Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2023 Jul 27.
Published in final edited form as: Stigma Health. 2021 Apr 15;8(2):179–186. doi: 10.1037/sah0000297

The Role of Partner Gender in Bisexual Men’s Stigma-Related Experiences and Mental Health: Results From a Probability-Based Sample in the United States

Brian A Feinstein 1, Jessie V Ford 2, Micah R Lattanner 3, Na Bo 4, Wanzhu Tu 4, Brian Dodge 5
PMCID: PMC10373686  NIHMSID: NIHMS1673876  PMID: 37502222

Abstract

Bisexual men are disproportionately affected by negative mental health outcomes compared to heterosexual and gay men. These disparities are related to the unique stressors that they experience, and emerging evidence suggests that their experiences of these stressors can be different depending on the gender of their partner. However, previous studies have largely focused on bisexual women and little is known about the role of partner gender in bisexual men’s experiences and mental health. We examined the associations between relationship type and outness, stigma-related experiences, and mental health using data from Wave 1 of the National Study of Stigma and Sexual Health, a probability-based sample of 502 gay and bisexual men in the U.S. Analyses focused on the subset of 128 men who identified as bisexual (44.53% in relationships with women, 14.84% in relationships with men, 40.63% not in relationships). Bisexual men in relationships with men reported being more out than those in relationships with women and those who were not in relationships; furthermore, bisexual men in relationships with men reported more discrimination and family stress than those in relationships with women. Bisexual men who were not in relationships reported more anticipated and internalized stigma than those in relationships with men; additionally, bisexual men who were not in relationships reported more anticipated stigma and depression than those in relationships with women. Partner gender plays a role in bisexual men’s stigma-related experiences and mental health, and efforts to improve bisexual men’s health should attend to sexual orientation, relationship status, and partner gender.

Keywords: bisexual, relationship, partner gender, stigma, depression

Bisexual men are disproportionately affected by depression and anxiety relative to both heterosexual and gay men (Ross et al., 2018). These disparities are related to the unique stressors that bisexual men experience, such as discrimination from both heterosexual and gay/lesbian people (Feinstein & Dyar, 2017). While romantic relationships are generally considered protective against negative mental health outcomes (Kamp Dush & Amato, 2005; Waite & Gallagher, 2000), people in socially devalued relationships (e.g., same-sex, interracial, and age-gap relationships) face unique challenges (e.g., stigma) that can compromise their relationships as well as their mental health (LeBlanc, Frost, & Wight, 2015; Lehmiller & Agnew, 2006; Rosenthal & Starks, 2015). In regard to bisexual people, recent studies have found that being in a relationship is associated with worse mental health (Feinstein, Latack, Bhatia, Davila, & Eaton, 2016; Whitton, Dyar, Newcomb, & Mustanski, 2018) and that the gender of a bisexual person’s partner can influence their experiences related to stigma and mental health (Dyar, Feinstein, & London, 2014; Molina et al., 2015; Sarno et al., 2020). For example, bisexual people in different-sex relationships report more depression and discrimination than those in same-sex relationships (Dyar et al., 2014; Molina et al., 2015; Sarno et al., 2020). However, only one of these studies focused on bisexual men (Sarno et al., 2020), and it used a community sample. The limited generalizability of community samples is particularly problematic for understanding bisexual people’s experiences, because they are less likely to be open about their sexual orientation and less likely to be connected to a broader sexual minority community than gay and lesbian people (Balsam & Mohr, 2007; Pew Research Center, 2013). To address this, we examined the associations between relationship type (relationship with a man, relationship with a woman, no relationship) and sexual orientation disclosure (“outness”), stigma-related experiences, and mental health in a probability-based sample of bisexual men in the U.S.

The mental health benefits of romantic relationships have been well established in samples of heterosexual individuals (Kamp Dush & Amato, 2005; Waite & Gallagher, 2000). In addition, despite the stigma associated with same-sex relationships (LeBlanc et al., 2015), previous studies have demonstrated that the mental health benefits of romantic relationships also extend to gay and lesbian individuals (Wayment & Peplau, 1995; Wienke & Hill, 2009). In contrast, relationship involvement is associated with worse mental health for bisexual individuals, including anxiety disorders (Feinstein et al., 2016) and psychological distress (Whitton et al., 2018). A recent study found that partnered bisexual individuals were less likely to report poor mental health in the past 30 days than unpartnered bisexual individuals (Du Bois, Guy, Legate, & Kendall, 2019), but follow-up analyses revealed that this only applied to bisexual women. These differences between gay/lesbian and bisexual people may be related to the unique forms of stigma that bisexual people face in relationships. For example, anyone in a same-sex relationship can be exposed to stigma regardless of whether they identify as gay/lesbian or bisexual, but bisexual people also experience having their identity misperceived based on the gender of their partner (i.e., being perceived as either gay/lesbian or heterosexual depending on the gender of their partner), rending their bisexuality invisible in the context of their relationship.

