Sexual Orientation and Estimates of Adult Substance Use and Mental Health
Abstract
Background: Research suggests that sexual minorities (e.g. people who identify as lesbian, gay, or bisexual) are at greater risk for substance use and mental health issues compared with the sexual majority population that identifies as being heterosexual. Although sexual orientation is not a new construct, many federally funded surveys have only recently begun to identify sexual minorities in their data collections. In 2015, the National Survey on Drug Use and Health (NSDUH) added two questions on sexual orientation, one for sexual identity and one for sexual attraction, making it the first nationally representative, comprehensive source of federally collected information on substance use and mental health issues among sexual minority adults.
Methods: To assess the validity of the data, NSDUH estimates of sexual attraction and sexual identity were compared with estimates from three other national surveys: the National Survey of Family Growth, the National Health Interview Survey, and the General Social Survey. Adults who self-identified in a question on sexual identity as being heterosexual or straight were defined as being in the sexual majority group. Adults who self-identified as being gay, lesbian, or bisexual in the same question were defined as being in the sexual minority group. This report presents estimates for substance use and mental health issues from the 2015 NSDUH for adults aged 18 or older by sexual identity. Additionally, NSDUH estimates for substance use and mental health issues were compared for sexual minorities and sexual majority members among all adults and within subgroups defined by sex and by age group. For comparisons of substance use and mental health estimates, statistically significant differences are noted between the sexual majority and sexual minority groups.
Results: Estimates from NSDUH for sexual attraction and sexual identity were comparable with estimates from other national surveys. Based on the 2015 NSDUH, 4.3 percent of adults aged 18 or older identified as a sexual minority, including 1.8 percent who identified as being lesbian or gay and 2.5 percent who identified as being bisexual. Sexual minorities were more likely than their sexual majority counterparts to have substance use and mental health issues. The greater likelihood of sexual minority adults to have substance use and mental health issues compared with their sexual majority counterparts was observed across subgroups of adults defined by sex and by age group. In particular, sexual minorities were more likely to use illicit drugs in the past year, to be current cigarette smokers, and to be current alcohol drinkers compared with their sexual majority counterparts. Sexual minority adults were also more likely than sexual majority adults to have substance use disorders in the past year, including disorders related to their use of alcohol, illicit drugs, marijuana, or misuse of pain relievers. Sexual minority adults were more likely than their sexual majority counterparts to need substance use treatment. Among adults who needed substance use treatment, sexual minority adults were more likely than their sexual majority counterparts to receive substance use treatment at a specialty facility. Sexual minority adults were also more likely than sexual majority adults to have any mental illness (AMI), serious mental illness (SMI), and AMI excluding SMI in the past year. Sexual minority adults were also more likely than their sexual majority counterparts to have a major depressive episode (MDE) or to have had an MDE with severe impairment in the past year. Sexual minority adults with AMI were more likely than sexual majority adults with AMI to receive mental health services during the past 12 months.
Conclusions: This first set of findings from NSDUH on substance use and mental health issues for adults by sexual identity is important to the Substance Abuse and Mental Health Services Administration for understanding the health issues faced by sexual minorities in the United States. Additional years of data will allow changes to be tracked over time for substance use, substance use treatment, mental health issues, and the use of mental health services among sexual minority adults and will enable researchers to examine issues in greater depth for specific sexual minority subgroups. Future research involving NSDUH and other data sources also will be useful for understanding factors associated with substance use or mental health issues among sexual minorities.
