Attitudes Towards Homosexuality and Associated Factors Among Medical Students

ABSTRACT

Objective:

This study aimed to determine the psychosocial factors that may influence attitudes toward sexual orientation among medical students and to explore the relationship between attitudes regarding gender roles, sexual myths, and homophobia.

Method:

A total of 457 medical students from Çanakkale Onsekiz Mart University in Turkiye were included in the study during the 2022-2023 academic year. Participants received the Sociodemographic Data Form, Hudson & Ricketts Homophobia Scale, Sexual Myths Scale, and Gender Role Attitudes Scale.

Results:

Homophobia scores were found to be lower among fifth- and sixth-grade medical students compared to first-year students. Lower rates of homophobia were observed in students receiving psychiatric treatment and those who identify as secular. Hierarchical regression analysis revealed a positive correlation between sexual myths and homophobia, and a negative correlation between gender role attitudes and homophobia. Predictors of homophobia include right-wing political orientation, conservatism, a high belief in sexual myths, and non-egalitarian attitudes toward gender roles. Finally, a mediation analysis demonstrated that attitudes toward gender roles serve as a partial mediating variable in the relationship between sexual myths and homophobia.

Conclusion:

The findings of our study highlight the significance of psychosocial and cultural factors in shaping attitudes toward sexual orientation and the need for accurate and comprehensive sexuality education in the medical curriculum. It is expected that thorough and equitable education will mitigate the stress associated with homophobia.

INTRODUCTION

Homophobia is a form of discrimination characterized by emotional reactions and negative attitudes stemming from myths and stereotypes about homosexual relationships (Snively 2004). This discrimination results in the exclusion, stigmatization, and abuse of individuals. When individuals become targets of discrimination, they face numerous personal and social challenges (Meyer 2003). Homophobia remains a significant social issue today. It generates external stresses, such as violence and discrimination, as well as internal stresses, like internalized homophobia, depending on the experiences of homosexual individuals within the processes of social stigmatization and marginalization. These stressors can have a detrimental impact on a person’s mental health (Newcomb and Mustanski 2010). Prejudice and discrimination against homosexual individuals in society increase the risk of mood and anxiety disorders, alcohol and substance abuse, and suicidality in this grup (Önal and Yalçınoğlu 2014). From this perspective, homophobia emerges as a critical mental health issue.

Prejudices and negative attitudes towards homosexuals are commonly observed in Turkiye. These negative attitudes are linked to the traditional, patriarchal, and authoritarian family structure prevalent in Turkish culture (Kağıtçıbaşı 2017). Orta and Camgöz (2018), in their research compiling studies on homophobia conducted in Turkiye between 2002 and 2017, found that prejudice against homosexuals is generally high and that attitudes are predominantly negative in Turkiye. The same study determined that homophobic attitudes are influenced by various factors such as gender, religious beliefs, attitudes toward gender roles in society, and the level of acquaintance with homosexual individuals. Community-based studies (Jäckle and Wenzelburger 2015, Rollè et al. 2022) report that men tend to have more negative attitudes towards homosexuals compared to women, and men’s perceptions of gender roles are more traditional (Öngen and Aytaç 2013, Yıldız and Keçeci 2016).