Despite accumulating evidence that relationship involvement is associated with worse mental health for bisexual people (Feinstein et al., 2016; Whitton et al., 2018), these previous studies have rarely accounted for partner gender and emerging evidence suggests that partner gender may play an important role in bisexual people’s experiences related to stigma and mental health. For example, qualitative studies have revealed the complexities of being in a relationship for bisexual people (Hequembourg & Brallier, 2009; Ross, Dobinson, & Eady, 2010). Given that bisexual people in different-sex relationships are assumed to be heterosexual, they may experience less prejudice from heterosexual people, while at the same time being excluded by gay/lesbian people (Hequembourg & Brallier, 2009; Ross, Dobinson, & Eady, 2010). In contrast, given that bisexual people in same-sex relationships are assumed to be gay/lesbian, they may experience more prejudice from heterosexual people (Hequembourg & Brallier, 2009; Ross et al., 2010) as well as negative reactions from gay/lesbian people if they disclose their bisexuality (Friedman et al., 2014). More recently, a few quantitative studies have examined the role of partner gender in bisexual people’s experiences, most of which have focused on bisexual women. One study found that bisexual women in different-sex relationships were less open about their sexual orientation than those in same-sex relationships, but bisexual women in different-sex relationships also experienced more interpersonal hostility from gay/lesbian individuals and they reported more depression than bisexual women in same-sex relationships (Dyar et al., 2014). Another study also found that bisexual women in different-sex relationships were less open about their sexual orientation than those in same-sex relationships, but bisexual women in different-sex relationships also reported more bisexual-specific discrimination and alcohol use problems than bisexual women in same-sex relationships (Molina et al., 2015). In a recent study, the first to examine the role of partner gender in bisexual men’s experiences, bisexual men in different-sex relationships experienced more interpersonal hostility from both heterosexual and gay/lesbian individuals than bisexual men in same-sex relationships (Sarno et al., 2020). Of note, partner gender was not associated with internalized binegativity (Molina et al., 2015; Sarno et al., 2020).

In sum, the available evidence suggests that being in a different-sex relationship as a bisexual person is associated with being less open about one’s sexual orientation, but it is also associated with experiencing more interpersonal hostility and bisexual-specific discrimination as well as worse mental health compared to being in a same-sex relationship as a bisexual person. However, only one study has examined the role of partner gender in bisexual men’s experiences (Sarno et al., 2020) and that study examined a subset of stigma-related experiences, it did not examine mental health outcomes, and it used a non-probability-based sample, limiting its generalizability. Scholars have described the advantages of probability-based sampling—the gold standard of sampling for survey research—and the need for probability-based samples of sexual minorities (Jeffries, 2009, 2011; Jeffries & Dodge, 2007; Meyer & Wilson, 2009). Finally, while there is evidence that partner gender plays a role in bisexual women’s mental health (Dyar et al., 2014; Molina et al., 2015), this has not yet been examined among bisexual men. To address these gaps, the current study examined the associations between relationship type (relationship with a man, relationship with a woman, no relationship) and outness, stigma-related experiences (anticipated binegativity, internalized binegativity, discrimination, and family stress related to one’s sexual orientation), and mental health (depression and anxiety), using data from the subset of bisexual men included in the National Study of Stigma and Sexual Health, a probability-based sample of gay and bisexual men in the U.S.

We considered these analyses exploratory because of the limited previous research on the role of partner gender in bisexual men’s experiences. That said, we used the available literature to guide tentative predictions. Consistent with evidence from previous studies focused on the genders of bisexual people’s partners (Dyar et al., 2014; Molina et al., 2015; Sarno et al., 2020), we hypothesized that, compared to bisexual men in same-sex relationships, those in different-sex relationships would report lower levels of outness, higher levels of stigma-related experiences (with the exception of internalized binegativity, which was not associated with partner gender in previous studies), and worse mental health. In addition, consistent with evidence that relationship involvement is associated with worse mental health among bisexual people (Feinstein et al., 2016; Whitton et al., 2018), we hypothesized that bisexual men in relationships would report worse mental health than those who are not in relationships. Still, given that these previous studies used non-probability-based samples, it remains unknown if their findings will generalize to the current probability-based sample.

Methods

Study Design

The data in this study come from the Ipsos (formerly GfK) KnowledgePanel®, the largest nationally representative online panel of the U.S. adult population. In 2009, KnowledgePanel® started employing an address-based sampling (ABS) methodology that allows probability-based address sampling from the Delivery Sequence File of the U.S. Postal Service (a database with coverage of all U.S. delivery points). ABS provides a statistically-valid sampling frame that covers approximately 97% of U.S. households. This sampling method maximizes population coverage, especially for hard-to-reach individuals such as sexual minority subgroups. Ipsos, which runs KnowledgePanel®, gives respondents a web-enabled device, such as a tablet computer, as well as free Internet service in households without Internet access, thereby enhancing the representativeness of the sample. All study procedures were approved by the Institutional Review Boards at Indiana University and Columbia University.

