A new UK study has found that, while those identifying as lesbian, gay, or bisexual reported poorer physical and mental health outcomes compared to straight people, bisexuals, in particular, experienced the worst outcomes. The findings highlight the need for better understanding when it comes to providing healthcare to the LGBTQ+ community.
Although evidence suggests that lesbian, gay and bisexual (LGB) people are more likely to experience anxiety, depression, eating disorders, substance abuse, and self-harm, there’s a lack of data on sexual orientation as a determinant of health.
A 2023 global survey published by Statista revealed that 3% of 22,514 respondents from 30 countries identified as lesbian or gay, and 4% identified as bisexual. Because LGB people are a minority, they’re often lumped together for the purposes of data analysis, which can mask information that’s relevant to specific subpopulations of the community.
A new study by researchers at the Brighton and Sussex Medical School, part of the University of Sussex in the UK, sought to answer two questions. The first was, is sexual orientation associated with reporting long-standing physical or mental health conditions, quality of life and confidence in managing one’s health? Second, are there differences between LGB populations in reporting these health outcomes? The researchers focused particularly on bisexual people who, previous studies have found, experience health disparities over and above those experienced by gays and lesbians.
“While it is well-established that persistent health disparities exist among LGB patients, very little is known about the specific experiences of bisexual people,” said Carrie Llewellyn, corresponding author of the study.
Biphobia is stigma, prejudice and discrimination directed towards bisexuality or people identifying as bi. It can manifest as a denial that bisexuality is a genuine sexual orientation or the perpetuation of negative stereotypes, such as that they’re promiscuous, greedy, or dishonest (“you’re really gay, you just don’t want to admit it”). Whereas bisexual women tend to be fetishized, bi men are ridiculed. And this prejudice can come from both wider society and within the LGBTQ+ community.
The researchers obtained anonymous data from the 2015-16 English General Practice Patient Survey (GPPS) national dataset, consisting of 836,312 responses, including 23,834 people who identified as LGB or “other.” The GPPS was chosen because it was the largest dataset available and had been administered in multiple languages.
The survey assessed sexual orientation as heterosexual, gay/lesbian, bisexual or other. Participants who answered “prefer not to say,” didn’t answer or answered by choosing more than one option were excluded. Variables on age, gender, ethnicity and working status were used in the analysis.
Participants were asked whether they believed they had a long-standing physical health condition such as asthma, diabetes, or cancer and, separately, whether they had a long-term mental health problem. For both questions, they could answer “yes” or “no,” and those who didn’t answer or answered “don’t know” were excluded. Participants were also asked how confident they were that they could manage their own health, answering on a four-point scale ranging from “very confident” to “not at all confident.”
After adjusting the data to account for variables, the researchers found that long-term physical and mental health problems were more than twice as likely to be reported for people in LGB groups compared to heterosexual groups. However, for bisexual women, their odds were more than four times greater.
For males, a long-standing health condition was reported in 43.8%, 46.6%, 46.1% and 49% for heterosexual, gay, bisexual, and “other” groups, respectively. And for females, it was 42.5%, 43%, 45.2% and 49.4%, respectively, for heterosexual, gay, bisexual, and “other” groups.
Similarly, a higher proportion of male and female people across gay, lesbian, bisexual and “other” groups reported a long-term mental health condition compared to the heterosexual group. The proportion of males was 4.5% in the heterosexual group compared to 13.5% in the bisexual group. For females, it was 5.5% and 22.1% in the heterosexual and bisexual groups, respectively.
With respect to quality of life, the median values across LGB groups were lower compared to the heterosexual group, indicating a significantly worse quality of life. The relationship between confidence in managing their own health and sexual orientation was also significant for both males and females. While 7.2% of heterosexual males were not confident in managing their health, 7.9% of gay males, 13.4% of bisexual males and 16.6% of “other” males reported the same. Similarly, 6.4% of heterosexual females were not confident in managing their health compared to 7.9% of lesbian females, 12.8% of bisexual females and 16.2% of “other” females.
The researchers say their study identifies the healthcare needs of LGB people, generally, and highlights the gap that exists in relation to bisexual people, especially bisexual women.
“Our results suggest that there is a greater prevalence of long-standing physical health conditions amongst people identifying as LGB,” Llewellyn said. “Furthermore, nearly all LGB individuals across all gender responses in the survey felt less confident in managing their own health. Our study goes some way to addressing this gap – finding that bisexual people, especially women, have the worst experiences in healthcare and the worst health outcomes of any sexuality.”
They say their study demonstrates that a better understanding of the needs of LGBTQ+ subpopulations is needed to provide equitable healthcare.
“It is important to recognize that interventions addressed to the LGB population as a whole may neglect the needs of subgroups further marginalized within this community, such as bisexual people,” said Llewellyn. “A better understanding of the different spectrum of health needs across LGBTQ+ subpopulations is required to provide adequate and equitable healthcare services for all.”
The study was published in The Journal of Sex Research.