Occurrence of multiple mental health or substance use outcomes among bisexuals: A respondent-driven sampling study

Greta R. Bauer, Corey Flanders, Melissa A. MacLeod, Lori E. Ross

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17 Scopus citations


Background: Bisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians. The co-occurrence of multiple outcomes has rarely been studied. Methods: Data were collected from 405 bisexuals using respondent-driven sampling. Weighted analyses were conducted for 387 with outcome data. Multiple outcomes were defined as 3 or more of: depression, anxiety, suicide ideation, problematic alcohol use, or polysubstance use. Results: Among bisexuals, 19.0 % had multiple outcomes. We did not find variation in raw frequency of multiple outcomes across sociodemographic variables (e.g. gender, age). After adjustment, gender and sexual orientation identity were associated, with transgender women and those identifying as bisexual only more likely to have multiple outcomes. Social equity factors had a strong impact in both crude and adjusted analysis: controlling for other factors, high mental health/substance use burden was associated with greater discrimination (prevalence risk ratio (PRR) = 5.71; 95 % CI: 2.08, 15.63) and lower education (PRR = 2.41; 95 % CI: 1.06, 5.49), while higher income-to-needs ratio was protective (PRR = 0.44; 0.20, 1.00). Conclusions: Mental health and substance use outcomes with high prevalence among bisexuals frequently co-occurred. We find some support for the theory that these multiple outcomes represent a syndemic, defined as co-occurring and mutually reinforcing adverse outcomes driven by social inequity.

Original languageEnglish (US)
Article number497
JournalBMC public health
Issue number1
StatePublished - Jun 10 2016
Externally publishedYes

Bibliographical note

Funding Information:
Work for this paper was funded through an operating grant from the Canadian Institutes of Health Research (FRN# MOP-106609). The funder played no role in the study’s design, data collection, analysis or interpretation of data, or in writing this manuscript.

Publisher Copyright:
© 2016 The Author(s).


  • Epidemiology
  • Health inequalities
  • Mental health
  • Sexual orientation
  • Substance use


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