Discrimination, Heterosexism and Perceived Stress Among Young LGBT Tunisians: Unveiling the Moderation Effects of Self-Esteem

Abstract

Background

LGBT individuals in Tunisia face discrimination and stigmatization due to prevailing socio-cultural and legal conditions which can negatively impact their mental health.

Aim

This study examined the relationship between perceived stress, heterosexist experiences, and self-esteem in a sample of LGBT young Tunisians.

Methods

We conducted an analytical cross-sectional study. Participants were recruited using a snowball sampling technique via social media. Heterosexism Harassment, Discrimination and Rejection Scale (HHRDS), Perceived Stress Scale (PSS-10), and Rosenberg Self-esteem Scale (RSES) were used as measurement instruments.

Results

A total of 73 young LGBT individuals were included. The multivariate analysis indicated that discrimination (β = 4.58, CI95% = [3.36, 5.81], p < 10⁻³) and self-esteem (β = −0.88, CI95% = [−1.09, −0.67], p < 10⁻³) were significant predictors for perceived stress. The moderation model revealed that self-esteem acts as a moderator in the relationship between discrimination and perceived stress (effect = −0.22; p = .02).

Conclusion

The study emphasizes the importance of self-esteem in improving the mental health and well-being of the LGBT community.

Introduction

The LGBT (Lesbian, gay, bisexual, Transgender, and other sexual and gender minorities) individuals face significant mental health disparities compared to their heterosexual counterparts (Moagi et al., 2021; Su et al., 2016). King et al. (2008) conducted a systematic review that highlighted that LGBT individuals are at a heightened risk of experiencing suicidal behavior, mental disorders, and substance misuse. These disparities have been attributed to the persistent social discrimination experienced by this community (Ayhan et al., 2020; Chan et al., 2024; Flage, 2019).

Tunisia, like many countries with repressive sociocultural and legal settings, struggles with issues of discrimination and marginalization against its LGBT community (Jelassi, 2020). According to the global LGBT social acceptance index, Tunisia ranked 119th, trailing behind Morocco at 118th and Algeria at 81st. Moreover, the findings of the report underscored a continuous decline in acceptance since 2000, indicative of worsening attitudes toward LGBT individuals within society (Flores, 2021). This rejection is primarily rooted in erroneous social representations reinforced by certain religious interpretations (Krefa & Tomren, 2021). Male homosexuality is generally regarded as an immoral and deadly sin. Same-sex relationships are criminalized by the existing law. According to Article 230 of the Tunisian penal code, men engaging in sexual practices with other men face up to three years in prison (Khoury & Levine-Spound, 2018).

Despite some progress in recent years toward recognizing the rights of LGBT individuals after the 2011 revolution, social stigma and legal constraints persist, impacting various aspects of their lives (Kréfa, 2019; Lachheb & Hamdi, 2022). Discrimination against LGBT individuals in Tunisia manifests in multiple forms, including harassment, violence, and social exclusion. Such experiences of discrimination can have profound implications for the mental health and well-being of LGBT individuals, contributing to increased levels of stress and psychological distress. In a previous study, Mtiraoui et al. (2022) found that Tunisian LGBT individuals experience high discrimination levels, and those who came out faced significantly higher discrimination and social rejection events compared to those who didn’t perform their outness.

It has been suggested that increased vulnerability to mental health problems in LGBT community is closely related to chronic stress exposure (Meyer, 2003; Newcomb et al., 2020). Sexual and gender minorities who experience day-to-day discrimination are more than twice as likely to endure a psychological disorder in comparison to the majority group (King et al., 2008).

These disparities can be understood through the lens of the minority stress theory (Meyer, 2003), which suggests that social discrimination, stigma, and prejudice create a stressful environment that contributes to the adverse mental health outcomes observed in LGBT populations. The chronic stress experienced by the LGBT population is closely related to social structures and objective events they face but it’s also determined by the individual’s appraisal and valuation of stressors. The theory suggested that self-esteem may play a moderator within the relationship between discrimination and psychological distress (Meyer, 2003).

Extended data from the literature propose that extreme social exclusion, discrimination, and stigma diminish self-esteem levels (Math & Seshadri, 2013) and that self-esteem would buffer the negative impact of stress through coping processes (Meyer, 2003). People with high self-esteem exhibit greater confidence in their ability to cope with environmental demands and can rely on general positive self-evaluations when singular dimensions of self are threatened. People with low self-esteem exhibit maladaptive ruminative coping behaviors, which are linked to increased stress (Urzúa et al., 2018; Zeigler-Hill, 2011).

