Homosexuality

Please note that this is a hot topic and CIR is working to cite credible sources. CIR has created a resource briefly compiling exerpts from the texts quoted on this page. It’s located here.

Key Texts

  1. Check, Paul and Janet Smith. Living the Truth in Love. Ignatius Press, 2015.
  2. Robert Graham et al., Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, Institute of Medicine, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding (Washington, D.C.: The National Academies Press, 2011).
  3. Harvey, John. The Truth about Homosexuality. Ignatius Press, 2003.
  4. Robert T. Michael et al., Sex in America: A Definitive Survey (New York: Warner Books, 1994).
  5. Edward O. Laumann et al., The Social Organization of Sexuality: Sexual Practices in the United States (Chicago: University of Chicago Press, 1994.
  6. Catechism of the Catholic Church. (Relevant excerpts here, with papal comments.

Key Abstracts

Travis Salway Hottes et al., “Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis,” American Journal of Public Health 106, no. 5 (2016): e1-e12.

BACKGROUND: Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment.

OBJECTIVES: To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community-based samples.

SEARCH METHODS: In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities.

SELECTION CRITERIA: We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand.

DATA COLLECTION AND ANALYSIS: Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using τ(2).

MAIN RESULTS: We pooled 30 cross-sectional studies, including 21,201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability.

AUTHOR’S CONCLUSIONS: Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide.

PUBLIC HEALTH IMPLICATIONS: Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.

Mayer LS, McHugh PR. Sexuality and gender: findings from the biological, psychological, and social sciences. New Atlantis. 2016 50:13-58.

While some people are under the impression that sexual orientation is an innate, fixed, and biological trait of human beings—that, whether heterosexual, homosexual, or bisexual, we are “born that way”—there is insufficient scientific evidence to support that claim. In fact, the concept of sexual orientation itself is highly ambiguous; it can refer to a set of behaviors, to feelings of attraction, or to a sense of identity. Epidemiological studies show a rather modest association between genetic factors and sexual attractions or behaviors, but do not provide significant evidence pointing to particular genes. There is also evidence for other hypothesized biological causes of homosexual behaviors, attractions, or identity—such as the influence of hormones on prenatal development—but that evidence, too, is limited. Studies of the brains of homosexuals and heterosexuals have found some differences, but have not demonstrated that these differences are inborn rather than the result of environmental factors that influenced both psychological and neurobiological traits. One environmental factor that appears to be correlated with non-heterosexuality is childhood sexual abuse victimization, which may also contribute to the higher rates of poor mental health outcomes among non-heterosexual subpopulations, compared to the general population. Overall, the evidence suggests some measure of fluidity in patterns of sexual attraction and behavior—contrary to the “born that way” notion that oversimplifies the vast complexity of human sexuality.

Homosexuality and scientific evidence: On suspect anecdotes, antiquated data, and broad generalizations (Kinney, systematic review, 2015).

The American Psychiatric Association and the American Psychological Association have suggested for many years now that there is significant empirical evidence supporting the claim that homosexuality is a normal variant of human sexual orientation as opposed to a mental disorder. This paper summarizes and analyzes that purported scientific evidence and explains that much (if not all) of the evidence is irrelevant and does not support the homosexuality-is-not-a-mental-disorder claim. As a result of their deficiencies and arbitrariness, the credibility those two groups that are typically deemed authoritative and trustworthy is called into question. Lay summary: At one time, homosexuality was considered to be mentally disordered. Since the 1970s, however, major medical associations in the U.S. have labeled homosexuality as a normal counterpart of heterosexuality. Those medical associations have proposed that their homosexuality-is-normal claim is based on “scientific evidence.” This article critically reviews that “scientific evidence” and finds that much of their literature does not support the claim that homosexuality is normal. This article suggests that instead of supporting their claim with scientific evidence, those major medical associations arbitrarily label homosexuality as normal.

Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD (Drescher, review, 2015)

The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM’s gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of ‘gender dysphoria’. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients’ needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process.