Physical and verbal attacks, as well as violence against homosexual individuals, can be seen in nearly every area of society (Kılıçaslan 2017). While reports indicate that positive attitudes toward sexual orientation diversity are increasing, stigmatization and discrimination continue to persist globally. This remains a primary cause of the health inequalities faced by sexual minorities (Başar 2025). Homosexual individuals often believe that disclosing their sexual identity and orientation will lead to negative behavior toward them and hinder their access to quality healthcare services (Ayhan et al. 2020). Keleş and colleagues (2018) reported in a study conducted in our country that lesbian, gay, bisexual, transgender, and those identifying with other sexual identities (LGBT+) face challenges in expressing themselves to healthcare professionals, feel marginalized, and encounter obstacles in accessing healthcare services due to physicians’ lack of knowledge and experience. Florez-Salamanca and Rubio (2013), while analyzing sexual prejudice among medical students in New York, conceptualize prejudice as a crucial factor in the stigmatization and exclusion of the LGBT population. When these findings are examined, it becomes clear that physicians’ attitudes not only impact the mental health of LGBT individuals but also directly influence their access to healthcare services. In this context, homophobia and the factors that may contribute to such attitudes are significant topics in psychiatry. Given that physicians, especially mental health professionals, frequently interact with homosexual individuals, the attitudes of healthcare professionals play a vital role in the mental well-being of LGBT individuals. From this perspective, increasing medical students’ interactions with both sexually minority individuals and psychiatry is essential. A study (Corrigan and Watson 2002) has indicated that individuals who have received or are currently receiving psychiatric treatment may develop a greater self-understanding and empathy for others, potentially contributing to a reduction in homophobic attitudes. In this regard, it is conceivable that the context of students’ engagement with psychiatry may also impact homophobia. For all these reasons, identifying medical students’ attitudes toward homosexuals, examining the factors that may contribute to these attitudes, determining the content of intervention programs to be developed in medical education, and ensuring that homosexual individuals receive higher-quality healthcare in the future are of great importance (Klamen et al. 1999).

Myths about sexuality are among the most significant factors influencing an individual’s perspective on sexuality and sexual experiences (Fennell and Grant 2019). These myths and prejudices about sexuality also contribute to negative attitudes toward homosexuality. A study conducted on mental health professionals found a positive correlation between participants’ belief in sexual myths and their homophobic attitudes. Moreover, myths related to sexual orientation, sexual behavior, and sexual satisfaction particularly predict high levels of homophobia (Turan and Güler 2022). Gender roles may significantly influence the effect of sexual myths on homophobia. Sexual myths can shape individuals’ misconceptions about sexuality, which may increase homophobic attitudes, especially among those who strongly adhere to gender norms. Gender roles create a context that either reinforces or mitigates homophobia by influencing individuals’ perceptions of themselves and others. Research indicates that homophobia is more prevalent among individuals with high levels of commitment to traditional gender norms (Herek, 2000). Furthermore, the findings suggest that heightened perceptions of gender equality may reduce homophobia, supporting the mediating effect of gender roles on this relationship (Sakallı, 2002). Therefore, exploring the role of gender roles in the connection between sexual myths and homophobia provides a valuable perspective for understanding the psychosocial mechanisms underlying homophobia.

This study aims to investigate the psychosocial, cultural, and demographic factors influencing homophobic attitudes among medical students, determine their attitudes toward gender roles, and explore their beliefs in sexual myths. Additionally, it seeks to examine the relationships between these elements. The hypotheses of the study are as follows: 1. Homophobic attitudes among medical students vary by gender; 2. The political and ideological views of medical students influence their levels of homophobia; 3. A history of psychiatric treatment impacts the levels of homophobia among medical students; 4. Medical students with traditional attitudes toward gender roles possess higher levels of homophobia; 5. Homophobic attitudes are more prevalent in students with strong beliefs in sexual myths; 6. Attitudes toward gender roles mediate the effect of belief in sexual myths on homophobia.

METHOD

This study was conducted with students who volunteered to participate and were enrolled in a state university in Turkiye (Çanakkale Onsekiz Mart) medical school during the 2022-2023 academic year. Students were contacted through their class representatives and informed about the study. Scales were administered to those who volunteered via online forms. The sample size was planned to include all students enrolled in the 2022-2023 academic year (N=1037). Assuming a margin of error (alpha)=0.05, power (1-β)=0.80, and the highest variance condition (p=0.5) for the attitude toward homosexuality being investigated in the study, the Cochran’s formula indicated that the minimum number required for this cross-sectional study was n=281 (Cochran, 1977). A total of N=572 participants voluntarily completed the scales. During the analyses, it was observed that 115 participants did not answer the questions appropriately (due to very short response times, inappropriate responses in the demographic and psychosocial data forms, and answering all questions with the same options). For data reliability, the data from these participants were excluded from the analyses. The final sample consisted of N=457 participants.

