Article

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

The Journal of Sex Research

November 2016
54(7):1-12

DOI:10.1080/00224499.2016.1236181

Authors:

Sabra Katz-Wise

Boston Children's Hospital

Ethan H. Mereish

University of Maryland, College Park

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = −0.16), greater pain (β = −0.16), and poorer general health (β = −0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.

Outness y no-monogamias: el rol mediador de la invisibilidad en mujeres y personas no binarias bisexuales.

Article

Full-text available

Mar 2024

Las personas no-monógamas experimentan dificultades para salir del armario (“outness” en inglés) a raíz del miedo a la discriminación, y esto parece aumentar en personas que pertenecen a más de un grupo minoritario, como las mujeres y personas no binarias bisexuales. El objetivo del presente estudio fue analizar la influencia del estilo relacional y la motivación a la invisibilidad en la relación entre la anticipación al rechazo y el outness en personas con diversas identidades minoritarias. Participaron 78 mujeres cis y personas no binarias bisexuales con edades comprendidas entre los 20 y los 57 años (M=29.04; DT=7.14). Se evaluaron variables sociodemográficas y el nivel de outness (ad hoc), la motivación a la invisibilidad (LGBIS) y la anticipación al rechazo (MSS). Los resultados indicaron que el nivel de motivación a la invisibilidad es mayor en personas no-monógamas. Los análisis de mediación moderada mostraron que en personas no-monógamas, la motivación a la invisibilidad tiene un efecto mediador en la relación entre la anticipación al rechazo y el outness, y esta mediación está moderada por el estilo relacional. Estos resultados destacan la importancia de normalizar los estilos relacionales diversos para proteger a las personas no-monógamas de la discriminación y el rechazo social.

Psychosocial adjustment in queer women and non-binary people: Intersections between gender and sexual orientation

Thesis

May 2023

Alicia Tamarit

People with gender and sexual minority identities face specific stressors that may put their psychosocial adjustment at risk. The study of intersectionality indicates that the overlap between stigmatizations could have a synergistic effect on the mental health and well-being of sexual minorities. Therefore, it is important to study the specific factors that influence the psychosocial adjustment of minority identities resulting from the intersection between sexual and gender identity, such as queer women and non-binary people (lesbian, bisexual, pansexual, asexual and aromantic). The main objective of this study was to analyse the psychosocial and sexual identity-associated factors that influence the psychosocial adjustment of queer women and non-binary people. To this end, the following specific objectives were proposed: (1) Analyse the concordance between sexual and romantic orientation, (2) Analyse the influence of gender and sexual orientation on LB identity dimensions, psychosocial factors, and psychosocial adjustment, (3) Analyse the relationship between LB identity dimensions, psychosocial factors, psychosocial adjustment, and well-being, and (4) Analyse the influence of minority stress on psychosocial adjustment as a function of queer identity as determined by the intersection between gender and sexual orientation. Following a cross-sectional, descriptive design, 1359 women and non-binary individuals aged 18-68 years (M= 27.69; SD=6.99) participated. Sociodemographic variables, affective-sexual orientation, LGB identity, psychosocial risk factors (minority stress) and protective factors (sense of community, outness, social support, self-esteem and emotional competencies), as well as their psychosocial adjustment (emotional symptomatology and well-being) were assessed. The results showed that there is concordance between sexual and romantic orientation for lesbians and bisexual and aromantic individuals, but not for asexual participants. Non-binary people presented higher levels of minority stress and worse psychosocial adjustment than cis women. Regarding minority stress, lesbians showed higher levels of distal stressors, and asexual participants showed higher levels of proximal stressors than all other identities. All participants showed levels of psychosocial adjustment below the reference population. Minority stress was positively related to emotional symptomatology and negatively related to protective factors and well-being. In addition, minority stress and self-esteem were shown to play a mediating role in the relationship between queer identity (determined by the intersection between gender and sexual orientation) and psychosocial adjustment. In conclusion, these results highlight the synergistic effect of belonging to gender and sexual minorities and their impact on psychosocial adjustment. This study highlights the importance of including stigmatized populations in the scientific literature and studying the specific needs of each sexual identity to ensure their visibility and adequate mental health care.

The Experience of Bi-Negativity in Mixed Gender Relationships

Article

Aug 2023

(89) GENDER-BASED DIFFERENCES ABOUT THE PSYCHOLOGICAL WELL-BEING OF THE ITALIAN BI+ POPULATION: AN EXPLORATORY EMPIRICAL RESEARCH

Article

Jul 2023

Objectives (1) to explore possible differences between Bi+ cisgender and transgender people in terms of identity affirmation, social support, and psychological well-being; (2) to test the mediating role of identity affirmation in the relationship between perceived social support and psychological well-being. Methods 497 Italian Bi+ individuals (362 cisgender and 135 transgender), aged 14 to 61, participated in an online survey. Gender differences in main variables were tested with the T-test for independent samples, while the mediation model was tested with the SPSS PROCESS macro with bias-corrected bootstrapping and 95% confidence intervals. This analysis was controlled for gender (cisgender vs transgender). Results (1) Bi+ transgender participants showed lower levels of perceived social support, environmental mastery, positive relations, purpose in life, self-acceptance and global psychological well-being than Bi+ cisgender counterparts, while Bi+ transgender participants showed higher levels of identity affirmation than Bi+ cisgender counterparts.(2) Perceived social support was positively associated with both identity affirmation and psychological well-being and identity affirmation was positively associated with psychological wellbeing. As identity affirmation was included as a mediator, there was a significant overall effect, while the direct effect remained significant, indicating a case of partial mediation. Indeed, the indirect effects showed that identity affirmation significantly mediated the relationship between perceived social support and psychological wellbeing. Gender was a significant control variable, indicating that being Bi+ cisgender was most strongly associated with psychological well-being than being Bi+ transgender. Conclusions The few studies on the Bi+ community show how it suffers from peculiar risk factors in addition to those common to the entire LGBT+ population. Our innovative research shed a light on gender differences showing a general lower level of psychological well-being of Bi+ transgender people despite a higher level of identity affirmation, maybe consequent to the visibility that this community must actively seek to be recognized. Conflicts of Interest Paolo Antonelli, Francesco Fantacci, Lorenzo Borrello, Anna Russo, Elisabetta Muto, and Cristiano Scandurra declare that they have no conflict of interest.

Social Support, Identity Affirmation, and Psychological Well-Being: A Developmental and Intersectional Comparison between Italian Cisgender and Non-Binary People with Bisexual Orientation

Article

Full-text available

Feb 2023
Int J Environ Res Publ Health

Incorporating the perspectives of positive psychology, intersectionality, and life course into minority stress theory, this study aimed to examine the relationships between social support, identity affirmation, and psychological well-being among 483 Italian individuals with bisexual orientation, accounting for differences in gender identity (cisgender vs. non-binary) and age groups (young, early, and middle adult). A mediation model was tested in which identity affirmation served as a presumed mediator between social support and psychological well-being. We also examined whether gender identity and age group moderated the hypothesized associations. Multivariate ANOVA and multigroup mediation analyses were conducted. Results showed that (a) cisgender individuals had higher social support and psychological well-being than non-binary individuals, but not identity affirmation, which was higher in the latter group, (b) psychological well-being, but not social support and identity affirmation, differed between groups, with the youngest cohort reporting worse health than their elders, (c) identity affirmation mediated the relationship between social support and psychological well-being, (d) mediation was significant only in binary individuals (compared to cisgender), whereas no age differences were found. Overall, this study highlights the need to consider bisexual individuals as a nonhomogeneous population living multiple life experiences, especially when minority identities intersect.

El proceso de aceptación y adaptación a la bisexualidad a través de la terapia cognitivo-conductual con enfoque afirmativo: Estudio de caso único [The process of acceptance and adjustment to bisexuality through cognitive-behavioral therapy with an afirmative approach: Case study]

Article

Full-text available

Nov 2022

Las personas del colectivo LGBTIQ+ vivencian en su día a día diversas situaciones de estigmatización social, repercutiendo en su bienestar emocional y su salud mental. Estas actitudes negativas pueden moderar los sentimientos y percepciones de aquellas que pasan a formar parte del colectivo, como ocurre con la bisexualidad. En este estudio se presenta un acercamiento cognitivo-conductual con enfoque afirmativo en un caso de adaptación y aceptación de una usuaria que recientemente “redescubre” su orientación bisexual. A lo largo de 12 sesiones, a través de la psicoeducación, la restructuración cognitiva, el entrenamiento en asertividad y la exposición; se consigue reducir en la usuaria las diferentes problemáticas detectadas. Se consigue reducir los sentimientos de tristeza y ansiedad, se reduce el estrés percibido en situaciones problemáticas y se optimizan sus recursos en gestión emocional, obteniendo mejores resultados cuantitativos en la Escala de Evaluación de Resultados. Se concluye que este tipo de abordajes psicoterapéuticos son efectivos. LGBTIQ+ people experience various situations of social stigmatization in their daily lives, affecting their emotional well-being and mental health. These negative attitudes can moderate the feelings and perceptions of those who become part of the group, as is the case with bisexuality. This study presents a cognitive-behavioral approach with an affirmative approach in a case of adaptation and acceptance of a client who recently “rediscovered” her bisexual orientation. During 12 sessions, through psychoeducation, cognitive restructuring, assertiveness training and exposure, the different problems de-tected were reduced in the client. Feelings of sadness and anxiety are reduced, perceived stress in problematic situations is reduced and her emotional management resources are optimized, obtaining better quantitative results in the Outcome RatingScale. It is concluded that these psychotherapeutic approaches are effective.

Minorities Within Minorities: Mental Health Outcomes Within Sexual Minority Youth

Article

Full-text available

Dec 2021

The mental health disparities for lesbian, gay, bisexual and queer (LGBQ) compared to heterosexual youth are well established. However, emerging evidence indicates there may be diversity in risk for mental health outcomes within sexual minority youth. This study examined mental health outcomes in 1,933 young people (aged 16 − 25 years) who used the online mental health platform ReachOut. We explored mental health outcomes, including mental health service use and hospitalization, depression, anxiety, stress, and risk for suicide among heterosexual, gay/lesbian, bisexual, queer+, and questioning young people. Compared to their heterosexual peers, bisexual, queer+, and questioning young people had significantly higher levels of depression, anxiety, and risk for suicide. Bisexual and queer + young people also had significantly higher levels of stress compared to heterosexual youth. Bisexual and young people questioning their sexuality were significantly more likely to have a previous mental health hospitalization. Lesbian/gay youth did not significantly differ from heterosexuals on depression, anxiety, stress, or previous hospitalization, but did for risk of suicide. These findings underscore the importance of measuring, reporting, and addressing the distinct mental health experiences of sexual minority youth.

Anticipated stigma and depression in Italian bisexual emerging adults: The mediating role of emotion regulation and resilience

Article

Mar 2025

Bisexual individuals experience societal stigmatisation due to their minoritized identity and are exposed to health disparities contributing to psychological distress. Drawing on the minority stress theory and the psychological mediation framework, the current study investigated the association between a proximal minority stressor (i.e. anticipated binegativity) and a mental health outcome (i.e. depression) through emotion regulation and resilience in 313 Italian bisexual emerging adults aged 18–29 years who responded to a web-based cross-sectional survey in May 2024. Data regarding socio-demographic characteristics, anticipated binegativity, emotion regulation (i.e. expressive suppression and cognitive reappraisal), resilience, and depression were statistically analysed using the structural equation modelling approach. Anticipated binegativity was positively associated with depressive symptoms, and both expressive suppression and resilience mediated the relationship between anticipated binegativity and depressive symptoms, separately. In addition, higher anticipated binegativity increased the level of depressive symptoms through greater expressive suppression (but not cognitive reappraisal), which in turn decreased resilience. The investigation of new psychological paths can inform clinical practice with bisexual emerging adults, who face unique developmental challenges and face increased risk of negative mental health outcomes due to their societal stigmatisation. Interventions should target adaptive emotion regulation strategies and resilience capacities that protect from the risk of depression.

Disparities in Mental Health Symptoms Among Sexual and Gender Diverse Subgroups in a National Sample of College Students

Article

Full-text available

Mar 2024

Mental health disparities experienced by sexual and gender diverse (SGD) young adults are well documented. Yet, few studies have examined mental health disparities between SGD subgroups. Even fewer have investigated disparities that may exist for individuals whose SGD identities are nonmonosexual (i.e., diverse sexual orientations besides gay/lesbian) or gender nonbinary, who may experience exacerbated marginalization and disparities. The present study examines differences in weight and shape concerns and symptoms of depression, anxiety (general, panic, social, and posttraumatic stress), alcohol use disorder, and insomnia among sexually diverse (SD) subgroups (lesbian or gay, bisexual, queer, asexual, pansexual, multiple identities, and questioning), and gender diverse (GD) subgroups (trans man, trans woman, and nonbinary) of college students. We hypothesized that nonmonosexual students would have a greater mental health symptom burden than their monosexual peers and we explored additional subgroup differences among SD and GD subgroups separately. Kruskal–Wallis tests with Mann–Whitney U post hoc tests were conducted to examine associations between mental health symptoms and sexual orientation and gender identity separately. Results show high mental health symptom levels among most subgroups. Some nonmonosexual SD subgroups were at particularly high risk; namely, pansexual students. Questioning and asexual SD subgroups had similar and lower symptom levels than their monosexual peers, respectively. SD subgroup disparities varied by mental health symptom type. No significant differences by GD subgroups were found. Clinicians and institutions should consider these disparities and future research should aim to better understand them.

