Archives of Sexual Behavior

, Volume 47, Issue 4, pp 1173–1182 | Cite as

The Relationship Between Indicators of Depression and Anxiety and Sexual Orientation in Canadian Women

  • Lanna J. PettersonEmail author
  • Doug P. VanderLaan
  • Tonje J. Persson
  • Paul L. Vasey
Original Paper


Previous studies examining the associations between women’s sexual orientation and mental health have obtained inconsistent results. Whereas some studies have suggested that status as a lesbian or bisexual woman may be associated with greater mental health risk, others have suggested that bisexual women may be specifically vulnerable to mental health problems. The current study examined two competing models in a non-clinical sample of Canadian women (N = 278). The first model predicted that women who reported bisexual attraction would endorse more indicators of depression and anxiety compared to women who reported monosexuality (either same- or opposite-sex attraction). The second model predicted that women who reported relatively greater same-sex attraction would exhibit elevated indicators of depression and anxiety compared to women who reported opposite-sex attraction. Consistent with Model 1, greater bisexual attraction predicted greater endorsement of indicators of depression and anxiety compared to greater same-sex or opposite-sex attraction. These findings suggest that, in women, bisexuality may be associated with higher risk of depression and anxiety than monosexuality. Future research may benefit from exploring risk factors potentially unique to the mental health of bisexual women.


Sexual orientation Depression Anxiety Mental health Bisexuality 



We thank all of the individuals who agreed to participate in our study. Various stages of this research were supported by the University of Lethbridge; by a Social Sciences and Humanities Research Council of Canada (SSHRC) Masters Scholarship and a Lethbridge Public Interest Research Group Research Grant to LJP; by a Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship to DPV; by a CIHR Doctoral Award to TJP; and by a CIHR Catalyst Grant (Methods and Measures for Gender, Sex, and Health; Grant No. 45546) and an Alberta Innovates Health Solutions Sustainability Fund Grant (Grant No. 43528) to PLV.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Statement

The University of Lethbridge Human Subjects Research Committee approved this research. Participants were required to provide informed consent prior to taking part in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the Canadian Tri-Council Policy Statement 2 (2014): Ethical Conduct for Research Involving Humans.


