Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States.

Abstract

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.
We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.
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.
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.

Full text

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DimensionsofSexualOrientationandthePrevalence
ofMoodandAnxietyDisordersintheUnitedStates
Wendy B. Bostwick, PhD, MPH, Carol J. Boyd, PhD, MSN, Tonda L. Hughes, PhD, RN,
and Sean Esteban McCabe, PhD, MSW
In the United States, mental health disorders
affect a substantial proportion of the general
population.1,2Data from the National Comor-
bidity Study show that approximately 29% of
adults meet Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV)3
criteria foranxiety disorder andnearly 21% for a
mooddisorder over their lifetime.1Data from the
2001–2002 National Epidemiologic Survey on
Alcohol and Related Conditions (NESARC) in-
dicate that11% of the US general population met
criteria for a DSM-IV independent (nonsub-
stance-induced) anxiety disorder in the past year
and 9.3% met criteria for a DSM-IV mood
disorder in the past year.2Given the personal
and societal costs associated with mental illness,4
it is necessary to understand which groups are
at disproportionate risk for mental health disor-
ders so that appropriate prevention and inter-
vention programs can be designed.
A growing body of evidence suggests that
sexual minorities are at higher risk for mental
health disorders than their heterosexual coun-
terparts.5–8In a meta-analysis, Meyer8con-
cluded the odds of lifetime mood and anxiety
disorders were twice as high for lesbian, gay, and
bisexual females and males as for heterosexuals.
However, as Meyer and others9,10have noted,
research on the mental health of sexual minor-
ities has been hampered by methodological lim-
itations, such as nonrandom samples that con-
strain the generalizability of findings. In addition,
many studies contain small samples, which pre-
clude analyses by age, race/ethnicity, and other
characteristics that vary with mental health dis-
orders. Lesbian, gay, and bisexual females and
males are often combined for analytic reasons,
such as the need to increase the overall sample
size and corresponding statistical power. This
obscures potential differences between lesbians
or gays and bisexuals as well as between males
and females—and can lead to biased results.
Although some researchers have considered
how different operationalizations of sexual
orientation may affect health outcomes,1 1–13
national studies rarely assess sexual orientation
and, to date, no national population-based study
has compared mental health outcomes across all
3 major dimensions of sexual orientation—iden-
tity, behavior, and attraction.14As others have
noted,10,15health risks associated with one di-
mension of sexual orientation, such as behavior,
may differ from those associated with another,
such as sexual identity. Furthermore, virtually no
population-based health studies of adults have
explored associations between sexual attraction
and health outcomes. Through the inclusion and
measurement of these 3 dimensions in popula-
tion-based health studies, we can begin to better
understand the different dimensions of sexual
orientation and their associations with health
behaviors and health outcomes.16–18
To address the aforementioned limitations
and to contribute to a greater understanding of
the prevalence of mental health disorders
among sexual minorities, we used data from the
2004–2005 NESARC to assess lifetime and
past-year prevalence of DSM-IV mood and
anxiety disorders among heterosexual and
sexual minority females and males. Our pur-
pose was to answer the following question:
does the prevalence of mood and anxiety dis-
orders differ across the 3 major dimensions of
sexual orientation and does it differ for males
and females?
METHODS
We analyzed cross-sectional data from wave
2 of the 2004–2005 NESARC. The NESARC
is a longitudinal survey that began in 2001,
with wave 2 data collected in 2004 and 2005.
The purpose of NESARC is to estimate the
prevalence of alcohol, drug, and mental health
disorders (e.g., mood, anxiety, and personality
disorders) among the noninstitutionalized gen-
eral population of the United States. Questions
related to sexual orientation were added in
wave 2.