Human Homosexuality: a Paradigmatic Arena for Sexually Antagonistic Selection? (Ciani et al, review, 2015)

Sexual conflict likely plays a crucial role in the origin and maintenance of homosexuality in our species. Although environmental factors are known to affect human homosexual (HS) preference, sibling concordances and population patterns related to HS indicate that genetic components are also influencing this trait in humans. We argue that multilocus, partially X-linked genetic factors undergoing sexually antagonistic selection that promote maternal female fecundity at the cost of occasional male offspring homosexuality are the best candidates capable of explaining the frequency, familial clustering, and pedigree asymmetries observed in HS male proband families. This establishes male HS as a paradigmatic example of sexual conflict in human biology. HS in females, on the other hand, is currently a more elusive phenomenon from both the empirical and theoretical standpoints because of its fluidity and marked environmental influence. Genetic and epigenetic mechanisms, the latter involving sexually antagonistic components, have been hypothesized for the propagation and maintenance of female HS in the population. However, further data are needed to truly clarify the evolutionary dynamics of this trait.

The Biological Basis of Human Sexual Orientation: is There a Role for Epigenetics? (Ngun and Vilain, review, 2015)

Sexual orientation is one of the largest sex differences in humans. The vast majority of the population is heterosexual, that is, they are attracted to members of the opposite sex. However, a small but significant proportion of people are bisexual or homosexual and experience attraction to members of the same sex. The origins of the phenomenon have long been the subject of scientific study. In this chapter, we will review the evidence that sexual orientation has biological underpinnings and consider the involvement of epigenetic mechanisms. We will first discuss studies that show that sexual orientation has a genetic component. These studies show that sexual orientation is more concordant in monozygotic twins than in dizygotic ones and that male sexual orientation is linked to several regions of the genome. We will then highlight findings that suggest a link between sexual orientation and epigenetic mechanisms. In particular, we will consider the case of women with congenital adrenal hyperplasia (CAH). These women were exposed to high levels of testosterone in utero and have much higher rates of nonheterosexual orientation compared to non-CAH women. Studies in animal models strongly suggest that the long-term effects of hormonal exposure (such as those experienced by CAH women) are mediated by epigenetic mechanisms. We conclude by describing a hypothetical framework that unifies genetic and epigenetic explanations of sexual orientation and the continued challenges facing sexual orientation research.

Sanders AR et al. Genome-wide scan demonstrates significant linkage for male sexual orientation. Psychol Med. 2015 May;45(7):1379-88. doi: 10.1017/S0033291714002451. Epub 2014 Nov 17.

BACKGROUND: Findings from family and twin studies support a genetic contribution to the development of sexual orientation in men. However, previous studies have yielded conflicting evidence for linkage to chromosome Xq28.

METHOD: We conducted a genome-wide linkage scan on 409 independent pairs of homosexual brothers (908 analyzed individuals in 384 families), by far the largest study of its kind to date.

RESULTS: We identified two regions of linkage: the pericentromeric region on chromosome 8 (maximum two-point LOD = 4.08, maximum multipoint LOD = 2.59), which overlaps with the second strongest region from a previous separate linkage scan of 155 brother pairs; and Xq28 (maximum two-point LOD = 2.99, maximum multipoint LOD = 2.76), which was also implicated in prior research.

CONCLUSIONS: Results, especially in the context of past studies, support the existence of genes on pericentromeric chromosome 8 and chromosome Xq28 influencing development of male sexual orientation.

Roberts AL, Glymour MM, Koenen KC. Does maltreatment in childhood affect sexual orientation in adulthood? Arch Sex Behav. 2013 Feb;42(2):161-71. doi: 10.1007/s10508-012-0021-9. Epub 2012 Sep 14.

Epidemiological studies find a positive association between physical and sexual abuse, neglect, and witnessing violence in childhood and same-sex sexuality in adulthood, but studies directly assessing the association between these diverse types of maltreatment and sexuality cannot disentangle the causal direction because the sequencing of maltreatment and emerging sexuality is difficult to ascertain. Nascent same-sex orientation may increase risk of maltreatment; alternatively, maltreatment may shape sexual orientation. Our study used instrumental variable models based on family characteristics that predict maltreatment but are not plausibly influenced by sexual orientation (e.g., having a stepparent) as natural experiments to investigate whether maltreatment might increase the likelihood of same-sex sexuality in a nationally representative sample (n = 34,653). In instrumental variable models, history of sexual abuse predicted increased prevalence of same-sex attraction by 2.0 percentage points [95 % confidence interval (CI) = 1.4-2.5], any same-sex partners by 1.4 percentage points (95 % CI = 1.0-1.9), and same-sex identity by 0.7 percentage points (95 % CI = 0.4-0.9). Effects of sexual abuse on men’s sexual orientation were substantially larger than on women’s. Effects of non-sexual maltreatment were significant only for men and women’s sexual identity and women’s same-sex partners. While point estimates suggest much of the association between maltreatment and sexual orientation may be due to the effects of maltreatment on sexual orientation, confidence intervals were wide. Our results suggest that causal relationships driving the association between sexual orientation and childhoodabuse may be bidirectional, may differ by type of abuse, and may differ by sex. Better understanding of this potentially complex causal structure is critical to developing targeted strategies to reduce sexual orientation disparities in exposure to abuse.

