Untangling mental health disparities in bisexual young adults

Among sexual minorities, bisexual people tend to experience higher levels of depression, anxiety, and suicidality than gay and lesbian people. But when it comes to mental health, bisexual people are often lumped into the broader LGBTQIA+ umbrella, so these unique struggles have remained relatively invisible. 

“When we disaggregate among sexual minorities, we’re seeing these really persistent and consistent disparities,” explained Kirsty Clark, a social and psychiatric epidemiologist at Vanderbilt University. Clark, along with other researchers, wondered, what was driving this gap? And how could the mental health of bisexual people be better addressed? 

A recent study led by Clark zooms in on the disparity, trying to understand how mental health and stress differ in bisexual people—those who are attracted to two genders—compared with monosexual people, a term for those who are attracted to one gender. The results, soon to be published in Clinical Psychological Science, revealed that bisexual people experience increased general life stress compared to their gay and lesbian peers. What’s more, the research revealed that bisexual experiences are more diverse than previously thought. Acknowledging this diversity, said Clark, can help researchers start to untangle the puzzle of how life experiences interact and propel inequities in mental well-being. 

In the study, Clark and her colleagues examined responses from nearly 750 sexual-minority young adults, including both bisexual and monosexual (gay or lesbian) people. They used data from the Pathways to Longitudinally Understanding Stress (PLUS) study, a data set that recruited a cohort from Sweden’s national public health survey. This gave the authors a population-based sample, allowing them to assess the mental health risks of a subset that closely represented sexual minorities in the overall Swedish population.  

The study confirmed that disparities in mental health persisted at a wider population level: Bisexual people experienced substantially higher levels of depression, anxiety, and suicidality than gay and lesbian people, consistent with previous research. 

In addition, the analysis found that general life stress, such as job loss, financial precarity, and relationship distress, was higher in bisexual than monosexual participants. This, too, was consistent with past analyses. For instance, a 2018 report by the Center of American Progress found that bisexual women in the United States were less likely to be employed and experienced more food insecurity than their lesbian peers. More recent research has also identified that bisexual people often have lower educational attainment (Mittleman, 2022) and income (Fredriksen-Goldsen et al., 2023).  

On the other hand, the analysis by Clark and colleagues found that minority stress, such as family rejection and sexual-orientation victimization, was lower among bisexual participants than their monosexual counterparts.  

“In LGBTQ mental health research, oftentimes, we rely upon the minority stress model to explain why we see poorer mental health among sexual minorities compared to heterosexuals,” Clark said. This finding adds to evidence that minority stress “might not be the only theory that we need to consider when we’re looking at disparities among sexual minorities.” 

The key to understanding the mechanisms behind these trends may be to delve deeper into differing life experiences. Bisexual individuals make up the largest group under the LGBTQIA+ umbrella, and, in the study, Clark found that bisexual people are not a monolith.  

Using an analytic technique based on patterns of responses, bisexual participants could be sorted into distinct groups according to their responses to four factors: the gender(s) they’re attracted to, the gender of their partners, how they conform to gender norms, and how important sexual identity is to the person’s sense of self. These varied experiences can then lead to different mental health outcomes. For example, Clark’s research found that bisexual individuals who were most attracted to people of their same gender did not have significantly worse mental health. Some even had lower anxiety than their monosexual counterparts. 

Expanding research to encompass these different experiences is important, as is looking beyond minority stress to help us understand differences in mental health between bisexual and monosexual individuals, Clark said. It can also help to develop affirming therapies that meet the unique needs of bisexual people, such as trauma-informed approaches that can support people in the wake of stressful life events. Clark also added that looking into bisexual-specific stressors, like negativity toward bisexual people and invalidation of their identities—as well as how these factors shape experiences—could be a future avenue of research. 

“This study lays the groundwork for the fact that general life stressors are an important mechanism underlying the bisexual–monosexual disparity in internalizing psychopathology,” Clark said. “But so much more work can be done on understanding what are the experiences of bisexual people that are driving their poorer mental health.” 

References 

Clark, K., Dyar, C., Bränström, R., & Pachankis, J. (in press). Psychosocial stressors explaining the monosexual–bisexual disparity in mental health: A population-based study of sexual minority young adults. Clinical Psychological Science. 

Fredriksen-Goldsen, K. I., Romanelli, M., Jung H. H., & Kim H. (2023). Health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults: Results from a population-based study, Behavioral Medicine, 50(2), 141–152. 

Mittleman, J. (2022). Intersecting the academic gender gap: The education of lesbian, gay, and bisexual America. American Sociological Review, 87(2), 303–335.