The NESARC wave 2 sample is represen-
tative of civilian adults, who were 20 years
and older, residing in noninstitutionalized
settings in the United States. Data were col-
lected in face-to-face interviews conducted in
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 orien-
tation, and sexual minority group. Whereas a lesbian, gay, or bisexual identity
was associated with higher odds of any mood or anxiety disorder for both males
and females, females 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
males than among sexual minority females. 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. (Am J Public
Health. 2009;99:XXX–XXX. doi:10.2105/AJPH.2008.152942)
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Published Ahead of Print on August 20, 2009, as 10.2105/AJPH.2008.152942

Page 2

respondents’ homes. The response rate at
baseline was 81.0% (a detailed discussion of
methods can be found elsewhere19). A total of
34653 interviews were conducted among the
eligible respondents. The wave 2 response rate
was 86.7% and the cumulative response rate for
both waves1and 2 was 70.2%.20
NESARC data are weighted on the basis
of a number of factors such as survey design,
nonresponse, and oversampling of Blacks,
Hispanics, and those aged 18 to 24 years.
Design weights are also calculated and adjusted
to conform to national census estimates of the
population on the basis of region, age, sex, race,
and ethnicity.19,20
Measures
DSM-IV mood and anxiety disorders. The
Alcohol Use Disorder and Associated Disabil-
ities Interview Schedule-IV (AUDADIS-IV) was
used to assess mood and anxiety disorders. The
AUDADIS-IV is a structured interview sched-
ule meant for use by lay interviewers. The
reliability and validity of this instrument has
been tested and described by numerous au-
thors.21,22
The AUDADIS-IV assesses the following
mood disorders: major depression, dysthymia,
mania, and hypomania. Anxiety disorders
assessed were panic disorder with and without
agoraphobia, social phobia, specific phobia, and
generalized anxiety disorder. The AUDADIS-
IV is structured to rule out mood and
anxiety disorders associated with a medical
condition or with bereavement.2We assessed
all disorders for lifetime and past-year time
frames.
Sexual orientation. To assess sexual identity,
sexual behavior, and sexual attraction, respon-
dents were shown a preprinted card with
response options.23Sexual identity was assessed
by asking, ‘‘Which of the categories on the card
best describes you? (1) heterosexual (straight),
(2) gay or lesbian, (3) bisexual, or (4) not sure?’’
Sexual attraction was assessed by asking, ‘‘People
are different in their sexual attraction to other
people. Which category on the card best de-
scribes your feelings? (1) only attracted to fe-
males, (2) mostly attracted to females, (3) equally
attracted to females and males, (4) mostly
attracted to males, or (5) only attracted to males.’’
Sexual behavior was assessed by asking, ‘‘In your
entire life, have you had sex with——? (1) only
males, (2) only females, (3) both males and
females, or (4) never had sex.’’
Demographic and background characteristics.
Demographic and background characteristics
included in the current analyses were sex,
age, race (White, Black, Native American,
Asian, Hispanic), educational level (less than
high school, high school, some college or
higher), job status (full-time, part-time, not
working), income ($19999 or less, $20000–
$34999, $35000–$69999, $70000 or
higher), health insurance coverage (yes or no),
and relationship status (married or cohabiting;
widowed, separated, or divorced; or never
married).
Data Analysis
The NESARC design included stratification
and clustering of the target population. In
addition, sampling weights were computed for
wave 2 respondents to offset unequal proba-
bilities of selection, differential nonresponse,
and poststratification of the population. Wave
2 data were also adjusted on the basis of the
2000 Decennial Census so that these data were
representative of the civilian noninstitutional-
ized US population by region, sex, age, race,
and ethnicity.19,24All analyses were conducted
with the SUDAAN,25which uses Taylor series
linearization to adjust variance estimates for the
complex survey design. Bivariate associations
were estimated for females and males separately,
and for lifetime as well as past-year time frames
(past-year data not shown). Multiple logistic re-
gression analyses were used to test for associa-
tions between the 3 sexual orientation dimen-
sions and DSM-IV mood and anxiety disorders
for females and males separately.
RESULTS
Table 1 summarizes the demographic char-
acteristics of the sample. Most participants
were White (70.9%) and more than half
were female (52.1%). More than one half of
participants reported educational levels be-
yond high school (58.5%). A large majority had
some type of health insurance coverage
(87.7%) and just over one half (53%) were
working full-time. In terms of sexual orienta-
tion, 1.4% of the sample identified as lesbian,
gay, or bisexual, 3.4% reported some same-
sex sexual behavior in their lifetime, and close
to 6% reported nonheterosexual sexual
attraction.
