High Prevalence of Depression Symptoms Among Bisexual Women: The Association of Sexual Orientation and Gender on Depression Symptoms in a Nationally Representative U.S. Sample

Abstract

Bisexual individuals experience higher rates of depression than heterosexual individuals and women experience higher rates of depression than men; however, few studies have quantified the joint effects of sexual orientation and gender. In the 2013–2014 and 2015-2016 National Health and Nutrition Examination Survey, depression symptoms were assessedusing the Patient Health Questionnaire. We used pooled and gender-stratified Poisson regression with robust variances to determine the independent effects of sexual orientation and gender on depression symptoms and calculated relative excess risk due to interaction to examine the joint effects of bisexual orientation and women’s gender on depression symptoms. In adjusted models, depression symptoms were 1.78 times higher in women than in men (99% confidence interval [CI]: 1.776, 1.782), 1.73 times higher in bisexual individuals than in heterosexual individuals (99% CI: 1.726, 1.735), and 3.15 times higher in bisexual women than in heterosexual men (99% CI: 3.145, 3.163). We found evidence for a non-additive model of the excess prevalence of depression symptoms among bisexual women. Gender-specific services addressing the unique mental health needs of bisexual women are needed.

Keywords:

• Depression
• lesbian gay and bisexual health
• NHANES
• intersectionality
• relative excess risk due to interaction

Acknowledgments

The authors would like to thank Dr. Jennifer Brooks, Associate Professor, Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, for her contributions to this study and her feedback on the manuscript.

Disclaimer

This study is a secondary analysis, and the primary data collection was conducted by the National Center for Health Statistics, Centers for Disease Control. The results of this study were presented at the American Public Health Association Annual Meeting in October 2021 in Denver, CO, USA.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

NHANES 2013–2014 and 2015–2016 datasets are publicly available to use at https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.

Additional information

Notes on contributors

Joshun J. S. Dulai

Joshun Dulai is a PhD student at the Dalla Lana School of Public Health, University of Toronto. They have a decade of research experience focusing on mental and sexual health issues in sexual minority populations such as depression, suicide, substance use, and sexually transmitted and blood-borne infections.

Rose A. Schmidt

Rose Schmidt, MPH, is a PhD candidate at the Dalla Lana School of Public Health, University Toronto. Her mixed-methods research focuses on harm reduction and trauma-informed approaches to perinatal substance use. She addresses gender-based determents of health inequity and integrates social epidemiological methodology into applied policy research.