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For example, a Canadian study of over individuals Bisexuals in ontario through random digit dialing reported a depression prevalence of 8. Studies comparing bisexual women with lesbians likewise found elevated rates of anxiety depression  — poor self-rated mental health and suicidality  —  for bisexual women. Greta R. Although lesbian, gay, bisexual, trans and queer identified LGBTQ people are as diverse as the general Canadian population in their experiences of mental health and well-being, they face higher risks for some mental health issues due to the effects of discrimination and the social determinants Bisexuals in ontario health. Invisible lives: Jesse resnick obituary erasure of transsexual and transgendered people. BMC Psychiatry 8 1 : 70— Journal of Bisexuality 8 1—2 : 81— While RDS provides opportunities to adjust for known biases in social network structure and has been shown to reach individuals who would be inaccessible through venue or other convenience sampling methods, some limitations of network-based sampling need to be acknowledged. For women, the rates were
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Research has shown that bisexuals have poorer health outcomes than heterosexuals, gays, or lesbians, particularly with regard to mental health and substance use.
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Research has shown that bisexuals have poorer health outcomes than heterosexuals, gays, or lesbians, particularly with regard to mental health and substance use. However, research on bisexuals is often hampered by issues in defining bisexuality, small sample sizes, and by the failure to address age differences between bisexuals and other groups or age gradients in mental health.
Daily smoking was low in this sample, with a weighted prevalence of 7. Youth aged 16—24 reported significantly higher weighted mean scores on depression and post-traumatic stress disorder, and higher rates of past year suicidal ideation The burden of mental health and substance use among bisexuals in Ontario is high relative to population-based studies of other sexual orientation groups.
Bisexual youth appear to be at risk for poor mental health. Additional research is needed to understand if and how minority stress explains this burden. This is an open-access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist. Population-based studies in several countries indicate health disparities associated with sexual orientation, wherein sexual minorities lesbians, gays or bisexuals have poorer health outcomes than heterosexuals, especially on measures of mental health and substance use  — .
In a recent analysis of Canadian population-based data, Significant disparities have also been reported in rates of cigarette smoking  —  , suicide attempts, anxiety disorders, and substance dependence . The mental health burden of anticipated and experienced discrimination associated with minority sexual orientations i.
In studies that compare bisexuals to their gay or lesbian peers, bisexuals report higher rates of anxiety  —  , depression  —  , and self-harm behaviour  — . Studies comparing bisexual women with lesbians likewise found elevated rates of anxiety  , depression  —  , poor self-rated mental health  , and suicidality  —  for bisexual women. Among men, the increased risk for suicidality compared to heterosexuals was nearly seven-fold for bisexuals and four-fold for gay men .
Significant gaps remain in our knowledge about bisexual mental health. Mental health outcomes in population-based data tend to be limited in their scope and focused on single-item measures of mood and anxiety disorder  , . Moreover, some research has used recent e.
A more comprehensive picture of bisexual health, including a variety of mental health and substance use outcomes for a population reflecting the use of this term in communities, is necessary in order to understand if and how the minority stress framework applies to bisexuals. Because the number of bisexuals in most population-based studies has been relatively small, few studies report how health outcomes among bisexuals might vary across age.
Lesbian, gay and bisexual youth and youth who report same-sex romantic attraction have higher rates of depressive symptoms and suicidality than their heterosexual peers  — . However, as noted by the Institute of Medicine in their recent report on the health of lesbian, gay, bisexual and transgender people, very little research has examined health and health care for bisexual youth specifically . In this study we aim to address these knowledge gaps by producing population estimates based on a large sample of bisexual individuals aged 16 and older in Ontario, Canada's most populous province.
We focus our analysis on seven mental health and substance use outcomes, disaggregating our findings according to age. Sampling was undertaken using respondent-driven sampling RDS with an internet-based English-language survey. RDS is a method of chain-referral sampling in which participants are able to recruit an additional number of eligible new participants here up to 10 , and recruitment proceeds through social networks.
In this way, researchers are able to make inferences about a population that cannot be sampled using traditional population-based methods such as random sampling  — . To date, empirical validation studies indicate that point estimates calculated using RDS are generally similar to population proportions  — .
Recruitment networks were tracked using a numerical coupon system, so that structural characteristics of the network could be used in statistical analysis to account for the non-randomness in social networks.
Based on previous community-based research by our team  , we opted for this inclusive attraction-based definition of bisexuality, which community members identified as most accurately reflecting use of the term within bisexual communities. The entire sample identified with this broad definition. In addition, most Participants self-completed the survey, which included a wide range of items related to demographics, mental health and substance use.
The 13 fixed options were developed in consultation with our community advisory committee to reflect sexual orientation identities currently in use among bisexual communities in Ontario, and included: Ambisexual, Asexual, Biaffectionate, Bisensual, Bisexual, Fluid, Heteroflexible, Homoflexible, Omnisexual, Pansexual, Queer, Questioning, and Not Sure.
The 8 fixed options were developed in consultation with our community advisory committee to reflect gender identities current in Ontario, and included: 2-Spirited, Bigendered, Crossdresser, Genderqueer, Man, Trans Man, Trans Woman, And Woman. Age was assessed by subtracting birth year from the year in which the survey was completed. Scoring indicates depression severity. This measure has been used in research with gay and trans samples  —  , and has demonstrated validity and test-retest reliability .