While previous research has examined the impact of discrimination and low self-esteem on mental health outcomes among LGBT populations (Mellinger & Levant, 2014; Urzúa et al., 2018), there remains a dearth of studies specifically focused on Tunisia. Given the unique sociocultural and legal context of the country, it is crucial to explore how discrimination and self-esteem intersect to influence perceived stress among LGBT youth in this settings.

This study aims to address this gap by examining the relationship between discrimination, self-esteem, and perceived stress within a sample of LGBT youth in Tunisia. Therefore, we hypothesized that in the LGBT community, discrimination and low self-esteem share a positive relationship with perceived stress and that the relationship between discrimination and perceived stress is moderated by self-esteem.

Methods

Study design and setting

We conducted an analytical cross-sectional study, among LGBT young Tunisians, over 9 months, starting from October 2020 to June 2021.

Study population

Participants

Participants were recruited from LGBT community-based Tunisian organizations. They were invited to participate if inclusion criteria were met: (1) self-identifying as LGBT (2) being 18 years of age or older and (3) giving informed consent to participate.

Sampling technique and procedure

The target population was not easily accessible for several reasons including the non-visibility of their sexual minority status; we directed a snowball sampling technique, common to LGBT communities.

Flyers and online announcements about the study were posted on various social media platforms of LGBT Tunisian organizations. The study was presented as part of a research project that sought to paint a picture of young LGBT Tunisians’ current mental health and associated psychosocial factors. Participants providing consent were invited to complete an online questionnaire. The announcements encouraged research participants to recruit other participants who might be interested in the study.

Assessment

Participants’ characteristics

We collected data related to age, educational level, current occupation, and marital status. Participants were assessed for personal history of suicidality. Information related to Sexual Orientation, Gender Identity and Expression, Sex Characteristics (SOGIESC), sex assigned at birth, and coming out were obtained as well. HIV status was also inquired.

Perceived stress

Perceived stress was assessed using the Perceived Stress Scale (PSS-10), a 10-item scale measuring the degree to which life situations are considered stressful (Cohen et al., 1983). The PSS is measured on a 5-point Likert-type scale. Responses ranged from 0 (never) to 4 (very often). Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress. (1) Scores ranging from 0-13 would be considered low stress. (2) Scores ranging from 14 to 26 would be considered moderate stress. (3) Scores ranging from 27 to 40 would be considered high perceived stress. The reported Cronbach’s alpha for the 10-item PSS ranged from 0.84 to 0.86. The scale was used in many studies engaging LGBT individuals as research participants (Pangtey et al., 2020; Tan & Anderson, 2024).

Heterosexist discrimination

Heterosexist discrimination was assessed using the Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS), a 14-item measuring the frequency of heterosexist discrimination that occurred within the last year. (Szymanski, 2006). Participants are asked to rate each question on a 6-point Likert-type scale ranging from 1 (the event has never happened) to 6 (the event happened almost all the time). The scale involves three subscales: (1) The harassment and rejection subscale assesses heterosexism among a variety of contexts, friends, and family. (2) The workplace and school discrimination subscale assesses heterosexism specifically in the context of work or school environment and (3) the other discrimination subscale evaluates heterosexism perpetrated by strangers, service workers, doctors, and caseworkers. The reported Cronbach’s alpha for the scale was high (α = 0.90). Individual items on the HHRDS were originally created for use with gay men and lesbians. In 2009, the author modified the items to be inclusive of bisexual and transgender individuals (Szymanski, 2009).

Self-esteem

Self-esteem level was evaluated using the Rosenberg Self-Esteem Scale (RSES) (Rosenberg, 1965). It is a 10-item scale that assesses self-worth and self-acceptance. The RSES was originally measured on a Guttmann scale but is more commonly measured on a 4-point Likert-type scale. Responses ranged from 0 (strongly agree) to 3 (strongly disagree). Higher scores indicate higher self-esteem; a score of less than 15 suggests low self-esteem may be an issue. The reported Cronbach’s alpha for the scale ranged from 0.77 to 0.88. The scale was used in research projects that included LGBT individuals as research participants (Canali et al., 2014; Walters & Simoni, 1993).

