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

AbstractBisexual 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: Depressionlesbian gay and bisexual healthNHANESintersectionalityrelative excess risk due to interaction AcknowledgmentsThe 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.DisclaimerThis 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 statementNo potential conflict of interest was reported by the author(s).Data availability statementNHANES 2013–2014 and 2015–2016 datasets are publicly available to use at https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.Additional informationNotes on contributorsJoshun J. S. DulaiJoshun 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. SchmidtRose 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.