Archives of Sexual Behavior

, Volume 48, Issue 4, pp 1111–1126 | Cite as

The Longitudinal Associations Between Outness and Health Outcomes Among Gay/Lesbian Versus Bisexual Emerging Adults

  • Brian A. FeinsteinEmail author
  • Christina Dyar
  • Dennis H. Li
  • Sarah W. Whitton
  • Michael E. Newcomb
  • Brian Mustanski
Original Paper


Sexual minorities are at increased risk for substance use and mental health problems. Although previous studies have examined the associations between outness and health outcomes, few have used longitudinal designs or examined differences across subgroups of sexual minorities. To address these gaps, the current study examined sexual orientation and gender as moderators of the longitudinal associations between outness and substance use (cigarettes, marijuana, illicit drugs, and alcohol) and mental health (depression and anxiety). Data were from a sample of 169 sexual minority emerging adults (98 women and 71 men) who provided self-report data at four times over 3.5 years. Results indicated that sexual orientation moderated the within-person associations between outness and changes in health. For bisexual individuals, being more out was associated with increases in marijuana use, illicit drug use, and depression. In contrast, for gay/lesbian individuals, being more out was associated with decreases in illicit drug use and it was not significantly associated with changes in marijuana use or depression. Additionally, outness was not significantly associated with changes in cigarette use, alcohol use, or anxiety for gay/lesbian or bisexual individuals, and gender did not moderate any of the associations. In sum, being more open about one’s sexual orientation had negative consequences for bisexual individuals but not for gay/lesbian individuals. Professionals who work with sexual minorities need to be aware of the potential risks of being open about one’s sexual orientation for bisexual individuals. Interventions are needed to facilitate disclosure decisions and to promote the health of sexual minorities.


Gay/lesbian Bisexual Outness Substance use Mental health Sexual orientation 



This research was supported by grants from the National Institute of Mental Health (R21MH095413; PI: Mustanski), the National Institute on Drug Abuse (U01DA036939; PI: Mustanski), the National Institute on Child and Human Development (R01HD089170; PI: Whitton), the American Foundation for Suicide Prevention (PI: Mustanski), the William T. Grant Foundation Scholars Award (PI: Mustanski), and the David Bohnett Foundation (PI: Mustanski). Brian A. Feinstein’s time was also supported by a grant from the National Institute on Drug Abuse (F32DA042708; PI: Feinstein). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Compliance with Ethical Standards

Conflict of interest

All 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 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

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


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute for Sexual and Gender Minority Health and WellbeingNorthwestern UniversityChicagoUSA
  2. 2.Department of PsychologyUniversity of CincinnatiCincinnatiUSA
  3. 3.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

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