Gay, bisexual people have worse health outcomes related to stress than straight counterparts

According to researchers comparing data from the National Health Interview Survey, lesbian, gay and bisexual American adults are at higher risk for poor health outcomes than their heterosexual counterparts. Psychological stress levels were especially high among bisexual people.

This disparity can possibly be explained by the greater social pressures placed on this population than those placed on the general population, researchers theorized. They experience more “interpersonal and structural discrimination” than the average person, which might manifest itself in worse health outcomes.

“Discriminatory environments and public policies can stigmatize LGBT people and engender feelings of rejection, shame and low self-esteem, which can negatively shape their health and health-related behaviors,” the study authors explained.

The situation is known as minority stress, or “the chronic stress associated with being a member of a marginalized minority group.” According to the CDC, 75 percent of gay, lesbian and bisexual adults (especially older adults) have reported feeling discriminated against.

Bisexual people might feel marginalized in both heterosexual and homosexual communities, leading to feelings of isolation and poor mental health, the study authors speculated.

The data is taken from the 2013 and 2014 surveys, which showed 1,149 people identifying themselves as gay or lesbian, 515 identifying themselves as bisexual and more than 67,000 identifying themselves as straight. The surveys for those two years did not offer “transgender” as a specific answer to the sexual identity question.

Health outcomes scored included respondents’ physical and mental abilities to perform daily activities, the incidence of 10 different conditions—including cancer, diabetes, arthritis—a self-reported health evaluation, a mental health rating and respondents’ use of cigarettes and alcohol.

About 17 percent of heterosexual men reported moderate or severe psychological stress, while about 26 percent of gay men and 40 percent of bisexual men reported such stress. Gay and bisexual men were also more likely to smoke. All three groups of men reported similar general health outcomes.

Lesbian, bisexual and heterosexual women also all reported similar general health conditions. But bisexual and lesbian women were much likelier to be stressed than heterosexual women. (Twenty-eight percent and 46 percent, respectively, compared with 22 percent.) They were also more likely to report two or more chronic medical conditions. Lesbian women were also more likely to drink and to smoke than straight women.

The researchers’ specific findings were published in the Journal of the American Medical Association Internal Medicine June 27. The study was one of the first of its kind because, until recently, there were few large-scale health surveys that differentiated between heterosexual and non-heterosexual health experiences.

The authors advise doctors and other clinicians to be sensitive to the physical and emotional health needs of their gay, lesbian and bisexual (and other sexual minority) patients that might different from their other patients’. A CMS Office of Minority Health report released June 28 also reminded physicians to be aware their older patients, ethnic and racial minority patients and disabled patients might also be members of sexual or gender minority groups and to take those intersecting identities into consideration when providing care.

In order to fulfill these clinical needs in gay, lesbian and bisexual communities, CMS’ Office of Minority Health announced it is developing a set of best practices for delivering healthcare to such individuals in order to help offset some of the negative health effects of discrimination.

The JAMA study authors also wrote they intend for this study to serve as a baseline to inform further progress or regression on the health of sexual minority populations in relation to the general population.

"We need to make sure all of our health surveys and electronic health records collect information on sexual orientation and transgender identity in order to track our progress towards eliminating LGBT health disparities," lead researcher Gilbert Gonzalez, PhD, MHA, told CNN.