Prevention Science

, Volume 18, Issue 6, pp 716–725 | Cite as

Bisexual-Specific Minority Stressors, Psychological Distress, and Suicidality in Bisexual Individuals: the Mediating Role of Loneliness

  • Ethan H. MereishEmail author
  • Sabra L. Katz-Wise
  • Julie Woulfe


Bisexual individuals are at higher risk for poor mental health outcomes compared to heterosexual as well as lesbian and gay individuals and experience minority stressors, such as discrimination, from both heterosexual and sexual minority communities. However, there is little research examining the negative effects of bisexual-specific minority stressors on bisexual individuals’ mental health as well as psychological factors that might help explain minority stressors’ deleterious effects. This research examined the effects of distal minority stressors (i.e., anti-bisexual experiences from both heterosexual as well as lesbian and gay people) and proximal stressors (i.e., internalized heterosexism and sexual orientation concealment) on psychological distress and suicidality among bisexual adults (N = 503). Building on the relational framing of the minority stress model, we also tested one relational factor (i.e., loneliness) as a mediator of the associations between distal and proximal minority stressors and poor mental health (i.e., psychological distress and suicidality). Structural equation modeling analyses were used to test the mediating effects of loneliness on the associations between minority stressors and psychological distress and suicidality. Although distal and proximal minority stressors were not associated with each other, loneliness mediated the effects of distal and proximal minority stressors on psychological distress and suicidality. The results of this study underscore the importance of targeting bisexual-specific minority stressors as well as loneliness in preventive interventions to improve the mental health of bisexual individuals.