Statistical analysis

Descriptive analyses were calculated for demographic psychological and sexual-related characteristics. A one-way ANOVA test was used to find out if the perceived stress level varies significantly across the categorical variables while the t-test was used for continuous variables. We conducted a bivariate analysis, using linear regression, to test the hypothesis that the studied elements (perceived stress, self-esteem, and discrimination) vary significantly across each other. We used a multivariate linear regression analysis to test the hypothesis that self-esteem and discrimination are significant predictors of the perceived stress level.

The hypothesized moderation model was analyzed using the PROCESS for SPSS version 4.1 based on ordinary least squares (OLS) regression (Hayes, 2022; Hayes & Rockwood, 2017). The bootstrapping resampling method developed by Preacher and Hayes is a powerful method for obtaining confidence intervals for specific indirect effects under most conditions by taking a sample of size n cases with replacement from the original sample.

The corrected 95% confidence interval (CI) was calculated with 5000 bootstrapping resamples. If the interval does not include zero, the effect is statistically significant at p < .05. The rate of missing data was inferior to 1% for each covariate of the dataset; no missing data management technique was used. All statistical analyses were performed with SPSS Software version 25.

Ethical considerations

This study was approved by the Ethics Committee of the Faculty of Medicine of Sousse, Tunisia (CEFMS 96/2021). Informed consent was obtained from all participants before starting the study. Participants were informed about the purpose of the study, the voluntary nature of their participation, and their right to withdraw from the study at any time without penalty. They were also assured of the confidentiality and anonymity of their responses.

Results

Participants characteristics

A total of 73 LGBT individuals were recruited. Their mean age was 23.04 ± 4.26 years. Sex-assigned at birth was masculine for 46 (63%) of them and 55 (75.34%) were cisgender. Among them, 29 (39.72%) self-identified as gays, 17 (23.28%) as lesbians and 41 (56.16%) stated that they have not come out yet. For those who came out, the mean age of outness was 21.22 ±2.31 years.

Out of the 73 participants, 54 (73.97%) have experienced suicidal thoughts and 27 (36.98%) have attempted suicide.

Perceived stress, heterosexism experience, and self-esteem general levels

The PSS mean score was 24.26 ± 8.58 with extremes ranging from 8 to 38. High perceived stress levels were reported by 36 (49.31%) participants.

The HHRD scale revealed that the general frequency of discrimination was around 2.80 ± 0.88 with extremes ranging from 1.50 to 4.96. Participants experienced Harassment and Rejection more frequently than the other two subscales. The Harassment and Rejection subscale (m₁ = 3.40; SD₁ = 1.09) were significantly greater than scores on the Workplace and School Discrimination subscale (m₂= 1.97, SD₂= 0.65; p < 10⁻³) and the Other Discrimination subscale (m₃= 3.05; SD₃ = 0.97; p < 10⁻³).

The RSES mean score was 12.61 ± 5.08 with extremes ranging from 6 to 25. 52 (71.23%) exhibited low self-esteem levels.

Detailed participants’ characteristics and scales general findings are summarized in Table 1.

Table 1.

Participants' characteristics.

		n (%)
Age (m ± SD)	23.04 ± 4.26
Sex assigned at birth	Masculine	46 (63.0 %)
	Feminine	27 (37.0%)
Educational level	College	7 (9.60%)
	High School	17 (23.30%)
	University	42 (57.50%)
	Professional Training	7 (9.6%)
Current occupation	Student	27 (37.0%)
	Worker	19 (26.0%)
	Job seeker	27 (37.0%)
Marital status	Single	41 (56.2%)
	In relationship/married	30 (41.1%)
	Divorced	2 (2.7%)
Sex characteristics	Male	43 (58.9%)
	Female	27 (37.0%)
	Intersex	3 (4.1%)
Gender identity	Cisgender	55 (75.3%)
	Transgender	9 (12.3%)
	Non-binary	9 (12.3%)
Gender expression	Masculine	44 (60.3%)
	Feminine	23 (31.5%)
	Androgynous	5 (6.8%)
	Other	1 (1.4%)
Sexual orientation	Lesbian	17 (23.3%)
	Gay	29 (39.7%)
	Bisexual	16 (21.9%)
	Pansexual	9 (12.3%)
	Asexual	2 (2.7%)
Coming out	Yes	32 (43.8%)
	No	41 (56.2%)
HIV status	Positive	5 (6.8%)
	Negative	47 (64.4%)
	I don’t know	20 (27.4%)
	I don’t want to answer	1 (1.4%)
Perceived Stress level (PSS)		24.26 ± 8.58
Self-esteem level (RSES)		12.62 ± 5.08
Discrimination level (HHRDS)		2.81 ± 0.89
Dimension 1: Harassment and Rejection		3.40 ± 1.09
Dimension 2: Workplace and School Discrimination		1.97 ± 0.65
Dimension 3: Other Discrimination		3.05 ± 0.97

