title: Bisexuality, poverty and mental health: A mixed methods analysis.
abstract: Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 560, Toronto, Ontario, M5T 3M7, Canada; Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada. Electronic address: l.ross@utoronto.ca.
authors.forename: Lori E
authors.initials: LE
authors.lastname: Ross
authors.affiliation: School of Rural and Northern Health, Laurentian University, 935 Ramsey Lake Rd., Sudbury, Ontario, P3E 2C6, Canada.
authors.forename: Laurel
authors.initials: L
authors.lastname: O'Gorman
authors.affiliation: Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, Kresge Building Room K201, London, Ontario, N6A 5C1, Canada.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: MacLeod
authors.affiliation: Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, Kresge Building Room K201, London, Ontario, N6A 5C1, Canada.
authors.forename: Greta R
authors.initials: GR
authors.lastname: Bauer
authors.affiliation: Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada.
authors.forename: Jenna
authors.initials: J
authors.lastname: MacKay
authors.affiliation: Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada; Ontario HIV Treatment Network, 1300 Yonge St. Suite 600, Toronto, Ontario, M4T 1X3, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Robinson
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011203:Poverty / Q000523:psychology* / Q000706:statistics & numerical data; D011287:Prejudice / Q000523:psychology; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Bisexuality; Canada; Mental health; Mixed methods; Poverty; Socioeconomic status