Andersen JP, Blosnich J. Disparities in adverse childhood experiences among sexual minority and heterosexual adults: results from a multi-state probability-based sample. PLoS One. 2013;8(1):e54691. doi: 10.1371/journal.pone.0054691. Epub 2013 Jan 23.

BACKGROUND: Adverse childhood experiences (e.g., physical, sexual and emotional abuse, neglect, exposure to domestic violence, parental discord, familial mental illness, incarceration and substance abuse) constitute a major public health problem in the United States. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences.

PURPOSE: To examine, using the ACE scale, prevalence of childhood physical, emotional, and sexual abuse and childhood household dysfunction among sexual minority and heterosexual adults.

METHODS: Analyses were conducted using a probability-based sample of data pooled from three U.S. states’ Behavioral Risk Factor Surveillance System (BRFSS) surveys (Maine, Washington, Wisconsin) that administered the ACE scale and collected information on sexual identity (n = 22,071).

RESULTS: Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers.

CONCLUSIONS: Sexual minority individuals have increased exposure to multiple developmental risk factors beyond physical, sexual and emotional abuse. We recommend the use of the Adverse Childhood Experiences scale in future research examining health disparities among this minority population.

Zietsch BP, Verweij KJ, Heath AC, Madden PA, Martin NG, Nelson EC, Lynskey MT. Do shared etiological factors contribute to the relationship between sexual orientation and depression? Psychol Med. 2012 Mar;42(3):521-32. doi: 10.1017/S0033291711001577. Epub 2011 Aug 26.

BACKGROUND: Gays, lesbians and bisexuals (i.e. non-heterosexuals) have been found to be at much greater risk for many psychiatric symptoms and disorders, including depression. This may be due in part to prejudice and discrimination experienced by non-heterosexuals, but studies controlling for minority stress, or performed in very socially liberal countries, suggest that other mechanisms must also play a role. Here we test the viability of common cause (shared genetic or environmental etiology) explanations of elevated depression rates in non-heterosexuals.

METHOD: A community-based sample of adult twins (n=9884 individuals) completed surveys investigating the genetics of psychiatric disorder, and were also asked about their sexual orientation. Large subsets of the sample were asked about adverse childhood experiences such as sexual abuse, physical abuse and risky family environment, and also about number of older brothers, paternal and maternal age, and number of close friends. Data were analyzed using the classical twin design.

RESULTS: Non-heterosexual males and females had higher rates of lifetime depression than their heterosexual counterparts. Genetic factors accounted for 31% and 44% of variation in sexual orientation and depression respectively. Bivariate analysis revealed that genetic factors accounted for a majority (60%) of the correlation between sexual orientation and depression. In addition, childhoodsexual abuse and risky family environment were significant predictors of both sexual orientation and depression, further contributing to their correlation.

CONCLUSIONS: Non-heterosexual men and women had elevated rates of lifetime depression, partly due to shared etiological factors, although causality cannot be definitively resolved.

Friedman MS, Marshal MP, Guadamuz TE, Wei C, Wong CF, Saewyc E, Stall R. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health. 2011 Aug;101(8):1481-94. doi: 10.2105/AJPH.2009.190009. Epub 2011 Jun 16.

OBJECTIVES: We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation.

METHODS: We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities.

RESULTS: Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s.

CONCLUSIONS: The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.

Rothman EF, Exner D, Baughman AL. The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: a systematic review. Trauma Violence Abuse. 2011 Apr;12(2):55-66. doi: 10.1177/1524838010390707. Epub 2011 Jan 19.