m: mean; SD: Standard deviation; n (%): number (percentage); SOGIESC: Sexual Orientation, Gender Identity and Expression, Sex Characteristics; HIV: Human Immunodeficiency Virus.

Factors associated with perceived stress level

Although the participants’ characteristics were thoroughly examined, there was no statistically significant association found between their demographic variables as well as the SOGIESC and the perceived stress general score (Table 2).

Table 2.

Factors associated with perceived stress level

		Stress levels (m ± SD)	p-value
Age			.67
Sex assigned at birth	Masculine	24.50 ± 9.23	.22
	Feminine	23.85 ± 7.51
Educational level	College	20.00 ± 8.39	.32
	High School	23.76 ± 8.15
	University	24.88 ± 8.65
	Professional Training	26.00 ± 9.83
Current occupation	Student	24.00 ± 9.19	.35
	Worker	27.11 ± 7.42
	Job seeker	22.52 ± 8.50
Marital status	Single	24.41 ± 8.98	.18
	In relationship/married	24.50 ± 8.18
	Divorced	17.50 ± 6.36
Sex characteristics	Male	24.05 ± 8.99	.09
	Female	23.44 ± 7.75
	Intersex	34.67 ± 1.53
Gender identity	Cisgender	23.05 ± 8.91	.69
	Transgender	27.89 ± 6.09
	Non-binary	28.00 ± 7.00
Gender expression	Masculine	23.07 ± 9.13	.36
	Feminine	24.48 ± 7.59
	Androgynous	32.20 ± 1.92
	Other	32.00
Sexual orientation	Lesbian	22.94 ± 7.94	.83
	Gay	24.07 ± 9.54
	Bisexual	24.63 ± 7.18
	Pansexual	24.56 ± 9.66
	Asexual	34.00 ± 1.41
Coming out	Yes	25.75 ± 8.58	.07
	No	23.10 ± 8.51
HIV status	Positive	25.26 ± 8.23	.16
	Negative	22.10 ± 8.81
	I don’t know	24.20 ± 8.32
	I don’t want to answer	21.00

The linear regression analysis revealed that perceived stress in LGBT young Tunisians was positively associated with heterosexist discrimination experience frequency (β = +8.84, CI95% = [7.90, 9.76], p < 10⁻³) and negatively correlated with the self-esteem level (β = −1.55, CI95% = [−1.71, −1.40], p < 10⁻³). The heterosexist experience frequency was negatively associated with the self-esteem level (β = −4.80, CI95% = [−5.54, −4.07], p < 10⁻³) (Table 3).

Table 3.

Bivariate analysis among the perceived stress, discrimination, and self-esteem levels.

	1	2
1- Perceived stress level	–	–
2- Self-esteem level	B = − 1.55; p = .000 95% CI = [−1.71; −1.40]	–
3- Discrimination level	B = +8.83; p = .000 95% CI = [7.91; 9.77]	β = − 4.81; p = .000 95% CI = [−5.54; −4.07]

95% CI: 95% Confidence Interval.

The multivariate linear regression analysis with perceived stress as a dependent variable showed that the heterosexist experience (β = 4.58, CI95% = [3.36, 5.81], p < 10⁻³) and self-esteem level (β = −0.88, CI95% = [−1.09, −0.67], p < 10⁻³) were significant predictors of the perceived stress level. The adjustment quality of our multivariate linear model was very good (Adjusted-R² = 91.4%) (Table 4).

Table 4.

Prediction model using linear regression.

