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Arch Gen Psychiatry. Background It has been suggested that homosexuality is associated with psychiatric morbidity. Methods Data were collected in face-to-face interviews, using the Composite International Diagnostic Interview. Classification as heterosexual or homosexual was based on reported sexual behavior in the preceding year. Five thousand nine hundred ninety-eight Differences in prevalence rates were tested by logistic regression analyses, controlling for demographics.
Psychiatric disorders were more prevalent among homosexually active people compared with heterosexually active people. Conclusion The findings support the assumption that people with same-sex sexual behavior are at greater risk for psychiatric disorders. Inthe American Psychiatric Association removed homosexuality from its list of mental disorders. This removal came about because of support from research findings 1 - 4 and as a result of a persistent plea by both professionals and activists.
In response to the former psychiatric stigmatization of homosexuality and ideologically inspired by a social movement aiming to achieve greater acceptance of homosexual people, some authors subsequently stressed the equality in mental health status of homosexual and heterosexual people. Although many studies have assessed the mental health status of homosexual men and women, the are still inconclusive. This is predominantly due to a variety of methodological problems, characteristic of most studies done since the s, such as the use of convenience samples, small sample sizes, lack of adequate comparison groups, failure to control for potentially confounding factors, application of nonstandardized research instruments, and questionable external validity.
Recent studies applying a more rigorous methodology showed that there is substantial support for the existence of orientation-related differences in mental health status. In a population-based study among adolescents, suicidal intent and actual suicide attempts were related to homosexuality in males but not females.
Our study aims to explore differences in the prevalence of DSM-III-R psychiatric disorders in relation to homosexuality and to overcome some of the limitations of the earlier studies. It does so by using a large, representative sample of the Dutch population selected without reference to sexual orientation and allowing for separate analyses for men and women. The study categorizes people as homosexual or heterosexual based on recent rather than lifetime behavior, the latter being a more diffuse categorization than the former.
By looking at both lifetime and month prevalence, we were able to assess the relationship between homosexuality and mental health more precisely than most other studies. A detailed description of the de of the study and the major outcomes have been ly published. One respondent was randomly selected in each household. The interviewers made a minimum of 10 calls or visits to an address at different points in time and days of the week to make contact. To optimize response and to compensate for possible seasonal influences, the initial fieldwork was extended over the entire period from February through December A total of persons were interviewed.
Respondents provided verbal consent after having been informed about the aims of the study. The interviewer entered data into a computer during the interview. According to the method of assessment, the response was Persons who declined to take part in the full interview were asked to furnish several key pieces of data. Of these persons, The psychiatric morbidity estimated with the General Health Questionnaire, 26 taking into sex, age, and urbanicity of these nonresponders did not ificantly differ from that of the respondents.
The CIDI has acceptable interrater reliability, 29 acceptable test-retest reliability 30 and acceptable validity for practically all diagnoses, with the exception of acute psychotic presentations. The following DSM-III-R diagnoses were recorded: mood disorders depression, dysthymia, bipolar disorderanxiety disorders panic disorder, agoraphobia, social phobia, simple phobia, obsessive-compulsive disorder, generalized anxiety disorderpsychoactive substance use disorders alcohol or other drug abuse and dependence, including sedatives, hypnotics, and anxiolytics.
Although eating disorders and schizophrenia and other nonaffective psychotic disorders were recorded as well, these data are not presented here because of their low prevalence. The assessment of psychiatric symptoms took place before subjects were asked about their sexual behavior, thus minimizing the chance of contamination. The fieldwork was done by 90 interviewers, experienced in systematic data collection and extensively trained in recruiting respondents and computer-assisted interviewing. Respondents were asked verbally whether they had sexual contact in the preceding year and the gender of their partner s.
If the respondent had had sex with someone of the same gender exclusively or nothe or she was categorized as homosexual. Other sexually active people were categorized as heterosexual. Homosexually active men and exclusively heterosexually active subjects are subsequently referred to in this article as homosexual and heterosexual persons, respectively. Sexual orientation itself was not assessed. Of the total of persons, 30 respondents did not answer the questions regarding their sexual behavior.
Of the remaining More men than women reported having been sexually active Of the sexually active respondents, 5 lacked the necessary data to classify them as heterosexual or homosexual, leaving persons for the present analysis. Of the men, 2. Of the women, 1. To assess differences in prevalence rates, adjusted odds ratios ORs were computed separately for men and women.
Age, level of education, residency, and not having a steady partner were controlled for in these analyses, given that these variables were positively related to prevalence rates in the total sample. Homosexual and heterosexual respondents differed on education and relationship status Table 1. Both homosexual men and women had a relatively higher educational level than heterosexual men and women. Both homosexual men and women less frequently reported being currently in a steady relationship than heterosexual men and women.
Homosexual and heterosexual men differed on residency status. Homosexual men were more likely than heterosexual men to live in urban areas. Compared with heterosexual men, homosexual men had ificantly higher month and lifetime rates of mood and anxiety disorders Table 2 and Table 3. Inspection of the specific mood disorders revealed that compared with heterosexual men, homosexual men had a much larger chance of having had month and lifetime bipolar disorders and a higher chance of having had lifetime major depression but no ificant differences were seen regarding dysthymia.
Regarding the specific anxiety disorders, the lifetime prevalence was ificantly higher in homosexual men than in heterosexual men for all but generalized anxiety disorder. The biggest differences were found in obsessive-compulsive disorder and agoraphobia.
