The study highlights gaps in measuring sexual orientation and mental health risks

Sexual orientation-; determined by factors such as sexual identity, attraction and behavior; it is difficult to measure in detail. This is reflected in the differences in the number of gay, lesbian and transgender people reported across surveys using different measurement methods. Many approaches focus on ‘sexual identity’ to understand differences in mental health, but differences in the concepts of ‘identity’ and ‘attraction/behaviour’ are common. For example, some people report same-sex attraction but identify as ‘heterosexual’ in surveys. This suggests an ‘invisible’ group of transsexuals-;who do not conform to traditional labels, but have the same psychological stress as other non-sexuals-; they are still not recognized by policies aimed at supporting mental health.

In order to improve the introduction and importance of the current measurements of sex, Assistant Professor Dr. Nicole F. Kahn of the University of Washington and the research team published their study in American Journal of Public Health on November 6, 2024. Dr. Kahn explains, “The purpose of this study was to describe and compare the responses of respondents to fill out 2 different research questions designed to measure sexual attitudes and to understand how the differences in responses to these questions are related to the results of mental health.“The team hypothesized that measures using a broad sexual continuum would identify more respondents who are sexually active (SM) than those using narrower criteria, and that people who identify as heterosexual in the survey e’ one and SM in the other will show the same mental health patterns as the SM respondents in both studies.

The National Longitudinal Study of Adolescent to Adult Health (Enhance Health) has a group of school students who were followed from 1994-1995 (wave I) until 2016-2019 (wave V ), and wave VI is ongoing. Between 2020 and 2021, participants in the Add Health study were invited to complete the Sexuality/Gender Identity, Socioeconomic Status, and Health in the Life Course (SOGI-SES) survey. Dr. Kahn says, “Participants identified as mostly heterosexual, heterosexual, same-sex or same-sex; report same-sex partners in waves III, IV or V; or were non-conforming in terms of sex at birth and gender identity (eg, androgynous or gender nonconforming) at wave V were all asked to participate in the SOGI-SES. We refer to respondents as sexual and gender minorities (SGMs)”.

In the survey, respondents answered two questions about sexual attitudes: one from the Add Health survey that provided a continuum from ‘100% heterosexual’ to ‘no sexual interest in men or women,’ ‘ second from the National Health Interview Survey (NHIS) to provide fewer options. Those who identified as “heterosexual (straight)” in both surveys were classified as such, while those who voted for non-heterosexual in both were classified as sexual minorities. A third group, called ‘invisible sexual minorities’, included those who identified as ‘100% heterosexual (straight)’ in one survey but in another as the choice of the minority sex. Mental health outcomes were assessed by asking respondents if they had ever been diagnosed with conditions such as depression, anxiety or panic attacks. Gender was assigned based on sex at birth and current gender identity.

Of the 2,576 respondents, Dr. Kahn noted, “A greater proportion of cisgender men (93.9%) and cisgender women (91.2%) identified as ‘straight’ in response to the NHIS questionnaire compared to cisgender men (92.2%) and cisgender women (79.1%) ) identified as ‘100% heterosexual’ in response to Add Health’s question.“This study finds that the ADD health questionnaire was able to detect more SM than the NHIS questionnaire (14.4% vs 6.8%). Interestingly, cisgender women were more likely of not being diagnosed by the NHIS than cisgender men (12.8% vs 2.6%).In terms of mental health outcomes, SMs and undiagnosed SMs were were more likely to report a depressive disorder than heterosexual respondents; similarly, prevalence of anxiety or panic attacks was significantly different between SMs and heterosexuals different or straight respondents among cisgender males (46.3% vs. 30.1%) and cisgender female respondents (54.7% vs. 37.1%).

Current sexist measures may lead to an underestimation of the SM population, thereby underestimating the health differences they experience.. “Further research on alternative interventions that consider response patterns that reflect broader sexuality development is needed to inform health policy and service planning to meet the needs of sexually minority populations,” concluded Dr. Kahn.