The Gender-Specific Binegativity Scale: Validation in a Spanish Sample of University Students and Proposal of a Brief Version

Article

Full-text available

Dec 2023
Sex Res Soc Pol

Introduction Bisexuality is a more frequent and vulnerable sexual orientation than homosexuality. Yet it has received considerably less attention, resulting in the limited availability of valid measures to detect negative attitudes toward bisexual individuals, even in countries where social rights are notably promoted. This study aims to provide validation of a Spanish version of the Gender-Specific Binegativity Scale and propose a brief version to assess binegativity toward bisexual women and men separately. Methods In 2019, 495 university students completed the women’s and men’s subscales for the Gender-Specific Binegativity Scale and other measures (social dominance orientation, homonegativity, ambivalent sexism, social desirability) for external validity. Results Exploratory factor analysis supported the one-factor solution of the original 30-item measure. However, confirmatory factor analysis indicated a poor model fit for this version but a satisfactory fit for an 8-item version with parallel items for both subscales. Reliability and external validity were confirmed for both subscales in both versions. Bisexual men were rated more negatively than bisexual women, and men rated bisexual women and men more negatively than women. Conclusions The results support a validation of the Gender-Specific Binegativity Scale in Spanish. Moreover, the proposed brief version appears more psychometrically sound and efficient, facilitating its use in research and applied contexts. Policy Implications Only valid and efficient tools allow for a confident assessment of current attitudes toward minorities. This is the first step to understanding attitudes particular societies might hold, which is essential for the development of coherent policies and competent assessment of social interventions.

Use of the Heterosexist Harassment, Rejection, and Discrimination Scale With Different Sexual Orientation, Gender, and Racial/Ethnic Groups: An Examination of Measurement Invariance

Article

Full-text available

Dec 2023
ASSESSMENT

The Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) is one of the most commonly used measures of sexual orientation-related discrimination, but little is known about its psychometric properties across different sexual orientations, gender, and racial/ethnic groups. A three-factor model was initially obtained, but most studies treat the HHRDS unidimensionally. Therefore, we tested whether the HHRDS exhibited measurement invariance across sexual orientation, gender, and racial/ethnic groups among 792 sexual minority young adults (aged 18–29) who participated in an online study. Across models, the three-factor solution fit better than the one-factor solution. All models achieved configural invariance and most achieved metric invariance; none of the considered models achieved scalar invariance (1–3 items were not equivalent across groups, depending on the comparison). Findings suggest that the HHRDS generally functions equivalently across sexual orientation, gender, and racial/ethnic groups, but some caution in interpreting scores is warranted.

Bi+ adults' daily wellbeing: The roles of relationship status and partner gender

Article

Jan 2022

This study examined whether relationship involvement and partner gender were associated with between-person differences and within-person fluctuation in positive and negative affect and alcohol use among people who are attracted to more than one gender or regardless of gender (e.g., bisexual, pansexual, queer; bi+). One hundred and ninety-eight bi+ individuals (M age 26.97; 73.1% non-Latinx White) completed a 28-day diary study. Multilevel regression analyses modeled between-person differences in daily affect and alcohol use as a function of relationship status and partner gender. ANCOVAs were conducted to examine differences in within-person fluctuation. Results partially support past findings that relationship involvement may not confer benefits for bi+ people and that mixed-gender partnerships could be particularly challenging. Future research directions are discussed.

The Impact of Provider Biphobia and Microaffirmations on Bisexual Individuals’ Treatment-Seeking Intentions

Article

Mar 2021

Bisexual individuals experience mental illness at higher rates than monosexual individuals. In addition, previous research has found that bisexual persons face documented discrimination from mental health providers. However, research is lacking in examining how negative experiences with providers impact attitudes toward mental health care utilization among bisexual clients. This study explores the associations between bisexual individuals’ level of outness with providers, experiences of provider biphobia, experiences of microaffirmations from providers, and help-seeking attitudes. We hypothesized that: (a) Anti-bisexual experiences from a mental health provider would mediate the relationship between outness and help-seeking intentions, and (b) Microaffirmations from a provider would mediate the relationship between outness and help-seeking intentions. Results indicated that greater outness with mental health providers predicted greater microaffirmation experiences from mental health providers. As expected, anti-bisexual experiences significantly and negatively impacted intent to seek mental health treatment. There was not evidence of mediation.

A Naturalistic Test of Minority Stress Theory: Examining Social and Psychological Well-Being Trends Across Heterosexual and Sexual Minority Adults from 2009 to 2022

Article

Full-text available

Feb 2025
J SEX RES

Minority stress theory suggests that shifts toward egalitarianism should reduce well-being disparities between heterosexual people and lesbian, gay, bisexual, and other sexual minorities (LGB+ people). However, few studies have examined well-being trends in these groups over periods of social change. We addressed this issue directly using a large nationwide random sample of New Zealand adults over thirteen years (from 2009 to 2022; Ntotal = 72,790; LGB+ n = 7,677). In doing so, we tracked people’s well-being both before and in the years following major legal changes that increased LGB+ rights. Multigroup latent growth curve models revealed stable well-being differences between LGB+ and heterosexual participants across five domains of well-being, with little evidence of disparities reducing over time. Differences were most pronounced between younger LGB+ and heterosexual groups, with young LGB+ women and men reporting the lowest psychological and social well-being, respectively. These results highlight the need to further examine the impact of minority stress, as well as intersectional identities, on well-being among LGB+ populations.

Biphobia: A Systematic Literature Review

Article

Full-text available

Aug 2024

Du fait de leur orientation sexuelle et/ou romantique, les personnes bisexuelles s’exposent à des stéréotypes, des préjugés et de la discrimination. Désignée par le terme biphobie, cette forme d’oppression s’est avérée une influence négative sur la santé physique et mentale des personnes bisexuelles. Malgré la nécessité évidente d’étudier ce phénomène, les publications existantes demeurent peu nombreuses et fragmentaires. Par conséquent, la présente revue systématique de la littérature vise à regrouper les connaissances récentes en matière de biphobie. Elle se penche plus précisément sur les articles scientifiques publiés entre 2011 et 2022, dans le but de recenser les constatations et les lacunes au niveau de la recherche. Cette analyse présente ainsi les principaux résultats et caractéristiques de 41 articles examinant le phénomène de la biphobie dans les contextes occidentaux. En particulier, trois thèmes sont abordés : les attitudes envers la bisexualité, les expériences de biphobie et les conséquences liées à la biphobie. Le présent article souligne également plusieurs limites de la littérature actuelle et fournit des pistes à explorer pour des recherches futures.

“Caught Between Two Worlds”: Managing Identity in Bisexual Fatherhood

Article

Full-text available

Jun 2024

Bisexuality in fatherhood is largely invisible, with very little known about the experiences of bisexual fathers. Conducted by researchers in the United Kingdom, this study is one of the first to explore the experiences of bisexual fathers, and, using an identify-focused approach, it aims to understand bisexual fathers’ experiences of managing their bisexuality and role as a father. Twenty-four bisexual fathers in Europe and North America took part in qualitative, semistructured interviews that focused on their bisexual identity, becoming a parent, experiences of family life, and community involvement. Reflexive thematic analysis was conducted, and four themes were identified: valuing different types of authenticity, seeking safety in the community, reconciling bisexuality with the traditional family, and sharing and learning across age groups. Despite describing their identity as often invisible, fathers indicated that their personal identity had a significant impact on their social interactions as well as their individual parenting and family practices. Findings contrast stage models of LGBTQ+ identity development, as fathers’ identity work practices were often more important for their identity development and integration than aspiring for full “outness.” Findings expand our scholarly understanding of the role of identity in parenting and highlight the need to improve representation and support for bisexual fathers.

Psychological Distress Mediates the Relationship Between Bisexual Discrimination and Disordered Eating Behaviors in Bi + Women

Article

Full-text available

Feb 2024

Marriage Expectations Among Different Groups of Gender and Sexual Minority Youth in the United States

Article

Mar 2024

Sexual orientation-related disparities in perinatal mental health among a prospective cohort study

Article

Full-text available

Feb 2024

Sexually minoritized women (SMW) may be at an increased risk of adverse perinatal mental health, though prior research is limited. We examined sexual orientation-related differences in perinatal mental health (i.e., stress and depression), and antidepressant utilization among those at different severities of clinically significant perinatal depressive symptoms. Nurses’ Health Study 3 participants with prospectively assessed pregnancies (N = 6,364) received pregnancy and postpartum questionnaires. Using weighted log-binomial generalized estimating equations, we examined differences in stress (Perceived Stress Scale 4 [PSS-4]), depression (the Edinburgh Postnatal Depression Scale [EDPS] at four cut-off scores [≥7, ≥9, ≥11, ≥13]), and patterns of antidepressant utilization across five groups: completely heterosexual with no same-sex sexual partners (reference group; n = 5,178); heterosexual with same-sex sexual partners (n = 245); mostly heterosexual (n = 770); bisexual (n = 106); and lesbian (n = 47). Compared to the completely heterosexual reference group, SMW reported increased stress during pregnancy (adjusted risk ratio [ARR]: 1.14, 95% confidence interval [1.02–1.28]). SMW reported an elevated risk of pregnancy depression at every EDPS score cutoff, with the magnitude of the disparity increasing as the score increased (ARRs: 1.09 [1.00–1.20]; 1.20 [1.05–1.36]; 1.37 [1.16–1.63]; 1.49 [1.18–1.89] for EDPS scores ≥7, ≥9, ≥11, ≥13, respectively). Disparities were highest in magnitude among the mostly heterosexual and bisexual subgroups. Utilization of postpartum antidepressants increased among the reference group with increasing symptom severity but was only associated at the highest score (≥13) among SMW subgroups. SMW have increased risks of pregnancy stress and depression and are more likely to use perinatal antidepressants; mostly heterosexual and bisexual individuals had the highest risk of antidepressant use. Postpartum symptom severity closely corresponded to antidepressant use among completely heterosexual, but not SMW—suggesting disparities in mental health treatment. Further research priorities include determining the causes of these disparities and appropriately tailored solutions.

Sexual orientation and psychotic-like experiences among Chinese college students: the role of gender

Article

Full-text available

Sep 2023

Objective The mental health of sexual minorities has received increasing attention, but there are few studies on the risk of psychotic-like experiences (PLEs) among sexual minorities. The purpose of this study is to explore the relationship between different sexual orientations and PLEs among college students and the moderating effect of gender. Methods A total of 4,460 college students from seven provinces participated in this cross-sectional survey. The χ² test and logistic regression were used to investigate the relationship between sexual orientation and PLEs. Results Of the participants, 4.9% identified as bisexual, 1.1% as lesbian/gay, and 5.6% were questioning/unsure; 60.1% of the sample experienced at least one PLE item, 59.2% reported delusional experiences (DEs), and 20.6% had hallucinatory experiences (HEs). Compared with heterosexual college students, bisexual and questioning students showed a higher risk of PLEs, DEs, and HEs, and lesbian/gay students showed a higher risk of HEs. Stratified analysis indicated that sexual orientation was significantly associated with PLEs only for female college students. Conclusion Sexual orientation is a predictive factor of PLEs. In particular, different sexual minority subgroups show the different effects on PLEs between male and female college students. Mental health interventions for PLEs could employ distinct strategies based on different sexual orientations and gender disparity.

Intimate Partner Violence Perpetration Among Sexual Minority Young Adults: Associations With Alcohol Use, PTSD Symptoms, Internalized Homophobia, and Heterosexist Discrimination

Article

Full-text available

Aug 2023

Lesbian, gay, bisexual, queer, and other sexual minority (LGBQ+) young adults report similar or higher rates of intimate partner violence (IPV) perpetration than their heterosexual peers. Elevated IPV risk among LGBQ+ young adults may be attributable to experiencing heterosexist discrimination and internalized homophobia. In addition, LGBQ+ people report disproportionate posttraumatic stress disorder (PTSD) symptoms, alcohol use, and IPV perpetration in dating relationships. Thus, this study explored which combinations of IPV risk factors (i.e., experiencing heterosexist discrimination, internalized homophobia, PTSD symptoms, alcohol use) related to forms of IPV perpetration, inclusive of psychological, physical, and sexual forms, in a sample of 342 LGBQ+ young adults. Internalized homophobia was related to psychological IPV perpetration at high and medium levels of PTSD symptoms and only high levels of alcohol use. PTSD symptoms and alcohol use interacted to predict psychological IPV perpetration; and PTSD symptoms related to increased psychological IPV perpetration at high and medium, but not low, alcohol use levels. Alcohol use was positively related to physical IPV perpetration. No other risk factors or interactions were significantly related to physical or sexual IPV perpetration. Results were consistent with prior findings that linked internalized homophobia, alcohol use, and PTSD symptoms to IPV perpetration and highlight the interacting nature of these IPV perpetration risk factors. Comprehensive IPV interventions with LGBQ+ young adults should evaluate the impact of simultaneously targeting these multiple IPV risk factors considering their interacting contributions to IPV perpetration risk. More research is needed to examine the temporal relations between minority stress, PTSD symptoms, alcohol use, and IPV perpetration.

