Abstract
BackgroundBisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians. The co-occurrence of multiple outcomes has rarely been studied.MethodsData were collected from 405 bisexuals using respondent-driven sampling. Weighted analyses were conducted for 387 with outcome data. Multiple outcomes were defined as 3 or more of: depression, anxiety, suicide ideation, problematic alcohol use, or polysubstance use.ResultsAmong bisexuals, 19.0 % had multiple outcomes. We did not find variation in raw frequency of multiple outcomes across sociodemographic variables (e.g. gender, age). After adjustment, gender and sexual orientation identity were associated, with transgender women and those identifying as bisexual only more likely to have multiple outcomes. Social equity factors had a strong impact in both crude and adjusted analysis: controlling for other factors, high mental health/substance use burden was associated with greater discrimination (prevalence risk ratio (PRR) = 5.71; 95 % CI: 2.08, 15.63) and lower education (PRR = 2.41; 95 % CI: 1.06, 5.49), while higher income-to-needs ratio was protective (PRR = 0.44; 0.20, 1.00).ConclusionsMental health and substance use outcomes with high prevalence among bisexuals frequently co-occurred. We find some support for the theory that these multiple outcomes represent a syndemic, defined as co-occurring and mutually reinforcing adverse outcomes driven by social inequity.
Highlights
Bisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians
Problem drinking was associated with polysubstance use as well as depression, and polysubstance use was associated with all outcomes other than suicide ideation
While research indicates bisexual populations experience a high prevalence of individual mental health or substance use conditions [5, 6, 9,10,11,12,13,14,15,16], a focus on individual outcomes disallows a fuller examination of the larger burden of mental health and substance use in these populations
Summary
Bisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians. Bisexual-identified individuals generally report worse mental health and higher substance use than heterosexuals, including anxiety, depression, and negative affect [5], alcohol/drug use and/or suicidality [9,10,11,12], and tobacco use [13]. Studies have found similarities between gay and bisexual men, who tend to report worse mental health and more substance use than heterosexual men [11, 14,15,16]. Bisexual women often report worse mental health and suicidality than lesbians [9, 10]
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