Females
As shown in Table 2, lesbian, bisexual, or
‘‘not sure’’ sexual identities were associated
with higher rates of most lifetime disorders
among females, with the highest rates concen-
trated among those identifying as bisexual.
More than one half (58.7%) of bisexual
females had a lifetime history of mood disor-
der, compared with 44.4% of lesbian females,
36.5% of females who were unsure about their
sexual identity, and 30.5% of heterosexual
females.
Behaviorally bisexual females reported a
higher prevalence of lifetime disorders. In
contrast, females who reported exclusive same-
sex sexual behavior had the lowest rates of
every disorder compared with the other be-
haviorally defined groups (i.e., those with ex-
clusively male sexual partners, those with both
male and female sexual partners, and those
who never had sex). Similarly, females
reporting exclusive same-sex attraction had
the lowest rates of most mood and anxiety
disorders compared with other attraction-
defined groups.
Patterns for past-year prevalence estimates
were similar to lifetime estimates (data not
shown; tables are available upon request from
author). Females who identified as bisexual had
the highest rates of any past-year mood and
anxiety disorders. In comparisons based on
sexual behavior, females with histories of both
male and female sexual partners had the high-
est rates of all mood and anxiety disorders,
whereas females with exclusively female sexual
partners had the lowest rates of almost every
past-year mood or anxiety disorder. Females
reporting exclusive same-sex attraction had the
lowest rates of most past-year disorders, which
is similar to what was found with lifetime
disorders.
After adjustment for demographic covari-
ates, the odds of any lifetime or past-year mood
or anxiety disorder were twice as high for self-
identified bisexual females as for heterosexual
females (Table 3). Lesbians had greater odds
than heterosexual females of any lifetime mood
disorder (adjusted odds ratio [AOR]=1.5; 95%
confidence interval [CI]=1.01, 2.1) or any
past-year anxiety disorder (AOR=1.7; 95%
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CI=1.02, 3.0). Compared with heterosexual
females, respondents who were unsure about
their sexual identity had greater odds of any
past-year anxiety disorder (AOR=1.8; 95%
CI=1.01, 3.3).
Significant differences in the odds of any
lifetime or past-year disorder on the basis of
sexual attraction were concentrated among
females who reported being attracted mostly to
males. These females had significantly higher
odds of any lifetime or past-year mood or
anxiety disorder compared with females
reporting exclusive attraction to males.
Females with histories of both male and
female sexual partners had significantly higher
odds of any lifetime or past-year disorder
than females whose sexual partners were ex-
clusively male. Notably, compared with females
reporting exclusively heterosexual behavior,
females with exclusively same-sex sexual part-
ners had significantly lower odds of any lifetime
mood disorder (AOR=0.6; 95% CI=0.4, 0.9).
Males
Mood and anxiety disorders among males
were also more concentrated in sexual minority
groups (Table 4). Compared with males who
identified as heterosexual, those who identified
as gay or bisexual or were unsure of their
sexual identity had higher rates of most lifetime
mood and anxiety disorders. For instance,
gay males had a higher prevalence than heter-
osexual males of any lifetime mood disorder
(42.3% vs 19.8%) and of any lifetime anxiety
disorder (41.2% vs 18.6%).
The prevalence of almost every mood and
anxiety disorder was lowest among males
reporting exclusive attraction to females; con-
versely, males reporting any same-sex attrac-
tion (only to males, mostly to males, to both
males and females, or mostly to females) had a
higher prevalence of most disorders. Among
males, those reporting sexual attraction mostly
to males had the highest prevalence of lifetime
major depression, dysthymia, panic disorder
with and without agoraphobia, specific phobia,
and generalized anxiety disorder. This is simi-
lar to the pattern seen among those females
reporting sexual attraction mostly to the same
sex.