Participants

The 128 bisexual men who participated in this survey come from the KnowledgePanel®, which consists of about 50,000 adult members (ages 18 and older). An estimated 900 identify as gay or bisexual men (GBM) based on the following screener items: “What is your sex?” (response options: male, female) and “Do you consider yourself to be: (1) heterosexual or straight, (2) gay/lesbian, (3) bisexual, (4) other (please specify)?” We partnered with Ipsos to recruit a sample of adult GBM (ages 18+, English- and/or Spanish-language speakers) from KnowledgePanel® to become part of a 2-year longitudinal cohort study, the National Study of Stigma and Sexual Health (NSASH). Participant sex/gender was confirmed as part of NSASH using the following item: “Are you a: (1) man, (2) woman, (3) transman, (4) transwoman, (5) other (please specify)?” Those who selected “man” were included in the sample. Five people were excluded at this stage because they selected “transman” (n = 3) or “other” (n = 2). Of note, the response options “man” and “woman” did not specify “cisgender” because, in field tests, the study team found that many people in the general population did not understand what “cisgender” meant. The final NSASH sample included 502 GBM, of whom 131 identified as bisexual. Three bisexual men were excluded from the current analyses because they were in relationships, but did not report their partner’s gender. As such, the final analytic sample included 128 bisexual men who were in relationships with men, in relationships with women, or not in relationships.

Sampling Plan

After the sampling frame is established, KnowledgePanel® members receive an email letting them know that there is a new survey available for them to take. This email notification includes a custom link that sends members directly to the online survey. After reading a brief description of the survey, participants completed a consent form followed by the survey. The survey asked about sexual, physical, mental, and behavioral health, as well as psychosocial factors unique to gay/bisexual men. All participants were given the option of completing the survey in English or Spanish. The median length for survey completion was approximately 30 minutes. Participants were paid $25 in Ipsos incentives—in the form of cash or points—as compensation for their time.

Measures

Partner gender.

Participants who indicated that they were currently dating or in a relationship with someone were asked: “Is your current dating/relationship partner a: (1) man, (2) woman; (3) transman, (4) transwoman, or (5) other, please specify?” As noted above, the final NSASH sample included 131 bisexual men, but three were excluded from the current analyses because they were in relationships, but they selected “other” in response to the question about their partner’s gender (one specified “man and woman” and two did not specify the gender of their partner). No participants selected “transman” or “transwoman.”

Outness.

Four items from a previous study (Meyer, Rossano, Ellis, & Bradford, 2002) were adapted to measure degree of disclosure of one’s bisexual identity (“How much are you out of the closet about your being bisexual?”) to (1) family members, (2) straight friends, (3) lesbian, gay, and bisexual friends, and (4) health care providers. These items are rated on a 4-point scale of 1 (out to none) to 4 (out to all). We computed an average score with higher scores representing a higher degree of disclosure of one’s bisexual identity (α = 0.81).

Anticipated Binegativity.

Participants completed the five-item Anticipated Binegativity subscale of the Bisexual Identity Inventory (Paul, Smith, Mohr, & Ross, 2014) to measure concerns about how others respond to one’s bisexual identity. Example items included: “People probably do not take me seriously when I tell them I am bisexual” and “People might not like me if they found out that I am bisexual.” These items are rated on a 4-point scale of 1 (do not agree) to 4 (agree strongly). We computed an average score with higher scores representing a higher level of concern about how others respond to one’s bisexual identity (α = 0.75).

Internalized Binegativity.

Participants completed the five-item Internalized Binegativity subscale of the Bisexual Identity Inventory (Paul et al., 2014) to measure negative feelings about oneself because of identifying as bisexual. Example items included: “It’s unfair that I am attracted to people of more than one gender” and “I wish I could control my feelings and aim them at one gender.” These items are rated on a 4-point scale of 1 (do not agree) to 4 (agree strongly). We computed an average score with higher scores representing higher levels of negative feelings about oneself because of identifying as bisexual (α = 0.91).

Discrimination.

Participants completed four items from the Experiences of Discrimination Scale (Ruan et al., 2008) to measure frequency of experiencing discrimination when obtaining and receiving health care, when seeking employment, and when in public settings. Items were adapted to refer to the last 6 months. Example items include: “During the last 6 months, about how often did you experience discrimination in how you were treated when you got health care because you were assumed to be gay or bisexual?” and “During the last 6 months, about how often did you experience discrimination in public, like on the street, or in stores or in restaurants because you were assumed to be gay or bisexual?” These items are rated on a 5-point scale of 1 (never) to 5 (very often). We computed an average score with higher scores representing more frequent experiences of discrimination due to one’s sexual orientation (α = 0.79).

Family Stress Related to One’s Sexual Orientation.

