers intended to find out if the
mental health is a predictor of the attitude towards aging of the respondents and to
prove or disprove that a less positive mental health leads to a pessimistic attitude
towards aging or the other way around. The respondents were given the MHI and ATAS
as to measure the mental health and the attitude towards aging respectively.
Consequently, the results indicated that a medium positive significant relationship exist
between the mental health and ATAS of the LG elders wherein good mental health
predicts a positive attitude towards and poor mental health predicts a negative attitude
towards aging.
Presented in Table 1 are the mean scores and standard deviation values of the
respondents Mental Health Status as measured by the Mental Health Inventory - 5
wherein M = 70.97 and

SD = 15.89. The results indicate that the LG elders are

experiencing mild depression and anxiety or none at all. This implies that the LG elders
have good overall mental health. This could be explained by the Socioemotional
Selectivity Theory wherein Carstensen and her colleauges (as cited by Berngtson et al.,
2008) concluded that older people have greater overall well-being including how they

view their aging process. The theory states that older people have better and superior
emotion regulation skills in where they are more capable of controlling anger, pondering
less about negative experiences, and experience less distress during difficult and
stressful situations. This in return leads to lower rates of subsyndromal depression,
dysthymia, major depression, and anxiety disorders lower rate of poor mental health.
When recapturing negative past memories, the older adults showed fewer physiological
reactions
In addition, the Socioemotional Selectivity Theory mentioned that older adults
shifts from achieving long-range goals for educational ambitions to more short-term
goals for emotional gratification which aids in the emotion regulation of the older adults
(Lang, Staudinger, and Carstensen, 1998; as cited by Berngston et al., 2008).
Also presented in Table 1 are the mean scores and standard deviation values of
the respondents Attitude towards Aging as determined by the Attitude Towards Aging
Scale (M = 135.75 , SD = 11.31). The results indicated that the LG elders have positive
attitude towards aging. This implies and agrees with the Crisis Comptence Theory that
suggests that gay men are better at coping with aging than their heterosexual
counterpart. Since older LG individuals renovated their social and sexual identities
through the coming out process and the experiences they had throughout their lifetime,
older LG individuals were forced to early learn how to be more resourceful, and to
develop stronger coping mechanisms and skills that allowed them to adjust to the aging
process (Friend, 1990; as cited in Schope, 2005; MacDonald & Rich, 2001).

To determine the relationship between the mental health and attitude towards
aging of the LG respondents, Pearson correlation was performed using SPSS Statistics.
It is presented in Table 2 that there is a medium positive significant relationship between
Mental Health Status and Attitude Towards Aging of LG Elders ( r= 0.277 , n=134,
p=0.003 < =0.05). This implies that mental health is a predictor of the attitude towards
aging of the respondents wherein a positive mental health leads to an optimistic attitude
towards aging. Supporting this are the Socioemotional Selectivity Theory and Crisis
Competence theory. As mentioned before, Socioemotional Selectivity Theory states that
older people have better and superior emotion regulation skills in where they are more
capable of controlling anger, pondering less about negative experiences, and
experience less distress during difficult and stressful situations which in turn results to
lower poor mental health. Further supporting this is the Crisis competence theory which
suggests that since LG elders renovated their social and sexual identities through the
coming out process and the experiences they had throughout their lifetime, LG elders
learned how to be more resourceful and developed stronger coping mechanisms as well
as skills that allowed them to adjust to the aging process (Friend, 1990; as cited in
Schope, 2005; MacDonald & Rich, 2001). It could be inferred from these theories that
since LG elders are more capable of regulating and controlling their emotions that
resulted from their experiences throughout their lifetime, LG elders experience better
mental health which therefore allows them to have a positive attitude towards aging that
allows them a healthier adjustment to the aging process.

Studies showing similar results to one aspect of the study wherein the mental
health and the attitude towards aging of their respondents were significantly related to
one another are that of Sarkisians study (as cited by Kavirajan et al., 2011) which
revealed that the better mental health and physical health was associated with the
positive aging expectations while advanced age and greater depression predicts
negative aging attributes. However, their main finding was that they associated a more
negative attitude towards aging with older age. Barrett (2003; as cited by Karivajan et
al., 2011) contradicts the study of Sarkisian but supports the present study and
concluded specifically that older age is associated with more youthful age identity a
more positive attitude towards aging.
On another study done by James Reid (1995; as cited by Clarke, Ellis, Peel, &
Riggs, 2010), he supported the mentioned theory and agrees to the findings of the
present study that the mental health of the LGBT older adults is related to the way they
view their aging process. He concluded that most of the LGBT older adults are active
and selectively engaging in activities that interests and benefits them rather than being
miserable and lonely. He contradicted the stereotypes of older lesbians and gay men.
Furthemore, as cited by Fredriksen-Goldsen and Muraco (2010), LGB adults
poor mental health outcomes are predicted by loneliness, low self-esteem, internalized
homophobia, and victimization based on sexual orientation, which corresponded with
higher rates of attempted suicide, suicidal thoughts, and drug abuse (DAugelli and
Grossman 2001) whereas successful aging among older LGB adults is influenced by
good health (Adelman 1990; Lee 1987; Quam and Whitford 1992), higher social status

and class (Lee 1987), increased social support (Jones and Nystrom 2002; Quam and
Whitford 1992), and community involvement (Quam and Whitford, 1992)
From this study, it could be concluded that since the self-identified Filipino LG
elders are experiencing good levels of mental health, these LG elders feel positively
towards aging .

Tables
Table 1
Summary table for Descriptive statistics of MHI-5 and ATAS (N=134)

Mental Health Status

SD

70.97

15.89

Attitude Towards Aging 135.75

11.31