Males who reported lifetime sexual behavior
with both male and female partners had the
highest rate of every mood and anxiety
TABLE 1—Demographic Characteristics of Study Participants: National Epidemiologic
Survey on Alcohol and Related Conditions, Wave 2, 2004–2005
Demographic Characteristic No.a
% (SE)b
Sex
Male14564 47.9 (0.34)
Female 2008952.1 (0.34)
Age, y
20–24 21837.6 (0.23)
25–44 1333338.5 (0.40)
45–64
‡65
Race/ethnicity
11960 34.6 (0.32)
717719.3 (0.34)
White, not Hispanic 2016170.9 (1.54)
Black, not Hispanic658711.0 (0.66)
American Indian, not Hispanic 5782.2 (0.18)
Asian or Pacific Islander, not Hispanic968 4.3 (0.52)
Hispanic 6359 11.6 (1.19)
Marital status
Married or cohabitating 1886663.8 (0.47)
Widowed, divorced, or separated9149 18.9 (0.26)
Never married 663817.3 (0.45)
Employment status
Working full-time (‡35 h/wk)
Working part-time (<35 h/wk)
1783353.0 (0.40)
367510.9 (0.20)
Not working13145 36.1 (0.42)
Education
Less than high school5514 14.0 (0.45)
Completed high school 945227.5 (0.53)
More than high school19687 58.5 (0.63)
Any health insurance coverage in past year
Sexual attractionc
30213 87.7 (0.39)
Only attracted to opposite sex 32062 94.2 (0.18)
Mostly attracted to opposite sex 1152 3.0 (0.18)
Equally attracted to both sexes390 1.0 (0.06)
Mostly attracted to same sex183 0.4 (0.05)
Only attracted to same sex
Lifetime sexual behaviorc
504 1.4 (0.08)
Only same sex5191.5 (0.08)
Only opposite sex3243894.6 (0.17)
Both sexes 7471.9 (0.09)
None 583 2.0 (0.13)
Sexual identityc
Heterosexual 3359898.1 (0.10)
Lesbian or gay 3350.8 (0.07)
Bisexual242 0.6 (0.05)
Unsure 170 0.5 (0.04)
Note. The total sample for wave 2 was 34653.
aBased on unweighted data.
bBased on weighted data.
cFor the sexual attraction, lifetime sexual behavior, and sexual identity variables, the ‘‘unknown’’ category included 357, 366,
and 308 people, respectively.
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disorder, which is similar to what was found for
females who reported both male and female
partners. Males reporting lifetime sexual be-
havior exclusively with males, as well as those
reporting never having had sex, were also
more likely to have experienced any lifetime
mood or anxiety disorder than males who
reported exclusively female partners. For ex-
ample, 46.5% of males who reported histories
of both female and male sexual partners expe-
rienced some mood disorder in their lifetime,
compared with 26.8% of males who reported
only same-sex sexual partners, 29.3% who
reported no sexual partners, and 19.4% who
reported exclusively female partners.
The pattern for past-year prevalence was
somewhat similar to that for lifetime prev-
alence (data not shown). For instance, be-
haviorally bisexual males had the highest
prevalence of all disorders. However, rates of
past-year disorders among behaviorally ho-
mosexual males and behaviorally heterosexual
males generally did not differ.
After control for demographic characteris-
tics, sexual identity was associated with greater
odds of lifetime and past-year mood and anx-
iety disorders (Table 3). Compared with het-
erosexual males, gay and bisexual males and
those not sure of their identity each had
higher odds of any lifetime mood or anxiety
disorder. In addition, gay males were at higher
odds of any past-year mood or anxiety
disorder.
Differences across sexual attraction were
also evident, again demonstrating higher
odds of both mood and anxiety disorders
among males with any same-sex attraction.
Differences were particularly apparent in
comparisons of males with exclusive attrac-
tion to females and those with attraction
mostly to males.
As with females, behaviorally bisexual males
had higher odds of both lifetime and past-year
disorders than behaviorally heterosexual
males. For example, they were more than 3
times as likely to meet diagnostic criteria for
any lifetime mood disorder (AOR=3.2; 95%
CI=2.2, 4.2).
