Wendy Bostwick

Dimensions of Sexual Orientation and the Prevalence of Mood and Anxiety Disorders in the United States

OBJECTIVES We used data from a nationally representative sample to examine the associations among 3 dimensions of sexual orientation (identity, attraction, and behavior), lifetime and past-year mood and anxiety disorders, and sex. METHODS We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS Mental health outcomes differed by sex, dimension of sexual orientation, and sexual minority group. Whereas a lesbian, gay, or bisexual identity was associated with higher odds of any mood or anxiety disorder for both men and women, women reporting only same-sex sexual partners in their lifetime had the lowest rates of most disorders. Higher odds of any lifetime mood or anxiety disorder were more consistent and pronounced among sexual minority men than among sexual minority women. Finally, bisexual behavior conferred the highest odds of any mood or anxiety disorder for both males and females. CONCLUSIONS Findings point to mental health disparities among some, but not all, sexual minority groups and emphasize the importance of including multiple measures of sexual orientation in population-based health studies.

The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States.

OBJECTIVES We examined the associations between 3 types of discrimination (sexual orientation, race, and gender) and substance use disorders in a large national sample in the United States that included 577 lesbian, gay, and bisexual (LGB) adults. METHODS Data were collected from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, which used structured diagnostic face-to-face interviews. RESULTS More than two thirds of LGB adults reported at least 1 type of discrimination in their lifetimes. Multivariate analyses indicated that the odds of past-year substance use disorders were nearly 4 times greater among LGB adults who reported all 3 types of discrimination prior to the past year than for LGB adults who did not report discrimination (adjusted odds ratio = 3.85; 95% confidence interval = 1.71, 8.66). CONCLUSIONS Health professionals should consider the role multiple types of discrimination plays in the development and treatment of substance use disorders among LGB adults.

Discrimination and Mental Health Among Lesbian, Gay, and Bisexual Adults in the United States

Health disparities among sexual minority groups, particularly mental health disparities, are well-documented. Numerous studies have demonstrated heightened prevalence of depressive and anxiety disorders among lesbian, gay, and bisexual groups as compared with heterosexuals. Some authors posit that these disparities are the result of the stress that prejudice and perceived discrimination can cause. The current study extends previous research by examining the associations between multiple types of discrimination, based on race or ethnicity, gender, and sexual orientation, and past-year mental health disorders in a national sample of self-identified lesbian, gay, and bisexual women and men (n = 577). Findings suggest that different types of discrimination may be differentially associated with past-year mental health disorders. Notably, sexual orientation discrimination was associated with higher odds of a past-year disorder only in combination with other types of discrimination. These findings point to the complexity of the relationship between discrimination experiences and mental health, and suggest that further work is needed to better explicate the interplay among multiple marginalized identities, discrimination, and mental health.

Mental Health and Suicidality Among Racially/Ethnically Diverse Sexual Minority Youths

OBJECTIVES We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents. METHODS Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72,691. RESULTS Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds. CONCLUSIONS Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.

‘Just a little hint’: bisexual-specific microaggressions and their connection to epistemic injustices

A growing body of evidence indicates disproportionate rates of mental health disorders among bisexual women compared to both heterosexual and lesbian women. Such disparities are often attributed to stressors related to minority status, including experiences of prejudice and discrimination. Prior research has made little distinction between the prejudicial experiences of bisexual groups as compared to lesbian/gay groups. Based on qualitative data gathered in focus groups with 10, predominantly White, bisexual-identified women, which occurred in a large city in the USA, we posit that differences in prejudicial experiences do exist for bisexual groups, and that such differences reside in the realms of the epistemic, yet have very real implications for bisexual womens daily lived experiences. We discuss everyday slights and insults, also known as microaggressions, reported by the participants vis-à-vis their bisexual identity. These bisexual-specific microaggressions include hostility; denial/dismissal; unintelligibility; pressure to change; lesbian, gay, bisexual and transgender legitimacy; dating exclusion; and hypersexuality. We consider how such microaggressions may adversely impact mental health and well-being and may assist in explaining the mental health disparities among bisexual women.