Participants completed the nine-item Family Reaction subscale of the Measure of Gay-Related Stressors Scale (Lewis, Derlega, Berndt, Morris, & Rose, 2001) to measure difficulties experienced with one’s family due to one’s sexual orientation. Example items include: “Rejection by family members due to my sexual orientation” and “Lack of support from family members due to my sexual orientation.” Despite the name of the measure referring to “gay-related stressors,” all of the items referred to one’s sexual orientation in general. Participants reported if they had experienced each family-related stressor in the past six-months. We computed a sum score with higher scores representing more difficulties experienced with one’s family due to one’s sexual orientation.

Depression.

Participants completed the 10-item Center for Epidemiologic Studies Depression Scale (Radloff, 1977) to measure symptoms of depression experienced during the past seven days. Example items include: “I was bothered by things that usually don’t bother me” and “I felt that everything I did was an effort.” These items are rated on a 4-point scale of 1 (rarely or none of the time – less than 1 day) to 4 (most or all of the time – 5 to 7 days). We computed an average score with higher scores representing more frequent experiences of depression symptoms during the past week (α = 0.90).

Anxiety.

Participants completed the 7-item Generalized Anxiety Disorder Scale (Spitzer, Kroenke, Williams, & Lowe, 2006) to measure symptoms of anxiety experienced during the past two weeks. Example items include: “Feeling nervous, anxious, or on edge” and “Not being able to stop or control worrying.” These items are rated on a 4-point scale of 1 (not at all) to 4 (nearly every day). We computed an average score with higher scores representing more frequent experiences of anxiety symptoms during the past two weeks (α = 0.93).

Data Analysis

First, after applying sampling weights, we computed the demographics of the analytic sample (Table 1) and summary statistics for the outcomes of interest (Table 2). Given that the sample was not a random sample, sampling weights were used to produce unbiased estimates that could be generalized. Specifically, we used SAS PROC SURVEYMEANS to adjust the estimates using the sampling weights provided by Ipsos, the company that conducted the survey. Summary statistics (means, medians, and the first and third quartiles) are presented for the full analytic sample and as a function of relationship type. Then, we used Kruskal-Wallis tests to examine the equality of the median values of the outcomes across the three relationship types. Finally, we used Dwass-Steel-Critchlow-Fligner (DSCF) tests for pairwise comparisons (Critchlow & Fligner, 1991). All statistical tests are reported in Table 2. P-values less than 0.05 were considered statistically significant. Nonparametric tests were used because the distributions of most of the outcomes were skewed in the three relationship type groups. All descriptive statistics reported in Tables 1 and 2 were adjusted for sampling weights, but nonparametric comparisons for inferential analyses (e.g., Kruskal-Wallis tests) were not adjusted because there are no existing methods for such adjustments.

Table 1.

Demographic characteristics of the analytic sample.

Demographic characteristic N (%)
Age
 18–25 10 (8.00%)
 26–35 38 (30.40%)
 36–45 19 (15.20%)
 46–55 24 (19.20%)
 56–65 17 (13.60%)
 65+ 17 (13.60%)
Race
 Non-white 32 (25.60%)
 White 93 (74.40%)
Hispanic ethnicity
 Hispanic 17 (13.60%)
 Non-Hispanic 108 (86.40%)
Education
 Less than high school or high school 47 (37.60%)
 Some college 51 (40.80%)
 Bachelor degree or higher 27 (21.60%)
Region
 Midwest 24 (19.20%)
 Northeast 25 (20.00%)
 South 48 (38.40%)
 West 28 (22.40%)
Metropolitan statistical area/urbanicity
 Metropolitan 110 (88.00%)
 Non-metropolitan 15 (12.00%)
Household income
 <$25,000 30 (24.19%)
 $25,000–$49,999 33 (26.61%)
 $50,000–74,999 17 (13.71%)
 $75,000+ 44 (35.48%)
Employment status
 Not working (due to layoff or looking for work) 9 (7.20%)
 Not working (retired, disabled, or other) 35 (28.00%)
 Working 81 (64.80%)
Open in a new tab

Notes. Descriptive statistics were adjusted for sampling weights.

Table 2.

Associations between type of relationship and outness, stigma-related experiences, and mental health among bisexual men.

