Using nationally representative Canadian data, bisexual women showed the highest disparities in cannabis use and mental health compared to heterosexual peers, while gay and bisexual men showed decreasing substance use over time.
LGBTQ+ health advocates, public health researchers, bisexual community health providers
Bisexual women: 3.3x higher odds of poor mental health
What the researchers found
Lesbians and bisexual women had elevated odds of cannabis use compared to heterosexual women. Bisexual women showed the highest disparities across all outcomes (mental health OR=3.3, plus elevated binge drinking, illicit drugs, and cannabis). Gay and bisexual men and lesbians showed decreasing substance use trends over time (2009-2014).
Why it matters
Understanding which specific subgroups face the greatest health disparities allows for more targeted interventions. Bisexual women appear uniquely vulnerable, which aligns with research on biphobia and erasure in both heterosexual and LGBTQ+ spaces.
The numbers in context
Weighted N=19.98 million. Bisexual women: OR=3.3 for poor mental health. Lesbians and bisexual women had elevated cannabis use. Gay/bisexual men and lesbians showed decreasing substance use 2009-2014.
How the study worked
Analysis of 2009-2014 Canadian Community Health Surveys with a weighted sample of 19.98 million individuals. Logistic regression stratified by sex examined health disparities across sexual orientations, adjusted for covariates.
What this study cannot tell us
Self-reported data. 2009-2014 data may not reflect current patterns. Sexual orientation categories were broad. Those answering "don't know" or "refuse" had reduced substance use odds, suggesting measurement complexity.
How to read the evidence
Strong: nationally representative weighted sample of nearly 20 million individuals with stratified analysis, though cross-sectional and from 2009-2014
When this study was published
Published in 2025 using 2009-2014 Canadian Community Health Survey data
The bigger picture
While overall LGBTQ+ health disparities are well documented, disaggregating by specific sexual orientation reveals that bisexual individuals, especially women, bear a disproportionate burden. Interventions targeting "LGBTQ+" broadly may miss these specific needs.
Questions still open
- Why are bisexual women uniquely affected? Have these disparities changed since 2014? Would biphobia-specific interventions improve outcomes?
Common questions
Which group had the highest cannabis use?
Are things getting better over time?
Read the original research
Disparities in self-reported mental health, physical health, and substance use across sexual orientations in Canada.
PloS one, 20(3), e0305019
Citation
Bellows, Zachary; Kim, Chungah; Bai, Yihong; Cao, Peiya; Chum, Antony. (2025). Disparities in self-reported mental health, physical health, and substance use across sexual orientations in Canada.. PloS one, 20(3), e0305019. https://doi.org/10.1371/journal.pone.0305019
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