The month prevalences of agoraphobia, simple phobia, and obsessive-compulsive disorder were higher in homosexual men than in heterosexual men. Regarding substance use disorders, the only ificant difference was found in lifetime alcohol abuse. This is the only disorder more frequently observed in heterosexual men than in homosexual men. Homosexual men were not more likely than heterosexual men to report 1 or more month and lifetime disorders. More homosexual men than heterosexual men had 2 or more disorders, both lifetime and in the preceding year.
Not controlling for relationship status resulted in an increase in the various ORs data not shown. Furthermore, some differences in month and lifetime prevalence became statistically ificant. There were no ificant differences between homosexual and heterosexual women in the month prevalence of mood and anxiety disorders. On a lifetime basis, homosexual women had a ificantly higher prevalence of general mood disorders and major depression than did heterosexual women.
The lifetime prevalence of anxiety disorders did not differ between homosexual and heterosexual women. Regarding the preceding year, homosexual women reported a substantially higher rate of substance use disorders than did heterosexual women, although differences in the specific substance use disorders were not ificant.
Lifetime prevalence of both alcohol and other drug dependence was also ificantly higher in homosexual women than in heterosexual women. Although more homosexual women than heterosexual women reported 1 or more DSM-III-R diagnoses, lifetime and in the preceding year, only the former difference was ificant.
Homosexual women were more likely than heterosexual women to have had 2 or more disorders during their lifetime but not in the preceding year. If relationship status was not controlled for, ORs increased and the differences in month alcohol dependence and lifetime social phobia were also ificant. This study found a higher prevalence of various psychiatric disorders in homosexual people compared with heterosexual people, both regarding the preceding 12 months as well as on a lifetime basis.
These differences seem to be gender specific with a higher prevalence of substance use disorders in homosexual women and a higher prevalence of mood and anxiety disorders in homosexual men, both compared with their heterosexual counterparts. The interpretation of these findings requires consideration of some potential limitations, which could have cumulatively either inflated or deflated actual differences in prevalence rates.
Although nonresponse to specific questions was negligible owing to the computer-assisted interviewing, subjects might have differed in their reporting behavior. Compared with heterosexual men, homosexual men might have been less reluctant to admit specific complaints. Although some demographics were statistically controlled for, the possibility remains that at least part of the observed differences are ed for by some other uncontrolled confounding variables. Finally, the study might underestimate the differences between homosexual and heterosexual people owing to the limited of homosexual subjects and the consequently broad CIs of the ORs.
When compared with other studies of sexual orientation and mental health, ours has several strengths. We used a large representative sample rather than a convenience sample and selected without reference to sexual orientation. The sample size allowed for separate analyses for men and women.
The importance of this is shown by our findings. Furthermore, the outcome variables studied were assessed with a reliable and standardized diagnostic instrument, and sexual behavior was assessed only after questions regarding psychiatric disorders were answered. This study not only looked at lifetime prevalence of psychiatric disorders but prevalence in the preceding year as well, testing the relationship with homosexuality more critically.
In doing this, the findings suggest that homosexuality is not only associated with mental health problems during adolescence and early adulthood, as has been suggested, 20 but also in later life. Finally, this study did not group people together based on lifetime experiences, a common practice to make up for small s, but looked at subjects' recent sexual behavior. Although various studies have demonstrated discrepancies between homosexual behavior and homosexual orientation or homosexual self-labeling, 233233 we think that recent homosexual behavior is a better indicator of homosexual self-labeling than any lifetime homosexual involvement.
It is unclear to what extent findings from this Dutch study can be generalized to other cultures or nations. Compared with other Western countries, the Dutch social climate toward homosexuality has long been and remains considerably more tolerant. The strategy to control for demographic variables in assessing differences between heterosexual and homosexual people could be debated.
Some of these demographic differences, which were found in other representative studies as well and seem to be structural, 233337 could be considered a consequence of and not an antecedent to people's homosexuality. The larger proportion of homosexual men in urban regions compared with rural areas is usually understood as a consequence of a tendency to migrate from places with high levels of social control to more congenial social environments.
Because of the study's cross-sectional de, it is not possible to adequately address the question of the causes of the observed differences.
Differences observed in the preceding year might be a consequence of earlier differences, since ever having had a specific disorder might predispose people to subsequent disorders. Because the acquired immunodeficiency syndrome can have an important effect on homosexual men and their mental health status, 44 we asked all respondents about their human immunodeficiency virus HIV serostatus. Only one person, a heterosexual woman, reported a positive HIV status. This result reflects the very low prevalence of HIV infection and acquired immunodeficiency syndrome in the general population as well as among homosexual men in the Netherlands.
The observed differences may result both from biological and social factors and an interaction between them. Biological and genetic factors in the causes and development of homosexuality 46 - 50 might also predispose homosexual people to developing psychiatric disorders. This is in line with the higher prevalence of bipolar disorder we found in homosexual men compared with heterosexual men, which is generally considered to be largely congenital. The differential pattern of differences for men and women can also be interpreted in various ways.
First, an effect of sexual orientation in women might be more difficult to demonstrate since women already show higher levels of mood and anxiety disorders than men regardless of sexual preference. In conclusion, this study offers evidence that homosexuality is associated with a higher prevalence of psychiatric disorders.
The outcomes are in line with findings from earlier studies in which less rigorous des have been employed. The processes underlying the established differences need further study. Research into these processes should be able to disentangle the potential interplay of various factors—social, attitudinal, behavioral, and biological—instead of testing one specific factor. The most promising de for such a study requires a large sample of both men and women, and is longitudinal and cross-cultural.
J Projective Techniques. Siegelman M Adjustment of male homosexuals and heterosexuals. Arch Sex Behav.
J Abnorm Psychol. Bayer R Homosexuality and American Psychiatry. Comer RJ Abnormal Psychology.Adult seeking sex Medicine Park
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