This article systematically reviews 75 studies that examine the prevalence of sexual assault victimization among gay or bisexual (GB) men, and lesbian or bisexual (LB) women, in the United States. All studies were published between 1989 and 2009 and report the results of quantitative research. The authors reviewed the reported prevalence of lifetime sexual assault victimization (LSA), and where available, childhood sexual assault (CSA), adult sexual assault (ASA), intimate partner sexual assault (IPSA), and hate crime-related sexual assault (HC). The studies were grouped into those that used a probability or census sampling technique (n=25) and those that used a non-probability or ”community-based” sampling technique (n=50). A total of 139,635 gay, lesbian, and bisexual(GLB) respondents participated in the underlying studies reviewed. Prevalence estimates of LSA ranged from 15.6-85.0% for LB women and 11.8-54.0% for GB men. Considering the median estimates derived from the collective set of studies reviewed, LB women were more likely to report CSA, ASA, LSA, and IPSA than GB men, whereas GB men were more likely to report HC than LB women. Across all studies, the highest estimates reported were for LSA of LB women (85.0%), CSA of LB women (76.0%), and CSA of GB men (59.2%). With some exceptions, studies using non-probability samples reported higher sexual assault prevalence rates than did population-based or census sample studies. The challenges of assessing sexual assault victimization with GLB populations are discussed, as well as the implications for practice, policy, and future research.

Hines M. Prenatal endocrine influences on sexual orientation and on sexually differentiated childhood behavior. Front Neuroendocrinol. 2011 Apr;32(2):170-82. doi: 10.1016/j.yfrne.2011.02.006. Epub 2011 Feb 17.

Both sexual orientation and sex-typical childhood behaviors, such as toy, playmate and activity preferences, show substantial sex differences, as well as substantial variability within each sex. In other species, behaviors that show sex differences are typically influenced by exposure to gonadal steroids, particularly testosterone and its metabolites, during early development (prenatally or neonatally). This article reviews the evidence regarding prenatal influences of gonadal steroids on human sexual orientation, as well as sex-typed childhood behaviors that predict subsequent sexual orientation. The evidence supports a role for prenatal testosterone exposure in the development of sex-typed interests in childhood, as well as in sexual orientation in later life, at least for some individuals. It appears, however, that other factors, in addition to hormones, play an important role in determining sexual orientation. These factors have not been well-characterized, but possibilities include direct genetic effects, and effects of maternal factors during pregnancy. Although a role for hormones during early development has been established, it also appears that there may be multiple pathways to a given sexual orientation outcome and some of these pathways may not involve hormones.

Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. Am J Public Health. 2010 Dec;100(12):2433-41. doi: 10.2105/AJPH.2009.168971. Epub 2010 Apr 15.

OBJECTIVES: We assessed sexual orientation disparities in exposure to violence and other potentially traumatic events and onset of posttraumatic stress disorder (PTSD) in a representative US sample.

METHODS: We used data from 34 653 noninstitutionalized adult US residents from the 2004 to 2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS: Lesbians and gay men, bisexuals, and heterosexuals who reported any same-sex sexual partners over their lifetime had greater risk of childhood maltreatment, interpersonal violence, trauma to a close friend or relative, and unexpected death of someone close than did heterosexuals with no same-sex attractions or partners. Risk of onset of PTSD was higher among lesbians and gays (adjusted odds ratio [AOR] = 2.03; 95% confidence interval [CI] = 1.34, 3.06), bisexuals (AOR = 2.13; 95% CI = 1.38, 3.29), and heterosexuals with any same-sex partners (AOR = 2.06; 95% CI = 1.54, 2.74) than it was among the heterosexual reference group. This higher risk was largely accounted for by sexual orientation minorities’ greater exposure to violence, exposure to more potentially traumatic events, and earlier age of trauma exposure.

CONCLUSIONS: Profound sexual orientation disparities exist in risk of PTSD and in violence exposure, beginning in childhood. Our findings suggest there is an urgent need for public health interventions aimed at preventing violence against individuals with minoritysexual orientations and providing follow-up care to cope with the sequelae of violent victimization.

Långström N, Rahman Q, Carlström E, Lichtenstein P.  Genetic and environmental effects on same-sex sexual behavior: a population study of twins in Sweden. Arch Sex Behav. 2010 Feb;39(1):75-80. doi: 10.1007/s10508-008-9386-1. Epub 2008 Jun 7.