			95% CI of B
	B	p-value	LLCI	ULCI
Intercept	22.531	.000	16.595	28.467
RSES Score	−0.884	.000	−1.098	−0.669
HHRDS Score	4.589	.000	3.361	5.818
Adjusted R-squared = 91.4%; p = .000

Dependent Variable: Perceived Stress

PSS: Perceived Stress Scale; RSES: Rosenberg Self-Esteem Scale; HHRDS: Heterosexist Harassment. Rejection. and Discrimination Scale; LLCI: Lower Limit Confidence Interval; ULCI: Upper Limit Confidence Interval.

Moderation effect of self-esteem on the relationship between perceived stress and discrimination

The results of Hayes PROCESS Model analyses showed that the interaction of RSES and HHDRS predict PSS significantly, suggesting a moderating effect of self-esteem (effect = −0.22; SE = 0.14; CI95% = [−0.41, −0.03]; p = .02) (Table 5).

Table 5.

Hayes PROCESS model: The moderation effect.

			95% CI of B
	B ± se	p-value	LLCI	ULCI
Intercept	18.21 ± 3.44	.000	11.346	25.071
RSES	−0.46 ± 0.21	.034	−0.880	−0.036
HHRDS	6.70 ± 1.09	.000	4.524	8.877
Moderation effect	−0.22 ± 0.14	.024	−0.410	−0.030
Adjusted R-squared = 92.2%; p = .000

Dependent Variable: PSS

se: standard error.

Discussion

This study focused on the discrimination experiences and perceived stress in a sample of LGBT young Tunisians. It aimed to examine the role played by self-esteem in moderating the relationship of heterosexist experiences with perceived stress.

According to the perceived stress scale results, our sample’s general level of perceived stress was about 24.26 ± 8.58 with extremes ranging from 8 to 38. Though, 36 (49.31%) of the respondents had high perceived stress. Dehghani Ashkezari et al. (2020) found that 38.8% of their LGBT participants had moderate to severe stress. The differences in stress levels can be explained by the circumstances and the country of study. Different cultural, legal, and social factors can influence the stress levels and the coping mechanisms of LGBT individuals leading to variations in research findings. Laws, societal attitudes, and social support toward sexual minorities can vary greatly between countries. In Tunisia, same-sex sexual practices are criminalized under the country’s penal code. Also, societal attitudes toward LGBT individuals are generally negative, and discrimination and prejudice against the community are common which may deteriorate the mental health of the local sexual and gender minorities (Hamdi et al., 2018; Lachheb & Hamdi, 2022; Mtiraoui et al., 2022).

Through the lens of this research, we exposed that the level of stress experienced by sexual and gender minorities was not influenced by the participants’ characteristics. This can be explained by the used scale that may not differentiate between chronic minority stress stemming from anti-LGBT discrimination experiences and everyday stressors unrelated to LGBT identity or discrimination experiences. This sensitivity becomes particularly crucial in repressive sociocultural settings, where stress related to discrimination and fear of arrest can significantly outweigh everyday stressors. Therefore, we recommend the development of more nuanced assessment tools that are capable of differentiating the source of distress, particularly in contexts where minority stress is compounded by severe social and legal repercussions.

Using a multivariate analysis, we didn’t find any significant association between the perceived stress general score and the socio-demographic characteristics as well as the SOGIESC data. Data in the literature is controversial, some researchers found that personal characteristics such as age, gender, sex assigned at birth, and sexual orientation were associated with stress levels (Bostwick et al., 2010; Frost et al., 2015; Thoma et al., 2021), others failed to replicate these findings (Collier et al., 2013; Wight et al., 2016).

This variety of conclusions may be due to the number of factors, including the complexity of stress and its many different causes and sources, as well as the fact that stress can affect individuals from all backgrounds and demographic groups as well as the context of the investigation and the population understudy (Juliana et al., 2022; Mofatteh, 2021). It is also possible that the sample used in this study may not have been large enough to accurately reflect the experience of the larger LGBT community, and further research may be needed to fully understand the relationship between stress and demographic factors. Another worth mentioning explanation might be that the relationship between perceived stress and personal characteristics would be mediated by other variables such as the perceived experience of discrimination, cognitive style, and self-esteem. Regardless of these findings, it is important to continue to prioritize and address the mental health needs of the LGBT community and to work toward reducing the levels of stress and improving the overall well-being of the marginalized group.