Outcome Type of relationship Mean (SE) Median (IQR) p-value (overall comparison) Pairwise comparison p-value (pairwise comparison)
Outness All 2.39 (0.12) 2.13 (1.52, 2.92) <.0001 With a woman vs. With a man 0.0001
None 2.41 (0.16) 2.14 (1.79, 2.87) With a woman vs. none 0.3391
With a man 3.13 (0.25) 2.97 (2.71, 3.64) With a man vs. none 0.0003
With a woman 1.99 (0.13) 1.81 (1.20, 2.22)
Anticipated binegativity All 2.34 (0.09) 2.21 (1.78, 2.78) 0.0186 With a woman vs. With a man 0.0763
None 2.53 (0.19) 2.68 (1.71, 2.95) With a woman vs. none 0.6962
With a man 2.07 (0.11) 2.00 (1.70, 2.22) With a man vs. none 0.0115
With a woman 2.33 (0.11) 2.18 (1.80, 2.70)
Internalized binegativity All 1.66 (0.12) 1.13 (1.00, 1.81) 0.0100 With a woman vs. With a man 0.7843
None 2.06 (0.24) 1.52 (1.00, 2.86) With a woman vs. none 0.0341
With a man 1.33 (0.08) 1.24 (1.00, 1.37) With a man vs. none 0.0325
With a woman 1.49 (0.18) 1.00 (1.00, 1.55)
Discrimination All 1.20 (0.06) 1.00 (1.00, 1.00) 0.0176 With a woman vs. With a man 0.0151
None 1.21 (0.09) 1.00 (1.00, 1.08) With a woman vs. none 0.4750
With a man 1.40 (0.19) 1.00 (1.00, 1.54) With a man vs. none 0.1286
With a woman 1.09 (0.07) 1.00 (1.00, 1.00)
Family stress All 1.63 (0.30) 0 (0, 2.66) 0.0034 With a woman vs. With a man 0.0043
None 1.51 (0.39) 0.40 (0, 1.49) With a woman vs. none 0.0948
With a man 2.90 (0.74) 2.59 (0, 3.77) With a man vs. none 0.1260
With a woman 1.08 (0.46) 0 (0, 1.84)
Depression All 1.88 (0.10) 1.59 (1.24, 2.28) 0.0112 With a woman vs. With a man 0.9758
None 1.95 (0.15) 1.75 (1.36, 2.31) With a woman vs. none 0.0146
With a man 2.13 (0.28) 1.98 (1.25, 2.33) With a man vs. none 0.1023
With a woman 1.70 (0.11) 1.42 (1.21, 2.15)
Anxiety All 1.73 (0.10) 1.42 (1.01, 2.18) 0.0966 With a woman vs. With a man 0.6329
None 1.65 (0.13) 1.26 (1.06, 1.97) With a woman vs. none 0.2632
With a man 1.96 (0.37) 1.41 (1.00, 2.84) With a man vs. none 0.1297
With a woman 1.68 (0.10) 1.47 (1.00, 2.06)
Open in a new tab

Notes. Descriptive statistics were adjusted for sampling weights, but nonparametric comparisons for inferential analyses (e.g., Kruskal-Wallis tests) were not adjusted because there are no existing methods for such adjustments.

Results

Demographics.

Between June and July 2018, 128 bisexual men (M age = 52.95, SD = 16.14), ages 18–84 years, completed our survey. Table 1 presents the demographics of the sample. Out of 128 bisexual men, 57 (44.53%) reported being in a relationship with a woman, 19 (14.84%) reported being in a relationship with a man, and 52 (40.63%) reported not being in a relationship. After applying sampling weights, the majority were white (74.40%), non-Hispanic (86.40%), currently employed (64.80%), and resided in a metropolitan area (88.00%). In addition, 21.60% had a Bachelor’s degree or higher and 35.48% reported an annual household income of $75,000 or greater.

Outness.

There was a statistically significant association between relationship type and outness (Table 2). Bisexual men in relationships with men reported higher levels of outness than those in relationships with women and those who were not in relationships. In contrast, there was not a statistically significant difference in outness between bisexual men in relationships with women and those who were not in relationships.

Stigma-related experiences.

There were statistically significant associations between relationship type and anticipated stigma, internalized stigma, discrimination, and family stress related to one’s sexual orientation (Table 2). Specifically, bisexual men who were not in relationships reported higher levels of anticipated stigma than those in relationships with men. Similarly, bisexual men who were not in relationships reported higher levels of internalized stigma than those in relationships with men and those in relationships with women. In contrast, there were not statistically significant differences in anticipated or internalized stigma between bisexual men in relationships with men and those in relationships with women. In regard to discrimination and family stress related to one’s sexual orientation, bisexual men in relationships with men reported higher levels of both compared to those in relationships with women. In contrast, discrimination and family stress related to one’s sexual orientation did not statistically differ between bisexual men who were not in relationships and those in either of the other groups.

Mental health.

Relationship type was statistically significantly associated with depression, but not with anxiety (Table 2). Bisexual men who were not in relationships reported higher levels of depression than those in relationships with women. In contrast, depression did not statistically differ between bisexual men in relationships with men and those in either of the other relationship groups.

Discussion

The goal of the current study was to examine the associations between relationship type and outness, stigma-related experiences, and mental health using data from a probability-based sample of bisexual men in the U.S. In addition, overall, we found that partner gender had important implications for bisexual men’s outness, stigma-related experiences, and mental health. We discuss these findings and their implications in detail below.

