Psychological and Physical Health of Mostly Heterosexuals: A Systematic Review

Abstract

We reviewed whether mostly heterosexuals, a sexual orientation group characterized by a small amount of same-sex sexuality, differ from heterosexuals and bisexuals on a variety of mental and physical health outcomes (e.g., internalizing problems, body dissatisfaction and disordered eating, obesity, sexual/reproductive health, physical health), health risk behaviors (e.g., substance use, sexual risk taking), and risk and protective factors (e.g., victimization, stressful/risky environment, socioeconomic status, personal and social relationships, gender nonconformity). A narrative and quantitative literature review was conducted of 60 papers covering 22 samples from five Western countries. Individual, mean, and median effect sizes (Cohen ds) were calculated whenever possible. Mostly heterosexuals reported higher levels of risk in most reviewed outcomes compared to heterosexuals (unweighted mean effect sizes ranged from 0.20 to 0.50) but typically somewhat lower than bisexuals (unweighted mean effect sizes ranged from −0.10 to −0.30). Various risk factors frequently reduced, but rarely eliminated, health disparities between mostly heterosexuals and heterosexuals. Findings are discussed through the lens of three potential explanations of elevated health risks among nonheterosexuals: minority stress, nonheterosexual lifestyles, and common causes. Because data on many outcomes were scarce or missing, particularly for men and in comparison with bisexuals, further research is needed.

Notes

^a Dataset abbreviation and full name.

^b Brief sample description; exact (sub)samples used in each study may differ; Ps = participants; RR = response rate.

^c Sexual orientation indicator/s assessed; response options provided only through midpoint of scale (i.e., bisexual). A = attraction; B = bisexual; H = heterosexual; HM = homosexual; I = identity; C = contact; F = fantasy/female; M = men/male; O = orientation; R = arousal; W = women.

^d Percentage on mostly heterosexuals (MH) and bisexuals (B) in each sample, across multiple waves, cohorts, and SO indicators when available; percentages computed after excluding missing, “unsure,” and “other” responses.

^e Out = Outcome(s) for which data were available on each sample. 1 = internalizing; 2 = body image/disordered eating; 3 = sexual/reproductive health; 4 = physical health; 5 = substance use; 6 = sexual risk taking; 7 = other risk taking; 8 = preventive health behaviors; 9 = victimization; 10 = stressful/risky environment; 11 = socioeconomic status; 12 = personal/social relationships; 13 = gender nonconformity; 14 = other personality/psychological characteristics.

^a Full sample unless otherwise specified. Add Health = National Longitudinal Study of Adolescent Health; ALSWH = Australian Longitudinal Study of Women's Health; ATR = Australian National Health and Medical Research Council Twin Register; BCAHS = British Columbia Adolescent Health Surveys; California = Students from a public university in northern California (convenience-based sample); CHDS = Christchurch Health and Development Study; DMHDS = Dunedin Multidisciplinary Health and Development Study; GUTS = Growing Up Today Study; Facebook = Facebook users residing in the United States; U Michigan = University of Michigan undergraduates (population-based sample); U Missouri = University of Missouri students (population-based sample); NAIAHS = National American Indian Adolescent Health Survey; NE & MW = Students from 8 colleges in the Northeast and Midwest (population-based sample); NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; NSHLEW & CHLEW = A combined and weighted sample from the National Study of Health and Life Experiences of Women and the Chicago Study of Health and Life Experiences of Women; NSFG = National Study of Family Growth; NSW Twins = Male twins from New South Wales, Australia; Ontario = Students from 25 high schools in a single school district in southern Ontario; PHDCN = Project on Human Development in Chicago Neighborhoods; UNSW medical students = Second-year medical students at University of New South Wales, Australia (convenience sample); W = wave; YINS = Young in Norway Study.

^b In longitudinal studies, age at earliest wave.

^c N = total sample size, excluding “missing” or “unsure” sexual orientation responses; * = sample sizes weighted and scaled to regional/national population size; † = repeated-measures observations.

^d SO = Sexual orientation indicator. A = attraction, B = behavior, F = fantasy, I = identity, O = orientation.

^e Operationalization of outcome variable. CESD = Center for Epidemiologic Studies Depression Scale; CSA = Childhood sexual abuse; CPA = Childhood physical abuse; EPQ-R = Eysenck Personality Questionnaire Revised; GNC = gender nonconformity; GP = general practitioner; MOS MHI = Medical Outcomes Study, Mental Health Inventory; r = reverse coded; Ps = partners; PSQYW = Perceived Stress Questionnaire for Young Women; PSS = Perceived Stress Scale; SE = sexually experienced subsample. Time reference is lifetime unless noted otherwise. Quantity is any unless noted otherwise.

^f Cohen ds = effect sizes for MHs compared to heterosexuals and bisexuals for men (M) and women (W). Effects sizes coded such that positive values indicate greater presence of outcome among MHs; “—” = no such participants included in study; † = effect size calculated controlling for one or more demographics; * = not used in creating mean effect sizes due to other more accurate/complete estimates from same sample; ‡ = reflects findings for men and women combined as no sex-specific data was available; NA = analyses for such participants not provided in study.

Note. All effect sizes are coded such that positive values indicate higher presence of the outcome among mostly heterosexuals compared to heterosexuals; k = number of samples providing effect sizes per outcome; each effect size per sample is often an average of multiple effect sizes across several studies, sexual orientation indicators, outcome indicators, or longitudinal waves.

Note. All effect sizes are coded such that positive values indicate higher presence of the outcome among mostly heterosexuals compared to bisexuals; k = number of samples providing effect sizes per outcome; each effect size per sample is often an average of multiple effect sizes across several studies, sexual orientation indicators, outcome indicators, or longitudinal waves.

^a Sample: Add Health = National Longitudinal Study of Adolescent Health; ALSWH = Australian Longitudinal Study of Women's Health; CHDS = Christchurch Health and Development Study; GUTS = Growing Up Today Study; NE & MW = Students from 8 colleges in the Northeast and Midwest; NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; PHDCN = Project on Human Development in Chicago Neighborhoods; YINS = Young in Norway Study.

^b Whether mostly heterosexuals were higher (H), lower (L), or not significantly different (n.s.) from heterosexuals before and after adjusting for potential mediators; NA = such analyses were not available in the study; “—” = such participants were not included in the study.

^c Most studies also adjusted for age, race/ethnicity, or geographical region/residence; these are not mentioned in the table.

^d STI = sexually transmitted infection.

References marked with an asterisk (*) indicate studies included in Table 1.