The relationship between physical activity, stress, and resilience in sexual and gender minority college students

Article

Aug 2023
J AM COLL HEALTH

Objective: To assess the role of sexual orientation and gender identity in the relationship between physical activity (PA), stress and resilience. Participants: A nationally-representative sample of students (n = 91,718) from United States postsecondary institutions. Methods: Students reported aerobic and strength training (ST) behaviors, stress, resilience, gender identity and sexual orientation. Moderated regressions examined the influence of gender identity and sexual orientation on the relationship between PA and stress or resilience. Results: Men and heterosexual students reported higher PA and resilience and lower stress than did women, gender minorities, and sexual minorities. Significant moderation was found for women, queer students, bisexual students, trans women and lesbians in the various models. Conclusions: Gender minority and sexual minority students display poorer levels of PA and mental health than cisgender and heterosexual counterparts, but this relationship varies by identity group.

Community (dis)connectedness and identity among LGBTQIA+ people during the COVID-19 pandemic: A qualitative cross-sectional and longitudinal trajectory study

Article

Jul 2023

The coronavirus disease 2019 (COVID-19) pandemic and associated shelter-in-place ordinances passed in the first year of the pandemic rapidly limited access to in-person social interactions, raising concerns of diminishing social support and community cohesion while psychological stressors increased. For LGBTQIA+ people, connectedness to the LGBTQIA+ community is known to buffer against the harmful effects of stressors and decrease risks for poor psychological and behavioural health outcomes. The current study uses qualitative cross-sectional and trajectory analysis methods to characterise how LGBTQIA+ people’s perceptions of community connectedness shifted during the first year of the pandemic. A convenience sample of LGBTQIA±identified people in the U.S. completed an initial online survey in September 2020 (n = 298 and a follow-up survey in September 2021 (n = 129). The survey included changes in connectedness to the LGBTQIA+ community since the pandemic’s beginning. Thus, we used both cross-sectional (between-person analyses) and longitudinal trajectory (within-person analyses) qualitative approaches to understanding changes in LGBTQIA+ people’s sense of connection to the LGBTQIA+ community across the first two years of the COVID-19 pandemic. Eight cross-cutting themes (related to identity shifts/exploration, disconnection, online connections, and increased awareness of social justice issues) were identified and then organised within each level of the Social-Ecological Model of LGBTQIA+ wellbeing (i.e. the individual-, couple-, interpersonal-, organisational-, community-, and chronosystem- level). Given the importance of social support for LGBTQIA+ wellbeing, more longitudinal research is needed to determine whether these changes persist after the resolution of the acute phase of the pandemic.

Bisexual-specific minority stress in nonsuicidal self-injury: The mediating role of perceived burdensomeness

Article

Full-text available

Jun 2023

Background: Bisexual-identifying individuals are at heightened risk for engaging in non-suicidal self-injury (NSSI), with the odds up to six times higher compared to heterosexual individuals and up to four times higher compared to lesbian/gay (L/G) individuals. While research has established that sexual minorities may be at increased risk because minority stressors exacerbate psychological processes associated with NSSI, little research has examined bisexual-specific pathways of risk. In this study, we replicated findings that suggest Interpersonal Theory of Suicide (IPTS) variables (i.e., perceived burdensomeness and thwarted belongingness) mediate the association between minority stress and NSSI and extended these findings by examining whether such mediation is moderated by sexual minority identity. Furthermore, we explored whether IPTS variables mediate the association between bisexual-specific minority stress and NSSI. Method: A sample of 259 cisgender L/G (n = 93) and bisexual (n = 166) MTurk workers completed measures assessing minority stress, NSSI, and IPTS variables. Results: Mediation analyses replicated findings that experiences of minority stress increase NSSI by increasing perceived burdensomeness [PB], though moderated mediation analyzes failed to provide evidence that sexual minority identity moderated this indirect effect. Rather, minority stress from both heterosexual and L/G individuals increased NSSI through increased PB for bisexual individuals. Limitations: The use of cross-sectional data does not allow conclusions of causal relationships. Conclusions: These results suggest that for bisexual individuals, minority stress from both heterosexual and L/G individuals increases NSSI by increasing PB. Future researchers and clinicians should consider the additive burden of minority stress in bisexual individuals.

An exploratory investigation of body esteem, body dissatisfaction and body change behaviours in sexual minority young adults from a risk and protective perspective

Article

Full-text available

Oct 2022

Body image and body change behaviours, as well as risk and protective factors for body esteem, were documented by sexual orientation in young adults aged 18-25 years. Cross-sectional data from My World Survey 2 Post Second Level (MWS2-PSL) were used. The sample consisted of 1,975 heterosexual, 256 gay, 169 bisexual, 89 questioning men and 4,521 heterosexual, 167 lesbian, 781 bisexual, 356 questioning and 121 pansexual women. Body esteem, body dissatisfaction and body change behaviours were profiled across sexual orientation groups. Risk factors including sexual minority stress (e.g., discrimination) and protective factors (e.g., resilience) for body esteem were analysed across groups using Chi Square Tests of Independence and Analyses of Covariance. Multiple regressions identified relationships between body esteem, body change behaviours and risk and protective factors for each group. Heterosexual men exhibited higher body esteem and lower body dissatisfaction than sexual minority men. Bisexual women demonstrated the lowest body esteem, while pansexual women exhibited lower body satisfaction versus heterosexual, lesbian and questioning women. Muscle building and weight loss attempts did not differ among women, but weight loss attempts were elevated in gay and bisexual men. Comfort with sexuality, resilience and social support were positively associated with body esteem. Risk and protective factors for body esteem varied by sexual orientation, highlighting the importance of examining these constructs separately across sexual minority subgroups.

A Socioecological Mixture Model of Asthma Prevalence Among Sexual Minority Adults in the United States

Article

Full-text available

Jun 2022

Purpose Sexual minority (SM) identity as well as sociodemographic and socioeconomic factors are associated with asthma prevalence. A syndemics framework analyzes disease conditions in a population and the social, economic, and environmental contexts in which they are found. We used a syndemic model of individual-level socioecological factors to identify profiles of asthma prevalence among SM adults. Methods Latent class analysis (LCA) was conducted on a subpopulation of SM adults aged 18–59 years from the 2001 to 2016 National Health and Nutrition Examination Survey. Indicators in the LCA model included current asthma, gender, sexual identity, poverty-income ratio, education, and serum cotinine level. Multinomial logistic regression analyzed the effects of covariates (race/ethnicity, nativity, age, marital status, body mass index, lifetime smoking, and mental health care seeking) on identified profiles. Results Four classes were identified among our sample of n = 1097 SM adults. Classes 1 and 2 had 19% and 18% conditional probabilities of current asthma, respectively, and were primarily female and bisexual. Classes 3 and 4 had 5% and 2% conditional probabilities of asthma, respectively, and were primarily male and gay. Classes 1 and 3 also had conditional probabilities of high income and educational attainment. Black individuals had higher odds than White individuals of being in Class 1 (odds ratio [OR] = 4.46, 95% confidence interval [CI] = 1.43–13.93), Class 2 (OR = 21.66, 95% CI = 7.50–62.60), and Class 4 (OR = 7.41, 95% CI = 2.05–26.71), relative to Class 3. Conclusion Findings extend past literature that suggests within-group asthma disparities among SM adults. Informational campaigns on asthma management should target this community to avoid severe disease exacerbations.

The Buckle of the Bible Belt: Sexual Minority Emerging Adults' Minority Stress in South Central Appalachia

Article

May 2022

Introduction Sexual minority emerging adults in Appalachia face multiple sources of stigma and discrimination. Methods We conducted four focus groups and five one-on-one interviews with sexual minority young adults and community stakeholders. Results Themes emerged from qualitative analysis: (1) Appalachian culture engenders discrimination and isolation; (2) A need to identify safe spaces; (3) Lack of access to identity-affirming health services; and (4) participants draw strength from limited but persistent resistance, advocacy, and visibility. Conclusion Sexual minority emerging adults experience intersectional stigma in a socially conservative Appalachian setting. Attention to their unique experiences points toward specific service and community support needs.

Trajectories of Loneliness Among Older Women and Men: Variation by Sexual Identity?

Article

Full-text available

Apr 2022
GERONTOLOGIST

Background and objectives: The aim of this study is to contribute to the literature on variation in later-life outcomes by sexual identity. Drawing on the Iridescent Life Course framework, we examined differences in loneliness trajectories, and tested the roles of social connectedness and support, and socioeconomic and health statuses in explaining any observed disparities. Research design and methods: Using growth models, we analysed 19 years of data (2001-2019) from adults aged 50 years and older from the Household, Income and Labour Dynamics in Australia Survey (n=5,500 individuals), where a question on sexual identity was asked twice in the study. Results: One percent of our sample reported a change in their sexual identity, which we grouped with individuals who reported as bisexual. Our sample comprised of 45.3% heterosexual men, 52.2% heterosexual women, 0.6% gay men, 0.6% lesbian women, 0.6% bisexual-plus men, and 0.6% bisexual-plus women. We found bisexual-plus men were vulnerable to loneliness as they aged. This group had the highest levels of loneliness at age 50, and differences compared with heterosexual men persisted over time. Loneliness of bisexual-plus men increased steeply from age 70. Socioeconomic and health statuses did not explain the increased loneliness of older bisexual-plus men. Lower social support and connectedness partly accounted for these disparities. Discussion and implications: Findings are discussed with regards to existing research and theories on social disadvantage and resilience over the life course. We expand knowledge on factors explaining loneliness and how it varies in women and men by sexual identity.

“In Order to Be Bi, You Have to Prove It”: A Qualitative Examination of Plurisexual Women’s Experiences With External and Internalized Pressure to Prove Their Identities

Article

Full-text available

Mar 2022

Plurisexual women, or women attracted to multiple genders, are a large and vulnerable population in the United States. Plurisexual women experience higher rates of negative mental, physical, and sexual health outcomes compared with monosexual men and women (i.e., straight, lesbian, or gay). One potential factor underlying the high rates of negative health outcomes among plurisexual women is the pressure to “prove” one’s plurisexuality through sexual and/or romantic behavior with persons of more than one gender. The current study used qualitative interviews with 25 plurisexual women of varying identities (e.g., bisexual, pansexual, and queer) who discussed their experiences with the pressure to prove their sexual identities, and what effects this pressure has had on their lives and relationships. Using thematic analysis, we identified two themes across participant responses: (a) external pressure to prove sexual identity and (b) internalized pressure to prove sexual identity. External pressure arose from others demanding plurisexual women disclose their sexual and romantic history, accusing them of faking plurisexuality for attention, and pressuring them into performing sexual acts. The notion that plurisexual women must provide behavioral evidence to be validated as plurisexual was internalized by participants (e.g., checking behavioral boxes, questioning identity due to insufficient “evidence”). The women in our sample discussed how their experiences with external and internalized pressure to prove their plurisexuality were harmful to their sense of identity and their relationships with others. External and internal pressures to prove plurisexuality were also connected to sexually coercive experiences. Our findings highlight two different forms of pressure to prove one’s plurisexual identity, which may underlie negative health outcomes among plurisexual women.

Disparities in Use/Misuse of Specific Illicit and Prescription Drugs among Sexual Minority Adults in a National Sample

Article

Jan 2022

Background: Compared to heterosexual adults, lesbian, gay, and bisexual (LGB) adults have higher rates of any illicit drug use and any prescription drug misuse, yet disparities regarding specific drugs remain poorly characterized. Methods: We examined disparities by sexual identity and sex for 8 illicit and prescription drugs using 2015-2019 National Survey on Drug Use and Health data. Outcomes included past-year use/misuse of cocaine/crack, hallucinogens, inhalants, methamphetamine, heroin, prescription opioids, prescription stimulants, prescription tranquilizers/sedatives, and level of polydrug use/misuse (2 substances; 3+ substances). For each outcome, odds ratios relative to heterosexual adults of same sex were estimated using logistic regression controlling for demographics; significant estimates were interpreted as a disparity. Results: Among gay men, significant disparities were present for all drugs except prescription stimulants and heroin; inhalant use was particularly elevated. Bisexual women exhibited significant disparities for every drug examined, as did bisexual men (except heroin). Among lesbian/gay women, disparities were only present for prescription opioids and stimulants. Relative to heterosexual peers, use of 3+ substances was 3 times higher among gay men and bisexual women and 2 times higher among bisexual men. Conclusions: Consistent with minority stress theory, prevalences of illicit and prescription drug use/misuse were 2-3 times higher among LGB adults than heterosexual adults. Illicit drug use should not be perceived as only impacting gay/bisexual men - bisexual women had similar - or higher - prevalences of hallucinogen, cocaine, methamphetamine, and heroin use. Yet, in contrast to bisexual women, lesbian/gay women did not exhibit disparities for any illicit drugs.