First, we found that bisexual men in relationships with men reported higher levels of outness than those in relationships with women and those who were not in relationships. These findings are consistent with previous research on bisexual women, which has similarly found that bisexual women in same-sex relationships are more open about their sexual orientation than those in different-sex relationships (Dyar et al., 2014; Molina et al., 2015). This association between partner gender and outness is likely related to their non-heterosexuality being visible when they are in a relationship with a partner of the same gender.

Second, we found that bisexual men in relationships with men also reported higher levels of discrimination and family stress related to one’s sexual orientation than those in relationships with women, which is likely related to their being more open about their bisexuality. These findings are in contrast to previous research on bisexual women, which has found that bisexual women in different-sex relationships report more interpersonal hostility and bisexual-specific discrimination than those in same-sex relationships (Dyar et al., 2014; Molina et al., 2015). Taken together, these findings suggest that bisexual men and women both experience more discrimination when they are in relationships with men compared to when they are in relationships with women. Although the stereotypes about bisexual men and women are different, in both cases, they communicate invalidation of their attractions to women. For example, bisexual men are stereotyped as being gay and afraid to come out “all the way” (thus, denying their attractions to women as valid) and bisexual women are stereotyped as being heterosexual and “pretending” to be attracted to women for the attention of heterosexual men (again, denying their attractions to women as valid) (Dodge et al., 2016; Fahs, 2009; Friedman et al., 2014). As such, bisexual men and women may both experience more discrimination when they are in relationships with men because their relationships confirm the stereotypes that they are “really” gay (in the case of bisexual men) and that they are “really” heterosexual (in the case of bisexual women).

Of note, one recent study (Sarno et al., 2020) found that bisexual men in different-sex relationships reported experiencing more interpersonal hostility compared to those in same-sex relationships. Their findings were consistent with previous research on bisexual women (Dyar et al., 2014; Molina et al., 2015), but inconsistent with our findings. These contrasting findings are likely due, at least in part, to sample differences between the two studies. Our data came from a probability-based sample of bisexual men in the U.S., participants ranged in age from 18–84, the majority were white and non-Hispanic, and a greater proportion were in relationships with women than men. In contrast, the study by Sarno and colleagues used data from a community sample of bisexual men in Chicago, participants were younger (16–29 at baseline), the majority were people of color, and a greater proportion had only been in relationships with men than women over the course of the longitudinal study.

Third, we found that bisexual men who were not in relationships reported higher levels of anticipated stigma than those in relationships with men as well as higher levels of internalized stigma than those in relationships with men and those in relationships with women. In contrast, we did not find significant differences in anticipated or internalized stigma between bisexual men in relationships with men and those in relationships with women. It is possible that anticipated and internalized stigma may prevent bisexual men from seeking and/or entering into relationships. However, it is also possible that being in a relationship may reduce anticipated and internalized stigma among bisexual men. It will be important for future studies to collect longitudinal data on bisexual men’s experiences to test these different hypotheses. We are not aware of any previous studies that have examined the association between partner gender and anticipated stigma among bisexual people. Previous research among bisexual women has not found significant associations between partner gender and internalized stigma (Dyar et al., 2014; Molina et al., 2015). Given that attitudes toward bisexual men tend to be more negative than attitudes toward bisexual women (Dyar & Feinstein, 2018), internalizing these negative attitudes may have a stronger influence on whether bisexual men seek and/or enter into relationships than they do for bisexual women. One recent study (Sarno et al., 2020) did not find a significant association between partner gender and internalized stigma among bisexual men either, but this may be due to differences in the composition of the samples (as described above). Finally, we found that bisexual men who were not in relationships reported higher levels of depression than those in relationships with women, which may be related to bisexual men who were not in relationships reporting higher levels of anticipated stigma, a significant correlate of depressive symptoms. Finally, consistent with previous research (Pew Research Center, 2013), a greater proportion of the bisexual men in our sample were in relationships with women (44.53%) compared to relationships with men (14.84%). The reasons for this difference require further exploration. However, given that anticipated and internalized stigma did not differ between these groups, they are unlikely to explain this difference.

Taken together, the current findings speak to the complex relations among partner gender, outness, stigma-related experiences, and mental health among bisexual individuals. While bisexual men in relationships with men reported the highest levels of outness and discrimination, bisexual men who were not in relationships reported the highest levels of anticipated stigma, internalized stigma, and depression. For bisexual men in relationships with men, although being open about one’s sexual orientation can lead to discrimination, it can also lead to support and community, which may protect them from experiencing depression even in the face of discrimination. In contrast, for bisexual men who are not in relationships, their higher levels of anticipated and internalized stigma are likely to contribute to their higher levels of depression. Even though they do not experience the highest levels of discrimination, they also do not have access to the protective factors (e.g., support, community) that bisexual men in relationships with men do.

