People who are gay, lesbian or bi have more mental health and substance use problems, survey finds

Despite increasing acceptance of the LGBTQ+ community, at least in some circles, adults who identify as gay, lesbian or bisexual are more likely than those who identify as straight to have serious thoughts of suicide and mental health conditions including major depressive episodes, and they are more likely to misuse substances like alcohol or drugs, according to a new US government report.

The report, published Tuesday, comes from the annual National Survey on Drug Use and Health, sponsored by the US Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration.

It included a question about how the participant identifies their sexual orientation since 2015.

The data in the report, which focuses on LGB adults, comes from 2021 and 2022. Next year’s survey will also aim to identify people who are transgender or nonbinary.

The report says that of the groups surveyed, people who identify as bisexual face discrimination like other members of the community but may also experience “invisibility and erasure” and a general lack of support.

Bisexual females were six times more likely to have attempted suicide in the previous year than their straight peers, for example, and were three times more likely to have an opioid use disorder.

Bisexual males were three times more likely to have had problems with serious mental illness in the previous year than their straight counterparts.

And about a third of all bisexual people and gay males said they had a problem with a substance use disorder in the year before they filled out the survey, the report found.

Mental health and substance use challenges can be even more difficult for women and people of color who are members of the LGB community, the report said.

For example, more than 1 in 4 bisexual females and more than 1 in 7 lesbian females had a major depressive episode in the year they took the survey.

Women who identify as lesbian or bi were about twice as likely than straight women to have smoked tobacco in the month they took the survey.

In the month before they took the survey, lesbian and bisexual females were also more likely than straight females to say they had been binge-drinking and about twice as likely to have been heavy drinkers.

The survey identifies binge drinking as consuming more than four or more drinks in one sitting for women or five or more for men.

Heavy drinking is defined as binge drinking on five or more days in the previous 30 days.

However, gay, bi and straight men seemed to have similar substance use patterns: There was no difference in smoking between straight and gay males, for example, and the rate of binge and heavy drinking in the month before they took the survey was the same among gay, bi and straight men.

Marijuana was the most commonly used illicit drug reported, regardless of sexual identity.

The researchers can’t explain exactly why the LGB community has more mental health and substance use challenges than the straight community, but the report notes that “sexual minorities experience unique stressors that can contribute to adverse substance use and mental health outcomes.”

This research is important to have, said Dr. Jeremy Kidd, a psychiatrist who has worked on studies to improve health outcomes for lesbian, gay, bisexual, transgender and queer populations.

“It is really important data, especially coming from an organization like SAMHSA that has such an influence over both national policy as well as resource allocation in terms of what kinds of prevention treatment and recovery services get supported at the federal level,” he said.

For decades, studies have shown that members of the LGBTQ community have a higher prevalence of substance use and mental health issues.

Kidd said models often show that LGBT people experience a kind of stress that members of the heterosexual community do not, called “minority stress.”

The American Psychological Association defines it as “the relationship between minority and dominant values and resultant conflict with the social environment experienced by minority group members.”

“LGBT individuals experience additional stress as a result of discrimination and stigma, stigma both at the societal level but also the way that living in a society that privileges heterosexuality that has homophobic laws and policies comes to sort of teach LGB people even to view themselves as inferior,” Kidd said.

Bisexuals may face more challenges because they may be experiencing minority stress in a way that is different from people who identify as gay or lesbian, he said.

“For instance, you can imagine being in environments that might be validating of people who have gay and lesbian identities but might either not recognize bisexual identity – so they are sort of invisible in that space – or might be really invalidating of individuals with bisexual identity, even while the environment is affirming or at least a little more neutral to folks who are gay or lesbian,” Kidd said.

Other studies have found that people who identify as bi are also more likely to have health problems like arthritis, obesity and gastrointestinal problems.

Bi men are more likely to have high cholesterol, high blood pressure and cardiovascular disease, studies have shown.

Kidd said the differences uncovered by the new survey are a good reminder for mental health professionals and policy-makers that affirming programming and treatment needs to intentionally support all the segments of the community.

What that effective kind of programming or policy looks like is still something researchers are trying to understand, Kidd said.

But what can make a difference, especially for preventing substance use problems among young LGBT people, is having at least one supportive adult in their life, such as a parent, grandparent, teacher, counselor, faith leader or health care provider.

“Having that person in that young person’s life that says ‘I see you, and I affirm you’ can be hugely protective against substance use problems later down the line, because it sort of challenges that narrative that we’re talking about when people experience stigma and discrimination that teaches people that they’re less than,” Kidd said.

Pride months are also important, Kidd said, because they give society an opportunity to send a message to people in the LGBT community that they are supported for who they are, and that can make a real difference in someone’s health.

“There are really important parts of the LGBT community that can be thought of as resilient, and that community aspect can be a really important protective factor for LGBTQ folks.”