DISCUSSION
Results of this study provide compelling
evidence that the prevalence of mental health
TABLE 2—Lifetime prevalence of DSM-IV Mood and Anxiety Disorders Among Females, by Sexual Identity, Sexual Attraction, and Sexual Behavior:
National Epidemiologic Survey on Alcohol and Related Conditions, Wave 2, 2004–2005
Sexual Identity
Sexual Attraction
Sexual Behavior
Disorder
Lesbian
(n=145),
% (SE)
Bisexual
(n=161),
% (SE)
Not Sure
(n=101),
% (SE)
Heterosexual
(n=19489),
% (SE)
Pa
Only
Females
(n=275),
% (SE)
Mostly
Females
(n=87),
% (SE)
Equally
Females
and Males
(n=260),
% (SE)
Mostly Males
(n=880),
% (SE)
Only Males
(n=18358),
% (SE)
Pa
Only
Females
(n=177),
% (SE)
Both
Females
and Males
(n=445),
% (SE)
Never Had
Sex
(n=334),
% (SE)
Only Males
(n=18904),
% (SE)
Pa
Any mood disorder
44.4 (4.9) 58.7 (4.4) 36.5 (6.6)
30.5 (0.5)
£.01 23.8 (3.1) 39.2 (7.0) 32.3 (3.7)
39.2 (2.1)
30.5 (0.5)
£.01 19.4 (3.4) 55.8 (2.9) 31.3 (3.1)
30.4 (0.5)
£.01
Major depression
41.8 (5.1) 52.3 (4.7) 32.1 (6.6)
27.3 (0.5)
£.01 20.5 (3.0) 35.8 (7.0) 27.9 (3.4)
35.3 (2.0)
27.3 (0.5)
£.01 15.0 (3.1) 51.0 (3.0) 27.5 (2.9)
27.2 (0.5)
£.01
Dysthymia
9.1 (3.0) 18.6 (3.6)
9.5 (3.2)
6.3 (0.2)
£.05
4.3 (1.5)
8.5 (3.6) 10.3 (2.5)
9.8 (1.3)
6.2 (0.2)
£.05
2.6 (1.2) 16.4 (2.1)
6.4 (1.5)
6.3 (0.2)
£.01
Mania
4.9 (1.9) 15.0 (2.8) 11.8 (3.9)
5.4 (0.2)
£.01
2.6 (0.9)
8.8 (3.7)
9.8 (2.0)
8.6 (1.1)
5.4 (0.2)
£.01
4.6 (1.7) 15.4 (2.0)
5.4 (1.6)
5.3 (0.2)
£.01
Hypomania
5.0 (2.3) 10.5 (3.3)
2.3 (1.7)
3.6 (0.1)
3.3 (1.2)
1.4 (1.0)
3.4 (1.3)
5.4 (1.0)
3.6 (0.2)
2.4 (1.0)
9.1 (2.0)
5.9 (1.4)
3.5 (0.2)
£.05
Any anxiety disorder
40.8 (5.2) 57.8 (4.7) 37.6 (6.7)
31.3 (0.6)
£.01 24.5 (3.4) 41.1 (7.2) 36.8 (3.6)
35.8 (2.1)
31.5 (0.6)
£.05 21.5 (4.0) 50.7 (3.0) 27.6 (2.9)
31.4 (0.6)
£.01
Panic (without agoraphobia) 11.6 (4.0) 23.5 (4.7) 14.4 (5.9)
7.4 (0.3)
£.05
5.8 (1.8) 11.0 (5.8) 10.1 (2.4)
9.6 (1.1)
7.5 (0.3)
6.0 (2.4) 17.7 (2.2)
3.3 (1.0)
7.5 (0.3)
£.01
Panic with agoraphobia
2.5 (0.1)
7.0 (2.7)
5.9 (3.1)
2.5 (0.1)
3.3 (1.3)
3.5 (2.2)
3.0 (1.2)
4.0 (1.0)
2.5 (0.1)
0.4 (0.4)
6.8 (1.6)
2.1 (0.9)
2.5 (0.1)
£.01
Social phobia
9.6 (3.0) 18.2 (3.1) 13.6 (5.6)
7.9 (0.3)
£.05
6.5 (2.0) 12.4 (4.0) 13.4 (2.3)
11.0 (1.2)
7.8 (0.3)
£.01
4.0 (2.1) 15.5 (2.1) 11.1 (2.0)
7.8 (0.3)
£.01
Specific phobia
27.6 (4.7) 35.0 (4.5) 23.7 (6.3)
19.5 (0.5)
£.01 14.1 (2.9) 25.2 (5.9) 21.5 (3.1)
21.3 (1.8)
19.7 (0.5)
12.6 (3.3) 31.3 (2.8) 15.5 (2.5)
19.6 (0.5)
£.01
Generalized anxiety
disorder
14.8 (4.0) 22.5 (3.9) 15.5 (5.6)
10.0 (0.3)
£.05
7.8 (1.6) 18.7 (6.2) 12.7 (2.6)
13.3 (1.6)
10.0 (0.3)
5.8 (1.8) 20.0 (2.2)
8.4 (1.7)
10.0 (0.3)
£.01
Note. DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
aBased on c2test of association.