Prospective Associations Between Bi+ Minority Stressors and Internalizing Symptoms: The Mediating Roles of General and Group-Specific Processes

Article

Full-text available

Oct 2021

Objective: The prevalence of anxiety and depressive (i.e., internalizing) disorders is higher among bi+ individuals (i.e., individuals with attractions to more than one gender and/or who identify as bisexual or pansexual) compared to both heterosexual and lesbian/gay individuals. Cross-sectional research has demonstrated that stressors unique to bi+ individuals are associated with internalizing symptoms. However, longitudinal research examining these associations and underlying mechanisms is extremely limited. Method: We utilized five waves of data (6 months between waves) from a diverse sample of bi+ individuals assigned female at birth (age 16-32; 29% gender minority; 72.9% racial/ethnic minority) to examine: (a) prospective associations between three bi+ stressors (enacted, internalized, anticipated bi+ stigma) and internalizing symptoms; (b) potential mediating role of rumination in these associations; and (c) potential mediating roles of internalized and anticipated bi+ stigma in associations between enacted bi+ stigma and internalizing symptoms. Results: At the within-person level, when participants experienced more bi+ stressors than usual during a particular wave, they experienced subsequent increases in internalizing symptoms. Increases in rumination mediated these associations. Associations between enacted bi+ stigma and internalizing symptoms were mediated by increases in internalized and anticipated bi+ stigma. Conclusions: Findings indicate that bi+ stressors prospectively predict increases in internalizing symptoms and rumination may play a mechanistic role. Further, findings suggest that internalized and anticipated bi+ stigma may play mechanistic roles in the associations between enacted bi+ stigma and internalizing symptoms. Interventions targeting rumination, internalized stigma, and anticipated bi+ stigma may help to reduce internalizing symptoms among bi+ individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Embodied, Situated, and Co-Constructed: Young Sexual Minority Men’s Experiences of Intersectional Identity and Minority Stress

Article

Full-text available

Nov 2021
SEX ROLES

Intersectionality, minority stress, and social ecological theories have all been important frameworks for understanding mechanisms that create and maintain sexual and gender minority health disparities. In this study, we integrated these frameworks to guide a grounded theory examination of identity-related experiences in specific settings among 33 Black, White, and Latino young sexual minority cisgender men who lived in Chicago. Analyses identified four key categories: Racism Manifests in Context- and Sexual Minority-Specific Ways, Sexual Orientation Can Mean Feeling Safe and Seen or Threatened and Alone, Gender is a Matter of Self-Expression, and Bodies Are Not Always Made to Fit In. Participants reported both identity-based privilege and marginalization as well as unique forms of minority stress at the intersection of specific identities. Across these categories, participants’ experiences of their intersecting identities and associated forms of minority stress were embodied in their physical appearance, situated in specific neighborhoods and contexts, and co-constructed through their interpersonal interactions with others. Further, participants’ narratives provide powerful insights about the nuanced ways in which young sexual minority men understand and negotiate their lived experiences. Findings highlight how experiences of identity and minority stress are both intersectional and located within specific social ecological contexts, which has important implications for research, clinical practice, and advocacy.

Building villages: Reflections and studies on the quality of relationships in legal recognition of non-monogamous families

Article

Full-text available

Jun 2021

Aurelio Castro

The following paper aims to contribute to the Italian literature on non-monogamy with a psychosocial interpretation towards the future of the political and legal recognition requests of non-monogamous and queer relationships, as well as of their families. Starting with a reflection on how normativities position those who are outside the binaries as noises to be ignored or cancelled, the paper then provides a critique of the concept of evaluation as a tool for acquiring rights (as it does not find a counterpart in the different-gender relationships). Psychosocial studies on the relationship quality of non-monogamous people should be used to strenghten the demands for the legal recognitions of non-monogamous relationships, families and multi-parenting. In fact, the available international literature has given voice and confirmed what the many polyfamilies experience in everyday life: that these families (non-monogamous, open, poly, extended, childless * or not) are a social reality with their positive charachteristics and criticalities. Starting from examples on the erasure of bisexualities and ame-gender families recognition – the paper discuss how including these types of psychosocial research can improve our struggle for the recognition and legal rights of non-monogamous agreements and relationships.

Impact of the 2016 Election on the Quality of Life of Sexual and Gender Minority Adults: A Difference-in-Differences Analysis

Article

Full-text available

Jul 2021

Purpose: The 2016 U.S. election significantly changed the political landscape for sexual and gender minority (SGM) individuals. The current study assessed the consequences of the election and transition to a new overtly discriminatory administration on the health-related quality of life of SGM adults compared with their cisgender and heterosexual counterparts. Methods: The study used repeated cross-sectional data from the 17 states that administered the sexual orientation and gender identity module in the 2015 and 2018 Behavioral Risk Factor Surveillance System surveys. The sample included 268,851 adult respondents: 12,006 SGM adults (5.35%) and 256,845 cisgender and heterosexual adults (94.65%). Outcomes were frequent (≥14 days in the last month) physical distress, mental distress, limited activity, and/or fair/poor general health. Difference-in-differences estimates were calculated from logistic regression models, controlling for sociodemographic, health care coverage, and chronic medical condition confounders. Results: Compared with the cisgender and heterosexual population, frequent mental distress among SGM adults increased by 5% points, corresponding to a relative increase of 32.5% (p < 0.001) from 2015. Rates of frequent physical distress, limited activity, and fair/poor general health were not significantly altered between the two populations. Gender minority adults were most negatively affected with a relative increase in frequent mental distress of 117.5% (p < 0.001). Conclusions: The 2016 U.S. election and administration changeover were associated with a substantial increase in the proportion of SGM adults reporting frequent mental distress. These data provide empirical evidence as to the psychological effects of an abrupt political realignment on SGM mental health.

The New Genetic Evidence on Same-Gender Sexuality: Implications for Sexual Fluidity and Multiple Forms of Sexual Diversity

Article

Feb 2021

Lisa M. Diamond

In September of 2019, the largest-ever (N = 477,522) genome-wide-association study of same-gender sexuality was published in Science. The primary finding was that multiple genes are significantly associated with ever engaging in same-gender sexual behavior, accounting for between 8–25% of variance in this outcome. Yet an additional finding of this study, which received less attention, has more potential to transform our current understanding of same-gender sexuality: Specifically, the genes associated with ever engaging in same-gender sexual behavior differed from the genes associated with one’s relative proportion of same-gender to other-gender behavior. I review recent research on sexual orientation and sexual fluidity to illustrate how these findings speak to longstanding questions regarding distinctions among subtypes of same-gender sexuality (such as mostly-heterosexuality, bisexuality, and exclusive same-gender experience). I conclude by outlining directions for future research on the multiple causes and correlates of same-gender expression.

Suicidality risk among adult sexual minorities: Results from a cross-sectional population-based survey

Article

Jan 2021

Jolynn Haney

Suicide among sexual minority adults is a serious public health issue. Data from the National Survey of Drug Use and Health (2015–2018) were analyzed to evaluate factors associated with past-year suicidality risk (thoughts, plans, or attempts) and self-reported sexual identity. Findings support previous research that sexual minority groups have a higher risk of suicidality compared to heterosexuals. Additionally, significant within-group gender differences were found for bisexuals with reported past-year suicide attempts. The risk ratio trajectory from suicidal ideation to suicidal attempt was the most striking for the gay and lesbian group compared to other populations. Implications and recommendations for future research are discussed.

Discursive power and resistance in the information world maps of lesbian, gay, bisexual, transgender, queer, intersex and asexual community leaders

Article

Apr 2021
J DOC

Purpose This qualitative study explores how discursive power shapes South Carolina lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) communities' health information practices and how participants resist this power. Design/methodology/approach In total, 28 LGBTQIA+ community leaders from South Carolina engaged in semi-structured interviews and information world mapping–a participatory arts-based elicitation technique–to capture the context underlying how they and their communities create, seek, use and share health information. We focus on the information world maps for this paper, employing situational analysis–a discourse analytic method for visual data–to analyze them. Findings Six themes emerged describing how discursive power operates both within and outside of LGBTQIA+ communities: (1) producing absence, (2) providing unwanted information, (3) commoditizing LGBTQIA+ communities, (4) condensing LGBTQIA+ people into monoliths; (5) establishing the community's normative role in information practices; (6) applying assimilationist and metronormative discourses to information sources. This power negates people's information practices with less dominant LGBTQIA+ identities and marginalized intersectional identities across locations such as race and class. Participants resisted discursive power within their maps via the following tactics: (1) (re)appropriating discourses and (2) imagining new information worlds. Originality/value This study captures the perspectives of an understudied population–LGBTQIA+ persons from the American South–about a critical topic–their health–and frames these perspectives and topics within an informational context. Our use of information world mapping and situational analysis offers a unique and still underutilized set of qualitative methods within information science research.

“An Extra Set of Bits for Your Fantasy”: A Qualitative Exploration of Bi + Women’s Fetishization Experiences

Article

Mar 2025

The Mental Health of Sexual Minority Individuals: Five Explanatory Theories and Their Implications for Intervention and Future Research

Article

Full-text available

Dec 2024
ANNU REV CLIN PSYCHO

Research on the disparity in common mental health problems borne by sexual minority individuals has entered a stage of increasing theoretical complexity. Indeed, such a substantial disparity is likely not determined by a singular cause and therefore warrants diverse etiological perspectives tested with increasingly rigorous methodologies. The research landscape is made even more complex by the constant and rapid shift in the ways in which sexual minority people understand and characterize their own identities and experiences. This review introduces readers to this complexity by summarizing the historical legacy of research on the sexual orientation disparity in mental health, describing five contemporary theoretical explanations for this disparity and their supporting evidence, and suggesting theoretically informed interventions for reducing this disparity. Last, we offer an agenda for future research to accurately model the complexity of the pathways and solutions to the disproportionately poorer mental health of sexual minority populations.

Differences in Minority Stress Experiences, Mental Health, and Relationship Quality Outcomes Among Bisexual, Pansexual, and Queer Women

Article

Dec 2023

The majority of sexual minority women in the United States today identify as bi+. Recent research suggests that “non-traditional” bi+ labels such as pansexual and queer are being adopted more frequently than ever before, making it increasingly important to evaluate whether these women have unique needs. In the current study, we explored differences in minority stress experiences, mental health, and relationship quality outcomes by sexual identity label among women who identify with the most common bi+ labels: bisexual, pansexual, and queer. Participants were 285 bi+ cisgender women in romantic relationships. They completed online measures of minority stress (antibisexual experiences, identity concealment, disconnection from the sexual and gender minority (SGM) community, and internalized stigma), mental health (depression and anxiety), and relationship quality (satisfaction and commitment). Overall, participants reported similar experiences of minority stress and few differences in their mental health outcomes. However, there were differences in antibisexual experiences by sexual identity label, such that pansexual women reported more frequent antibisexual experiences than bisexual and queer women. There were also differences in relationship quality by sexual identity label, such that bisexual women reported higher satisfaction than pansexual women and higher commitment than both pansexual and queer women. Findings suggest that pansexual and queer women may be facing their own unique challenges, even compared to bisexual women. Clinical prevention and intervention efforts can be tailored for these women to include strategies to cope with more frequent exposure to antibisexual experiences, as well as relationship education and skill-building to promote healthy romantic relationships.

Contextualizing Cisgender Women's Histories of Intimate Partner Violence Victimization With Men and Women

Article

Full-text available

Sep 2023

Sexual minoritized women (SMW) are more likely than exclusively heterosexual women to experience intimate partner violence (IPV). We conducted in-depth interviews with a clinic-based sample of plurisexual SMW ( n = 25) ages 18 to 34 about the gender of their perpetrators. Participants primarily experienced physical and sexual IPV in relationships with men and emotional abuse in relationships with women. IPV perpetrated by men often included weapons with women fearing for their lives. Offering patients information about IPV resources and supports that do not make assumptions about women's sexualities may create more opportunity for empathic and effective communication with SMW experiencing IPV.

Citation Network Analysis of Minority Stress Scholarship: Past, Present, and Potential Directions

Article

Full-text available

Aug 2023

This study is a citation network analysis of minority stress scholarship to elucidate its past, present, and potential directions based on how authors use (i.e., cite) these publications. Using CitNetExplorer, we analyzed a network of 4,494 publications and 61,335 citation links. The analysis yielded 12 citation clusters. The most dominant cluster included foundational frameworks and reviews. Additional clusters focused on specific populations (i.e., transgender people and gender diversity issues, lesbian, gay, bisexual, transgender, and queer [LGBTQ+] youth, LGBTQ+ people of color and minority stress intersections, bisexual people and issues, men who have sex with men) or domains of experiences (i.e., same-sex couples and relationships, substance use, intimate partner violence, body image and eating problems, microaggressions, COVID-19). A promising finding was that the network was characterized by substantial citation connectivity, indicating that scholars are integrating knowledge across domains of minority stress scholarship. In addition, the cluster on LGBTQ+ people of color and minority stress intersections spanned across most other clusters, indicating its integration with minority stress scholarship about various populations and experiences. A notable area of citation disconnection was that the intimate partner violence cluster had limited overlap with several other clusters (e.g., transgender people and gender diversity issues, bisexual people and issues, substance use, microaggressions). This suggests a need and opportunity to reconnect minority stress scholarship on intimate partner violence with other key areas. In addition to these strengths and potential directions, the findings underscore the need for intentional citation practices to credit key foundational works (e.g., Brooks, 1981).

