Bi+ Visibility: Characteristics of Those Who Attempt to Make Their Bisexual+ Identity Visible and the Strategies They Use

Development and validation of the SAFE (Socially Ascribed intersectional identities For Equity) questionnaire

Traditional questionnaires do not capture the complexity of how people are viewed by others and grouped into categories on the basis of what is inferred (or not) about them. This is critical in applying an intersectionality framework in research because people are negatively impacted because of "who they are" but also based on "how others see them." The purpose of this project was to develop and validate a questionnaire, grounded in intersectionality theory and a nuanced understanding of social position, that can be applied in large-scale, population-based surveys and studies. Drawing on 61 existing quantitative surveys collecting identity-based information and 197 qualitative studies on intersectionality describing the complex ways in which people's social positions are constructed and experienced, we created a draft questionnaire comprising five parts: 1) Sex and Gender, 2) Sexuality and Sexual Orientation, 3) Cultural Context, 4) Disability, Health, and Physical Characteristics, and 5) Socioeconomic Status. A draft of the questionnaire was then reviewed by experts via the Delphi process, which gauged the accessibility of the questionnaire (e.g., language used, length) and the relevance of its content using a 5-point scale and open-ended questions. These responses were ranked, analyzed, and synthesized to refine the questionnaire and, ultimately, to obtain ≥75 % consensus on each questionnaire item and response option. The SAFE questionnaire provides an opportunity to take a significant step forward in advancing our understanding of the complex, intersectional nature of social participation and marginalization.

Relationships Among Determinants of Health, Cancer Screening Participation, and Sexual Minority Identity: A Systematic Review

Purpose: To address cancer screening disparities and reduce cancer risk among sexual minority (SM) groups, this review identifies individual, interpersonal, and community/societal determinants of cancer screening (non)participation among differing SM identities. Methods: Seven scientific databases were searched. Inclusion criteria were as follows: (1) used quantitative methods; (2) English language; (3) cancer screening focus; and (4) at least one SM group identified. Articles were excluded if: (1) analysis was not disaggregated by SM identity (n = 29) and (2) quantitative analysis excluded determinants of cancer screening (n = 19). The Sexual and Gender Minority Health Disparities Research Framework guided literature synthesis. Results: Twelve studies addressed cervical (n = 4), breast (n = 3), breast/cervical (n = 3), or multiple cancers (n = 2). Other cancers were excluded due to inclusion/exclusion criteria. The total sample was 20,622 (mean 1525), including lesbian (n = 13,409), bisexual (n = 4442), gay (n = 1386), mostly heterosexual (n = 1302), and queer (n = 83) identities. Studies analyzing individual-level determinants (n = 8) found that socioeconomic status affected cervical, but not breast, cancer screening among lesbian and bisexual participants (n = 2). At the interpersonal level (n = 7), provider-patient relationship was a determinant of cervical cancer screening among lesbian participants (n = 4); a relationship not studied for other groups. Studies analyzing community/societal determinants (n = 5) found that rurality potentially affected cervical cancer screening among lesbian, but not bisexual people (n = 3). Conclusions: This review identified socioeconomic status, provider-patient relationship, and rurality as determinants affecting cancer screening among SM people. While literature addresses diverse SM groups, inclusion/exclusion criteria identified studies addressing cisgender women. Addressing disparities in the identified determinants of cervical cancer screening may improve participation among SM women. Further research is needed to understand determinants of cancer screening unique to other SM groups.

Community connection is associated with lower psychological distress for sexual minority women who view community connection positively

We examined factors associated with sexual minority women's evaluations of belonging to the lesbian, gay, bisexual, transgender and queer (LGBTQ) community in Australia, and assessed whether a positive view of community participation impacted levels of psychological distress. 2424 cisgender sexual minority women participated in a national, online, cross-sectional survey of LGBTIQ adult Australians' health and well-being. Multivariable regression analyses were conducted to investigate sociodemographic factors associated with sexual minority women's belonging to the LGBTQ community, feelings towards community connection, and associations between community connection and recent psychological distress. Most sexual minority women (58.9%) reported feeling that they are part of the LGBTQ community, and a majority of the participants felt positive about being connected to this community (68.5%). Participants who were bisexual, non-university educated, and who resided in an outer-suburban location were least likely to evaluate participation in the LGBTQ community positively. Feeling positive about community connection was associated with lower levels of psychological distress. Feeling a part of LGBTQ community was associated with lower psychological distress, but this link appears contingent upon positive feelings about community participation. Sexual minority women's' relationships to the LGBTQ community are often complex, and community connection and participation in and of itself is not a panacea for the negative outcomes associated with sexual minority stressors.