The study was conducted using an electronic survey created with Google Forms. At the start of the study, all participants were informed about the research and asked if they wished to continue; informed consent was obtained online. Only participants who selected the ‘yes’ option were directed to the survey page, and they could withdraw from the study at any time. The personal information of the participating students, such as their names and ID numbers, was not recorded anywhere. The internet link to the online form was shared with all term representatives via a messaging application, and a poster about the study was sent to all medical school students through the university’s information management system. All participants completed the survey in 20 to 30 minutes.

Four different data collection tools were used in the study: (1) a Sociodemographic Data Form to gather information about participants’ demographic characteristics and their thoughts on social life, (2) the Hudson & Ricketts Homophobia Scale to examine their views and attitudes towards homosexuals, (3) the Sexual Myths Scale to evaluate their beliefs about sexuality, and (4) the Gender Role Attitudes Scale to assess their perceptions and attitudes towards social gender roles. Approval for this research was obtained from the Çanakkale Onsekiz Mart University Faculty of Medicine Ethics Committee (18.01.2023-2023/02-18).

Data Forms

Demographic and Psychosocial Data Form

This form includes 29 questions created by the researcher, intended to gather demographic information about the participants, their views on the role of religion in society and marriage, domestic violence, mental illness, treatment history, and their political and ideological beliefs. To assess religious upbringing (whether they were raised according to religious rules) and the presence of conservative views (strict adherence to cultural and religious traditions, and a cautious approach to change), specific questions were posed. Definitions of political and ideological perspectives were outlined: Left-wing political view: an ideological approach advocating equality, social justice, and a greater role for the state in the economy; Right-wing views: perspectives that prioritize traditional values and support market-based economic policies; Centrist views: positions that adopt a middle ground, distinct from both right-wing and left-wing ideas. Participants were then asked to indicate which concept they felt closest to.

Hudson & Ricketts Homophobia Scale (HRHS)

The 25-item, single-dimensional, 6-point Likert-type scale was developed by Hudson and Ricketts (1980) to measure attitudes toward homosexual individuals. In the study, the 24-item Turkish version of the scale, adapted by Sakallı and Uğurlu (2001), was utilized. The Turkish version demonstrated high reliability, with a Cronbach’s alpha value of 0.94. Participants rated each item on a scale from 1 (strongly disagree) to 6 (strongly agree). High scores on the scale indicate elevated levels of homophobia. For the study sample, Cronbach’s alpha was also computed for the HRHS, yielding a value of 0.96.

Sexual Myths Scale (SMS)

To measure attitudes toward sexual myths, the 5-point Likert-type Sexual Myths Scale, developed by Gölbaşı and colleagues (2016) and validated for reliability by researchers, was utilized. This scale consists of 28 questions and includes items reflecting responses in the form of ‘Strongly Disagree (1), Disagree (2), Undecided (3), Agree (4), and Strongly Agree (5).’ A high score indicates a strong belief in sexual myths. In this study sample, Cronbach’s alpha value for the SMS was calculated to be 0.96.

Gender Role Attitudes Scale (GRAS)

The GRAS was developed by García-Cueto et al. (2015). The scale consists of 20 items designed to measure individuals’ attitudes toward gender roles. It uses a single-dimensional 5-point Likert-type rating scale (1 = Strongly Disagree, 5 = Strongly Agree). The Turkish reliability and validity of the scale were established by Bakioğlu and Türküm (2018). High scores on the scale indicate egalitarian attitudes, while low scores suggest traditional attitudes. In this study sample, Cronbach’s alpha value for the scale was calculated to be 0.90.

