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Bisexual Men on the "Down Low" Run Risk for Poor Mental Health

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First study to look at the mental health of closeted bisexuals finds that concealment takes a toll

Bisexual men are less likely to disclose and more likely to conceal their sexual orientation than gay men. In the first study to look at the mental health of this population, researchers at Columbia University's Mailman School of Public Health found that greater concealment of homosexual behavior was associated with more symptoms of depression and anxiety.

The study published in the American Psychological Association's Journal of Consulting and Clinical Psychology, examined bisexual men "on the down low," a subgroup of bisexual men who live predominantly heterosexual lives and do not disclose their same-sex behavior, a group that has not been studied to date. The researchers studied 203 nongay-identified men in New York City, who self-reported being behaviorally bisexual and had not disclosed their same-sex behavior to their female partners.

According to findings, men who live with a wife or girlfriend, who think of themselves as heterosexual, and who have a lower frequency of sex with men were more likely to conceal their same-sex behavior. Greater frequency of sex with women also correlated with greater concealment. Men with a household income of $30,000 or more per year reported greater concealment about their same-sex behavior than men with lower incomes.

"Our research provides information on the factors that might contribute to greater concealment among this group of behaviorally bisexual men," said Eric Schrimshaw, PhD, assistant professor of Sociomedical Sciences and lead author. "Such information is critical to understanding which of these bisexual men may be at greatest risk for mental health problems."

Nearly 38% of the men reported that they have not shared with anyone that they have sex with men. Only 41% reported that they had confided in a best friend or parent.

Dr. Schrimshaw and colleagues found that greater concealment correlated with more symptoms of depression and anxiety and lower positive emotions. However, disclosure to a few close friends or family did not seem to help; disclosure to confidants was not associated with good mental health.

"The fact that concealment, but not disclosure, was associated with the mental health of these bisexual men is critically important for the way therapeutic interventions are conducted in this population," said Karolynn Siegel, PhD, professor of Sociomedical Sciences and co-author. "Although disclosure may result in acceptance from family and friends, in other cases -- particularly with female partners -- disclosure may also result in rejecting reactions, which are adversely associated with mental health."

The research also suggests reasons why concealment was negatively associated with mental health. Bisexual men who were more concerned than others about concealing their same-sex behavior also tended to report lower levels of social support and more internalized homophobia – that is, negative attitudes toward their same-sex behavior.

The findings indicate that publically disclosing their same-sex behavior may not be necessary to their mental health, as long as bisexual men have adequate emotional support to cope with other stressors in their lives. Professionals who do therapeutic work with bisexual men may wish to focus instead on helping such men reduce their perceived need to conceal their same-sex behavior and accept their sexual orientation.

Funding for the study was provided by the National Institute of Mental Health (R01-MH076680) and National Institute on Drug Abuse (T32-DA007233).

January 2, 2013