Manjšinski stres LGBT+ mladih v okviru vzgoje in izobraževanja: integrativni pregled literature

Article

Full-text available

Jul 2023

LGBT+ osebe v šolskem prostoru poleg splošnih oblik stresa značilnih za vse učenke_ce doživljajo tudi manjšinski stres. Model manjšinskega stresa predstavlja generalne procese stresa in procese manjšinskega stresa. Ravno slednji pa zaznamujejo življenja LGBT+ oseb, saj so osnovani na spolu in spolni usmerjenosti, ki so v okviru tega modela označeni kot distalni procesi manjšinskega stresa. Iz teh izhajajo proksimalni procesi, ki nastanejo kot odziv na distalne stresorje. Z namenom razumevanja teh procesov, predstavitve relevantne tuje literature o manjšinskem stresu LGBT+ oseb v okviru vzgoje in izobraževanja ter možnosti oblikovanja temeljev za empirično raziskovanje tega področja v slovenskem področju, smo s pregledom literature identificirale_i situacije, ki za LGBT+ osebe v kontekstu šolskega prostora predstavljajo vir manjšinskega stresa. V končno analizo je vključenih 57 gradiv iz podatkovnih baz Scopus in Web of Science. V dotičnem prispevku jih predstavljamo zgolj 21, saj so ostale zaradi obravnave povezane teme rezilientnosti opisane v ločenem prispevku. Izbrane raziskave naslavljajo manjšinski stres LGBT+ oseb in vključujejo mlade LGBT+ osebe in/ali za vzgojno-izobraževalni prostor relevantna tematska področja. Vsa gradiva so bila pregledana s programom Nvivo in obdelana s kvalitativno tematsko analizo. Nekateri rezultati kažejo, da lahko šolski prostor za LGBT+ osebe predstavlja osrednji vir distalnih (nasilje, diskriminacije, mikroagresije, predsodki, stereotipi) in proksimalnih (ponotranjena stigma, pričakovana zavrnitev, upravljanje s stigmo) manjšinskih stresorjev. Ti imajo številne negativne vplive na življenje in zdravje LGBT+ učenk_cev, kar nakazuje na potrebo po spremembah, s katerimi bi bilo mogoče zmanjšati ravni manjšinskega stresa in LGBT+ osebam zagotoviti varno ter spoštljivo vzgojno-izobraževalno izkušnjo.

Bisexual Women's Experiences of Receiving Help for Mental Health Difficulties Through Psychological Therapy: A Qualitative Exploration

Article

Full-text available

Apr 2023

Bisexual women face higher rates of mental health difficulties and worse treatment outcomes from psychological therapies than other groups within the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Yet, research exploring treatment outcomes has predominantly investigated LGBTQ+ individuals as a homogenous group. This study investigated bisexual women's experiences of receiving help for mental health difficulties through psychological therapy. Eight bisexual women participated in online, semistructured qualitative interviews that explored their experiences of receiving psychological therapy and views on how to improve services. Qualitative data were audio-recorded, transcribed, and inductively analyzed using Reflexive Thematic Analysis. Participants described challenges, such as experiences of discrimination, that came with being both bisexual and a woman, alongside exacerbating difficulties associated with being neurodivergent or part of a marginalized ethnic group. These experiences led them to anticipate biphobia from their therapist, which participants managed through strategies such as identity concealment. Negative help-seeking experiences included therapists pathologizing bisexuality. Positive experiences included where therapists adopted a nonjudgmental and collaborative approach. Participants emphasized the importance of feeling that their identity was understood but expressed differing opinions about whether client-therapist identity matching is necessary. Results highlight the challenges associated with navigating bisexuality within clinical encounters amongst other marginalized identities, alongside the need for bisexual women to actively manage these challenges to keep themselves safe. Clinical implications include the need for therapists to receive training about bisexual women's needs and to acknowledge the impact of social and systemic injustice relating to their marginalized identities within clinical formulations.

Issues in Bisexual Men’s Lives: Identity, Health and Relationships

Article

Oct 2022

Mark McCormack

This article provides a critical review of recent research about bisexual men. It foregrounds research dedicated to this group, rather than when bisexual men are included in a broader study, providing a rationale for the importance of doing this. The review finds that there is still a preponderance of research on bisexual men focused on experiences of stigma and discrimination, often from a public health perspective or with a focus on negative health outcomes. Social science research explores disclosure of bisexual identity, with evidence of widespread stigma but also positive experiences of disclosure. Bisexual men have diverse experiences of romantic relationship, with the gender and sexuality of the partner influencing relationship dynamics. Research also highlights sexual health issues, including difficulties in accessing healthcare. The review shows that further research is needed into this understudied population.

Associations between anti-bisexual minority stress and body esteem and emotional eating among bi+ individuals: The protective role of individual- and community-level factors

Article

Oct 2021
Eat Behav

Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current study examined the associations between bisexual-specific minority stress and emotional eating and body esteem in a sample of bisexual plus (bi+) adults (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity), and tested the moderating effects of identity centrality, affirmation, and community connectedness as potential protective factors. This study leveraged data from an online survey of 498 adults (77.46% cisgender women; 79.7% White), ages 18 to 64 years (M = 28.5; SD = 9.59). Bisexual-specific minority stress was associated with more emotional eating (β = 0.15, p = .013) and lower body esteem (β = −0.16, p = .005), while controlling for sociodemographic characteristics, body mass index, and heterosexist minority stress. This finding remained the same when sensitivity analyses were conducted with participants who identified specifically as bisexual. Identity centrality and affirmation and community connectedness did not demonstrate moderating effects but they had main effects, such that they were positively associated with body esteem (β = 0.16, p = .001; β = 0.21, p < .001; β = 0.13, p = .004, respectively). Results suggest that anti-bisexual minority stress has a unique association with bi+ individuals' emotional eating and body esteem, and identified potential individual- and community-level protective factors for body esteem. These findings inform future research and interventions for this understudied population.

Disclosure, Minority Stress, and Mental Health Among Bisexual, Pansexual, and Queer (Bi+) Adults: The Roles of Primary Sexual Identity and Multiple Sexual Identity Label Use

Article

Full-text available

Sep 2021

Bisexual people are at increased risk for anxiety and depression compared with heterosexual and gay/lesbian people, but little is known about people who use other labels to describe attractions to more than one gender (e.g., pansexual, queer; collectively bi+). In addition, some people use more than one label to describe their sexual orientation, but research has yet to examine whether using one versus multiple labels is associated with identity-related experiences or mental health. To address these gaps, we explored potential differences in disclosure, minority stress, and mental health among bi+ adults based on primary sexual identity and multiple label use. As part of a larger project, 669 bi+ adults completed an online survey. Primary sexual identities included bisexual (53.2%), pansexual (26.3%), and queer (20.5%), and 55.2% used multiple labels. Compared with bisexual participants, pansexual participants reported higher disclosure, discrimination from heterosexual people, and depression. Pansexual participants also reported higher anxiety and lower internalized binegativity, but these associations became nonsignificant after adjusting for demographics. Queer participants reported higher disclosure, discrimination from heterosexual people, and anxiety, but only the difference in disclosure remained significant in adjusted analyses. Finally, participants who used multiple labels reported higher disclosure and discrimination from heterosexual and gay/lesbian people, but only the difference in discrimination from gay/lesbian people remained significant in adjusted analyses. Findings highlight the heterogeneity of bi+ individuals and the importance of considering bisexual, pansexual, and queer individuals as unique groups as well as considering whether bi+ individuals use one or multiple sexual identity labels.

Self‐assessment of health status among lesbian, gay, and bisexual cancer survivors in the United States

Article

Full-text available

Aug 2021
CANCER-AM CANCER SOC

Background Research is lacking for understanding the health disparities in cancer survivorship in the lesbian, gay, and bisexual (LGB) population in the United States. Self‐reported health status is used as a predictor of health disparities. Methods This secondary data analysis study used 2018 Behavioral Risk Factor Surveillance System data to analyze cancer survivorship characteristics by sexual orientation and sex through the use of logistic regressions. Results Overall, 17,656,329 US cancer survivors were included in this study after weighting, with percentage estimates of 1.52% for gays/lesbians and 1.41% for bisexuals. LGB participants were younger and more ethnically diverse. Significantly, bisexuals had current smoking (32.3% vs 13.6%) and binge drinking rates (17.1% vs 9.1%) twice those of heterosexuals; 16.6% of bisexuals versus 4.1% of heterosexuals reported no health insurance coverage (P < .0001). After adjustments for socioeconomic, health‐related behavioral risk, and health care access factors, bisexual females reported poorer general health (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.31‐1.36) as well as mental health (OR, 2.43; 95% CI, 2.39‐2.46) than their heterosexual peers (P < .0001). Bisexual males were 5.14 times more likely to be told that they had depressive disorders than their heterosexual counterparts (95% CI, 5.05‐5.23), whereas bisexual females were 3.23 times more likely for the same outcome (95% CI, 3.18‐3.28). All LGB groups reported significantly more inadequate sleep than their heterosexual counterparts (especially lesbians: OR, 2.14; 95% CI, 2.10‐2.18). Conclusions This study indicates that LGB cancer survivors have worse survivorship than their heterosexual peers with heterogeneity in subgroups. Future studies should use larger sample sizes, further investigate disparities, and promote survivorship in LGB populations. Lay Summary It has been observed that lesbian, gay, and bisexual (LGB) cancer survivors may face challenges in cancer survivorship that are not as prevalent in the heterosexual community. This cross‐sectional study has found that LGB cancer survivors, especially bisexuals, have overall poorer physical and mental health, are more likely to be told that they have depressive disorders, and have worse sleep quality in comparison with their heterosexual counterparts. These results also differ by sex, and this can provide rationales for future studies and guide interventions to relocate resources to better promote equality.

EL GÉNERO COMO ELEMENTO MODERADOR DE LA RELACIÓN ENTRE LA CULPA LIGADA AL CONFLICTO FAMILIA-TRABAJO Y LA SATISFACCIÓN VITAL

Chapter

Jan 2020

Reproductive Health Risks and Clinician Practices with Gender Diverse Adolescents and Young Adults

Article

May 2021

Background Reproductive health counseling is essential for adolescents and young adults (AYAs). Transgender and gender diverse (TGD) AYAs would benefit from tailored counseling given concerns about iatrogenic infertility and sexual dysfunction, and high rates of interpersonal violence, unplanned pregnancies and sexually transmitted infections, yet there are multiple obstacles to providing this care at the patient/family and clinician levels. Objectives This narrative review summarizes the literature on reproductive health considerations for TGD AYAs, current practices, and clinician barriers and facilitators to providing culturally sensitive reproductive care for TGD AYAs. Specific areas of focus include: reproductive health goals, risks, and access barriers; clinician knowledge practices and challenges; and strategies for improving counseling practices. Materials/Methods PubMed, Google Scholar, Medline, Web of Science, and PsycInfo databases were searched using the following terms: transgender, non‐binary, gender expansive, gender non‐conforming, reproductive health, sexual health, fertility, family planning/building, contraception, sexual dysfunction; gender affirming hormones/surgery, clinician, physician or provider knowledge and attitudes; counseling. Results Many TGD AYAs desire biological children and improved sexual experiences. TGD AYAs may experience infertility and sexual dysfunction associated with transition; have disproportionate HIV/STI risk; experience high rates of interpersonal/sexual violence and trauma; and encounter barriers to accessing competent medical care. Clinicians lack knowledge about reproductive health needs of TGD AYAs; inconsistently discuss family building options; perceive counseling challenges; and desire more training in this area. Discussion Enriched communication training for medical/mental health clinicians is necessary to provide a skilled workforce for TGD AYAs. Web‐based reproductive health training with other populations (e.g., oncology) demonstrates efficacy for improving communication skills and confidence in counseling, Conclusion This review highlights barriers to adequate reproductive care encountered by TGD AYAs, exacerbated in underserved minority youth. Dedicated training for providers, and programs increasing access are important goals for improving care. The need for additional research is also emphasized.

Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence

Article

Full-text available

Aug 2013

Ilan H Meyer

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

Differences in Sexual Orientation Diversity and Sexual Fluidity in Attractions Among Gender Minority Adults in Massachusetts

Article

Full-text available

Jul 2015

This study characterized sexual orientation identities and sexual fluidity in attractions in a community-based sample of self-identified transgender and gender-nonconforming adults in Massachusetts. Participants were recruited in 2013 using bimodel methods (online and in person) to complete a one-time, Web-based quantitative survey that included questions about sexual orientation identity and sexual fluidity. Multivariable logistic regression models estimated adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) to examine the correlates of self-reported changes in attractions ever in lifetime among the whole sample (n = 452) and after transition among those who reported social gender transition (n = 205). The sample endorsed diverse sexual orientation identities: 42.7% queer, 19.0% other nonbinary, 15.7% bisexual, 12.2% straight, and 10.4% gay/lesbian. Overall, 58.2% reported having experienced changes in sexual attractions in their lifetime. In adjusted models, trans masculine indivi

Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences

Article

Full-text available

Jun 2015
J Gay Lesb Soc Serv

Background: The goal study of this was to explore attitudes, health knowledge, and experiences with healthcare setting and providers among gay, lesbian, bisexual, transgender, queer/questioning (GLBTQ) individuals and to identify areas for improvement. Methods: Members of Equality Florida™ residing in the five counties of the Tampa Bay region were recruited through email invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with healthcare providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency. Results: 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants was White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the healthcare setting (<10%). Healthcare settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs. Conclusion: Results show high rates of sexual orientation disclosure, greater acceptance from providers of GLBTQ status, and the need for examination of hospital policies and improved cultural competency.