Statistical Analysis

Descriptive statistics were employed to summarize the data collected in this study. Continuous (numerical) variables, such as HRHS score, SMS score, GRAS score, and age, are expressed as mean ± standard deviation, along with minimum and maximum values. In contrast, categorical variables are presented as counts and percentages. Before performing statistical analyses, the dataset was evaluated to ensure it met the criteria for standard normal distribution. For assessing the normality of numerical variables, skewness and kurtosis values ranging from -1.5 to +1.5 were considered as a reference (Tabachnick et al. 2019). Furthermore, the Central Limit Theorem indicates that if the sample size is sufficiently large (n=30+), the sampling distribution of the means will be normally distributed, regardless of the distribution of the variables, and a violation of normal distribution will not pose a significant issue (Tabachnik and Fidel, 2013). Given this information, it was determined that analyses would be performed using parametric statistical techniques. Independent samples t-tests, one-way analysis of variance (ANOVA), Welch ANOVA, Pearson correlation, and partial correlation analyses were performed for all continuous variables. Cohen’s effect size intervals for the correlation coefficient are as follows: 0.10 < r < 0.30 indicates a small effect, 0.30 < r < 0.50 signifies a moderate effect, and r ≥0.50 represents a large effect (Cohen, 1988). Post-hoc LSD and Bonferroni tests were conducted on statistically significant results from ANOVA. Hierarchical multiple regression analysis was implemented to identify the factors predicting homophobia. The adjusted R² value was utilized to assess the proportion of variance in the dependent variable explained by the model (dummy variables were applied in cases with multiple categories). To evaluate whether attitudes toward gender roles serve as a mediating variable in the relationship between sexual myths and homophobia, a mediating variable analysis was performed. Statistical significance was established at p<0.05, and all statistical significance tests were two-tailed. The statistical analysis of the acquired data was conducted using IBM SPSS 28.0 (IBM, NY, USA). The PROCESS Macro (Model 4) was employed to ascertain whether attitudes toward gender roles function as a mediating variable in the relationship between sexual myths and homophobia.

RESULTS

The sociodemographic data of the participants are presented in Table 1. Of the 457 participants in the study, 53.8% were female (n = 246) and 46.2% were male (n = 211). When comparing scale scores by gender, it was found that total scores for HRHS, SMS, and GRAS were significantly higher in male students (all p < 0.001).

Table 1.

Demographic and clinical characteristics of participants

	Total (n, %)	Male (n, %)	Female (n, %)	p
Total participants	457	211 (46.2%)	246 (53.8%)	0.100
Distribution by grades				0.490
1. Grade	142 (31.1%)	57 (40.1%)	85 (59.9%)
2. Grade	73 (16.0%)	34 (46.6%)	39 (53.4%)
3. Grade	42 (9.2%)	24 (57.1%)	18 (42.9%)
4. Grade	36 (7.9%)	17 (47.2%)	19 (52.8%)
5. Grade	84 (18.4%)	41 (48.8%)	43 (51.2%)
6. Grade	80 (17.5%)	38 (47.5%)	42 (52.5%)
Raised with a religious upbringing	281 (61.5%)	130 (61.6%)	151 (61.4%)	0.060
Endorses religious rules in social life	89 (19.5%)	44 (20.9%)	45 (18.3%)	0.490
Self-identifies as a conservative	102 (22.3%)	50 (23.7%)	52 (21.1%)	0.054
Self-identifies as a nationalist	276 (60.4%)	127 (60.2%)	149 (60.6%)	0.934
Self-identifies as a secular	364 (79.6%)	167 (79.1%)	197 (80.1%)	0.081
Political orientation				0.055
- Left-wing	240 (52.5%)	104 (49.3%)	136 (55.3%)
- Centrist	178 (38.9%)	82 (38.9%)	96 (39%)
- Right-wing	39 (8.5%)	25 (11.8%)	14 (5.7%)
Exposure to domestic violence	70 (15.3%)	39 (18.5%)	31 (12.6%)	0.082
History of mental illness	113 (24.7%)	47 (22.3%)	66 (26.8%)	0.143
History of psychiatric treatment	64 (14.0%)	25 (11.8%)	39 (15.9%)	0.219
Family history of mental illness	74 (16.2%)	31 (14.7%)	43 (17.5%)	0.420

HRHS: Hudson & Ricketts Homophobia Scale; SMS: Sexual Myths Scale; GRAS: Gender Role Attitudes Scale.