Examining the Measurement Invariance of the Conformity to Masculine Norms Inventory (CMNI-30) by Sexual Orientation

An abbreviated version of the Conformity to Masculine Norms Inventory, the CMNI-30, was developed with several strengths. However, its measurement invariance across men with different sexual orientations has not been examined in a U.S. sample, so it is unclear whether these different populations understand the items similarly. In addition, no studies have compared conformity to masculinity norms across sexual orientations. This would be important to understand sexual minority men's experience of masculinity and how it differs from heteronormative masculinity. This article explores the measurement invariance of the CMNI-30 among 882 heterosexual, gay, and bisexual+ men using confirmatory factor analysis, and compares their CMNI-30 subscale scores. Results indicated that the CMNI-30 demonstrated residual invariance between men of different sexual orientations, suggesting that men of different sexual orientations interpreted the items similarly. We also found higher levels of conformity to the masculine norms of Winning, Heterosexual self-presentation, and Power over women among heterosexual men relative to gay and bisexual+ men, and higher levels of Pursuit of status among gay men relative to the other groups. Results provide support for the use of the CMNI-30 in research with men of different sexual orientations.

Bisexual-specific minority stress in nonsuicidal self-injury: The mediating role of perceived burdensomeness

Background

Bisexual-identifying individuals are at heightened risk for engaging in non-suicidal self-injury (NSSI), with the odds up to six times higher compared to heterosexual individuals and up to four times higher compared to lesbian/gay (L/G) individuals. While research has established that sexual minorities may be at increased risk because minority stressors exacerbate psychological processes associated with NSSI, little research has examined bisexual-specific pathways of risk. In this study, we replicated findings that suggest Interpersonal Theory of Suicide (IPTS) variables (i.e., perceived burdensomeness and thwarted belongingness) mediate the association between minority stress and NSSI and extended these findings by examining whether such mediation is moderated by sexual minority identity. Furthermore, we explored whether IPTS variables mediate the association between bisexual-specific minority stress and NSSI.

Method

A sample of 259 cisgender L/G (n = 93) and bisexual (n = 166) MTurk workers completed measures assessing minority stress, NSSI, and IPTS variables.

Results

Mediation analyses replicated findings that experiences of minority stress increase NSSI by increasing perceived burdensomeness [PB], though moderated mediation analyzes failed to provide evidence that sexual minority identity moderated this indirect effect. Rather, minority stress from both heterosexual and L/G individuals increased NSSI through increased PB for bisexual individuals.

Limitations

The use of cross-sectional data does not allow conclusions of causal relationships.

Conclusions

These results suggest that for bisexual individuals, minority stress from both heterosexual and L/G individuals increases NSSI by increasing PB. Future researchers and clinicians should consider the additive burden of minority stress in bisexual individuals.

Bi+ adults' daily wellbeing: The roles of relationship status and partner gender

This study examined whether relationship involvement and partner gender were associated with between-person differences and within-person fluctuation in positive and negative affect and alcohol use among people who are attracted to more than one gender or regardless of gender (e.g., bisexual, pansexual, queer; bi+). 198 bi+ individuals (M age 26.97; 73.1% non-Latinx White) completed a 28-day diary study. Multilevel regression analyses modeled between-person differences in daily affect and alcohol use as a function of relationship status and partner gender. ANCOVAs were conducted to examine differences in within-person fluctuation. Results partially support past findings that relationship involvement may not confer benefits for bi+ people, and that mixed-gender partnerships could be particularly challenging. Future research directions are discussed.

Bisexual+ visibility attempts: Associations with minority stress, affect, and substance use in a daily diary study

The efforts of bisexual+ people to make their sexual orientation visible are associated with positive and negative outcomes, but little is known about the temporality or directionality of these associations. Using data from a 28-day diary study with 208 bi+ individuals, we found that bi+ visibility attempts were concurrently associated with more positive affect, higher identity affirmation, less depressed/anxious affect, as well as more anti-bisexual experiences and rejection sensitivity. Prospectively, the likelihood of consuming alcohol (but not marijuana) was higher the day after making a visibility attempt, and positive affect was higher the day before making an attempt. Making visibility attempts in contexts that may have been more supportive (e.g., with friends, partners, and lesbian/gay individuals) was associated with more positive outcomes (e.g., more positive affect), while making attempts in contexts that may have been less supportive (e.g., with family, strangers, people who are unaccepting of bi+ identities, and heterosexual people) was associated with more negative outcomes (e.g., higher rejection sensitivity and more discrimination). These findings suggest that the contexts in which visibility attempts are made may play an important role in the impact that bi+ visibility attempts have on stigma-related stress and wellbeing.

