Bisexual individuals are at greater risk of poor mental health than lesbians and gay men: The mediating role of sexual identity stress at multiple levels

J Affect Disord. 2020 Jan 1:260:292-301. doi: 10.1016/j.jad.2019.09.020. Epub 2019 Sep 4.


Background: Although earlier studies have indicated that lesbian, gay, and bisexual (LGB) individuals are at greater risk of psychiatric symptoms than heterosexual individuals, limited attention has been paid to the mental health disparities within LGB populations, especially in non-Western societies. This study examined the disparities in depression, anxiety, and mental well-being between gay/lesbian and bisexual individuals and investigated how the disparities are explained by the greater sexual identity stress experienced by bisexual individuals compared to their gay and lesbian counterparts.

Methods: The study sample included 931 cisgender LGB individuals in Hong Kong, with 70.1% identifying as gay/lesbian and 29.9% identifying as bisexual. They completed a self-report questionnaire on sexual identity stress and mental health.

Results: Bisexual individuals showed higher levels of depressive and anxiety symptoms than lesbians and gay men. Structural equation modeling showed that, compared with lesbians and gay men, bisexual individuals were more likely to report identity uncertainty, conceal their sexual orientation, and have a weaker sense of connection to the LGBT community, which were in turn associated with greater affective symptoms and poorer mental well-being.

Limitations: The use of cross-sectional data does not allow conclusions on causal relationships among variables.

Conclusions: Given the greater vulnerability of bisexual individuals to common mental health problems, evidence-based psychological interventions that strategically target their identity stress at multiple levels should be developed and made available to those in need. Social and psychoeducational interventions are also necessary to transform the monosexist culture and eradicate binegativity in the LGBT and wider communities.

Keywords: Anxiety; Bisexuality; Depression; Mental health disparities; Mental well-being; Sexual identity stress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / epidemiology
  • Anxiety / psychology
  • Bisexuality / psychology*
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Depression / psychology
  • Female
  • Homosexuality / psychology*
  • Hong Kong / epidemiology
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Risk Factors
  • Self Report
  • Sexual and Gender Minorities / psychology*
  • Stress, Psychological / psychology*
  • Young Adult