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Published Online: 1 August 2024

Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use

Evan A. Krueger, Ph.D. [email protected], Meg D. Bishop, Ph.D., Allen B. Mallory, Ph.D., Ankur Srivastava, Ph.D., and Stephen T. Russell, Ph.D.Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 181, Number 8
https://doi.org/10.1176/appi.ajp.20230458
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Abstract

Objective:

Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people.

Methods:

Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health.

Results:

Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=−0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=−0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs.

Conclusions:

Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 181 • Number 8 • August 01, 2024
Pages: 753 - 760
PubMed: 39086296

History

Received: 7 June 2023
Revision received: 11 September 2023
Revision received: 12 October 2023
Accepted: 8 November 2023
Published online: 1 August 2024
Published in print: August 01, 2024

Keywords

  1. Epidemiology
  2. Identity Change
  3. Lesbian/Gay/Bisexual/Transgender (LGBT) Issues
  4. Mental Health
  5. Sexual Identity
  6. Substance Use

Authors

Affiliations

Evan A. Krueger, Ph.D. [email protected]
School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell).
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Meg D. Bishop, Ph.D.
School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell).
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Allen B. Mallory, Ph.D.
School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell).
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Ankur Srivastava, Ph.D.
School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell).
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Stephen T. Russell, Ph.D.
School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell).
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Notes

Send correspondence to Dr. Krueger ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Research reported in this article is part of the Generations study, supported by the National Institute of Child Health and Human Development (grant R01HD078526). This research was also supported by NIAAA (grant F32AA030194 to Dr. Bishop) and NIDA (grants L60DA057024 to Dr. Krueger and L60DA054640 to Dr. Mallory). Additional support was provided by the California Department of Cannabis Control (grant RG-1603145394-175 to Dr. Krueger), the Centers for Disease Control and Prevention (cooperative agreement U48DP006382 to the University of Maryland Prevention Research Center), and the National Institute of Child Health and Human Development (grants P2CHD041041 to the Maryland Population Research Center, P2CHD058484 to Ohio State University’s Institute for Population Research, and P2CHD042849 to the Population Research Center at University of Texas at Austin).

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