Dimensions of Sexual Orientation and the Prevalence of Mood and Anxiety Disorders in the United States

Objectives. We used data from a nationally representative sample to examine the associations among 3 dimensions of sexual orientation (identity, attraction, and behavior), lifetime and past-year mood and anxiety disorders, and sex.Methods. We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.Results. Mental health outcomes differed by sex, dimension of sexual orientation, and sexual minority group. Whereas a lesbian, gay, or bisexual identity was associated with higher odds of any mood or anxiety disorder for both men and women, women reporting only same-sex sexual partners in their lifetime had the lowest rates of most disorders. Higher odds of any lifetime mood or anxiety disorder were more consistent and pronounced among sexual minority men than among sexual minority women. Finally, bisexual behavior conferred the highest odds of any mood or anxiety disorder for both males and females.Conclusions. Findings point to mental health disparities among some, but not all, sexual minority groups and emphasize the importance of including multiple measures of sexual orientation in population-based health studies.In the United States, mental health disorders affect a substantial proportion of the general population.^1,2 Data from the National Comorbidity Study show that approximately 29% of adults meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)³ criteria for anxiety disorder and nearly 21% for a mood disorder over their lifetime.¹ Data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) indicate that 11% of the US general population met criteria for a DSM-IV independent (nonsubstance-induced) anxiety disorder in the past year and 9.3% met criteria for a DSM-IV mood disorder in the past year.² Given the personal and societal costs associated with mental illness,⁴ it is necessary to understand which groups are at disproportionate risk for mental health disorders so that appropriate prevention and intervention programs can be designed.A growing body of evidence suggests that sexual minorities are at higher risk for mental health disorders than their heterosexual counterparts.^5–8 In a meta-analysis, Meyer⁸ concluded the odds of lifetime mood and anxiety disorders were twice as high for lesbian, gay, and bisexual women and men as for heterosexuals. However, as Meyer and others^9,10 have noted, research on the mental health of sexual minorities has been hampered by methodological limitations, such as nonrandom samples that constrain the generalizability of findings. In addition, many studies contain small samples, which preclude analyses by age, race/ethnicity, and other characteristics that vary with mental health disorders. Lesbian, gay, and bisexual women and men are often combined for analytic reasons, such as the need to increase the overall sample size and corresponding statistical power. This obscures potential differences between lesbians or gays and bisexuals as well as between men and women—and can lead to biased results.Although some researchers have considered how different operationalizations of sexual orientation may affect health outcomes,^11–13 national studies rarely assess sexual orientation and, to date, no national population-based study has compared mental health outcomes across all 3 major dimensions of sexual orientation—identity, behavior, and attraction.¹⁴ As others have noted,^10,15 health risks associated with one dimension of sexual orientation, such as behavior, may differ from those associated with another, such as sexual identity. Furthermore, virtually no population-based health studies of adults have explored associations between sexual attraction and health outcomes. Through the inclusion and measurement of these 3 dimensions in population-based health studies, we can begin to better understand the different dimensions of sexual orientation and their associations with health behaviors and health outcomes.^16–18To address the aforementioned limitations and to contribute to a greater understanding of the prevalence of mental health disorders among sexual minorities, we used data from the 2004–2005 NESARC to assess lifetime and past-year prevalence of DSM-IV mood and anxiety disorders among heterosexual and sexual minority women and men. Our purpose was to answer the following question: does the prevalence of mood and anxiety disorders differ across the 3 major dimensions of sexual orientation and does it differ for women and men?