There is still uncertainty about the relative importance of genes and environments on human sexual orientation. One reason is that previous studies employed self-selected, opportunistic, or small population-based samples. We used data from a truly population-based 2005-2006 survey of all adult twins (20-47 years) in Sweden to conduct the largest twin study of same-sex sexual behaviorattempted so far. We performed biometric modeling with data on any and total number of lifetime same-sex sexual partners, respectively. The analyses were conducted separately by sex. Twin resemblance was moderate for the 3,826 studied monozygotic and dizygotic same-sex twin pairs. Biometric modeling revealed that, in men, genetic effects explained .34-.39 of the variance, the shared environment .00, and the individual-specific environment .61-.66 of the variance. Corresponding estimates among women were .18-.19 for genetic factors, .16-.17 for shared environmental, and 64-.66 for unique environmental factors. Although wide confidence intervals suggest cautious interpretation, the results are consistent with moderate, primarily genetic, familial effects, and moderate to large effects of the nonshared environment (social and biological) on same-sex sexual behavior.

Wilson HW, Widom CS. Does physical abuse, sexual abuse, or neglect in childhood increase the likelihood of same-sex sexual relationships and cohabitation? A prospective 30-year follow-up. Arch Sex Behav. 2010 Feb;39(1):63-74. doi: 10.1007/s10508-008-9449-3. Epub 2009 Jan 7.

Existing cross-sectional research suggests associations between physical and sexual abuse in childhood and same-sex sexual orientation in adulthood. This study prospectively examined whether abuse and/or neglect in childhood were associated with increased likelihood of same-sex partnerships in adulthood. The sample included physically abused (N = 85), sexually abused (N = 72), and neglected (N = 429) children (ages 0-11) with documented cases during 1967-1971 who were matched with non-maltreated children (N = 415) and followed into adulthood. At approximately age 40, participants (483 women and 461 men) were asked about romantic cohabitation and sexual partners, in the context of in-person interviews covering a range of topics. Group (abuse/neglect versus control) differences were assessed with cross-tabulations and logistic regression. A total of 8% of the overall sample reported any same-sex relationship (cohabitation or sexual partners). Childhood physical abuse and neglect were not significantly associated with same-sex cohabitation or sexual partners. Individuals with documented histories of childhood sexual abuse were significantly more likely than controls to report ever having had same-sex sexual partners (OR = 2.81, 95% CI = 1.16-6.80, p < or = .05); however, only men with histories of childhood sexual abuse were significantly more likely than controls to report same-sex sexual partners (OR = 6.75, 95% CI = 1.53-29.86, p < or = .01). These prospective findings provide tentative evidence of a link between childhood sexual abuse and same-sex sexual partnerships among men, although further research is needed to explore this relationship and to examine potential underlying mechanisms.

King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, Nazareth I. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008 Aug 18;8:70. doi: 10.1186/1471-244X-8-70.

BACKGROUND: Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.

METHOD: We conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.

RESULTS: Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54-2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51-4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97-5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88).

CONCLUSION: LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.

Cochran SD, Mays VM. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: results from the California Quality of Life Survey. Am J Public Health. 2007 Nov;97(11):2048-55. Epub 2007 Apr 26.

OBJECTIVES: We examined evidence that minority sexual orientation is associated with more-frequent reports of physical health complaints. We also investigated the possible role of HIV infection among gay men and higher rates of psychological distress among lesbians, gay men, and bisexually and homosexually experienced heterosexual individuals in generating these health disparities.

METHODS: We used data from the California Quality of Life Survey (N=2272 adults) to examine associations between sexual orientation and self-reports about physical health status, common health conditions, disabilities, and psychological distress.

RESULTS: Prevalent HIV infection was reported by nearly 18% of gay, bisexual, and homosexually experienced heterosexual men.Gay men and bisexual and homosexually experienced heterosexual individuals had higher levels of psychological distress compared with exclusively heterosexual individuals. Self-reported physical health status varied by gender and by sexual orientation.

CONCLUSIONS: Lesbians and bisexual and homosexually experienced heterosexual women reported a greater variety of health conditions and limitations compared with exclusively heterosexual women; however, these differences mostly disappeared when distress levels were taken into account. Among men, differences in health complaints appeared to reflect the ongoing burden of HIV and other sexually transmitted diseases in the gay male community.