Bisexual Minority stress Mental health Psychological distress Suicide Loneliness 


Compliance with Ethical Standards


Dr. Katz-Wise was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K99HD082340).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Arbuckle, J. (2011). IBM SPSS Amos 20.0 [computer program]. New York: IBM.Google Scholar
  2. Balsam, K. F., & Mohr, J. J. (2007). Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology, 54, 306–319. doi: 10.1037/0022-0167.54.3.306.CrossRefGoogle Scholar
  3. Bostwick, W., & Hequembourg, A. (2014). ‘Just a little hint’: Bisexual-specific microaggressions and their connection to epistemic injustices. Culture, Health & Sexuality, 16, 488–503. doi: 10.1080/13691058.2014.889754.CrossRefGoogle Scholar
  4. Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100, 468–475. doi: 10.2105/AJPH.2008.152942.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Breiding, M. J., Chen, J., & Black, M. C. (2010). Intimate partner violence in the United States—2010 (C. National Ctr for Injury Prevention and Control, Div of Violence Prevention, Trans.). Atlanta, GA.Google Scholar
  6. Brewster, M. E., & Moradi, B. (2010). Perceived experiences of anti-bisexual prejudice: Instrument development and evaluation. Journal of Counseling Psychology, 57, 451–468. doi: 10.1037/a0021116.CrossRefGoogle Scholar
  7. Brewster, M. E., Moradi, B., DeBlaere, C., & Velez, B. L. (2013). Navigating the borderlands: The roles of minority stressors, bicultural self-efficacy, and cognitive flexibility in the mental health of bisexual individuals. Journal of Counseling Psychology, 60, 543–556. doi: 10.1037/a0033224.CrossRefPubMedGoogle Scholar
  8. Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness. Perspectives on Psychological Science, 10, 238–249. doi: 10.1177/1745691615570616.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Chang, E. C., Sanna, L. J., Hirsch, J. K., & Jeglic, E. L. (2010). Loneliness and negative life events as predictors of hopelessness and suicidal behaviors in Hispanics: Evidence for a diathesis-stress model. Journal of Clinical Psychology, 66, 1242–1253.CrossRefPubMedGoogle Scholar
  10. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9, 233–255.CrossRefGoogle Scholar
  11. Díaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities. American Journal of Public Health, 91, 927–932.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Dodge, B., Herbenick, D., Friedman, M. R., Schick, V., Fu, T.-C., Bostwick, W., & ... Sandfort, T. G. M. (2016). Attitudes toward bisexual men and women among a nationally representative probability sample of adults in the United States. PLOS ONE, 11, e0164430. doi:  10.1371/journal.pone.0164430.
  13. Eliason, M. (1997). The prevalence and nature of biphobia in heterosexual undergraduate students. Archives of Sexual Behavior, 26, 317–326. doi: 10.1023/A:1024527032040.CrossRefPubMedGoogle Scholar
  14. Feinstein, B. A., Dyar, C., Bhatia, V., Latack, J. A., & Davila, J. (2014). Willingness to engage in romantic and sexual activities with bisexual partners: Gender and sexual orientation differences. Psychology of Sexual Orientation and Gender Diversity, 1, 255–262. doi: 10.1037/sgd0000047.CrossRefGoogle Scholar
  15. Firestein, B. A. (1996). Bisexuality: The psychology and politics of an invisible minority. Thousand Oaks: Sage Publications, Inc..Google Scholar
  16. Flanders, C. E., Robinson, M., Legge, M. M., & Tarasoff, L. A. (2016). Negative identity experiences of bisexual and other non-monosexual people: A qualitative report. Journal of Gay & Lesbian Mental Health, 20, 152–172. doi: 10.1080/19359705.2015.1108257.CrossRefGoogle Scholar
  17. Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R., Bowling, J., & ... Reece, M. (2014). From bias to bisexual health disparities: Attitudes toward bisexual men and women in the United States. LGBT Health, 1, 309–318.Google Scholar
  18. Gierveld, J. D. J., & Tilburg, T. V. (2006). A 6-item scale for overall, emotional, and social loneliness: Confirmatory tests on survey data. Research on Aging, 28, 582–598. doi: 10.1177/0164027506289723.CrossRefGoogle Scholar
  19. Gierveld, J. D. J., & Van Tilburg, T. (2010). The De Jong Gierveld short scales for emotional and social loneliness: Tested on data from 7 countries in the UN generations and gender surveys. European journal of ageing, 7, 121–130.CrossRefGoogle Scholar
  20. Harris, K. M. (2013). Sexuality and suicidality: Matched-pairs analyses reveal unique characteristics in non-heterosexual suicidal behaviors. Archives of Sexual Behavior, 42, 729–737.CrossRefPubMedGoogle Scholar
  21. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730. doi: 10.1037/a0016441.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine, 40, 218–227. doi: 10.1007/s12160-010-9210-8.
  23. Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, D.C.: The National Academies Press.Google Scholar
