Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults.

Growing evidence suggests that lesbian, gay, and bisexual adults may be at elevated risk for mental health and substance use disorders, possibly due to anti-gay stigma. Little of this work has examined putative excess morbidity among ethnic/racial minorities resulting from the experience of multiple sources of discrimination. The authors report findings from the National Latino and Asian American Survey (NLAAS), a national household probability psychiatric survey of 4,488 Latino and Asian American adults. Approximately 4.8% of persons interviewed identified as lesbian, gay, bisexual, and/or reported recent same-gender sexual experiences. Although few sexual orientation-related differences were observed, among men, gay/bisexual men were more likely than heterosexual men to report a recent suicide attempt. Among women, lesbian/bisexual women were more likely than heterosexual women to evidence positive 1-year and lifetime histories of depressive disorders. These findings suggest a small elevation in psychiatric morbidity risk among Latino and Asian American individuals with a minority sexual orientation. However, the level of morbidity among sexual orientation minorities in the NLAAS appears similar to or lower than that observed in population-based studies of lesbian, gay, and bisexual adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of mental disorders, psychological distress, and mental services use among lesbian, gay, and bisexual adults in the United States.

Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"I only read about myself on bathroom walls": the need for research on the mental health of lesbians and gay men

The very recent history of pathologizing homosexuality still has a strong impact on the public in general and mental health professionals in particular. In contrast to the early research on sexual reorientation of lesbians and gay men, there is relatively little empirical research on the mental health issues of lesbians and gay men. Whether researchers choose to define sexual orientation by sexual behavior, self-definition, or membership in lesbian and gay community groups will have an impact on the results. Research on mental health issues that include lesbians, gay men, and heterosexual women and men would allow an examination of the relative salience of gender versus sexual orientation. Finally, the experiences of lesbians and gay men in society may place them at increased risk for some mental health problems and may protect them from other mental health problems.     

Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school.

This study examined victimization during high school based on sexual orientation of 350 lesbian, gay, or bisexual (lgb) youths aged 21 and younger. Experiences of direct victimization as well as knowledge of other lgb youths' victimization were assessed. Over half reported verbal abuse in high school because of their sexual orientation, and 11% said they had been physically assaulted. Youths who were more open in high school about their sexual orientation and who had a history of more gender atypical behavior were victimized more often. Male youths were targeted significantly more often than females, Youths' current mental health symptoms, especially traumatic stress reactions, were associated with having experienced more verbal abuse in high school. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults.

This study extends research on dimensions of sexual minority experience by examining differences between bisexual and lesbian/gay adults in adaptation to sexual orientation stigma. The authors investigated sexual orientation self-disclosure, connection to community, and 4 identity-related variables (internalized homonegativity, stigma sensitivity, identity confusion, and identity superiority) in a community sample of 613 lesbian, gay, and bisexual adults. Sexual orientation effects were found on 3 of these 6 variables: Bisexual participants reported higher levels of identity confusion and lower levels of both self-disclosure and community connection relative to their lesbian/gay peers. Taken together, the 6 variables predicted indicators of psychosocial functioning. Associations among the 6 dimensions of sexual minority experience and psychosocial functioning did not differ for bisexual and lesbian/gay participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tobacco, marijuana, and sensation seeking: Comparisons across gay, lesbian, bisexual, and heterosexual groups.

This study examined patterns of smoked substances (cigarettes and marijuana) among heterosexuals, gays, lesbians, and bisexuals based on data from the 2000 National Alcohol Survey, a population-based telephone survey of adults in the United States. We also examined the effect of bar patronage and sensation seeking/impulsivity (SSImp) on tobacco and marijuana use. Sexual orientation was defined as lesbian or gay self-identified, bisexual self-identified, heterosexual self-identified with same-sex partners in the past 5 years, and exclusively heterosexual (heterosexual self-identified, reporting no same-sex partners). Findings indicate that bisexual women and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than exclusively heterosexual women. Bisexual women, lesbians, and heterosexual women with same-sex partners also used marijuana at significantly higher rates than exclusively heterosexual women. Marijuana use was significantly greater and tobacco use was elevated among gay men compared with heterosexual men. SSImp was associated with greater use of both of these substances across nearly all groups. Bar patronage and SSImp did not buffer the relationship between sexual identity and smoking either cigarettes or marijuana. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women, and underscore the importance of developing prevention and treatment services that are appropriate for sexual minorities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Within-group differences in sexual orientation and identity.

The purpose of this investigation was to examine within-group differences among self-identified sexual orientation and identity groups. To understand these within-group differences, 2 types of analysis were conducted. First, a sample of 2,732 participants completed the Sexual Orientation and Identity Scale. Cluster analyses were used to identify 3 types of bisexual women, 3 types of bisexual men, 2 types of heterosexual women, and 2 types of gay men. Lesbians and heterosexual men were clustered into singular groupings. In addition, a subsample of 838 participants also completed measures of sexual identity development and lesbian, gay, and bisexual knowledge and attitudes. Within-group differences were found for bisexual men and women, gay men, and heterosexual women along these dimensions. Findings supported the existence of distinct subgroups of bisexual men, bisexual women, gay men, and heterosexual women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental Health of Lesbian, Gay, Bisexual, and Heterosexual Siblings: Effects of Gender, Sexual Orientation, and Family.