Limitations

The current findings should be considered in light of several limitations. First, while our use of a probability-based sample represented a major strength of the study, the number of bisexual men in each type of relationship was relatively small, especially the number of bisexual men in relationships with men, limiting our statistical power. Second, all of our participants were cisgender men and all of their partners were cisgender men or cisgender women. As such, it will be important for future research to examine bisexual transgender men’s experiences related to stigma and mental health as well as bisexual men’s experiences with transgender and gender diverse partners. Third, in addition to partner gender, it is likely that other demographics (e.g., race, ethnicity, age) have influences on bisexual men’s experiences related to stigma and mental health. Our sample was not large enough to examine bisexual men’s experiences at the intersections of these and other identities and demographics, but it will be important to do so in future studies. Third, our data were cross-sectional and, as such, we were unable to examine the temporality of the associations in question.

Conclusion

Despite these limitations, the current study was the first to examine the role of partner gender in bisexual men’s experiences related to stigma and mental health using data from a probability-based U.S. sample. We found that partner gender had important implications for bisexual men’s experiences, such that bisexual men in relationships with men tended to be more open about their sexual orientation and to experience more discrimination, whereas bisexual men who were not in relationships tended to report greater anticipated and internalized stigma as well as depression. Despite the fact that bisexual men are at increased risk for depression and anxiety (Ross et al., 2018), there are no evidence-based interventions specifically designed to address their unmet mental health needs. Recently, an intervention was developed to improve the mental and behavioral health of gay and bisexual men by addressing their experience related to stigma (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015), but very few bisexual men were included in their initial trial. The current findings suggest that it may be important to address the role of partner gender in shaping bisexual men’s experiences in order to meet their mental health needs. To do so, healthcare providers need to assess both sexual orientation and partner gender, and to avoid making assumptions about sexual orientation based on the gender of one’s partner. Finally, the current findings highlight the critical need for continued research on bisexual people’s experiences and health, including the need for large and representative samples of bisexual individuals with measures of their unique stigma-related experiences.

Acknowledgments

Funding: The National Institute of Mental Health (R01MH112384, MPI: Hatzenbuehler/Dodge) funded this study. Brian Feinstein’s time was supported by a grant from the National Institute on Drug Abuse (K08DA045575). Micah Lattanner’s time was supported by a grant from the National Institute of Mental Health (T32MH013043). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