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disorders does differ across dimensions of
sexual orientation and that patterns of risk are
different for females and males, as well as for
specific sexual minority groups. Among males,
any sexual minority status—whether defined
by identity, attraction, or behavior—was gen-
erally associated with a higher prevalence of
lifetime disorders. Among females, however,
although any sexual minority identity was asso-
ciated with higher rates of lifetime and past-year
disorders, this was not the case in comparisons
based on sexual attraction or sexual behavior.
Exclusive same-sex attraction, as well as exclu-
sive lifetime same-sex behavior, was associated
with lower rates of almost all lifetime and
past-year mood and anxiety disorders among
females. For example, 44.4% of females with a
lesbian identity reported some lifetime mood
disorders, compared with 23.8% of females
reporting only same-sex attraction and 19.4%
reporting only same-sex behavior.
That ‘‘nonheterosexuality’’ by any definition
was more consistently associated with in-
creased mental health disorders among males
indicates that the role of sexual orientation in
health outcomes probably functions differently
for males and females. Although there are
many ways to understand this sex disparity
(e.g., genetically, biologically, or culturally),
the difference probably emerges in large part
from the more extreme stigma that isassociated
with male homosexuality in the United States.
For example, surveys of attitudes toward
gays and lesbians demonstrate more negative
attitudes toward gay males than lesbian fe-
males.26,27Furthermore, transgressions of het-
eronormative behavioral scripts or violations of
‘‘traditional’’ sex norms are more severely sanc-
tioned among and by males,28leading to more
serious types of victimization, such as physical
violence.29Experiences of physical harm, as well
as threats of harm, are strongly associated with
poor mental health outcomes.10,30
The finding that same-sex attraction or be-
havior may confer protective mental health
benefits for females highlights the need to
broaden discussions of the health status of
sexual minority populations, and to move be-
yond what some have deemed a ‘‘minoritizing’’
or ‘‘repathologizing’’ view.31,32Rather than as-
sume that sexual minority status is always asso-
ciated with poorer health outcomes, we must
acknowledge that there are positive aspects of
being a member of a sexual minority and, con-
versely, that heterosexuality may also carry
health risks. Results demonstrating better overall
mental health for some sexual minority females
compared with heterosexual females point to the
need for further exploration of the health bene-
fits of sexual minority status33and more con-
sidered inquiry into areas such as resilience and
functional well-being among lesbian, gay, and
bisexual groups (K.M. Kertzner et al., unpub-
lished data).
