Bisexuality, Poverty & Mental Health: A Mixed Methods Analysis

Highlights

• Poverty is associated with poor mental health among bisexual people.
• Poverty is also associated with experiences of discrimination among bisexuals.
• Multiple pathways may link bisexuality, poverty, and mental health.
• Lack of affordable culturally competent services may sustain the disparities.

Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. 

In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. 

Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. 

Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. 

These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health.

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By:  Ross LE1, O'Gorman L2, MacLeod MA3, Bauer GR3, MacKay J4, Robinson M4.

• 1Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 560, Toronto, Ontario, M5T 3M7, Canada; Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada. Electronic address: l.ross@utoronto.ca.
• 2School of Rural and Northern Health, Laurentian University, 935 Ramsey Lake Rd., Sudbury, Ontario, P3E 2C6, Canada.
• 3Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, Kresge Building Room K201, London, Ontario, N6A 5C1, Canada.
• 4Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada. 
• Soc Sci Med. 2016 Mar 10;156:64-72. doi: 10.1016/j.socscimed.2016.03.009

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Barriers to Health Care among Adults Identifying as Sexual Minorities: A US National Study

OBJECTIVES:

To assess the extent to which lesbian, gay, and bisexual (LGB) adults aged 18 to 64 years experience barriers to health care.

METHODS:

We used 2013 National Health Interview Survey data on 521 gay or lesbian (291 men, 230 women), 215 bisexual (66 men, 149 women), and 25 149 straight (11 525 men, 13 624 women) adults. Five barrier-to-care outcomes were assessed (delayed or did not receive care because of cost, did not receive specific services because of cost, delayed care for noncost reasons, trouble finding a provider, and no usual source of care).

RESULTS:

Relative to straight adults, 

• gay or lesbian and bisexual adults had higher odds of delaying or not receiving care because of cost. 
• Bisexual adults had higher odds of delaying care for noncost reasons, 
• and gay men had higher odds than straight men of reporting trouble finding a provider. 

By contrast, gay or lesbian women had lower odds of delaying care for noncost reasons than straight women. 

• Bisexual women had higher odds than gay or lesbian women of reporting 3 of the 5 barriers investigated.

CONCLUSIONS:

Members of sexual minority groups, especially bisexual women, are more likely to encounter barriers to care than their straight counterparts

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By:  Dahlhamer JM1, Galinsky AM1, Joestl SS1, Ward BW1.

1The authors are with the National Center for Health Statistics, Hyattsville, MD

Am J Public Health. 2016 Mar 17:e1-e7.

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Sexual Orientation Disparities in Physical Health: Age & Gender Effects in a Population-Based Study

Background

Recent studies have identified substantial health disparities between lesbian, gay, and bisexual (LGB) individuals compared to heterosexuals. However, possible variation in sexual orientation health disparities by age and according to gender remains largely unexplored.

Purpose

To examine physical health disparities between LGB and heterosexual individuals in a general population sample in Sweden, to explore potential age and gender differences in these disparities, and to test potential mechanisms underlying any observed disparities.

Method

Between 2008 and 2013, 60,922 individuals (16–84 years of age) responded to nationwide population-based health surveys. In the sample, 430 (0.7 %) individuals self-identified as gay/lesbian and 757 (1.3 %) self-identified as bisexual. Logistic and negative binomial regression analyses were used to explore health disparities based on sexual orientation.

Results

Overall, LGB individuals were more likely to report worse self-rated health as well as more physical health symptoms (e.g., pain, insomnia, dermatitis, tinnitus, intestinal problems) and conditions (e.g., diabetes, asthma, high blood pressure) compared to heterosexuals. However, these physical health disparities differed by age. Disparities were largest among adolescents and young adults and generally smallest in older age groups. Health behaviors and elevated reports of exposure to perceived discrimination, victimization, and threats of violence among sexual minorities partially explained the sexual orientation disparities in physical health.

Conclusions

Age emerged as an important effect modifier of physical health disparities based on sexual orientation. Gender-specific findings suggest that sexual orientation disparities persist into adulthood for women but are gradually attenuated for older age groups; in contrast, for men, these disparities disappear starting with young adults. These results support a developmental model of minority stress and physical health among LGB individuals.

Below:  Proportion of men and women reporting poor/fair health by sexual orientation showing differences by age group

Full article at:   http://goo.gl/eSTZCu

By:  Richard Bränström, Mark L. Hatzenbuehler, and John E. Pachankis

Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77 Stockholm, Sweden

Department of Sociomedical Sciences, Columbia University, New York, NY USA

Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT USA

Richard Bränström, Phone: 46 7 681 117 21, Email: es.ik@mortsnarb.drahcir.

Corresponding author.