However, our findings indicate that the stress level experienced by the LGBT sample understudy was associated with the discrimination and heterosexism level. Our bivariate analysis revealed a positive correlation between stress levels and heterosexism frequency (β = +8.84, CI95% = [7.90, 9.76], p < 10⁻³). This relationship was maintained when further analysis was conducted using a multivariate linear regression model (β = 4.58, CI95% = [3.36, 5.81], p < 10⁻³). In their meta-analysis, Pascoe and Smart Richman (2009) suggested that there may be pathways linking perceived discrimination to adverse health outcomes. Based on their results, discrimination was positively associated with high-stress levels. This relationship goes side by side with the minority stress model, which posits that regular exposure to negative societal attitudes, discrimination, and prejudice can lead to chronic social stress and negative health outcomes related to minority identity (Frost et al., 2015; Meyer, 2003).

Discrimination can generate stress by creating negative responses in individuals who experience it. It can lead to social isolation, as well as difficulty accessing resources and opportunities, which can further contribute to stress. These experiences can take a toll on an individual’s mental health, leading to higher levels of stress, anxiety, and depression. Additionally, the constant threat of discrimination can create a chronic stress response, which can have long-term health effects. Therefore, it is important to address and reduce discrimination to improve the mental health and well-being of the LGBT community (Kneale & Bécares, 2021).

The results of the bivariate analysis revealed a negative correlation between self-esteem and perceived stress (β = −1.55, CI95% = [−1.71, −1.40], p < 10⁻³), and this association was maintained in the multivariate analysis (β = −0.88, CI95% = [−1.09, −0.67], p < 10⁻³). In other words, higher levels of self-esteem were associated with lower levels of perceived stress. This suggests that self-esteem may serve as a protective factor or buffer against the effects of perceived stress in the LGBT community. As a matter of fact, individuals with high self-esteem have a positive view of themselves and their abilities and are more likely to view stress and discrimination as external challenges that can be overcome. This positive view provides them with a greater sense of resilience, allowing them to manage stress more effectively (Camp et al., 2020).

According to our hypothesis, self-esteem may play a moderator in the relationship between heterosexism experiences with perceived stress. Hayes PROCESS Model was used to test the moderation effect. In this model, heterosexist experience (HHDRS) was entered as the independent variable, perceived stress (PSS) was the dependent variable, and self-esteem (RSES) was entered as a moderator (Hayes, 2022; Hayes & Rockwood, 2017). The model showed that the interaction of RSES and HHDRS predicted PSS significantly, suggesting a moderating effect of self-esteem (effect = −0.22; SE = 0.14; CI95% = [−0.41, −0.03]; p = .02).

Self-esteem has been found to play a moderating role in the relationship between perceived stress and discrimination within the LGBT community. Research has shown that individuals with high self-esteem are better equipped to manage the effects of stress and discrimination. They may be less likely to internalize negative experiences, such as discrimination, and instead see them as external challenges that can be overcome (Szymanski, 2009). Additionally, individuals with high self-esteem are often more resilient in the face of adversity and have better-coping skills to manage the effects of stress (Szymanski & Gupta, 2009).

Limitation

To our knowledge, this study represents the first in-depth exploration of an LGBT-related issue in Tunisia. Despite utilizing a robust analytical model with bootstrapping, the study is limited by its sample size. Future research should include a larger sample to determine if the moderation effect varies. Additionally, the study is constrained by the use of the snowball sampling technique. This method may lead to over- or under-representation of certain subgroups within the LGBT community, potentially affecting the analysis. The study may also be limited by the measurement instrument used. Although the Perceived Stress Scale is widely used in the literature, in certain sociocultural contexts, stress related to anti-LGBT discrimination might overshadow stressors unrelated to sexual and gender identity. This could influence the outcomes and interpretations of the study.

Conclusion

Self-esteem plays a fundamental role in moderating the impact of discrimination events on perceived stress. These findings highlight the importance of addressing the needs of the LGBT Tunisian community, particularly mental health, to reduce the levels of stress and improve the overall well-being of this marginalized group. Notably, the sex assigned at birth was not an associated factor to perceived stress levels. The results of our study emphasize the need for policies and programs that support and empower the LGBT community. Future research could explore the longitudinal effects of discrimination and other stressors on the mental health of LGBT individuals in Tunisia, as well as the potential protective factors that may buffer against negative outcomes.

Funding Statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.