  1. Abelson, J., Lambevski, S., Crawford, J., Bartos, M., & Kippax, S. (2006). Factors associated with ‘feeling suicidal’: The role of sexual identity. Journal of Homosexuality, 51, 59–80.CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  3. Anderson, R., & Fetner, T. (2008). Cohort differences in tolerance of homosexuality: Attitudinal changes in Canada and the United States 1981–2000. Public Opinion Quarterly, 72, 311–330.CrossRefGoogle Scholar
  4. Austin, S. B., Jun, H.-J., Jackson, B., Spiegelman, D., Rich-Edwards, J., Corliss, H. L., & Wright, R. J. (2008). Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses’ Health Study II. Journal of Women’s Health, 17, 597–606.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Balsam, K. F., Beauchaine, T. P., Mickey, R. M., & Rothblum, E. D. (2005). Mental health of lesbian, gay, bisexual, and heterosexual siblings: Effects of gender, sexual orientation, and family. Journal of Abnormal Psychology, 114, 471–476.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: A comparison of lesbian, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology, 73, 477–487.CrossRefPubMedGoogle Scholar
  8. Bartlett, M. S. (1954). A note on the multiplying factors for various chi square approximations. Journal of the Royal Statistical Society: Series B, 16, 296–298.Google Scholar
  9. Bolton, S. L., & Sareen, J. (2011). Sexual orientation and its relation to mental disorders and suicide attempts: Findings from a nationally representative sample. Canadian Journal of Psychiatry, 56, 35–43.CrossRefPubMedGoogle Scholar
  10. Booker, C. L., Rieger, G., & Unger, J. B. (2017). Sexual orientation health inequality: Evidence from Understanding Society, the UK Longitudinal Household Study. Preventative Medicine. doi: 10.1016/j.ypmed.2017.06.010.Google Scholar
  11. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Burton, C. M., Marshal, M. P., Chisolm, D. J., Sucato, G. S., & Friedman, M. S. (2013). Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: A longitudinal analysis. Journal of Youth and Adolescence, 42, 394–402.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Cochran, S. D., & Mays, V. M. (2000a). Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: Results from NHANES III. American Journal of Public Health, 90, 573–578.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Cochran, S. D., & Mays, V. M. (2000b). Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. American Journal of Epidemiology, 151, 516–523.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100, 1953–1960.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of discloser of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy, 10, 35–42.CrossRefPubMedGoogle Scholar
  18. Dyar, C., Feinstein, B. A., & London, B. (2014). Dimensions of sexual identity and minority stress among bisexual women: The role of partner gender. Psychology of Sexual Orientation and Gender Diversity, 1, 441–451.CrossRefGoogle Scholar
  19. Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876–880.CrossRefPubMedGoogle Scholar
  20. Fredriksen-Goldsen, K. I., Kim, H. J., Barkan, S. E., Balsam, K. F., & Mincer, S. L. (2010). Disparities in health-related quality of life: A comparison of lesbians and bisexual women. American Journal of Public Health, 100, 2255–2261.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R. D., 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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Frisell, T., Lichtenstien, P., Rahman, Q., & Långerström, N. (2010). Psychiatric morbidity associated with same-sex sexual behaviour: Influence of minority stress and familial factors. Psychological Medicine, 40, 315–324.CrossRefPubMedGoogle Scholar
  23. Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Ostrow, D., & Kessler, R. C. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the national comorbidity survey. American Journal of Public Health, 9, 933–939.Google Scholar
  24. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological medication framework. Psychological Bulletin, 135, 707–730.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Hatzenbuehler, M. L. (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 1, 896–903.CrossRefGoogle Scholar
  26. Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99, 2275–2281.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Erickson, S. J. (2008). Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychology, 27, 455–462.CrossRefPubMedGoogle Scholar
  28. Hatzenbuehler, M. L., O'Cleirigh, C., Grasso, C., Mayer, K., Safren, S., & Bradford, J. (2012). Effects of same-sex marriage laws on health care use and expenditures in sexual minority men: A quasi-natural experiment. American Journal of Public Health, 102, 285–291.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Herek, G. M. (2002). Heterosexuals’ attitudes toward bisexual men and women in the United States. Journal of Sex Research, 39, 264–274.CrossRefPubMedGoogle Scholar
  30. Jorm, A. F., Korten, A. E., Rodgers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and mental health: Results from a community survey of young and middle-aged adults. British Journal of Psychiatry, 180, 423–427.CrossRefPubMedGoogle Scholar