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Risky Sexual Behaviors among Sexually Active First-Year Students Matriculating at a Historically Black College: Is A Positive Self-Image An Instigator?

A sample of 498 sexually active first-year students matriculating at a historically Black college in North Carolina was used to determine correlates of risky sexual behaviors. 

In an Ordinary Least Squares regression, the self-esteem element "I take a positive attitude toward myself", non-condom use because of partner issues and being drunk or high, oral sex, anal sex, and bisexuality all increased the number of these behaviors. Higher scores on the condom usage scale were found to decrease the number of risky sexual behaviors. Illicit drug use was an underpinning of the surprisingly positive relationship between positive self-image and risky sexual behaviors. 

It was concluded that school-based social workers, mental health care professionals, and community-based prevention providers can play a critical role in the training of peer facilitators, development, and supervision of peer-driven risk-reduction programs to address the complex interplay among self-esteem, sex, and substances.

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By:  Ellis WL1.

• 1 Social Work Program , Livingstone College , Salisbury , North Carolina , USA. 
• Soc Work Health Care. 2016 Feb 11:1-19.

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Community Connectedness, Challenges, and Resilience among Gay Latino Immigrants

To date, relatively little psychological research has focused on the experiences of lesbian, gay, bisexual, and transgender (LGBT) Latino/a immigrants to the United States. 

This qualitative study used face-to-face semi-structured interviews to explore the unique sources of stress, challenges, as well as opportunities and factors related to resilience among 13 gay Latino first- and second-generation immigrants. Iterative coding of interview transcripts revealed four key themes, each of which is illustrated with verbatim quotes: 1) feelings of connectedness to the LGBT community, 2) feelings of connectedness to the Latino/a community, 3) intersectional challenges and strategies, and 4) well-being, strength, and resilience. 

As suggested by these themes, gay Latino immigrants have distinct sources of stress and conflict, many of them associated with community memberships, but also draw on unique sources of support and adaptive thoughts and behaviors in facing stressors. 

Implications for studying risk and resilience factors among stigmatized populations, including LGBT individuals and immigrants, are discussed.

...As Hector, a 42-year-old second-generation gay man who adopted a more masculine gender presentation noted:

I guess because I'm not flamboyant a lot of people don't realize [I’m gay] in just general public settings. So I guess if I was more effeminate it would be more obvious and then it might've been an issue for me… because of that I also stay away from gay culture more.

Hector recalled that the only gay role models he had growing up were extremely feminine and that he never identified or saw commonality with them. Presently, he stated that he chooses to affiliate with more masculine men, and wishes to be seen by others and by mainstream society as “just a regular guy.”

Another source of disconnection involved the perceived tension between ethnic groups within the LGBT community or between an ethnic community and the “mainstream” gay community. Some participants felt that being an ethnic minority member of the LGBT community was difficult at times; they perceived the LGBT community as largely White and privileged. Perhaps reflecting this, many also felt that ethnic minorities were poorly represented within the community, including in community spaces, in discussions of activism, and in the media. Ernesto, a 49-year-old Peruvian who moved to the U.S. as an adult, described his perception of the LGBT community as narrowly focused, and as having an agenda that was mainly driven by White, gay men. Having lived in several multicultural communities throughout his lifetime, he was particularly attuned to what he felt was a one-dimensional approach to defining the priorities of the LGBT community:

I think their interests are very, like I said, self-serving. It’s about what interests them. It’s like this whole Prop 8 thing…everyone's fighting for that. That's fine, but you know minorities are fighting for other things. But, but still the White elite, they think that gay minorities should be fighting for the same thing they are fighting. But it’s like what about when they are fighting about immigration, or, you know, the Dream Act, or other stuff? We don't see them. You know, they’re, they’re just not there, you know? They're totally out of touch...

Sample demographics (n = 13).

Pseudonym	Age	Sexual Orientation	Generation (Birth Country)	Primary Language	Employment Status	Education	Income
Humberto	51	Gay	1st (Venezuela)	Spanish	Full time	Graduate	$75k-$100k
Jorge	21	Queer	1st (Mexico)	English	Student	Some College	<$20k
Ernesto	49	Gay	1st (Peru)	English	Unemployed	Bachelor's	<$20k
Jose Luis	37	Gay	1st (Mexico)	English & Spanish	Full time	Graduate	$75k-$100k
Manuel	32	Gay	1st (Mexico)	English	Full time	Bachelor's	$100k+
David	19	Gay	2nd (Mexico/Mexico)	English	Part time	High School	<$20k
Carlos	26	Gay	2nd (Mexico/Mexico)	English	Full time	Some College	$20k - $30k
Oscar	53	Gay	2nd (U.S./Mexico)	English	Unemployed	Some College	<$20k
Hector	42	Gay	2nd (U.S./Mexico)	English	Self-employed	Some College	<$20k
Gabriel	29	Gay	2nd (Mexico/Mexico)	English	Full time	Some College	$20k - $30k
Edgar	23	Gay	2nd (El Salvador/Guatemala)	English	Part time	Some College	<$20k
Raul	33	Gay	2nd (Mexico/Mexico)	English	Unemployed	Associate's	<$20k
Hugo	48	Gay	2nd (Venezuela/Italy)	English	Part time	Graduate	N/A

Note: Birth country for 2nd-generation is represented as (Mother’s Birth Country/Father’s Birth Country.)