Sexual orientation-; determined by factors such as sexual identity, attraction and behavior; it is difficult to measure in detail. This is reflected in the differences in the number of gay, lesbian and transgender people reported across surveys using different measurement methods. Many approaches focus on ‘sexual identity’ to understand differences in mental health, but differences in the concepts of ‘identity’ and ‘attraction/behaviour’ are common. For example, some people report same-sex attraction but identify as ‘heterosexual’ in surveys. This suggests an ‘invisible’ group of transsexuals-;who do not conform to traditional labels, but have the same psychological stress as other non-sexuals-; they are still not recognized by policies aimed at supporting mental health.

In order to improve the introduction and importance of the current measurements of sex, Assistant Professor Dr. Nicole F. Kahn of the University of Washington and the research team published their study in American Journal of Public Health on November 6, 2024. Dr. Kahn explains, “The purpose of this study was to describe and compare the responses of respondents to fill out 2 different research questions designed to measure sexual attitudes and to understand how the differences in responses to these questions are related to the results of mental health.“The team hypothesized that measures using a broad sexual continuum would identify more respondents who are sexually active (SM) than those using narrower criteria, and that people who identify as heterosexual in the survey e’ one and SM in the other will show the same mental health patterns as the SM respondents in both studies.

The National Longitudinal Study of Adolescent to Adult Health (Enhance Health) has a group of school students who were followed from 1994-1995 (wave I) until 2016-2019 (wave V ), and wave VI is ongoing. Between 2020 and 2021, participants in the Add Health study were invited to complete the Sexuality/Gender Identity, Socioeconomic Status, and Health in the Life Course (SOGI-SES) survey. Dr. Kahn says, “Participants identified as mostly heterosexual, heterosexual, same-sex or same-sex; report same-sex partners in waves III, IV or V; or were non-conforming in terms of sex at birth and gender identity (eg, androgynous or gender nonconforming) at wave V were all asked to participate in the SOGI-SES. We refer to respondents as sexual and gender minorities (SGMs)”.

In the survey, respondents answered two questions about sexual attitudes: one from the Add Health survey that provided a continuum from ‘100% heterosexual’ to ‘no sexual interest in men or women,’ ‘ second from the National Health Interview Survey (NHIS) to provide fewer options. Those who identified as “heterosexual (straight)” in both surveys were classified as such, while those who voted for non-heterosexual in both were classified as sexual minorities. A third group, called ‘invisible sexual minorities’, included those who identified as ‘100% heterosexual (straight)’ in one survey but in another as the choice of the minority sex. Mental health outcomes were assessed by asking respondents if they had ever been diagnosed with conditions such as depression, anxiety or panic attacks. Gender was assigned based on sex at birth and current gender identity.

Of the 2,576 respondents, Dr. Kahn noted, “A greater proportion of cisgender men (93.9%) and cisgender women (91.2%) identified as ‘straight’ in response to the NHIS questionnaire compared to cisgender men (92.2%) and cisgender women (79.1%) ) identified as ‘100% heterosexual’ in response to Add Health’s question.“This study finds that the ADD health questionnaire was able to detect more SM than the NHIS questionnaire (14.4% vs 6.8%). Interestingly, cisgender women were more likely of not being diagnosed by the NHIS than cisgender men (12.8% vs 2.6%).In terms of mental health outcomes, SMs and undiagnosed SMs were were more likely to report a depressive disorder than heterosexual respondents; similarly, prevalence of anxiety or panic attacks was significantly different between SMs and heterosexuals different or straight respondents among cisgender males (46.3% vs. 30.1%) and cisgender female respondents (54.7% vs. 37.1%).

Current sexist measures may lead to an underestimation of the SM population, thereby underestimating the health differences they experience.. “Further research on alternative interventions that consider response patterns that reflect broader sexuality development is needed to inform health policy and service planning to meet the needs of sexually minority populations,” concluded Dr. Kahn.