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Is Being Gay in America Hazardous to Your Health?

New research finds bisexuals in particular have higher levels of psychological distress.

By Tom Jacobs


(Photo: torbakhopper/Flickr)

There is evidence that suffering racial discrimination is hazardous to one’s health. But does that equation — stigmatization causes stress, which ultimately produces health problems — also hold true for sexual minorities?

Newly published research suggests it may very well.

In a large-scale, nationally representative survey, American adults reported similar levels of self-rated health regardless of their sexual orientation. Members of sexual minority groups — especially bisexuals — suffered far more physiological distress, however, and were more likely to drink heavily.

These “significant health disparities — particularly in mental health and substance use — (are) likely due to the minority stress that lesbian, gay, and bisexual adults experience as a result of their exposure to both interpersonal and structural discrimination,” writes a research team led by Gilbert Gonzales of Vanderbilt University. The researchers’ study is published in the journal JAMA Internal Medicine.

The researchers analyzed data collected as part of the National Health Interview Survey in 2013 and 2014. It included information on 68,814 adults, including 525 who identified as lesbian, 624 who identified as gay, and 515 who identified as bisexual.

A culture of inclusive, judgment-free medical care would make a bigger difference in people’s lives.

Participants rated their own health, and reported whether they suffered from any of 10 serious conditions, including cancer, asthma, and diabetes. They also completed a standard psychological distress scale, noting how often during the previous 30 days they felt “nervous, hopeless, worthless, so sad that nothing could cheer him or her up, restless or fidgety, and that everything was an effort.”

“While 16.9 percent of heterosexual men had moderate or severe psychological distress, 25.9 percent of gay men, and 40.1 percent of bisexual men reported moderate or severe psychological distress,” the researchers report. The figures were similar for women, with moderate or severe distress suffered by 21.9 percent of heterosexuals, 28.4 percent of lesbians, and 46.4 of bisexuals.

Participants also reported whether they smoked cigarettes, and the amount (if any) of alcohol they typically consume. More than 14 drinks per week for men, or seven drinks for women, placed one in the “heavy drinker” category.

“The prevalence of heavy drinking was highest among bisexual men (10.9 percent), compared with heterosexual (5.7 percent) or gay (5.1 percent) men,” Gonzales and his colleagues write. “Bisexual men were (also) more likely to be heavy smokers (9.3 percent), compared with heterosexual (6.0 percent) and gay (6.2 percent) men.”

Again, the results were similar for women. “Heavy alcohol consumption was highest among bisexual women (11.4 percent),” they write, “but lesbian women (8.9 percent) were more likely to be heavy drinkers compared with heterosexual women (4.8 percent).”

Interestingly, gays and lesbians in the study “were advantaged in terms of education and (for lesbian women) income, relative to their heterosexual counterparts.”

“Research has long demonstrated a strong link between socioeconomic status and better health,” the researchers note. “However, the effect of sexual minority status appears to have an even stronger influence on health, and health risk factors.”

So why the particularly high rates of both psychological issues and substance abuse among bisexuals? Gonzales and his colleagues offer some ideas.

“Bisexual people are not only marginalized by the larger heterosexual population,” they write, “but (they may also) experience stigma from gay and lesbian individuals, resulting in lower connections with the sexual minority community.”

This can lead to feelings of isolation, which can be a catalyst for psychological pain and self-destructive coping mechanisms.

Such explanations are, necessarily, speculative. It’s very difficult, if not impossible, to show that the pressures that come with being a member of a disliked or distrusted minority directly causes these negative outcomes.

But it’s extremely plausible. As the researchers conclude, the results “should serve as a call to health-care professionals … to pay particular attention to the current and future health outcomes of this small, diverse, and vulnerable population.”

While making the Stonewall Inn a national monument is a welcome step, a culture of inclusive, judgment-free medical care would make a bigger difference in people’s lives.