A Systematic and Meta-Analytic Review of Identity Centrality among LGBTQ Groups: An Assessment of Psychosocial Correlates

The degree to which an identity is an important aspect of one's self-concept (i.e., identity centrality) relates to both health and prejudice experiences of minority groups. Individuals with greater levels of identity centrality view their world through the lens of that identity. This allows them to engage in more positive identity-relevant experiences. However, it could also heighten their perceptions of in-group threat. Among LGBTQ groups, the relationship between identity centrality and psychosocial outcomes is yet to be established. In this paper, we investigated the relationship between LGBTQ identity centrality and psychosocial outcomes via a comprehensive systematic (k = 89, N = 35,950) and meta-analytic (k = 57, N = 26,704) literature review. Results indicated that greater levels of LGBTQ centrality relates to more positive identity-relevant affirmations (.155 ≤ r's ≤ .419), but also greater prejudice/discrimination perceptions and experiences (-.271 ≤ r's ≤ -.128). We found no evidence of a relationship between LGBTQ centrality and health outcomes (-.052 ≤ r's ≤ .040). Importantly, we found that these relationships are more beneficial for some LGBTQ groups (gay men), than for others (bisexual/transgender individuals). Findings from this review provide important and necessary insights on the role of LGBTQ identity centrality and identify crucial gaps in the literature that should be addressed.

Use of different strategies to make one's bisexual+ identity visible: Associations with dimensions of identity, minority stress, and health

Bisexual+ people (i.e., those who are attracted to more than one gender or regardless of gender) use a variety of strategies to make their identity visible to others, but little is known about the extent to which using different strategies is related to other dimensions of identity, minority stress, and health. To address this, we surveyed 715 bi+ people about their use of five different types of visibility strategies (direct communication, indirect communication, community engagement, gender-based visual displays, and public behavioral displays). Results indicated that people who used visibility strategies more often (aggregated across types) reported higher identity centrality and affirmation, and lower internalized bi-illegitimacy and internalized binegativity. However, they also reported more discrimination from heterosexual and gay/lesbian individuals and higher depression and anxiety. When we examined the unique associations between each of the five types of visibility strategies and our other variables, we found different patterns of associations for different strategies. For example, direct communication was uniquely associated with more discrimination from gay/lesbian individuals, while indirect communication, gender-based visual displays, and public behavioral displays were uniquely associated with more discrimination from heterosexual individuals. Only indirect communication was uniquely associated with higher depression and anxiety, while community engagement was uniquely associated with lower anxiety. Finally, public behavioral displays were uniquely associated with more alcohol use problems and a higher likelihood of cigarette use. These findings highlight the importance of examining the specific strategies that people use to make their bi+ identity visible in order to understand their experiences and health.

How, When, and Why do Bisexual+ Individuals Attempt to Make Their Identity Visible?

There is ample evidence of and concern about the invisibility of bisexual+ individuals, which results from the tendency to deny or ignore their identities. Recent research has begun to examine whether and how bisexual+ individuals (an umbrella term that includes all individuals who are attracted to more than one gender, regardless of the specific identity label they use) attempt to make their identity visible to others. This study builds on prior research by exploring novel questions regarding how, when, and why bisexual+ individuals attempt to make their identity visible, using data from an internet survey of 715 individuals who reported attractions to more than one gender. Results indicated that participants were most likely to use bi+ visibility attempt strategies involving indirect forms of communication (e.g., sharing things related to their identity on social media) and direct forms of communication (e.g., telling others in person), though they perceived indirect communication as less successful at communicating their identity to others than direct communication. They were most likely to make bi+ visibility attempts in situations with other bisexual+ individuals or in LGBT contexts, as well as with partners or when single, and they did so for reasons related to a sense of activism or pride. Future directions for research and barriers to bi+ visibility are discussed.

A transdiagnostic minority stress intervention for gender diverse sexual minority women's depression, anxiety, and unhealthy alcohol use: A randomized controlled trial

OBJECTIVE

To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health.

METHOD

The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use.

RESULTS

Compared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction.

CONCLUSIONS

This study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).