Correlation Analyses

The relationship between HRHS, SMS, and GRAS was examined using Pearson correlation analysis. Significant relationships were identified between the scales (all p values <0.001) (Table 2). After controlling for students’ age, gender, and academic year, a strong positive correlation (r=0.52, p<0.001) was noted between homophobia and sexual myths. In contrast, a moderate negative correlation (r=-0.44, p<0.001) was found between homophobia and attitudes toward gender roles.

Table 2.

Scale scores, comparison between gender groups, and correlation analysis between scores

Scales	Scale Score (Mean ± SD)	HRHS	SMS	GRAS
HRHS	Male: 81.19 ± 27.26	-
	Female: 64.17 ± 27.03
	*p < 0.001
SMS	Male: 63.37 ± 21.65	r = 0.592	-
	Female: 47.92 ± 18.62	p < 0.001
	*p < 0.001
GRAS	Male: 62.02 ± 9.59	r = -0.532	r = -0.594	-
	Female: 50.66 ± 10.21	p < 0.001	p < 0.001
	*p < 0.001

SD: standard deviation; HRHS: Hudson & Ricketts Homophobia Scale; SMS: Sexual Myths Scale; GRAS: Gender Role Attitudes Scale.

^*Comparison of scale scores between gender groups

When evaluating the relationship between scale scores (HRHS, SMS, and GRAS) and age using Pearson correlation analysis, a negative correlation was found between age and SMS scores (r= -0.175, p<0.001). No significant correlation was observed between age and the other scale scores (p>0.05). Additionally, HRHS scores were significantly lower in individuals with a history of mental health treatment (t=3.812, p<0.001), while scores on the other scales remained comparable (p>0.05).

Variables Predicting Hudson & Ricketts Homophobia Scale Scores

The scores of the Hudson & Ricketts Homophobia Scale were analyzed using a hierarchical multiple regression model (Table 3).

Table 3.

Factors Predicting Hudson & Ricketts Homophobia Scale Scores: Hierarchical Regression Model

		Unstandardized coefficients		Standardized coefficients			95% CI
Model		β	SD	β	t	p	Lower	Upper
1	(Constant)	78.04	2.36		32.99	<0.001	73.40	82.69
	Grade 2	-10.29	4.05	-0.13	-2.53	0.012	-18.27	-2.31
	Grade 3	-3.85	4.95	-0.03	-0.77	0.436	-13.58	5.87
	Grade 4	-4.99	5.26	-0.04	-0.94	0.34	-15.33	5.34
	Grade 5	-9.18	3.88	-0.12	-2.36	0.018	-16.80	-1.55
	Grade 6	-11.08	3.94	-0.14	-2.81	0.005	-18.83	-3.34
	Male	17.48	2.53	0.31	6.92	<0.001	12.52	22.44
2	(Constant)	80,86	9.09		8.88	<0.001	62.98	98.74
	GRAS	-0.68	0.11	-0.27	-6.05	<0.001	-0.91	-0.46
	SMS	0.56	0.06	0.42	9.29	<0.001	0.44	0.68
3	(Constant)	115.47	12.64		9.13	<0.001	90.62	140.32
	Religious Upbringing	1.07	2.04	0.01	0.52	0.60	-2.94	5.08
	Endorses religious rules in social life	4.83	2.83	0.06	1.70	0.088	-0.73	10.41
	History of psychiatric treatment	-11.76	2.79	-0.14	-4.20	<0.001	-17.26	-6.26
	Centrist	4.86	2.15	0.08	2.25	0.025	0.62	9.09
	Right-wing	9.69	4.02	0.09	2.41	0.016	1.78	17.61
	Conservative	11.99	2.94	0.17	4.07	<0.001	6.21	17.77
	Secular	-6.35	2.70	-0.090	-2.35	0.019	-11.66	-1.03
	Model 1: R²=0.109, p<0.001; Model 2: R²=0.401, p<0.001; Model 3: R²=0.526, p<0.001

