Depressive symptoms and tobacco, alcohol and other substance use among sexual minority men and women: Differences by gender and orientation identity

Background: Several studies indicate increased prevalence of tobacco, alcohol and other substance use among sexual minority men (SMM) and women (SMW). One explanation for this disparity is an increased prevalence of depressive symptoms among sexual minorities (SM) due to stigma and discrimination. Previous studies suggest such a relationship; however, few utilize nationally representative data or examine this relationship within gender and orientation identity groups (i.e., lesbian, gay, bisexual, MSM, FSF). Method: Utilizing National Health and Nutrition Examination Survey (NHANES) 2005-08 data (N=5512), we compared prevalence of current depressive symptoms (PHQ-9 >4) and tobacco, alcohol and other substance use for SM to both heterosexuals and by gender and orientation identity. We also conducted a logistic regression analysis to determine if depressive symptoms explained increased tobacco, alcohol or other substance use among SM. Results: SM were significantly (p<.01) more likely to be current smokers (34% vs.26%), indicate a history of repeated binge drinking (5+ drinks on most days) (22% vs. 16%), lifetime marijuana use (82% vs. 62%), lifetime illicit drug use (41% vs. 21%), and to have current depressive symptoms (33% vs. 21%). Prevalence for all variables except binge drinking was higher among SMW compared to SMM, and among bisexuals compared to gay men/lesbians. Presence of depressive symptoms could not fully account for increased tobacco, alcohol or substance use among SM. Conclusion: Tobacco, alcohol and other substance use are greater among SM compared to heterosexuals, they vary by gender and orientation identity, and cannot be fully explained by presence of depressive symptoms.