Full article at:   http://goo.gl/KL9XCL

By:  Nicole N. Gray, David M. Mendelsohn, and Allen M. Omoto

Nicole N. Gray, Department of Psychology, Claremont Graduate University;

Contributor Information.

Correspondence concerning this article should be addressed to Nicole N. Gray, Department of Psychology, Claremont Graduate University (http://www.cgu.edu/pages/1.asp), 123 E. 8^th Street, Claremont, CA 91711. Email: ude.ugc@yarg.elocin

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The Sexual Activity and Behavior of Americans

Via:   http://goo.gl/zGZAmm  By:  https://twitter.com/fedira

Upset Over Sexual versus Emotional Infidelity among Gay, Lesbian, Bisexual, and Heterosexual Adults

One hypothesis derived from evolutionary perspectives is that men are more upset than women by sexual infidelity and women are more upset than men by emotional infidelity. The proposed explanation is that men, in contrast to women, face the risk of unwittingly investing in genetically unrelated offspring. Most studies, however, have relied on small college or community samples of heterosexual participants. 

We examined upset over sexual versus emotional jealousy among 63,894 gay, lesbian, bisexual, and heterosexual participants. Participants imagined which would upset them more: their partners having sex with someone else (but not falling in love with them) or their partners falling in love with someone else (but not having sex with them). 

Consistent with this evolutionary perspective, heterosexual men were more likely than heterosexual women to be upset by sexual infidelity (54 vs. 35 %) and less likely than heterosexual women to be upset by emotional infidelity (46 vs. 65 %). This gender difference emerged across age groups, income levels, history of being cheated on, history of being unfaithful, relationship type, and length. 

The gender difference, however, was limited to heterosexual participants. Bisexual men and women did not differ significantly from each other in upset over sexual infidelity (30 vs. 27 %), regardless of whether they were currently dating a man (35 vs. 29 %) or woman (28 vs. 20 %). Gay men and lesbian women also did not differ (32 vs. 34 %). 

The findings present strong evidence that a gender difference exists in a broad sample of U.S. adults, but only among heterosexuals.

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By:  Frederick DA1, Fales MR2.

• 1Department of Psychology, Crean School of Health & Life Sciences, Chapman University, One University Drive, Orange, CA, 92866, USA. enderflies1@aol.com.
• 2Psychology Department, University of California, Los Angeles, CA, USA.
• Arch Sex Behav. 2016 Jan;45(1):175-91. doi: 10.1007/s10508-014-0409-9. Epub 2014 Dec 18. 

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Conservative Beliefs, Attitudes Toward Bisexuality, and Willingness to Engage in Romantic and Sexual Activities with a Bisexual Partner

Negative attitudes toward bisexuals have been documented among heterosexuals as well as lesbians/gay men, and a common theme is that bisexuals would not be suitable romantic or sexual partners. While gender, sexual orientation, and attitudes toward bisexuality influence people's willingness to engage in romantic or sexual activities with a bisexual partner, there are other individual differences that may contribute. 

The current study examined the associations between four types of conservative beliefs and willingness to engage in romantic/sexual activities with a bisexual partner in a sample of heterosexuals and lesbians/gay men (N = 438). Attitudes toward bisexuality were examined as a mediator of these associations. 

In general, results indicated that higher social dominance orientation, political conservatism, and essentialist beliefs about the discreteness of homosexuality were associated with lower willingness to engage in romantic/sexual activities with a bisexual partner. 

Further, more negative attitudes toward bisexuality mediated these associations. There were several meaningful differences in these associations between heterosexual women, heterosexual men, lesbian women, and gay men, suggesting that influences on people's willingness to be romantically or sexually involved with a bisexual partner may differ for different gender and sexual orientation groups. 

Implications for reducing stigma and discrimination against bisexual individuals are addressed.

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By:   Feinstein BA1, Dyar C2, Bhatia V2, Latack JA2, Davila J2.

• 1Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., Suite 2700, Chicago, IL, 60611, USA. brian.feinstein@northwestern.edu.
• 2Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
• Arch Sex Behav. 2015 Dec 28.  