References

  1. Balsam KF, & Mohr JJ (2007). Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology, 54, 306–319. [Google Scholar]
  2. Critchlow DE, & Fligner MA (1991). On Distribution-Free Multiple Comparisons in the One-Way Analysis of Variance. Communications in Statistics - Theory and Methods, 20, 127–139. [Google Scholar]
  3. Dodge B, Herbenick D, Friedman MR, Schick V, Fu TJ, Bostwick W, . . . Sandfort TG (2016). Attitudes toward Bisexual Men and Women among a Nationally Representative Probability Sample of Adults in the United States. PLoS One, 11, e0164430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Du Bois SN, Guy AA, Legate N, & Kendall AD (2019). Partnership-level health associations among bisexual individuals in a U.S. population-level sample. Journal of Bisexuality, 19, 361–385. [Google Scholar]
  5. Dyar C, & Feinstein BA (2018). Binegativity: Attitudes toward and stereotypes about bisexual individuals. In Swan DJ & Habibi S. (Eds.), Bisexuality: Theories, research, and recommendations for the invisible sexualtiy (pp. 145–163). Springer. [Google Scholar]
  6. Dyar C, Feinstein BA, & London B. (2014). Dimensions of sexual identity and minority stress among bisexual women: The role of partner gender. Psychology of Sexual Orientation and Gender Diversity, 1, 441–451. [Google Scholar]
  7. Fahs B. (2009). Compulsory bisexuality?: The challenges of modern sexual fluidity. Journal of Bisexuality, 9, 431–449. [Google Scholar]
  8. Feinstein BA, & Dyar C. (2017). Bisexuality, minority stress, and health. Curr Sex Health Rep, 9(1), 42–49. doi: 10.1007/s11930-017-0096-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Feinstein BA, Latack JA, Bhatia V, Davila J, & Eaton NR (2016). Romantic relationship involvement as a minority stress buffer in gay/lesbian versus bisexual individuals. Journal of Gay & Lesbian Mental Health, 20, 237–257. [Google Scholar]
  10. Friedman MR, Dodge B, Schick V, Herbenick D, Hubach R, Bowling J, . . . Reece M. (2014). From Bias to Bisexual Health Disparities: Attitudes toward Bisexual Men and Women in the United States. LGBT Health, 1, 309–318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hequembourg AL, & Brallier SA (2009). An exploration of sexual minority stress across the lines of gender and sexual identity. Journal of Homosexuality, 56, 273–298. [DOI] [PubMed] [Google Scholar]
  12. Jeffries WL IV. (2009). Sociodemographic, sexual, and HIV and other sexually transmitted disease risk profiles of nonhomosexual-identified men who have sex with men. American Journal of Public Health, 99, 1042–1045. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jeffries WL IV. (2011). The number of recent sex partners among bisexual men in the United States. Perspectives on Sexual and Reproductive Health, 43, 151–157. [DOI] [PubMed] [Google Scholar]
  14. Jeffries WL IV, & Dodge B. (2007). Male bisexuality and condom use at last sexual encounter: results from a national survey. Journal of Sex Research, 44, 278–289. [DOI] [PubMed] [Google Scholar]
  15. Kamp Dush CM, & Amato PR (2005). Consequences of relationship status and quality for subjective well-being. Journal of Social and Personal Relationships, 22, 607–627. [Google Scholar]
  16. LeBlanc AJ, Frost DM, & Wight RG (2015). Minority Stress and Stress Proliferation Among Same-Sex and Other Marginalized Couples. Journal of Marriage and Family, 77, 40–59. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Lehmiller JJ, & Agnew CR (2006). Marginalized relationships: the impact of social disapproval on romantic relationship commitment. Personality and Social Psychology Bulletin, 32, 40–51. [DOI] [PubMed] [Google Scholar]
  18. Lewis RJ, Derlega VJ, Berndt A, Morris LM, & Rose S. (2001). An empirical analysis of stressors for gay men and lesbians. Journal of Homosexuality, 42, 63–88. [DOI] [PubMed] [Google Scholar]
  19. Meyer IH, Rossano L, Ellis JM, & Bradford J. (2002). A brief telephone interview to identify lesbian and bisexual women in random digit dialing sampling. Journal of Sex Research, 39, 139–144. [DOI] [PubMed] [Google Scholar]
  20. Meyer IH, & Wilson PA (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56, 23. [Google Scholar]
  21. Molina Y, Marquez JH, Logan DE, Leeson CJ, Balsam KF, & Kaysen DL (2015). Current intimate relationship status, depression, and alcohol use among bisexual women: The mediating roles of bisexual-specific minority stressors. Sex Roles, 73(,43–57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Pachankis JE, Hatzenbuehler ML, Rendina HJ, Safren SA, & Parsons JT (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83, 875–889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Paul R, Smith NG, Mohr JJ, & Ross LE (2014). Measuring dimensions of bisexual identity: Initial development of the Bisexual Identity Inventory. Psychology of Sexual Orientation and Gender Diversity, 1, 452–460. [Google Scholar]
  24. Pew Research Center. (2013). A survey of LGBT Americans: Attitudes, experiences and values in changing times. Retrieved from https://www.pewsocialtrends.org/wp-content/uploads/sites/3/2013/06/SDT_LGBT-Americans_06-2013.pdf
  25. Radloff LS (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. [Google Scholar]
  26. Rosenthal L, & Starks TJ (2015). Relationship stigma and relationship outcomes in interracial and same-sex relationships: Examination of sources and buffers. Journal of Family Psychology, 29, 818–830. [DOI] [PubMed] [Google Scholar]
  27. Ross LE, Dobinson C, & Eady A. (2010). Perceived determinants of mental health for bisexual people: a qualitative examination. American Journal of Public Health, 100, 496–502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Ross LE, Salway T, Tarasoff LA, MacKay JM, Hawkins BW, & Fehr CP (2018). Prevalence of Depression and Anxiety Among Bisexual People Compared to Gay, Lesbian, and Heterosexual Individuals:A Systematic Review and Meta-Analysis. Journal of Sex Research, 55, 435–456. [DOI] [PubMed] [Google Scholar]
  29. Ruan WJ, Goldstein RB, Chou SP, Smith SM, Saha TD, Pickering RP, . . . Grant BF(2008). The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and Alcohol Dependence, 92, 27–36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Sarno EL, Newcomb ME, Feinstein BA, & Mustanski B. (2020). Bisexual men’s experiences with discrimination, internalized binegativity, and identity affirmation: Differences by partner gender. Archives of Sexual Behavior, 49, 1783–1798. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Spitzer RL, Kroenke K, Williams JB, & Lowe B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. [DOI] [PubMed] [Google Scholar]
  32. Waite LJ, & Gallagher M. (2000). The case for marriage: Why married people are happier, healthier, and better off financially. New York, NY: Broadway Books. [Google Scholar]
  33. Wayment HA, & Peplau LA (1995). Social support and well-being in heterosexual and lesbian women: A structural modeling approach. Personality and Social Psychology Bulletin, 21, 1189–1199. [Google Scholar]
  34. Whitton SW, Dyar C, Newcomb ME, & Mustanski B. (2018). Romantic involvement: A protective factor for psychological health in racially-diverse young sexual minorities. Journal of Abnormal Psychology, 127, 265–275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Wienke C, & Hill GJ (2009). Does the ‘marriage benefit’ extend to partners in gay and lesbian relationships? Evidence from a random sample of sexually active adults. Journal of Family Issues, 30, 259–289. [Google Scholar]

RESOURCES