β: Beta, CI: Confidence Interval, SD: Standard Deviation, SMS: Sexual Myths Scale; GRAS: Gender Role Attitudes Scale.

First, variables representing the period during which the participants studied and their gender (reference category: female) were added to the model, explaining 10.9% of the variance in homophobia. In the second step, the SMS and GRAS variables were incorporated. After controlling for gender and period variables, these two measures accounted for 28.6% of the variance in homophobia (p<0.001). In the third step, the model included the influence of religion in upbringing, adherence to religious rules in social life, history of psychiatric treatment, participants’ political views, and whether individuals identified as conservative and/or secular. After controlling for period, gender, SMS, and GRAS variables, these six additional factors explained 12% of the variance (p<0.001). Considering all models together, the independent variables accounted for 51.5% of the variance in homophobia, and all three models were statistically significant (all p-values <0.001).

Mediator Variable Analysis Results

Hayes (Process) Analysis (model 4) was used to determine whether attitudes toward gender roles acted as a mediating variable in the relationship between sexual myths and homophobia. Initially, findings regarding the impact of sexual myths on homophobia were presented without incorporating attitudes toward gender roles into the model. According to these findings, the effect of sexual myths on homophobia was significant (p<0.001). The results indicated a positive relationship between the variables, accounting for 35% of the variation in HRHS scores (R²=0.350). In the second stage, when attitudes toward gender roles were added to the model, the focus shifted to the effects of sexual myths on attitudes toward gender roles and the impacts of both sexual myths and attitudes toward gender roles on homophobia (Figure 1).

Figure 1.

The Mediating Role of Gender Roles Attitude Score in the Relationship Between Sexual Myths and Homophobia

When examining the findings in Figure 1, it is clear that the effect of sexual myths on attitudes toward gender roles (path a) is significant (p<0.001). This shows a negative relationship between the current variables, with sexual myths accounting for 35.3% of the change in the GRAS score (R²=0.353). Furthermore, the effect of attitudes toward gender roles on homophobia (path b) is also significant (p<0.001). The direct effect of sexual myths on homophobia (path c) is significant as well (p<0.001). It was observed that there is a positive relationship among the current variables, with sexual myths accounting for 18.1% of the variation in HRHS scores (β²=0.181).

When these findings were evaluated in conjunction with the significant relationship between sexual myths and attitudes toward gender roles, they indicated a notable connection between sexual myths, attitudes toward gender roles, and homophobia (p<0.001). However, a closer examination revealed that the relationship between sexual myths and homophobia remained significant, even after controlling for gender role attitudes (p<0.001). Based on these findings, gender role attitudes were identified as a ‘partial mediating variable.’ When the attitude toward gender roles, identified as a partial mediator variable, was included in the model, it accounted for 28% of HRHS scores through an indirect effect (Table 4).

Table 4.

The Direct Effect of Sexual Myths Scale Scores on Homophobia Scale Scores and the Indirect Effect through the Gender Roles Attitude Scale

				95% CI
Type	Effect	Estimate	S.E.	Lower	Upper	β	z	p
Indirect	Sexual myths ⇒ gender roles ⇒ homophobia	0.219	0.038	0.145	0.294	0.166	5.77	<0.001
Component	Sexual myths ⇒ gender roles	-0.315	0.020	-0.354	-0.276	-0.594	-15.80	<0.001
	Gender roles ⇒ homophobia	-0.697	0.112	-0.917	-0.476	-0.279	-6.20	<0.001
Direct	Sexual myths ⇒ homophobia	0.563	0.060	0.446	0.679	0.426	9.45	<0.001
Total	Sexual myths ⇒ homophobia	0.782	0.050	0.684	0.880	0.592	15.67	<0.001

β: Beta; CI: Confidence Interval; S.E.: Standard Error. Note: All betas represent fully standardized effect sizes.