Our study is unique in that it included
groups that were unsure about their sexual
identity. Some investigators have suggested
TABLE 3—Adjusted Odds Ratios (AORs) for Any Lifetime or Past-Year Mood and Anxiety
Disorders, by Sexual Identity, Sexual Attraction, and Sexual Behavior: National
Epidemiologic Survey on Alcohol and Related Conditions, Wave 2, 2004–2005
Any Lifetime
Mood Disorder,
AOR (95% CI)
Any Lifetime
Anxiety Disorder,
AOR (95% CI)
Any Past-Year
Mood Disorder,
AOR (95% CI)
Any Past-Year
Anxiety Disorder,
AOR (95% CI)
Males
Sexual identity
Gay (n=190)2.4 (1.6, 3.7)2.7 (1.8, 4.1) 1.8 (1.1, 3.1)2.3 (1.4, 3.7)
Bisexual (n=81)2.1 (1.2, 3.7)2.7 (1.6, 4.5) 1.7 (0.8, 3.7)2.4 (1.2, 4.7)
Not sure (n=69)2.1 (1.1, 3.8)2.2 (1.1, 4.2) 4.0 (1.9, 8.3)2.0 (0.8, 5.0)
Heterosexual (n=14109) (Ref)1.01.0 1.01.0
Sexual attraction
Only males (n=229) 1.7 (1.1, 2.5)2.2 (1.6, 3.1) 1.1 (0.7, 1.8) 1.6 (1.01, 2.7)
Mostly males (n=96) 2.6 (1.4, 4.7)3.3 (1.5, 5.6)2.2 (1.04, 4.7)4.0 (2.2, 7.6)
Both males and females (n=130) 2.3 (1.5, 3.5)1.6 (0.9, 2.6) 2.5 (1.4, 4.5) 1.4 (0.7, 2.7)
Mostly females (n=277)1.7 (1.2, 2.3) 1.5 (1.1, 2.2) 2.2 (1.4, 3.4)1.6 (0.9, 2.5)
Only female (n=13704) (Ref) 1.01.0 1.0 1.0
Lifetime sexual behavior
Only males (n=342)1.6 (1.1, 2.2)1.5 (1.1, 2.1) 1.3 (0.9, 2.0)1.2 (0.7, 1.9)
Both males and females (n=302) 3.2 (2.2, 4.2)2.5 (1.9, 3.3)2.3 (1.5, 3.5) 2.1 (1.4, 3.0)
Never had sex (n=249)1.2 (0.8, 1.7) 1.5 (0.9, 2.2)1.1 (0.7, 1.9) 1.5 (0.9, 2.5)
Only females (n=13534) (Ref)1.0 1.01.01.0
Females
Sexual identity
Lesbian (n=145) 1.5 (1.01, 2.3)1.4 (0.9, 2.1) 1.6 (0.9, 2.7)1.7 (1.02, 3.0)
Bisexual (n=161) 2.6 (1.8, 3.8)2.7 (1.8, 4.0)2.1 (1.4, 3.1)2.2 (1.4, 3.3)
Not sure (n=101) 1.2 (0.6, 2.1)1.2 (0.7, 2.1)1.1 (0.6, 2.0)1.8 (1.01, 3.3)
Heterosexual (n=19489) (Ref)1.01.01.01.0
Sexual attraction
Only females (n=275)0.7 (0.5, 1.03) 0.7 (0.5, 1.1)0.8 (0.5, 1.3)0.8 (0.5, 1.2)
Mostly females (n=87)1.4 (0.8, 2.5)1.5 (0.8, 2.8) 2.1 (1.02, 4.2)2.0 (0.9, 4.1)
Both females and males (n=260)1.1 (0.8, 1.6) 1.4 (1.02, 1.9)1.2 (0.9, 1.8) 1.3 (0.9, 1.9)
Mostly males (n=880) 1.5 (1.2, 1.7)1.2 (1.02, 1.5)1.6 (1.3, 2.0)1.4 (1.1, 1.7)
Only males (n=18358) (Ref)1.01.01.01.0
Lifetime sexual behavior
Only females (n=177)0.6 (0.4, 0.9) 0.6 (0.4, 1.0)0.7 (0.4, 1.2) 0.6 (0.3, 1.1)
Both females and males (n=445)2.3 (1.8, 2.9)2.0 (1.5, 2.5)2.2 (1.6, 2.8) 2.1 (1.6, 2.8)
Never had sex (n=334)0.9 (0.6, 1.2) 0.8 (0.6, 1.1) 1.2 (0.8, 1.7)0.9 (0.7, 1.4)
Only males (n=18904) (Ref)1.0 1.01.01.0
Note. AOR=adjusted odds ratio; CI=confidence interval. Odds ratios are adjusted for race, age, educational status,
employment status, marital status, and health insurance status. Results for these variables are not shown.
RESEARCH AND PRACTICE
October 2009, Vol 99, No. 10 | American Journal of Public Health
Bostwick et al. | Peer Reviewed | Research and Practice | 5