Patterns of Mental Health Needs, Barriers to Care and Mental Health Service Utilization Among Bisexual People

Background/Purpose

Mental health disparities are particularly pronounced among bisexual, pansexual, queer and other non-monosexual people (bisexual+, bi+; i.e., people identifying as having attraction to more than one gender), who comprise most of the growing population of sexual minority adults in the United States. In addition to documented disparities in mental health needs, odds of reporting unmet need for mental health care are disproportionately high among bi+ people as compared to cisgender heterosexual people. Building on emerging evidence, this study sought to explore the extent to which bi+ mental health disparities may be affected by factors that do not similarly impact non-bi+ sexual minority people with respect to mental health care.

Methods

This research seeks to identify potential distinct mechanisms underlying mental health disparities for bi+ people (as compared to gay and lesbian people). It employs Latent Class Analysis (LCA) for two aims: 1) to determine how patterns of mental health needs and barriers to care for bi+ people may differ from those of gay and lesbian people (i.e., non-bi+ sexual minority people); and 2) to understand how these distinct patterns of mental health needs and barriers to care correspond to mental health service utilization for bi+ people, as compared to non-bi+ sexual minority people. We utilized data from the 7^th version of All of Us, a population health dataset that includes information on a large and diverse convenience sample of adults in the United States. Analyses integrated responses across several questionnaires, including The Basics, Overall Health, COVID-19 Participant Experience and Healthcare Access & Utilization surveys. The data include participant demographics, assessments of mental health needs, reports of barriers to accessing health care and mental health service utilization behavior. A total of 1,554 sexual minority people were included in the LCA.

Results

The data supported a four-class solution based upon the included indicator variables. The classes were characterized based upon reported barriers to care and mental health needs among participants as follows: Class 1) Low barriers/low need; Class 2) Low barriers/high need; Class 3) Moderate barriers/low need; Class 4) High barriers/high need. The low barrier/low need class had the lowest concentration of people who identified as bi+ (41%), whereas bi+ people comprised 63% of the low barrier/high need class, 75% of the moderate barrier/low need, and 74% of the high barrier/high need class, indicating that bi+ people face greater barriers to care and mental health needs. Despite reporting more barriers to care, bi+ people also reported a significantly higher prevalence of mental health service utilization compared to their gay and lesbian counterparts.

Conclusions and Implications

The study findings point to a need for deeper understanding of how bi+ people are differentially impacted by mental health needs and barriers to mental health care. The ubiquity of unmet need for mental health care among bi+ people, along with the present study’s results indicating higher rates of mental health service utilization among bi+ people, supports further research on mental health care providers and care systems to better serve the unique needs of this population.