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Out of DSM: Depathologizing Homosexuality

In 1973, the American Psychiatric Association (APA) removed the diagnosis of “homosexuality” from the second edition of its Diagnostic and Statistical Manual (DSM). This resulted after comparing competing theories, those that pathologized homosexuality and those that viewed it as normal. In an effort to explain how that decision came about, this paper reviews some historical scientific theories and arguments that first led to the placement of homosexuality in DSM-I and DSM-II as well as alternative theories that eventually led to its removal from DSM III and subsequent editions of the manual. The paper concludes with a discussion of the sociocultural aftermath of that 1973 decision...

APA’s 1973 diagnostic revision was the beginning of the end of organized medicine’s official participation in the social stigmatization of homosexuality. Similar shifts gradually took place in the international mental health community as well. In 1990, the World Health Organization removed homosexuality per se from the International Classification of Diseases (ICD-10) [64]. As a consequence, debates about homosexuality gradually shifted away from medicine and psychiatry and into the moral and political realms as religious, governmental, military, media, and educational institutions were deprived of medical or scientific rationalization for discrimination.

As a result, cultural attitudes about homosexuality changed in the US and other countries as those who accepted scientific authority on such matters gradually came to accept the normalizing view. For if homosexuality was no longer considered an illness, and if one did not literally accept biblical prohibitions against it, and if gay people are able and prepared to function as productive citizens, then what is wrong with being gay? Additionally, if there is nothing wrong with being gay, what moral and legal principles should the larger society endorse in helping gay people openly live their lives?

The result, in many countries, eventually led, among other things, to (1) the repeal of sodomy laws that criminalized homosexuality; (2) the enactment of laws protecting the human rights of lesbian, gay, bisexual and transgender (LGBT) people in society and the workplace; (3) the ability of LGBT personnel to serve openly in the military; (4) marriage equality and civil unions in an ever growing number of countries; (5) the facilitation of gay parents’ adoption rights; (6) the easing of gay spouses’ rights of inheritance; and (7) an ever increasing number of religious denominations that would allow openly gay people to serve as clergy.

Most importantly, in medicine, psychiatry, and other mental health professions, removing the diagnosis from the DSM led to an important shift from asking questions about “what causes homosexuality?” and “how can we treat it?” to focusing instead on the health and mental health needs of LGBT patient populations [65]...

Full article at:  http://goo.gl/FdUZKh

By:   Jack Drescher ^1,2,3,4

¹440 West 24 Street, #1A, New York, NY 10011, USA; Tel.: +1-212-645-2232

²Department of Psychiatry, New York Medical College, 20 Hospital Rd, Valhalla, New York, NY 10595, USA

³Postdoctoral Program in Psychotherapy and Psychoanalysis, New York University, 547 La Guardia Place, New York, NY 10012, USA

⁴William A. White Institute, 20 West 74th Street, New York, NY 10023, USA

Academic Editors: Carol North and Alina Suris

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Regular Clinic Attendance in Two Large San Francisco HIV Primary Care Settings

Although poor clinic attendance is associated with increased morbidity and mortality among HIV-infected individuals, less is known about predictors of retention and the acceptability of targeted interventions to increase regular clinic attendance. 

To better understand which patients are at risk for irregular clinic attendance and to explore interventions to aid in retention to care, we surveyed patients attending two outpatient HIV clinics affiliated with the University of California, San Francisco. 

A total of 606 participants were surveyed, and the analysis was restricted to the 523 male respondents. Of this group, 45% (N = 299) reported missing at least one visit a year. Missing a clinic visit was associated with 

• being African American
• being a man who has sex with both men and women, and 
• reporting at least weekly methamphetamine use. 
• Participants who reported a monthly income greater than $2,000 were less likely to miss an appointment. 

Regarding possible retention interventions, most patients preferred phone calls over other forms of support. These findings support the need for ongoing engagement support with particular attention to at-risk sub-groups.

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By:   Cohen JK1, Santos GM2,3, Moss NJ4, Coffin PO5, Block N6, Klausner JD7.

• 1 Department of Internal Medicine , University of California , San Francisco , CA , USA.
• 2 Center for Public Health Research , San Francisco Department of Public Health , San Francisco , CA , USA.
• 3 Department of Community Health Systems , University of California , San Francisco , CA , USA.
• 4 Alameda County Department of Public Health , Oakland , CA , USA.
• 5 San Francisco Department of Public Health , San Francisco , CA , USA.
• 6 Berkeley Joint Medical Program , University of California , Berkeley , CA , USA.
• 7 Department of Medicine, Division of Infectious Diseases , University of California , Los Angeles , CA , USA. 

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