  24. Katz-Wise, S. L., & Hyde, J. S. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. The Journal of Sex Research, 49, 142–167. doi: 10.1080/00224499.2011.637247.CrossRefPubMedGoogle Scholar
  25. Kenny, D. A. (2011). Terminology and basics of SEM from
  26. Kerr, D. L., Santurri, L., & Peters, P. (2013). A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues. Journal of American College Health, 61, 185–194. doi: 10.1080/07448481.2013.787619.CrossRefPubMedGoogle Scholar
  27. Kraut, R., Olson, J., Banaji, M., Bruckman, A., Cohen, J., & Couper, M. (2004). Psychological research online: Report of Board of Scientific Affairs’ Advisory Group on the Conduct of Research on the Internet. American Psychologist, 59, 105–117. doi: 10.1037/0003-066X.59.2.105.CrossRefPubMedGoogle Scholar
  28. Kuyper, L., & Fokkema, T. (2011). Minority stress and mental health among Dutch LGBs: Examination of differences between sex and sexual orientation. Journal of Counseling Psychology, 58, 222–233. doi: 10.1037/a0022688.CrossRefPubMedGoogle Scholar
  29. Little, T., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation Modeling, 9, 151–173.CrossRefGoogle Scholar
  30. Little, T., Rhemtulla, M., Gibson, K., & Schoemann, A. M. (2013). Why the items versus parcels controversy needn’t be one. Psychological Methods, 18, 285–300.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343.CrossRefPubMedGoogle Scholar
  32. MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–128.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Mereish, E. H., & Poteat, V. P. (2015). A relational model of sexual minority mental and physical health: The negative effects of shame on relationships, loneliness, and health. Journal of Counseling Psychology, 62, 425–437. doi: 10.1037/cou0000088.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. doi: 10.1037/0033-2909.129.5.674.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Mohr, J., & Fassinger, R. (2000). Measuring dimensions of lesbian and gay male experience. Measurement and Evaluation in Counseling and Development, 33, 66–66.Google Scholar
  36. Mohr, J., & Kendra, M. (2011). Revision and extension of a multidimensional measure of sexual minority identity: The Lesbian, Gay, and Bisexual Identity Scale. Journal of Counseling Psychology, 58, 234–245. doi: 10.1037/a0022858.CrossRefPubMedGoogle Scholar
  37. Moradi, B., Mohr, J. J., Worthington, R. L., & Fassinger, R. E. (2009). Counseling psychology research on sexual (orientation) minority issues: Conceptual and methodological challenges and opportunities. Journal of Counseling Psychology, 56, 5–22.CrossRefGoogle Scholar
  38. Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30, 1019–1029.CrossRefPubMedGoogle Scholar
  39. Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R):Validation with clinical and nonclinical samples. Assessment, 8, 443–454. doi: 10.1177/107319110100800409.CrossRefPubMedGoogle Scholar
  40. Parent, M. C. (2013). Handling item-level missing data: Simpler is just as good. The Counseling Psychologist, 41, 568–600. doi: 10.1177/0011000012445176.CrossRefGoogle Scholar
  41. Pompili, M., Lester, D., Forte, A., Seretti, M. E., Erbuto, D., Lamis, D. A., & ... Girardi, P. (2014). Bisexuality and suicide: A systematic review of the current literature. The Journal of Sexual Medicine, 11, 1903–1913. doi:  10.1111/jsm.12581.
  42. Pyra, M., Weber, K. M., Wilson, T. E., Cohen, J., Murchison, L., Goparaju, L., & ... Cohen, M. H. (2014). Sexual minority women and depressive symptoms throughout adulthood. American Journal of Public Health, 104, e83-e90. doi:  10.2105/AJPH.2014.302259.
  43. Roberts, T. S., Horne, S. G., & Hoyt, W. T. (2015). Between a gay and a straight place: Bisexual individuals’ experiences with monosexism. Journal of Bisexuality, 15, 554–569. doi: 10.1080/15299716.2015.1111183.CrossRefGoogle Scholar
  44. Rust, P. C. (2002). Bisexuality: The state of the union. Annual Review of Sex Research, 13, 180.PubMedGoogle Scholar
  45. Schumacker, R. E., & Lomax, R. (2010). Structural equation modeling. NY: Routlege.Google Scholar
  46. Szymanski, D. M., & Sung, M. R. (2010). Minority stress and psychological distress among Asian American sexual minority persons. The Counseling Psychologist, 38, 848–872.CrossRefGoogle Scholar
  47. Thompson, B. (2000). Ten commandments of structural equation modeling. In L. G. Grimm & P. R. Yarnold (Eds.), Reading and understanding more multivariate statistics (pp. 261–295). Washington, D.C.: American Psychological Association.Google Scholar

Copyright information

© Society for Prevention Research 2017

Authors and Affiliations

  • Ethan H. Mereish
    • 1
    Email author
  • Sabra L. Katz-Wise
    • 2
  • Julie Woulfe
    • 3
  1. 1.Department of Health StudiesAmerican UniversityWashingtonUSA
  2. 2.Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital and Department of PediatricsHarvard Medical SchoolBostonUSA
  3. 3.VA Boston Healthcare SystemBostonUSA

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