The Association Between Sexual Orientation Identity and Behavior Across Race/Ethnicity, Sex, and Age in a Probability Sample of High School Students

OBJECTIVES We examined the prevalence and associations between behavioral and identity dimensions of sexual orientation among adolescents in the United States, with consideration of differences associated with race/ethnicity, sex, and age. METHODS We used pooled data from 2005 and 2007 Youth Risk Behavior Surveys to estimate prevalence of sexual orientation variables within demographic sub-groups. We used multilevel logistic regression models to test differences in the association between sexual orientation identity and sexual behavior across groups. RESULTS There was substantial incongruence between behavioral and identity dimensions of sexual orientation, which varied across sex and race/ethnicity. Whereas girls were more likely to identify as bisexual, boys showed a stronger association between same-sex behavior and a bisexual identity. The pattern of association of age with sexual orientation differed between boys and girls. CONCLUSIONS Our results highlight demographic differences between 2 sexual orientation dimensions, and their congruence, among 13- to 18-year-old adolescents. Future research is needed to better understand the implications of such differences, particularly in the realm of health and health disparities.

Measurement of Sexual Identity in Surveys: Implications for Substance Abuse Research

Researchers are increasingly recognizing the need to include measures of sexual orientation in health studies. However, relatively little attention has been paid to how sexual identity, the cognitive aspect of sexual orientation, is defined and measured. Our study examined the impact of using two separate sexual identity question formats: a three-category question (response options included heterosexual, bisexual, or lesbian/gay), and a similar question with five response options (only lesbian/gay, mostly lesbian/gay, bisexual, mostly heterosexual, only heterosexual). A large probability-based sample of undergraduate university students was surveyed and a randomly selected subsample of participants was asked both sexual identity questions. Approximately one-third of students who identified as bisexual based on the three-category sexual identity measure chose “mostly heterosexual” or “mostly lesbian/gay” on the five-category measure. In addition to comparing sample proportions of lesbian/gay, bisexual, or heterosexual participants based on the two question formats, rates of alcohol and other drug use were also examined among the participants. Substance use outcomes among the sexual minority subgroups differed based on the sexual identity question format used: bisexual participants showed greater risk of substance use in analyses using the three-category measure whereas “mostly heterosexual” participants were at greater risk when data were analyzed using the five-category measure. Study results have important implications for the study of sexual identity, as well as whether and how to recode responses to questions related to sexual identity.

Assessing Bisexual Stigma and Mental Health Status: A Brief Report

Bisexual women often report higher rates of depression and mental health problems than their heterosexual and lesbian counterparts. These disparities likely occur, in part, as a result of the unique stigma that bisexual women face and experience. Such stigma can in turn operate as a stressor, thereby contributing to poor mental health status. This pilot study tested a new measure of bisexual stigma and its association with mental health. Results suggest a moderate positive correlation between the two and point to areas for future consideration when measuring bisexual stigma.

Minding the Noise: Conducting Health Research Among Bisexual Populations and Beyond

In this article, we draw upon our experiences conducting health-related studies with sexual minorities to suggest guidelines and best-practices for carrying out research among bisexual populations specifically. Too often bisexuality has been treated as “noise in the data,” because it does not conform to monosexual notions of sexual orientation. We discuss methodological, theoretical and conceptual concerns as they pertain to conducting research among bisexual persons. We hope that the insights we offer will prompt greater attention to bisexual groups and their specific concerns, not only among health researchers, but among those from other fields and disciplines as well.

Health Behavior, Status, and Outcomes Among a Community-Based Sample of Lesbian and Bisexual Women

PURPOSE To compare health behaviors, and physical and mental health outcomes in a community-based sample of bisexual and lesbian women. METHODS The Chicago Health and Life Experiences of Women (CHLEW) study is a longitudinal study of sexual minority womens health. Wave 3 of the CHLEW used a modified version of respondent-driven sampling to recruit a supplemental sample of bisexual-identified women into the study, with an additional focus on younger women, and Black and Latina women. Face-to-face interviews were conducted and data were captured using computer-assisted interviews. Data from the supplemental Wave 3 sample are reported here. RESULTS Bisexual (n=139) and lesbian women (n=227) did not differ on most health outcomes, either in terms of prevalence or adjusted odds. Bisexual women were at higher risk of ever being diagnosed with a sexually transmitted infection (STI) (AOR=3.01) and scoring 10 or more on the Center for Epidemiologic Studies Depression Scale (CES-D) (AOR=1.73) compared to lesbian women. CONCLUSION In contrast to the prevailing view of bisexual women as being at higher risk for many/most negative health outcomes, we found relatively few differences between bisexual and lesbian women in the current study. Additional research is needed to better understand risk and resilience factors among bisexual women specifically, and sexual minority women more broadly.