DISCUSSION

According to the results of the study, homophobia scores were significantly higher among male students than among their female counterparts. Similarly, male students displayed a stronger belief in sexual myths and maintained more negative attitudes toward gender roles. In this respect, the results confirmed the hypothesis that homophobic attitudes vary by gender. A study conducted by Banwari and colleagues (2015) on medical students revealed that female students had more positive attitudes toward homosexuals. The results of the current study support previous research in this regard. This gender difference can be understood within the context of gender roles. Homophobia is viewed as part of the cultural norms associated with appropriate gender roles. In this context, homosexuality is seen as outside acceptable gender behavior and, in particular, as a threat to ‘male’ gender identity (Nungesser 1983). Women generally experience less exposure to the heteronormative and patriarchal social pressures that men encounter in this context (Barron et al. 2008). Sensitivity to conformity with gender roles is greater among men than among women. This stems from heterosexual men’s tendency to avoid the label of homosexuality, often associated with femininity, weakness, and deviation from gender norms (Sakallı Uğurlu and Sakallı 2004).

Another finding of the study is that fifth- and sixth-grade students exhibit significantly lower levels of homophobia compared to first-graders. These results align with similar studies in the scientific literature. According to Grabovac and colleagues (2014), sixth-year medical students have more positive attitudes toward homosexuals than fifth-year students (Grabovac et al. 2014). In another study by Dunjić-Kostić and colleagues (2012), knowledge levels about homosexuality among second-year medical students were found to be lower than those of sixth-year students and interns. Research on healthcare professionals in Turkiye is limited. Yertutanol et al. (2018) examined attitudes toward homosexuals among psychiatrists, non-psychiatrist physicians, and first-year medical students. The results indicated that negative attitudes toward homosexuals were highest among first-year medical students and lowest among psychiatrists. The findings from the literature and the current research can be evaluated in the context of medical education and clinical experience. Research suggests that as clinical experience increases, medical students display more positive attitudes towards homosexuals (Sanchez et al. 2006; Burke et al. 2015). It can be anticipated that medical education enhances students’ knowledge regarding sexuality and gender issues, consequently reducing their homophobic attitudes. Additionally, students’ interactions with patients and their clinical experience grow through internships and pre-medical training. Increased contact with diverse patient populations may elevate students’ levels of empathy, positively influencing their attitudes toward LGBTQ+ individuals.

Medical students receiving treatment for mental illness exhibit lower levels of homophobia compared to those not undergoing treatment. Although there are few studies in the scientific literature exploring the connection between psychiatric treatment and homophobia, these findings can be linked to the stigmatization faced by both homosexuals and individuals in psychiatric care. Homosexual individuals experience stigma on individual, interpersonal, and structural levels due to their sexual orientation. The minority stress they endure from discrimination and stigma leads them to internalize the homophobic attitudes of those around them (Hatzenbuehler and Pachankis 2016). Patients with mental illness undergoing treatment also face similar minority stress and stigma (Yin et al. 2020). Individuals with mental disorders are often labeled and stigmatized by society because of behaviors and appearances that deviate from social norms (Goffman 1986). Likewise, those who are stigmatized and experience minority stress are more likely to show tolerance and empathy toward each other. This dynamic may be associated with more positive attitudes toward homosexuals and other minority individuals among those receiving psychiatric treatment.

