A recent study published in the American Journal of Public Health highlights significant challenges in measuring sexual orientation, revealing potential gaps in understanding the mental health risks faced by sexual minorities. The research, led by Assistant Professor Dr. Nicole F. Kahn from the University of Washington, indicates that current measurement approaches often fail to capture the full spectrum of sexual identities, leading to an underestimation of mental health disparities among lesbian, gay, bisexual, and transgender (LGBT) populations.
Sexual orientation is influenced by various factors, including sexual identity, attraction, and behavior. However, many surveys primarily focus on sexual identity, which can overlook individuals who experience same-sex attraction but identify as heterosexual. This creates an “invisible” sexual minority group that, despite not fitting traditional labels, faces similar mental health challenges as other sexual minorities. Dr. Kahn emphasizes the necessity for more inclusive measurement tools to better identify these individuals and address their mental health needs.
In their study, Dr. Kahn and her team compared responses from participants using two different survey questions designed to assess sexual orientation. They hypothesized that broader measures would identify more sexual minority respondents than narrower definitions. The research utilized data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which has tracked a cohort of adolescents since 1994. Participants were invited to complete the Sexual Orientation/Gender Identity, Socioeconomic Status, and Health Across the Life Course (SOGI-SES) survey between 2020 and 2021.
The study included respondents who identified as mostly heterosexual, bisexual, or homosexual, as well as those who reported same-sex partners or identified as gender nonconforming. Participants answered two sexual orientation questions: one from the Add Health survey, which offered a continuum of options, and another from the National Health Interview Survey (NHIS), which provided fewer choices.
Among the 2,576 respondents, the study found that a higher percentage of cisgender males (93.9%) and females (91.2%) identified as “straight” on the NHIS question compared to those identifying as “100% heterosexual” in the Add Health survey (92.2% of males and 79.1% of females). Notably, the Add Health survey detected a greater proportion of sexual minorities (14.4%) compared to the NHIS (6.8%). Additionally, cisgender females were more likely to be classified as undetected sexual minorities (12.8%) compared to cisgender males (2.6%).
Mental health outcomes revealed that both sexual minorities and undetected sexual minorities reported higher rates of depression than heterosexual respondents. The study also found significant differences in anxiety and panic disorder diagnoses between sexual minorities and heterosexual respondents among both cisgender males (46.3% vs. 30.1%) and females (54.7% vs. 37.1%).
Conclusion
The findings suggest that current methods of measuring sexual orientation may lead to an underestimation of the sexual minority population and the health disparities they face. Dr. Kahn concludes, “Further research on measures that include response options reflecting a broader continuum of sexuality is essential to inform health policy and service planning to better meet the needs of the sexual minority population.”
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