We examined both mean PHQ-9 scores and categories of depression severity using cut-off scores suggested by Kroenke et al. In this study, the PHQ-9 had high internal consistency with a Cronbach's alpha of 0.
The test includes 10 questions that are measured on a 5-point Likert scale with varying anchors of frequency e. A cut-off of 4 or more is often recommended for women, and a cut-off of 5 or more is usually recommended for men. Considering the inclusion of trans-identified people in our study, a cut-off of 5 was selected for both men and women to indicate problem drinking. Chronbach alpha's are generally reported in the 0. In our study, the Cronbach's alpha demonstrated good internal consistency with a value of 0.
Researchers are currently exploring the psychometrics of the DUDIT-E and there is support for the strength of this measure  — . In our study, internal consistency was high with a Cronbach's alpha of 0.
Given that the DUDIT-E was developed for use in populations with high levels of substance use, responses were categorized for this analysis into no past year drug use, single drug use, and polydrug use. Skip patterns were forward-filled to provide past-year measures for the entire study sample. Tobacco Use. Participants aged 16 and 17 years of age consented on their own behalf; consent of their next of kin, caretakers or guardians was not sought due to the potentially sensitive knowledge that would be disclosed through the consent process i.
Following the example of the Hospital for Sick Children, the CAMH Research Ethics Board considers that those who are 16 years of age and up may provide their own consent to participate and that children under age 16 may assent but need the formal consent of their parents or guardians. Data were cleaned and coded in SAS version 9. Since chi-square tests cannot be conducted using this method, variance recovery methods were used to produce confidence intervals around the differences in proportions not shown  , and p-values were generated from these .
Of 18 seeds, 15 generated at least one additional participant, with a resulting final sample of A maximum of nine waves of recruitment was achieved beyond the original seeds. The recruitment structure is displayed in Figure 1. Total tree sizes ranged from 2 to Weighted estimates of demographics for networked bisexual individuals in Ontario are presented in Table 1. Networked bisexuals were also estimated to be predominantly female assigned at birth A substantial proportion identified as trans or a related term; for example, an estimated 6.
Finally, the networked population of bisexual people in Ontario was estimated to be predominantly white Weighted prevalence estimates for the seven mental health and substance use outcomes are presented in Table 2. However, using this cut-off, the weighted prevalence of problem drinking was Rates of daily smoking were very low, with a weighted prevalence of 7.
When estimates for the networked population of bisexual youth vs. The difference between weighted estimates for youth and non-youth was statistically significant for weighted mean PHQ-9 scores 9. No significant differences were found between youth and non-youth for any of our indicators of anxiety or regarding substance use. To our knowledge, this study represents the first RDS sample specifically of bisexual people undertaken.
While RDS provides opportunities to adjust for known biases in social network structure and has been shown to reach individuals who would be inaccessible through venue or other convenience sampling methods, some limitations of network-based sampling need to be acknowledged.
We thus cannot say with certainty that our results are valid, and there is a total absence of true population data for comparison. Prevalence estimates for most mental health and substance use outcomes investigated in this study were higher than those reported in the general population.
For example, a Canadian study of over individuals recruited through random digit dialing reported a depression prevalence of 8. This is consistent with studies that have used other indicators of depression: for example, using population-based data from the Canadian Community Health Survey, For women, the rates were Similarly, our rates for past year suicidal ideation and attempt are substantially higher than those previously reported in population studies.
In our data, the weighted prevalence of past year suicidal ideation among non-youth was Similarly, Again, these disparities are consistent with other population-based studies: CCHS data from reported a lifetime suicidality rate of For women, the corresponding figures were Finding that suicidality was higher in our study than others may reflect a time trend. In a province-wide school-based study of adolescents in British Columbia, Canada, suicidal ideation and attempts remained stable for heterosexual adolescents, and decreased dramatically for gay males, but increased substantially between and for lesbians and for bisexual male and female teens .
It is unclear whether a similar time trend exists for bisexuals beyond adolescence, or whether it has continued beyond While post-traumatic stress disorder is less often assessed in population-based surveys, on the basis of US population-based epidemiological surveys, a lifetime prevalence of This is consistent with the weighted prevalence of With respect to smoking, it is notable that rates of daily smoking were very low 7.
Daily smoking rates among sexual minority individuals are generally higher than among heterosexuals. For example, in a population-based study of adults in California, With respect to alcohol and illicit drug use, however, we report higher rates than figures previously reported for the Canadian population.
For example, in the Canadian Community Health Survey With respect to illicit drug use, Canadian Community Health Survey data indicated that Rates of both single and polydrug use were also higher in this study than in the general Canadian population Our finding that bisexual identity is associated with elevated rates of not only one, but several different poor health outcomes is consistent with the hypothesis that experiences of stigma, prejudice and discrimination i.
Although little research has evaluated the discrimination experiences of bisexual people, the studies that do exist indicate that bisexual people often experience multiple forms of minority stress  , . Further, discrimination may come not only from heterosexual individuals and institutions, but also from gay or lesbian individuals and institutions  — .
Additional research, involving both between- and within-group comparisons, is needed to test this hypothesis. Relative to other sexual minority identities, bisexuality tends to be endorsed among younger relative to older age groups, particularly among women .