Self-identified lesbian, gay male, and bisexual (LGB) individuals were recruited via convenience sampling, and they in turn recruited their siblings (79% heterosexual, 19% LGB). The resulting sample of 533 heterosexual, 558 lesbian or gay male, and 163 bisexual participants was compared on mental health variables and their use of mental health services. Multilevel modeling analyses revealed that sexual orientation predicted suicidal ideation, suicide attempts, self-injurious behavior, use of psychotherapy, and use of psychiatric medications over and above the effects of family adjustment. Sexual orientation was unrelated to current psychological distress, psychiatric hospitalizations, and self-esteem. This is the 1st study to model family effects on the mental health of LGB participants and their siblings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Execution of Legal Documents by Sexual Minority Individuals.

Sexual minority individuals (specifically bisexual, gay, lesbian and transgendered [BGLT]) have identities and relationships that are socially stigmatized and legally unrecognized. An online survey of 398 BGLT individuals was conducted concerning their execution of 5 legal planning documents: a will, powers of attorney for finances and health care, a living will, and hospital visitation authorization. We found support for the hypothesis that BGLT individuals who are in committed relationships, have disclosed their sexual orientation to immediate family, and have more income are more likely to have executed some or all of these documents. The authors discuss implications for BGLT individuals and same-sex couples, the need for policy changes and therapeutic intervention, and future directions for research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Was it a phase? Young women's relinquishment of lesbian/bisexual identities over a 5-year period.

There have been many anecdotal accounts of individuals who self-identify as lesbian, gay, or bisexual only to relinquish these identities later. The current study examines this phenomenon among a sample of young nonheterosexual women who underwent 3 interviews over a 5-year period. Over a quarter of the women relinquished their lesbian/bisexual identities during this period: half reclaimed heterosexual identities and half gave up all identity labels. These women did not differ from those who maintained lesbian/bisexual identities regarding the age at which they underwent sexual identity milestones, the factors that precipitated their sexual questioning, or their recollection of childhood "indicators" same-sex sexuality. Women who relinquished their identities for heterosexual identities had small ratios of same-sex to other-sex attractions across the 5-year assessment period, but their attractions did not significantly change. Only 1 woman described her previous same-sex identification as a phase; the rest emphasized changes in how they interpreted or acted on their attractions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Victimization Over the Life Span: A Comparison of Lesbian, Gay, Bisexual, and Heterosexual Siblings.

Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey.

In recent population-based surveys, minority sexual orientation has been identified as a potential risk indicator for psychiatric morbidity. However, methodological limitations in the studies to date have led to concerns that current estimates are biased due to inadequate measurement of sexual orientation and uncontrolled confounding from prevalent HIV infection. In the present study, the authors investigate associations between sexual orientation and mental health/substance use morbidity using information obtained from 2,272 individuals, including 652 sexual orientation minorities, age 18 to 72 years, interviewed in the California Quality of Life Survey. Results confirm that minority sexual orientation is a risk indicator for psychiatric morbidity. However, levels of increased risk vary within this subpopulation by both gender and patterns of sexual orientation expression. Among gay/bisexual men, much of this greater burden is related to concurrent HIV infection. Reducing excess mental health morbidity risk among sexual orientation minorities could result in possibly a 5% to 11% reduction in the burden of the disorders assessed here among the adult population. Sexual orientation represents an important, but relatively understudied, individual characteristic shaping risk for psychiatric morbidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring attitudes regarding bisexuality in lesbian, gay male, and heterosexual populations.

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) 2010 APA, all rights reserved)     

Sexual identity development: The influence of valuative frameworks on identity synthesis.

Examines the influence of valuative frameworks on sexual identity development and synthesis. This involves incorporating an understanding of attribution and volition that is often omitted in alternative models of sexual identity development. The models can be organized into categories that address (1) general sexual identity development (defined to include gay and lesbian experiences), (2) gay identity development, and (3) lesbian identity development. Following a review of these various models, the role of valuative frameworks on identity development and synthesis is addressed, and an alternative model is proposed to address the experiences of those who experience same-sex attraction but do not experience a gay, lesbian, or bisexual identity synthesis. The proposed model has 5 stages: (1) identity confusion or crisis, (2) identity attribution, (3) identity foreclosure versus expansion, (4) identity reappraisal, and (5) identity synthesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of sexual orientation similarity and counselor experience level on gay men's and lesbians' perceptions of counselors.