A Relational Model of Sexual Minority Mental and Physical Health: The Negative Effects of Shame on Relationships, Loneliness, and Health

Article

Full-text available

May 2015

Sexual minorities (e.g., lesbians, gay men, bisexual individuals) are at an increased risk for poorer mental and physical health outcomes than heterosexuals, and some of these health disparities relate to minority stressors such as discrimination. Yet, there is little research elucidating pathways that predict health or that promote resiliency among sexual minorities. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health within a relational framework. Specifically, the study tested mediators of the relationships between distal (i.e., discrimination, rejection, victimization) and proximal stressors (i.e., internalized homophobia, sexual orientation concealment) and psychological and physical distress for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test 4 models reflecting the mediating effects of shame, poorer relationships with a close peer and the lesbian/gay/bisexual/transgender (LGBT) community, and loneliness on the associations between minority stressors and psychological distress (i.e., depression and anxiety) and physical distress (i.e., distressing physical symptoms). As hypothesized, the associations between distal and proximal minority stressors and distress were mediated by shame, poorer relationships with a close peer and the LGBT community, and loneliness. Findings underscore the possible relational and interpersonal mechanisms by which sexual minority stressors lead to psychological and physical distress. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Willingness to Engage in Romantic and Sexual Activities With Bisexual Partners: Gender and Sexual Orientation Differences

Article

Full-text available

Sep 2014

Despite knowledge of negative attitudes toward bisexuals, it remains unclear if this extends to people’s willingness to engage in romantic and sexual activities with bisexual partners. The current study examined gender and sexual orientation differences in willingness to date, have sex with, or be in a relationship with bisexual partners. Participants (N = 801) completed an online survey that included a measure of willingness to engage in romantic and sexual activities with same-gender and different-gender bisexual partners. Results indicated that heterosexuals and lesbians/gay men were less willing than bisexuals to engage in romantic/sexual activities with bisexual partners. Additionally, people were generally less willing to be in a relationship with a bisexual partner than they were to have sex with or to date one. Thus, negative attitudes toward bisexuals appear to extend to people’s willingness to engage in romantic/sexual activities with bisexual partners, and such willingness differs as a function of gender and sexual orientation. Efforts are needed to educate people about bisexuality and to dispel myths that contribute to negative attitudes toward bisexuals. Such efforts have the potential to reduce stigma and discrimination toward bisexuals as well as reduce health disparities related to bisexuality.

Minority Stress and Mechanisms of Risk for Depression and Suicidal Ideation Among Lesbian, Gay, and Bisexual Youth

Article

Full-text available

Mar 2015

The experience of minority stress is often named as a cause for mental health disparities among lesbian, gay, and bisexual (LGB) youth, including higher levels of depression and suicidal ideation. The processes or mechanisms through which these disparities occur are understudied. The interpersonal-psychological theory of suicide posits 2 key mechanisms for suicidal ideation: perceived burdensomeness and thwarted belongingness (Joiner et al., 2009). The aim of the current study is to assess the mental health and adjustment among LGB youth emphasizing the minority stress model (Meyer, 2003) and the interpersonal-psychological theory of suicide (Joiner et al., 2009). With a survey of 876 LGB self-identified youth, levels of coming-out stress, sexual orientation victimization, perceived burdensomeness, thwarted belongingness, depression, and suicidal ideation were examined. The results of a multigroup mediation model show that for all gender and sexual identity groups, the association of sexual orientation victimization with depression and suicidal ideation was mediated by perceived burdensomeness. For gay, lesbian, and bisexual girls coming-out stress was also found to be related to depression and suicidal ideation, mediated by perceived burdensomeness. The results suggest that feeling like a burden to "people in their lives" is a critical mechanism in explaining higher levels of depression and suicidal ideation among LGB youth. These results have implications for community and social support groups, many of which base their interventions on decreasing social isolation rather than addressing youths' beliefs of burdensomeness. Implications for future research, clinical and community settings are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Examining the Existence of Biphobia in the Heterosexual and Homosexual Populations

Article

Full-text available

Sep 2002

Biphobia, which has been defined as negative attitudes about bisexuality and bisexual individuals (Bennett, 1992), is a psychological construct that is, at present, not well understood. Ochs (1996) described the denigration that bisexual individuals face as “double discrimination,” which she defined as discrimination from both heterosexual and homosexual communities. A 30-item instrument, the Biphobia Scale, was developed to measure negative cognitions, affect, and behaviors regarding bisexuality and bisexual individuals. The instrument has provided empirical support for the existence of the construct of biphobia and suggests that it exists in both the heterosexual and homosexual communities. The results support the theory that bisexual individuals are subjected to “double discrimination.”

From Bias to Bisexual Health Disparities: Attitudes Toward Bisexual Men and Women in the United States

Article

Full-text available

Dec 2014

A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed "biphobia." However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity. Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates. Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men; and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values <.05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values <.001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values <.05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values <.05). This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.

A Conceptual Framework for Clinical Work With Transgender and Gender Nonconforming Clients: An Adaptation of the Minority Stress Model

Article

Full-text available

Aug 2012

In the last few years, transgender and gender nonconforming people have become more visible in our society, which has sparked a marked increase in awareness, interest, and attention among psychologists. Questions have emerged about the extent to which psychologists are able to work competently with this population. This article presents a framework for understanding key clinical issues that psychologists who work with transgender and gender nonconforming individuals will likely encounter in their clinical work. This article does not address the knowledge and skills required to provide services related to gender transition, but rather to provide other psychological services that these clients may need, in light of the high levels of gender-related victimization and discrimination to which they are exposed. An adaptation of the Minority Stress Model (Meyer, 2003) is presented and translated to incorporate the unique experiences encountered by transgender and gender nonconforming individuals. In particular, we examine adverse experiences that are closely related to gender identity and expression, resulting expectations for future victimization or rejection, and internalized transphobia. The impact of Minority Stress Model factors on suicide attempts is presented as a detailed example. Mechanisms by which transgender and gender nonconforming persons develop resilience to the negative psychological effects of these adverse experiences are also discussed. Recommendations for clinicians are then made to assist psychologists in developing competence in working with this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Handling Item-Level Missing Data

Article

Full-text available

May 2013
COUNS PSYCHOL

Mike C. Parent

The topic of missing data has been receiving increasing attention, with calls to apply advanced methods of handling missingness to counseling psychology research. The present study sought to assess whether advanced methods of handling item-level missing data performed equivalently to simpler methods in designs similar to those counseling psychologists typically engage in. Results of an initial preliminary analysis, an analysis using real-world data, and a series of simulation studies were used in the present investigation. Results indicated that available case analysis, mean substitution, and multiple imputation had similar results across low levels of missing data, though in data with higher levels of missing data and other problems (e.g., small sample size or scales with weak internal reliability) mean substitution produced inflation of correlation coefficients among items. The present results support the use of available case analysis when dealing with low-level item-level missingness.

Minority stress and physical health among sexual minority individuals

Article

Full-text available

Jul 2013
J BEHAV MED

This study examined the effects of minority stress on the physical health of lesbians, gay men, and bisexuals (LGBs). Participants (N = 396) completed baseline and one year follow-up interviews. Exposure to stress and health outcomes were assessed with two methods: a subjective self-appraisal method and a method whereby two independent judges externally rated event narratives using standardized criteria. The odds of experiencing a physical health problem at follow-up were significantly higher among LGBs who experienced an externally rated prejudice event during the follow-up period compared to those who did not. This association persisted after adjusting for experiences of general stressful life events that were not related to prejudice. Self-appraised minority stress exposures were not associated with poorer physical health at 1-year follow-up. Prejudice-related stressful life events have a unique deleterious impact on health that persists above and beyond the effect of stressful life events unrelated to prejudice.

Navigating the Borderlands: The Roles of Minority Stressors, Bicultural Self-Efficacy, and Cognitive Flexibility in the Mental Health of Bisexual Individuals

Article

Full-text available

Jul 2013

The present study examined the relations of minority stressors (i.e., experiences of prejudice, expectations of stigma, internalized biphobia, outness/concealment of bisexuality) as well as posited mental health promoters (i.e., bicultural self-efficacy, cognitive flexibility) with psychological distress and well-being in a sample of 411 bisexual people. Most of the minority stress variables were related positively with psychological distress and negatively with well-being, whereas the mental health-promoting variables were related negatively with psychological distress and positively with well-being. Results also indicated that expectations of stigma mediated the associations of antibisexual prejudice with greater distress and lower well-being, internalized biphobia was related directly with greater distress and lower well-being, and outness was linked with some costs and benefits. Moderated mediation analyses offered some evidence consistent with cognitive flexibility (but not bicultural self-efficacy) as a moderator. Specifically, within the mediation models, cognitive flexibility moderated the unique direct relation of antibisexual prejudice with psychological well-being, the relation of antibisexual prejudice with expectations of stigma, and the indirect relations of antibisexual prejudice with distress and well-being through the mediating role of expectations of stigma. These moderations were consistent with the expected buffering role of cognitive flexibility, but they also revealed that some of this buffering effect is exhausted in the context of high prejudice. Limitations of the study as well as implications for future research and practice with bisexual populations are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Sexual Victimization and Associated Risks Among Lesbian and Bisexual Women

Article

Full-text available

Jun 2013
VIOLENCE AGAINST WOM

This study examines relationships among childhood sexual abuse (CSA), risky alcohol use, and adult sexual victimization among bisexual and lesbian women. Half (51.2%) of women reported CSA and 71.2% reported adult sexual victimization. Perpetrators were generally male, and 56.4% of women's most recent adult sexual victimization incidents occurred after coming out. Regression results indicated that adult sexual victimization severity was associated with a bisexual identity, more severe CSA history, more lifetime sexual partners, and higher alcohol severity scores. Compared to lesbians, bisexual women reported more severe adult sexual victimization experiences, greater revictimization, riskier drinking patterns, and more lifetime male sexual partners.

Multiple Regression: Testing And Interpreting Interactions

Article

Full-text available

Dec 1999

This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Attitudes Toward Bisexual Men and Women in a University Context: Relations with Race, Gender, Knowing a Bisexual Man or Woman and Sexual Orientation

Article

Full-text available

Jul 2010

The aim of this study was to investigate differences pertaining to race, gender, knowing a bisexual person, religiosity and sexual orientation in relation to attitudes toward bisexual women and men in South Africa. The Attitudes Regarding Bisexuality Scale was administered. The reliability of the scale was significantly lower than desired for the sample of 1,459 university students. In an attempt to understand the sample's views on bisexuality, a focus group was organized, resulting in a revised instrument. The revised scale, a sexual orientation scale and a biographical questionnaire were consequently completed by 578 university students. The results indicated differences in attitudes between men and women, knowing or not knowing a bisexual person, being deeply religious or not, and various sexual orientation groups.

Biphobia: It goes more than two ways.

Article

Full-text available

Robyn Ochs

outlines the realities of external oppression as they manifest in the form of homophobia and biphobia and discusses how such oppressions are internalized by bisexuals, compromising their health and psychological well-being and ultimately that of all members of "lesbigay" and heterosexual communities / suggestions are made for addressing sources of external oppression and for overcoming the damaging effects of internalized homophobia and biphobia (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Measuring Attitudes Regarding Bisexuality in Lesbian, Gay Male, and Heterosexual Populations

Article

Full-text available

Jul 1999

Five studies on the development and validation of the Attitudes Regarding Bisexuality Scale (ARBS) were conducted. Factor analysis of an initial pool of 80 items yielded 2 factors assessing the degree to which bisexuality is viewed as a tolerable, moral sexual orientation (Tolerance) and a legitimate, stable sexual orientation (Stability). Three forms of the ARBS were created: a form to assess attitudes about female and male bisexuality (i.e., ARBS-FM) and forms to assess attitudes about female bisexuality (i.e, ARBS-F) and male bisexuality (ARBS-M). These forms evidenced moderate-to-high internal consistency reliability in both lesbian and gay samples and heterosexual samples. In heterosexual women and men, subscale were most strongly related to attitudes toward lesbians and gay men; frequency of religious attendance; political ideology; and prior contact with lesbian, gay, and bisexual people. In lesbians and gay men, subscales correlated with prior experiences with bisexual people, desired contact with bisexual people, contact with homosexual people, and sexual orientation identity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Perceived Experiences of Anti-Bisexual Prejudice: Instrument Development and Evaluation

Article

Full-text available

Oct 2010

This research describes the development and psychometric evaluation of the Anti-Bisexual Experiences Scale (ABES). Items were developed on the basis of prior literature, revised on the basis of expert feedback, and submitted to psychometric evaluation. Exploratory factor analysis of data from 350 bisexual participants yielded 3 factors of reported experiences of prejudicial treatment reflecting (a) Sexual Orientation Instability, (b) Sexual Irresponsibility, and (c) Interpersonal Hostility. This structure emerged with bisexual persons' reported experiences of prejudice from heterosexual people as well as from lesbian and gay people. Confirmatory factor analysis of data from a separate sample of 349 bisexual individuals supported the stability of this 3-factor structure. The data offered evidence of acceptable reliability (i.e., Cronbach's alphas of .81 to .94), convergent validity (i.e., with stigma consciousness, r = .37 to .54; with awareness of public devaluation, r = .28 to .41), and discriminant validity (i.e., for impression management, r = –.00 to .09). Relative levels of the various types of perceived experiences of anti-bisexual prejudice and the role of such experiences within the minority stress framework were also explored. With a separate sample of 176 bisexual individuals, data on the final 17-item version of the ABES yielded 2-week test–retest reliability coefficients of .77 to .89 and Cronbach's alphas of .86 to .96 across subscales. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Counseling Psychology Research on Sexual (Orientation) Minority Issues: Conceptual and Methodological Challenges and Opportunities

Article

Full-text available

Jan 2009

This lead article of the special issue discusses conceptual and methodological considerations in studying sexual minority issues, particularly in research conducted by counseling psychologists (including the work represented in this special issue). First, the overarching challenge of conceptualizing and defining sexual minority populations is described. Second, the importance and value of scholarship about sexual minority issues are highlighted. Third, challenges in sexual minority research are outlined, using the articles in this special issue for illustrative purposes, and suggestions are offered for consideration in future research. Finally, the article concludes with a discussion of the ways in which counseling psychologists are uniquely positioned to advance knowledge, practice, and social justice through research on sexual minority issues.