According to our study, adopting right-wing political views and a conservative stance predicts higher levels of homophobia. Terrizzi and colleagues (2010) found that social conservatism is linked to prejudices against homosexuality. A more recent investigation examining the correlation between economic and sociopolitical ideologies and homophobia (Barnett et al. 2018) identified a positive relationship between conservative ideology and homophobia. It is emphasized that anti-gender movements are emerging in Turkiye and globally due to the influence of right-wing populist policies, which reinforce homophobic attitudes (Gezgin 2024). This study predicts that conservative and right-wing policies promote anti-gender equality rhetoric and worsen homophobia.

We found that students’ adoption of non-egalitarian perspectives on gender roles was linked to higher levels of homophobia. A study by Sanberk et al. (2016) among university students revealed that those who displayed more masculine gender roles exhibited stronger homophobic attitudes. Similarly, research involving adolescents (Weber and Gredig 2018, Zmyj and Huber-Bach 2019) indicated that non-egalitarian views on gender roles predicted homophobia. Homophobia arises as a result of hierarchical attitudes toward genders and reflects traditional beliefs tied to rigid gender roles. In this context, homophobia serves as a mediating factor in upholding values and influences related to conventional masculinity and femininity. Given this perspective, it is anticipated that non-egalitarian attitudes regarding gender forecast higher levels of homophobia.

The study also found that belief in sexual myths predicted high levels of homophobia. It was also observed that individuals who strongly believe in sexual myths held more non-egalitarian attitudes toward gender roles. In the mediation analysis, when examining the effect of sexual myths and attitudes toward gender roles on homophobia, attitudes toward gender roles were identified as a partial mediator. In light of this information, it can be stated that beliefs about sexuality, attitudes toward gender, and attitudes toward homosexuality are shaped along a common axis and interact with one another. The concepts of “masculinity” and “femininity,” defined within the framework of gender roles, bring certain expectations to sexual life. A recent study conducted in Turkiye (Turan and Güler 2022) investigated the relationship between attitudes toward gender roles, homophobia, and belief in sexual myths among mental health professionals. The results showed that attitudes toward gender roles were negatively associated with both homophobia and belief in sexual myths. In contrast, there was a positive association between homophobia and belief in sexual myths. In the current study, participants who identified as male, conservative, believed that religious rules should take precedence in society and marriage, and held right-wing political views were found to have a higher belief in sexual myths, more non-egalitarian gender perspectives, and more homophobic attitudes. When these findings are examined, it can be argued that common risk factors shape all three variables. This supports the hypothesis that the concepts of sexual myth, gender roles, and homophobia reflect a shared ideological and cognitive orientation.

Some limitations must be considered in this study. It was limited to students enrolled in the medical faculty of a single public university during one academic semester. Larger, multicenter studies are necessary to generalize the findings. Additionally, several variables not included in the study may influence attitudes toward sexual orientation. The reliance on self-report measures poses another limitation due to the potential for social desirability bias. The sexual orientations of the participants were also not assessed. Furthermore, students may not have fully understood or accurately reported their political or ideological views, and the inability to evaluate this represents another limitation of the study. Despite these limitations, the study has several strengths. Few studies in the scientific literature concurrently examine the relationship between homophobia, gender roles, and sexual myths. Additionally, the relatively large sample size of the survey enhances its scientific validity.

CONCLUSION

Numerous sociocultural, ideological, and social factors shape individuals’ attitudes toward homosexuality. In this respect, providing accurate information about sexuality is essential. Physicians’ attitudes in this area are likely to influence public opinion. Therefore, implementing structured sexual education and conducting informational sessions for medical students throughout their training is beneficial. Additionally, leveraging the contributions of psychiatry to raise awareness among medical students about this issue is vital. These contributions may include emphasizing sexual orientation and diversity during psychiatry clerkships, utilizing role-playing and case-based experiential learning, and exploring the narratives of patients who have faced stigma and prejudice. Considering all these findings, it can be anticipated that structured and comprehensive training programs will enhance students’ knowledge levels, and that training interventions designed to improve familiarity and communication with LGBTQ+ individuals will be advantageous.