Investigated the effects of sexual orientation similarity of counselor and client as well as counselor experience level on perceptions of counselors by gay men and lesbians. After receiving pre-session information in which the variables of counselor sexual orientation (gay male/lesbian or heterosexual) and experience level (experienced vs inexperienced) were manipulated, 40 gay male and 40 lesbian Ss in parallel experiments viewed different 15-min videotapes of same-sex counselor–client pairs and then completed the Counselor Rating Form (A. Barak and M. B. LaCrosse, 1975). Results indicated that the lesbian Ss rated the experienced therapists, both lesbian and heterosexual, as more expert; there were no other significant main or interaction effects. The results suggest that sexual orientation of the counselor may be a less salient concern of gay men and lesbians when the therapeutic issue is not sexual in nature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section: Mental health of lesbians and gay men.

There has been little focus on the mental health of lesbians and gay men in the 2 decades since homosexuality was removed as a diagnostic category from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; American Psychiatric Association, 1980). This special section contains articles on research methodology on lesbian and gay mental health; the practice and ethics of sexual orientation conversion therapy; the mental health results of the National Lesbian Health Care Survey; ethnicity and sexual orientation; sexual orientation as a factor in research on eating disorders and body dissatisfaction; and verbal and physical abuse as stressors in the lives of lesbian and gay youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual orientation and suicide attempt: A longitudinal study of the general Norwegian adolescent population.

Past and future suicide attempt rates among gay, lesbian, and bisexual (GLB) young people were compared with those of heterosexual young people. A sample of Norwegian students (N=2,924; grades 7-12) was followed in 3 data collection waves. Risk factors included previous suicide attempt, depressed mood, eating problems, conduct problems, early sexual debut, number of sexual partners, pubertal timing, self-concept, alcohol and drug use, atypical gender roles, loneliness, peer relations, social support. parental attachment, parental monitoring, and suicidal behavior among family and friends. When homosexual attraction, homosexual identity, and same-sex sexual behavior were entered to predict suicide attempt, only same-sex sexual behavior was significantly predictive. The increased odds could not be attributed to GLB students' greater exposure to risk factors for suicide attempt. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents

PURPOSE: A recent study found a disproportionate number of pregnancies among Euro-American lesbian and bisexual adolescents compared to heterosexual peers. American Indian adolescents have reported higher prevalence of gay/lesbian/bisexual orientations than Euro-Americans; do they also report higher prevalence of pregnancy? METHODS: The study assessed prevalence of teen pregnancy and related factors by sexual orientation among sexually experienced, reservation-based American Indian adolescent males (n = 2056) and females (n = 1693) who participated in a national school-based survey in 1991. Self-reported orientation was classified as heterosexual, gay/lesbian/bisexual, and "unsure" of orientation. RESULTS: Gay/bisexual males were more likely than other males to report early heterosexual intercourse (<14 years), more consistent contraception, and a higher prevalence of abuse and running away (p < 0.05 to p < 0.0001). Likewise, lesbian/bisexual females were more likely to report early onset of heterosexual intercourse, more frequent intercourse, and running away. Sexual or physical abuse did not vary by orientation for females. Prevalence of pregnancy also did not vary by orientation (males, 18.6% gay/bisexual vs. 10.4% "unsure" vs. 11.8% heterosexual; females, 25.0% lesbian/bisexual vs. 22.1% "unsure" vs. 21.9% heterosexual). For lesbian/bisexual females, no variables were significantly associated with pregnancy history; for "unsure" females, pregnancy was associated with contraceptive frequency and early onset of heterosexual activity. For heterosexual females, age, intercourse frequency, and physical abuse were associated. For gay/bisexual males, intercourse frequency, ineffective contraception, and physical abuse were associated with involvement in a pregnancy; for "unsure" and heterosexual males, most items except ineffective contraception were related to pregnancy involvement history. CONCLUSIONS: Although prevalence of pregnancy is similar, findings show group differences in associated risk factors by sexual orientation. Interventions to reduce pregnancy among American Indian adolescents should include assessment of sexual orientation and behavioral risk factors.     

The impact of minority stress on mental health and substance use among sexual minority women.

Objective: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. Method: 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. Results: The final model demonstrated acceptable fit, χ2(79) = 414.00, p 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. Conclusions: 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. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Mostly straight" young women: Variations in sexual behavior and identity development.

Researchers have begun to explore and identify various gradations in sexual orientation identity, paying attention to alternative sexual identity categories and attempting to clarify potential subtypes of same-sex sexuality, particularly among women. This study utilizes both quantitative and qualitative data to explore the behavioral experiences and identity development processes among women of a particular sexual identity subtype, "mostly straight." Participants were 349 female college students whose primary sexual identities included exclusively straight, mostly straight, bisexual, and lesbian. Results indicated that, on most behavioral variables, mostly straight women fell directly between and were significantly different from exclusively straight and bisexual/lesbian women. Mostly straight women were also distinct from exclusively straight women but were similar to bisexual women and lesbians on several quantitative measures of identity. Narratives about sexual identity development for mostly straight women revealed the complexities of sexual identity exploration, uncertainty, and commitment within this population. As a whole, this study encourages researchers to begin to recognize and examine mostly straight as a distinct sexual identity subtype in young women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)