The Problem With the Phrase Women and Minorities: Intersectionality-an Important Theoretical Framework for Public Health

Article

Full-text available

May 2012
AM J PUBLIC HEALTH

Lisa Bowleg

Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health's commitment to social justice makes it a natural fit with intersectionality's focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.

The Impact of Minority Stress on Mental Health and Substance Use Among Sexual Minority Women

Article

Full-text available

Feb 2011

We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social-psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social-psychological resources as a mediator between minority stress and health. The final model demonstrated acceptable fit, χ²(79) = 414.00, p < .05, confirmatory fit index = .93, Tucker-Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social-psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. Findings indicate a significant impact of minority stressors and social-psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments.

Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14-94

Article

Full-text available

Oct 2010
J SEX MED

Despite a demonstrated relationship between sexual behaviors and health, including clinical risks, little is known about contemporary sexual behavior. To assess the rates of sexual behavior among adolescents and adults in the United States. We report the recent (past month, past year) and lifetime prevalence of sexual behaviors in a nationally representative probability sample of 5,865 men and women ages 14 to 94 in the United States (2,936 men, 2,929 women). Behaviors assessed included solo masturbation, partnered masturbation, giving and receiving oral sex, vaginal intercourse, and anal intercourse. Masturbation was common throughout the lifespan and more common than partnered sexual activities during adolescence and older age (70+). Although uncommon among 14- to 15-year olds, in the past year 18.3% of 16- to 17-year-old males and 22.4% of 16- to 17-year-old females performed oral sex with an other-sex partner. Also in the past year, more than half of women and men ages 18 to 49 engaged in oral sex. The proportion of adults who reported vaginal sex in the past year was highest among men ages 25-39 and for women ages 20-29, then progressively declined among older age groups. More than 20% of men ages 25-49 and women ages 20-39 reported anal sex in the past year. Same-sex sexual behaviors occurring in the past year were uncommonly reported. Men and women engage in a diverse range of solo and partnered sexual behaviors throughout the life course. The rates of contemporary sexual behavior provided in this report will be valuable to those who develop, implement, and evaluate programs that seek to improve societal knowledge related to the prevalence of sexual behaviors and to sexual health clinicians whose work to improve sexual health among the population often requires such rates of behavior.

A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health

Article

Full-text available

Oct 2010
AM J PUBLIC HEALTH

We provide estimates of several leading US adult health indicators by sexual orientation identity and gender to fill gaps in the current literature. We aggregated data from the 2001-2008 Massachusetts Behavioral Risk Factor Surveillance surveys (N = 67,359) to examine patterns in self-reported health by sexual orientation identity and gender, using multivariable logistic regression. Compared with heterosexuals, sexual minorities (i.e., gays/lesbians, 2% of sample; bisexuals, 1%) were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on 3-year Papanicolaou tests, lifetime mammography, diabetes, or heart disease. Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk. Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease. Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women. Sexual orientation disparities in chronic disease risk, victimization, health care access, mental health, and smoking merit increased attention. More research on heterogeneity in health and health determinants among sexual minorities is needed.

How Does Sexual Minority Stigma "Get Under the Skin"? A Psychological Mediation Framework

Article

Full-text available

Sep 2009

Mark L. Hatzenbuehler

Sexual minorities are at increased risk for multiple mental health burdens compared with heterosexuals. The field has identified 2 distinct determinants of this risk, including group-specific minority stressors and general psychological processes that are common across sexual orientations. The goal of the present article is to develop a theoretical framework that integrates the important insights from these literatures. The framework postulates that (a) sexual minorities confront increased stress exposure resulting from stigma; (b) this stigma-related stress creates elevations in general emotion dysregulation, social/interpersonal problems, and cognitive processes conferring risk for psychopathology; and (c) these processes in turn mediate the relationship between stigma-related stress and psychopathology. It is argued that this framework can, theoretically, illuminate how stigma adversely affects mental health and, practically, inform clinical interventions. Evidence for the predictive validity of this framework is reviewed, with particular attention paid to illustrative examples from research on depression, anxiety, and alcohol-use disorders.

The Moderator-Mediator Variable Distinction in Social Psychological Research

Article

Full-text available

Dec 1986

In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.

Minority Stress and Mental Health in Gay Men

Article

Full-text available

Apr 1995

Ilan H Meyer

This study describes stress as derived from minority status and explores its effect on psychological distress in gay men. The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay men's direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence. The mental health effects of the three minority stressors were tested in a community sample of 741 New York City gay men. The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures. Odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress.

Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence

Article

Full-text available

Sep 2003

Ilan H Meyer

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

Physical Health Complaints Among Lesbians, Gay Men, and Bisexual and Homosexually Experienced Heterosexual Individuals: Results From the California Quality of Life Survey

Article

Full-text available

Dec 2007
AM J PUBLIC HEALTH

We examined evidence that minority sexual orientation is associated with more-frequent reports of physical health complaints. We also investigated the possible role of HIV infection among gay men and higher rates of psychological distress among lesbians, gay men, and bisexually and homosexually experienced heterosexual individuals in generating these health disparities. We used data from the California Quality of Life Survey (N=2272 adults) to examine associations between sexual orientation and self-reports about physical health status, common health conditions, disabilities, and psychological distress. Prevalent HIV infection was reported by nearly 18% of gay, bisexual, and homosexually experienced heterosexual men. Gay men and bisexual and homosexually experienced heterosexual individuals had higher levels of psychological distress compared with exclusively heterosexual individuals. Self-reported physical health status varied by gender and by sexual orientation. Lesbians and bisexual and homosexually experienced heterosexual women reported a greater variety of health conditions and limitations compared with exclusively heterosexual women; however, these differences mostly disappeared when distress levels were taken into account. Among men, differences in health complaints appeared to reflect the ongoing burden of HIV and other sexually transmitted diseases in the gay male community.

Minority Stress and Lesbian Women.

Article

Nov 1982

We're Here and We're Queer: Sexual Orientation and Sexual Fluidity Differences Between Bisexual and Queer Women

Article

Aug 2016

Theorists and researchers have noted an overlap between individuals who are bisexually-identified and queer-identified. Although early definitions of bisexuality may have been predominantly binary (i.e., attracted to women and men), in recent years there has been a move toward a more “queer” understanding of bisexuality (e.g., attraction to more than one gender beyond women and men). The purpose of this study was to examine similarities and differences between adult women who were bisexually-identified and those who were queer-identified, ages 18 to 66 years, on sociodemographic characteristics, two dimensions of sexual orientation (sexual behaviors and attractions), fluidity in attractions and sexual orientation identity, and identity centrality and affirmation in an online sample (N = 489), which was mostly from the United States (73.5%). Results indicated that women who are bisexual and queer were similar in terms of sociodemographic characteristics, with the exception of education; women identifying as queer were more educated than women identifying as bisexual. Women identifying as queer were also more likely than women identifying as bisexual to report variability in their sexual behaviors and attractions and more fluidity in their sexual orientation identity. Additionally, women identifying as queer reported higher levels of identity centrality and affirmation than women identifying as bisexual. Considerations for sexual minority women's health research are discussed.

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

Article

Jun 2015

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 women's 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.

Sociodemographic Differences by Survey Mode in a Respondent-Driven Sampling Study of Transgender People in Ontario, Canada

Article

Dec 2015

Purpose: To describe survey mode uptake and sociodemographic differences by mode among respondents to a respondent-driven sampling survey of transgender people in Ontario, Canada. Survey mode was left to participant choice. Methods: Data were collected from 433 transgender Ontarians in 2009-2010 through a self-administered questionnaire, available online, by paper copy, or by telephone with language interpretation. Results: Paper respondents (9.5%) were significantly more likely to be Aboriginal or persons of color, underhoused, sex workers, and unemployed or receiving disability benefits. Conclusion: In Canada and similar high-income countries, sampling transgender populations that are diverse with respect to social determinants of health may be best carried out with multimode surveys.

Sexual Orientation and Gender Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending LGBT Health Disparities

Article

Mar 2014

The Institute of Medicine's (IOM's) 2011 report on the health of LGBT people pointed out that there are limited health data on these populations and that we need more research. It also described what we do know about LGBT health disparities, including lower rates of cervical cancer screening among lesbians, and mental health issues related to minority stress. Patient disclosure of LGBT identity enables provider-patient conversations about risk factors and can help us reduce and better understand disparities. It is essential to the success of Healthy People 2020's goal of eliminating LGBT health disparities. This is why the IOM's report recommended data collection in clinical settings and on electronic health records (EHRs). The Center for Medicare and Medicaid Services and the Office of the National Coordinator of Health Information Technology rejected including sexual orientation and gender identity (SOGI) questions in meaningful use guidelines for EHRs in 2012 but are considering this issue again in 2013. There is overwhelming community support for the routine collection of SOGI data in clinical settings, as evidenced by comments jointly submitted by 145 leading LGBT and HIV/AIDS organizations in January 2013. Gathering SOGI data in EHRs is supported by the 2011 IOM's report on LGBT health, Healthy People 2020, the Affordable Care Act, and the Joint Commission. Data collection has long been central to the quality assurance process. Preventive health care from providers knowledgeable of their patients' SOGI can lead to improved access, quality of care, and outcomes. Medical and nursing schools should expand their attention to LGBT health issues so that all clinicians can appropriately care for LGBT patients.

Multiple Regression: Testing and Interpreting Interactions

Article

Jan 1994
J OPER RES SOC

The Bisexual Experience

Article

Jul 2004

Mary Bradford

This study examined how bisexually-identified individuals experience cultural attitudes toward bisexuality, how they establish a sense of community for themselves, and how their experience has affected their self-concept. Twenty self-identified bisexual women and men were interviewed for a descriptive study. The results indicate that cultural attitudes toward bisexuality affect sexual identity development, self-definition, visibility, and relationships. Three steps to establishing a sense of community included: perception of outsider status, location of bisexual individuals and community, and formation of new community. The effects on self-concept of forming and maintaining bisexual identity included: enhanced self-reliance, openness, and enrichment. Both gender and cultural minority status had an impact on the experience of bisexuality. On the basis of the findings, the author proposes a theory of bisexual identity development which includes the following stages: questioning reality, inventing the identity, maintaining the identity, and transforming adversity.

Understanding Linkages Between Bullying and Suicidal Ideation in a National Sample of LGB and Heterosexual Youth in the United States

Article

Oct 2014

While there is an extant research base regarding suicidal ideation in relation to bullying and peer harassment, how findings may be similar and different for lesbian, gay, and bisexual (LGB) and non-LGB youth is less well understood. To address this gap, we analyzed data from 5,542 13- to 18-year-old youth who were nationally surveyed online in the United States in 2010. Results suggest that the relative odds of suicidal ideation are elevated for youth who are victims of bullying (OR = 5.61, 95 % CI, 4.11, 7.64), as well as those who are victims of peer harassment (OR = 2.06, 95 % CI, 1.53, 2.79). Within the context of other important factors, bullying was associated with odds of suicidal ideation twice that of non-victimized youth (aOR = 2.02, 95 % CI, 1.30, 3.13). Within sexual identity, the relation between bullying and suicidal ideation was particularly strong for gay, lesbian, and queer youth, even after adjusting for other influential factors (aOR = 6.29, 95 % CI, 2.69, 14.66). Across sexual identities, the odds of suicidal ideation are higher for bisexual youth (aOR = 1.77, 95 % CI, 1.23, 2.55) but not for other sexual minority youth when compared with otherwise similar heterosexual youth. Other factors, including depressive symptomatology and low self-esteem, were also predictive of recent ideation across all sexual identities. Findings highlight the complexity of bullying and suicidal ideation. Furthermore, given the relation between bullying and suicidal ideation, and the disproportionate level of bullying experienced by LGB youth, our findings suggest the need for more protective environments for LGB youth.

Community-Based Participatory Research for Health: From Process to Outcomes

Article

Jan 2010

Mapping the Margins: Intersectionality, Identity Politics, and Violence Against Women of Color

Article

Jul 1991
STANFORD LAW REV

Kimberle Crenshaw

Over the last two decades, women have organized against the almost routine violence that shapes their lives. Drawing from the strength of shared experience, women have recognized that the political demands of millions speak more powerfully than the pleas of a few isolated voices. This politicization in turn has transformed the way we understand violence against women. For example, battering and rape, once seen as private (family matters) and aberrational (errant sexual aggression), are now largely recognized as part of a broad-scale system of domination that affects women as a class. This process of recognizing as social and systemic what was formerly perceived as isolated and individual has also characterized the identity politics of people of color and gays and lesbians, among others. For all these groups, identity-based politics has been a source of strength, community, and intellectual development. The embrace of identity politics, however, has been in tension with dominant conceptions of social justice. Race, gender, and other identity categories are most often treated in mainstream liberal discourse as vestiges of bias or domination-that is, as intrinsically negative frameworks in which social power works to exclude or marginalize those who are different. According to this understanding, our liberatory objective should be to empty such categories of any social significance. Yet implicit in certain strands of feminist and racial liberation movements, for example, is the view that the social power in delineating difference need not be the power of domination; it can instead be the source of political empowerment and social reconstruction. The problem with identity politics is not that it fails to transcend difference, as some critics charge, but rather the opposite- that it frequently conflates or ignores intra group differences. In the context of violence against women, this elision of difference is problematic, fundamentally because the violence that many women experience is often shaped by other dimensions of their identities, such as race and class. Moreover, ignoring differences within groups frequently contributes to tension among groups, another problem of identity politics that frustrates efforts to politicize violence against women. Feminist efforts to politicize experiences of women and antiracist efforts to politicize experiences of people of color' have frequently proceeded as though the issues and experiences they each detail occur on mutually exclusive terrains. Al-though racism and sexism readily intersect in the lives of real people, they seldom do in feminist and antiracist practices. And so, when the practices expound identity as "woman" or "person of color" as an either/or proposition, they relegate the identity of women of color to a location that resists telling. My objective here is to advance the telling of that location by exploring the race and gender dimensions of violence against women of color. Contemporary feminist and antiracist discourses have failed to consider the intersections of racism and patriarchy. Focusing on two dimensions of male violence against women-battering and rape-I consider how the experiences of women of color are frequently the product of intersecting patterns of racism and sexism, and how these experiences tend not to be represented within the discourse of either feminism or antiracism... Language: en

Why Bisexual Health?

