Bisexual men have higher rates of mental health problems than gay men do, and new research suggests that this burden might stem from their desire to keep their sexual relationships with men secret.
Researchers evaluated the mental health of more than 200 bisexual men in the New York City area who were on the down-low, meaning they were married to or in a relationship with a woman and had had sex with a man in the past year. None of the men had told their female partner about their same-sex relationship.
The study found that men who wanted to conceal their sex with other men and were afraid of people finding out were more likely to experience depression and anxiety and lack positive feelings.
Men who had disclosed their bisexual behaviour to someone other than their partner, like a close friend, were not less likely to suffer one of these mental health problems.
The study was published Jan. 2 in the Journal of Consulting and Clinical Psychology.
Secrets cause stress
"Trying to maintain a constant vigilance and thinking, 'Will someone find out?' and 'What would happen if somebody knew?' appears to be a stressor that adversely affects these men," said study author Eric Schrimshaw, an assistant professor of sociomedical sciences at Columbia University Mailman School of Public Health.
But the good news is that there could be ways for these men to ease the toll of hiding their bisexual behaviour.
The study suggests that concealment is linked to mental health problems only in men who have homophobic feelings and who lack good social support.
"Our primary goal should be working with these men to help them feel more comfortable with their identity so that they are less concerned about who might find out and dealing with concealment concerns," Schrimshaw said.
Previous research has found that about 37 percent of men in the United States who have sex with both men and women experience clinical depression at some point in their lives, compared with 23% of men who only have sex with men and 15% of men who only have sex with women.
The current study involved 203 men who were aged 18 and older. The men led primarily heterosexual lives, having had sex with a woman in the past year with whom they were or had been in a relationship that lasted for at least three months.
The men also had sex with a man within the past year and did not consider themselves to be gay.
Schrimshaw and his colleagues found that 38% of the men had not told anyone about their sex with men, and the remainder had told at least one person, in most cases a parent or close friend.
The participants who reported concealing their gay relationship, fearing others would find out and being embarrassed about it were more likely to be married or live with their female partner, less likely to have a regular male partner or frequent male sex, and a full-time job.
These men could have a stronger desire to conceal because they have more to lose, Schrimshaw noted.
Although concealing exacted a mental toll on these men, the study did not find mental health benefits among the men who had told someone about their bisexual behaviour.
Schrimshaw suspects this discrepancy is because the men in their study could still have been dealing with their sexuality and needed to come to terms on their own with what might happen if someone found out before they could get to the point of feeling comfortable disclosing.
Although bisexual men can become more accepting of their sexuality over time, and possibly experience fewer mental problems, it is not known if they typically progress from becoming aware of their sexuality to exploring and disclosing it, as is thought to be the case for gay men, Schrimshaw said.
Commenting on the study, Brian Mustanski, director of the IMPACT LGBT (Lesbian, Gay, Bisexual and Transgender) Health and Development Program at Northwestern University, said, "Bisexual groups have not been studied as much, and that is a major strength of this paper."
However, disclosing could turn out to improve bisexual men's mental health if they received acceptance from the person they told, Mustanski said. The study did not compare the mental health of men who experienced positive and negative reactions to sharing their sexuality.
The finding that the relationship between concealing and poor mental health could be due to men lacking support and having negative attitudes about their sexuality could help psychologists and counselors, Mustanski said.
"Instead of discussing disclosure, you're perhaps better off discussing their sexuality as part of who they are and building networks of accepting people in their lives," Mustanski said.
Nonetheless, Schrimshaw and his colleagues wrote in their study, encouraging disclosing can be appropriate if men have accepted their sexuality, and in cases where their female partner could be at risk of HIV or another sexually transmitted disease.
Mustanski encourages men who are having sex with both men and women and who want help to go to an LGBT center where they can find a therapist and receive health care.
Straight, gay or bi?
For more information and a directory of health care providers, visit the Gay and Lesbian Medical Association.
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