Psychiatric, Substance Use, and Structural Disparities Between Gay and Bisexual Men with Histories of Childhood Sexual Abuse and Recent Sexual Risk Behavior

Sexual minority men disproportionately experience childhood sexual abuse (CSA) compared to heterosexual men, resulting in greater risk of psychiatric and substance use diagnoses, sexual risk taking, and HIV acquisition later in life. However, little is known about psychiatric and substance use disparities between gay and bisexual men who have experienced CSA. We recruited a purposive convenience sample in Boston and Miami, involving self-report and clinical interview data from 290 sexual minority men (M age = 38.0 years) who reported CSA, defined as unwanted sexual contact before 13 years of age with an adult or person five years older, or unwanted sexual contact between 13 and 16 years of age with a person 10 years older (or any age with the threat of force or harm). We compared those who self-identified as gay (n = 199) versus bisexual (n = 64) on demographic and structural variables (i.e., government benefits, unstable housing, and neighborhood crime) as well as psychiatric and substance use diagnoses. Across 15 unique diagnoses, three were more common in bisexual men than gay men in unadjusted models: bipolar disorder (OR = 2.90, 95% CI: 1.01–8.34), obsessive compulsive disorder (OR = 2.22, 95% CI: 1.01–4.88), and alcohol use disorder (OR = 1.86, 95% CI: 1.03–3.38). Bisexual men were also more likely to meet criteria for “any substance use disorder” than were gay men (OR = 1.99, 95% CI: 1.10–3.59). However, when race, education, and income were included as covariates, the odds ratios reduced significantly (bipolar disorder: aOR = 1.98, 95% CI: 0.59–6.61; obsessive compulsive disorder: aOR = 1.56, 95% CI: 0.64–3.77; alcohol use disorder, aOR = 1.54, 95% CI: 0.80–2.98; any substance use disorder, aOR = 1.79, 95% CI: 0.93–3.45, respectively). Our results highlight the mental health needs, including problematic substance use, of bisexual men with histories of CSA, as well as the importance of accounting for potential confounding demographic variables that may influence disparities in mental health and substance use.