Article

Apr 2012

Julie Ebin

Defining bisexual health and its components will help people better understand it, highlight its importance and give investigators and proponents a common language and starting point from which to discuss the purpose and foundation of work on the intersections of bisexuality and health. Bisexual health can be parsed into individual and community-level components, taking into account those who identify as bisexual and those who do not but who have sexual or romantic attractions and/or behaviors with more than one gender. These populations will benefit from efforts to describe and compare the health of these two groups in more detail, as well as compare it to the health of straight, gay and lesbian populations. This information will shed light on potential health disparities; will pinpoint when and how to tailor health education, outreach and messaging; will assist health providers in becoming culturally competent; will help individuals become empowered consumers and health advocates; and will illuminate successful strategies that bisexuals may use to protect their health and the health of their communities.

Applying Ethical Standards to Research and Evaluations Involving Lesbian, Gay, Bisexual, and Transgender Populations

Article

Apr 2003
J Gay Lesb Soc Serv

This manuscript examines the application of ethical standards to research on LGBT populations and the evaluation of programs and practices that impact them. It uses social work's Code of Ethics (National Association of Social Workers, 1996) and psychology's Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 1992) to examine specific ethical issues as they pertain to research involving LGBT populations. It notes that when conducting studies with these populations, researchers may need to take additional measures to protect participants from harm and to ensure the relevance and usefulness of their findings. In addition, heterosexist and genderist biases are examined as ethical issues, as is the tension between scientific objectivity and values in research involving LGBT populations.

Minority Stress and Psychological Distress Among Asian American Sexual Minority Persons 1Ψ7

Article

Jul 2010
COUNS PSYCHOL

The purpose of this study was to examine multiple minority stressors (i.e., heterosexist events, racist events, heterosexism in communities of color, racism in sexual minority communities, race-related dating and relationship problems, internalized heterosexism or homophobia, outness to family, and outness to world) as they relate to the psychological distress of 144 Asian American lesbian, gay, bisexual, transgender, and questioning (LGBTQ) persons. When examined concomitantly, these minority stress variables accounted for approximately one third of the variance in psychological distress scores. Results indicate that heterosexism in communities of color, race-related dating and relationship problems in the LGBTQ community, internalized heterosexism, and outness to world were the only significant and unique predictors of Asian American LGBTQ persons’ psychological distress. In addition, no support was found for the moderating or mediating roles of outness in the internalized heterosexism-distress link.

Bisexuality and Transgenderism

Article

Apr 2003

This introduction to the collection Bisexuality and Transgenderism: InterSEXions of the Others provides an overview of how considering bisexuality and transgenderism (each broadly defined) can inform and challenge larger cultural understandings of sexuality and gender. The authors provide an overview of extant literature on the subject, propose some of their own productive “intersections” between bisexuality and transgenderism, and introduce the pieces contained in the collection.

The Bisexual Experience: Living in a Dichotomous Culture.

Article

Mary Bradford

This reprinted chapter originally appeared in the Journal of Bisexuality, Vol 4(1-2) 2004, 7-23. (The following abstract of the original article appeared in record 2005-03558-001.) This study examined how bisexually-identified individuals experience cultural altitudes toward bisexuality, how they establish a sense of community for themselves, and how their experience has affected their self-concept. Twenty self-identified bisexual women and men were interviewed for a descriptive study. The results indicate that cultural attitudes toward bisexuality affect sexual identity development, self-definition, visibility, and relationships. Three steps to establishing a sense of community included: perception of outsider status, location of bisexual individuals and community, and formation of new community. The effects on self-concept of forming and maintaining bisexual identity included: enhanced self-reliance, openness, and enrichment. Both gender and cultural minority status had an impact on the experience of bisexuality. On the basis of the findings, the author proposes a theory of bisexual identity development which includes the following stages: questioning reality, inventing the identity, maintaining the identity, and transforming adversity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Does Internalized Heterosexism Moderate the Link Between Heterosexist Events and Lesbians' Psychological Distress?

Article

Feb 2006

Dawn M. Szymanski

The purpose of this study was to examine the relationship between heterosexist events and various indices of psychological distress in lesbians. In addition, it examined the potential moderating role of internalized heterosexism in the link between heterosexist events and psychological distress. Furthermore, psychometric support for the Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) developed for this study is provided. Consistent with feminist theory and previous research, results indicated that recent perceived heterosexist harassment, rejection, and discrimination correlated positively with several indices of psychological distress. Contrary to research on gay men, internalized heterosexism did not moderate the relationship between external heterosexism and lesbians' psychological distress.

Victimization Experiences of Lesbian, Gay, and Bisexual Individuals: A Meta-Analysis

Article

Mar 2012
J SEX RES

This meta-analysis quantitatively compiled the results of studies from 1992 to 2009 to determine the prevalence and types of victimization experienced by lesbian, gay, and bisexual (LGB) individuals. Based on the results of three searches, 386 studies were retrieved and coded. Comparisons were made across all LGB individuals (138 studies), between LGB and heterosexual individuals (65 studies), and between LGB females and males (53 studies), with over 500,000 participants. Multiple types of victimization were coded, including discrimination, physical assault, and school victimization. Findings revealed that for LGB individuals, reports of victimization experiences were substantial (e.g., 55% experienced verbal harassment, and 41% experienced discrimination) and some types have increased since a 1992 review, while others have decreased. LGB individuals experienced greater rates of victimization than heterosexual individuals (range: d = .04-.58). LGB males experienced some types of victimization more than LGB females (e.g., weapon assault and being robbed) but, overall, the gender differences were small. It can be concluded that LGB individuals still experience a substantial amount of victimization. Implications for research methods are discussed, including recommendations for sampling and measurement of victimization. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Sex Research for the following free supplemental resource(s): Supplementary Tables. These tables are referred to in the text of this article as "Table S1," "Table S2," etc.].

Gender and Binegativity: Men's and Women's Attitudes Toward Male and Female Bisexuals

Article

May 2011
ARCH SEX BEHAV

This study assessed the influence of gender on attitudes about bisexuals. A total of 164 heterosexual female and 89 heterosexual male undergraduates completed the Biphobia Scale (Mulick & Wright, 2002), rewritten to refer to bisexual men and bisexual women and thus re-named the Gender-Specific Binegativity Scale. A mixed-design ANOVA revealed an interaction between rater's sex and target's sex: women equally accepted bisexual men and bisexual women, but men were less accepting of bisexual men than bisexual women. A mediation analysis indicated the relationship between rater's sex and greater acceptance of bisexual women was partially explained by eroticization of female same-sex sexuality. Finally, participants also responded to two open-ended items, which provided additional information about the content of binegativity: participants described male bisexuals negatively, as gender-nonconforming, and labeled them "really gay," whereas participants described female bisexuals positively, as sexy, and labeled them "really heterosexual." These findings suggest multiple underlying beliefs about bisexuals that contribute to binegativity, particularly against bisexual men. Results also confirm the importance of considering gender (of both the target and the rater) when assessing sexual prejudice.

An Event-Level Analysis of the Sexual Characteristics and Composition Among Adults Ages 18 to 59: Results from a National Probability Sample in the United States

Article

Oct 2010
J SEX MED

Although studies of specific groups of individuals (e.g., adolescents, "high risk" samples) have examined sexual repertoire, little is known, at the population level, about the sexual behaviors that comprise a given sexual encounter. To assess the sexual behaviors that men and women report during their most recent sexual event; the age, partner and situational characteristics related to that event; and their association with participants' evaluation of the sexual event. During March-May 2009, data from a United States probability sample related to the most recent partnered sexual event reported by 3990 adults (ages 18-59) were analyzed. Measures included sexual behaviors during the most recent partnered sexual event, event characteristics (i.e., event location, alcohol use, marijuana use, and for men, erection medication use), and evaluations of the sexual experience (pleasure, arousal, erection/lubrication difficulty, orgasm). Great diversity exists in the behaviors that occur during a single sexual event by adults, with a total of 41 combinations of sexual behaviors represented across this sample. Orgasm was positively related to the number of behaviors that occurred and age was related to greater difficulty with erections and lubrication. Men whose most recent event was with a relationship partner indicated greater arousal, greater pleasure, fewer problems with erectile function, orgasm, and less pain during the event compared with men whose last event was with a nonrelationship partner. Findings demonstrate that adults ages 18 to 59 engage in a diverse range of behaviors during a sexual event and that greater behavior diversity is related to ease of orgasm for both women and men. Although both men and women experience sexual difficulties related to erectile function and lubrication with age, men's orgasm is facilitated by sex with a relationship partner whereas the likelihood of women's orgasm is related to varied sexual behaviors.

The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs

Article

Apr 1993
MED CARE

Cross-sectional data from the Medical Outcomes Study (MOS) were analyzed to test the validity of the MOS 36-Item Short-Form Health Survey (SF-36) scales as measures of physical and mental health constructs. Results from traditional psychometric and clinical tests of validity were compared. Principal components analysis was used to test for hypothesized physical and mental health dimensions. For purposes of clinical tests of validity, clinical criteria defined mutually exclusive adult patient groups differing in severity of medical and psychiatric conditions. Scales shown in the components analysis to primarily measure physical health (physical functioning and role limitations-physical) best distinguished groups differing in severity of chronic medical condition and had the most pure physical health interpretation. Scales shown to primarily measure mental health (mental health and role limitations-emotional) best distinguished groups differing in the presence and severity of psychiatric disorders and had the most pure mental health interpretation. The social functioning, vitality, and general health perceptions scales measured both physical and mental health components and, thus, had the most complex interpretation. These results are useful in establishing guidelines for the interpretation of each scale and in documenting the size of differences between clinical groups that should be considered very large.

Heterosexuals' Attitudes Toward Bisexual Men and Women in the United States

Article

Dec 2002

Gregory M. Herek

This paper examines heterosexual adults attitudes toward bisexual men and women using data from a 1999 national RDD survey (N = 1,335). Ratings on 101-point feeling thermometers were lower (less favorable) for bisexual men and bisexual women than for all other groups assessed--including religious, racial, ethnic, and political groups--except injecting drug users. More negative attitudes toward bisexuals were associated with higher age, less education, lower annual income, residence in the South and rural areas, higher religiosity, political conservatism, traditional values concerning gender and sexual behavior, authoritarianism, and lack of contact with gay men or lesbians. White heterosexual women expressed significantly more favorable attitudes than other women and all men. A gender difference was observed in attitudes toward bisexuals and homosexuals: Heterosexual women rated bisexuals significantly less favorably than they rated homosexuals, regardless of gender, whereas heterosexual men rated male targets less favorably than female targets, regardless of whether the target was bisexual or homosexual.

Sexual Orientation, Health Risk Factors, and Physical Functioning in the Nurses' Health Study II

Article

Dec 2004

To examine associations between sexual orientation and breast cancer risk factors, cardiovascular disease (CVD) risk factors, mental health status, and health-related functioning. We compared participants in the Nurses' Health Study II (NHSII) reporting a lesbian or bisexual orientation with those reporting a heterosexual orientation, with heterosexuals serving as the reference group for all comparisons. Prevalence of health behaviors and conditions was adjusted for differences in the distribution of age, ancestry, and region of residence by standardizing to the distribution of the overall cohort. Multivariate prevalence ratios were calculated to compare lesbians and bisexuals with heterosexuals using binomial regression with the log link function. Means of health conditions were measured using continuous scales standardized to the distribution of the overall cohort. Differences in means comparing lesbians and bisexuals with heterosexuals were tested by multivariate linear regression. All comparisons were adjusted for age, ancestry, and region of residence. Based on information from 90,823 women aged 32-51 in 1995, those reporting a sexual orientation of lesbian (n = 694) had a higher prevalence of risk factors for breast cancer, including nulliparity and high daily alcohol intake, compared with heterosexual women. Lesbians also had a higher prevalence of several risk factors for CVD, including higher body mass index (BMI) and elevated prevalence of current smoking. Lesbians were more likely to report depression and the use of antidepressants. Key results for health risk factors were similar for lesbians and bisexual women (n = 317). Lesbian and bisexual women were found to have a higher prevalence of several important risk factors for breast cancer, CVD, and poor mental health and functioning outcomes. Most of these risk factors are modifiable, and appropriate interventions could play an important role in improving the health status of lesbian and bisexual women.

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

Abstract

No full-text available

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