High Prevalence of Depression Symptoms Among Bisexual Women: The Association of Sexual Orientation and Gender on Depression Symptoms in a Nationally Representative U.S. Sample

Bisexual individuals experience higher rates of depression than heterosexual individuals and women experience higher rates of depression than men; however, few studies have quantified the joint effects of sexual orientation and gender. In the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey, depression symptoms were assessedusing the Patient Health Questionnaire. We used pooled and gender-stratified Poisson regression with robust variances to determine the independent effects of sexual orientation and gender on depression symptoms and calculated relative excess risk due to interaction to examine the joint effects of bisexual orientation and women's gender on depression symptoms. In adjusted models, depression symptoms were 1.78 times higher in women than in men (99% confidence interval [CI]: 1.776, 1.782), 1.73 times higher in bisexual individuals than in heterosexual individuals (99% CI: 1.726, 1.735), and 3.15 times higher in bisexual women than in heterosexual men (99% CI: 3.145, 3.163). We found evidence for a non-additive model of the excess prevalence of depression symptoms among bisexual women. Gender-specific services addressing the unique mental health needs of bisexual women are needed.