  31. Juster, R. P., Smith, N. G., Ouellet, É., Sindi, S., & Lupien, S. J. (2013). Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosomatic Medicine, 75, 103–116.CrossRefPubMedGoogle Scholar
  32. Kaiser, H. F. (1974). An index of factorial simplicity. Psychometrika, 39, 31–36.CrossRefGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. King, M., McKeown, E., Warner, J., Ramsay, A., Johnson, K., Cort, C., … Davidson, O. (2003). Mental health and quality of life of gay men and lesbians in England and Wales: Controlled, cross-sectional study. British Journal of Psychiatry, 183, 552–558.CrossRefPubMedGoogle Scholar
  35. King, M., Semlyen, J., See Tai, S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people. BMC Psychiatry, 8, 70. doi: 10.1186/1471-244X-8-70.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia, PA: W. B. Saunders.Google Scholar
  37. Koh, A. S., & Ross, L. K. (2006). Mental health issues: A comparison of lesbian, bisexual and heterosexual women. Journal of Homosexuality, 51, 33–57.CrossRefPubMedGoogle Scholar
  38. Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian, gay, and bisexual: Associations with psychological distress, suicidality, and substance abuse. Archives of Sexual Behavior, 43, 1571–1578.CrossRefPubMedGoogle Scholar
  39. Lewis, R. J., Derlega, V. J., Griffin, J. L., & Krowinski, A. C. (2003). Stressors for gay men and lesbians: Life stress, gay-related stress, stigma consciousness, and depressive symptoms. Journal of Social and Clinical Psychology, 22, 716–729.CrossRefGoogle Scholar
  40. Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869–1876.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.CrossRefPubMedGoogle Scholar
  42. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Pachankis, J. E., Cochran, S. D., & Mays, V. M. (2015). The mental health of sexual minority adults in and out of the closet: A population-based study. Journal of Consulting and Clinical Psychology, 83, 890–901.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Persson, T. J., Pfaus, J. G., & Ryder, A. G. (2015). Explaining mental health disparities for non-monosexual women: Abuse history and risky sex, or the burdens of non-disclosure? Social Science and Medicine, 128, 366–373.CrossRefPubMedGoogle Scholar
  45. Sandfort, T. G. M., Bakker, F., Schellevis, F. G., & Vanwesenbeeck, I. (2006). Sexual orientation and mental and physical health status: Findings from a Dutch population survey. American Journal of Public Health, 96, 1119–1125.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Sandfort, T. G. M., de Graaf, R., Bijl, R. V., & Schnabel, P. (2001). Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58, 85–91.CrossRefPubMedGoogle Scholar
  47. Udry, J. R., & Chantala, K. (2002). Risk Assessment of adolescents with same-sex relationships. Journal of Adolescent Health, 31, 84–92.CrossRefPubMedGoogle Scholar
  48. Vanden Berghe, W. V., Dewaele, A., Cox, N., & Vincke, J. (2010). Minority specific determinants of mental well-being among lesbian, gay, and bisexual youth. Journal of Applied Social Psychology, 40, 153–166.CrossRefGoogle Scholar
  49. Wamala, S., Boström, G., & Nyqvist, K. (2007). Perceived discrimination and psychological distress in Sweden. British Journal of Psychiatry, 190, 75–76.CrossRefPubMedGoogle Scholar
  50. Warner, J., McKeown, É., Griffin, M., Johnson, K., Ramsay, A., Cort, C., & King, M. (2004). Rates and predictors of mental illness in gay men, lesbians and bisexual men and women. British Journal of Psychiatry, 185, 479–485.CrossRefPubMedGoogle Scholar
  51. Widmer, E. D., Treas, J., & Newcombe, R. (1998). Attitudes toward nonmarital sex in 24 countries. Journal of Sex Research, 35, 349–358.CrossRefGoogle Scholar
  52. Zietsch, B. P., Verweij, K. J. H., Bailey, J. M., Wright, M. J., & Martin, N. G. (2011). Sexual orientation and psychiatric vulnerability: A twin study of neuroticism and psychoticism. Archives of Sexual Behavior, 40, 133–142.CrossRefPubMedGoogle Scholar
  53. Zietsch, B. P., Verweij, K. J. H., Heath, A. C., Madden, P. A. F., Martin, N. G., Nelson, E. C., & Lynskey, M. T. (2012). Do shared etiological factors contribute to the relationship between sexual orientation and depression? Psychological Medicine, 42, 521–532.CrossRefPubMedGoogle Scholar
  54. Zivony, A., & Lobel, T. (2014). The invisible stereotypes of bisexual men. Archives of Sexual Behavior, 43, 1165–1176.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Lanna J. Petterson
    • 1
    Email author
  • Doug P. VanderLaan
    • 2
    • 3
  • Tonje J. Persson
    • 4
  • Paul L. Vasey
    • 1
  1. 1.Department of PsychologyUniversity of LethbridgeLethbridgeCanada
  2. 2.Department of PsychologyUniversity of Toronto MississaugaMississaugaCanada
  3. 3.Underserved Populations Research Program, Child, Youth and Family DivisionCentre for Addiction and Mental HealthTorontoCanada
  4. 4.Department of PsychologyConcordia UniversityMontrealCanada

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