Sexual orientation disparities in depression and substance use among adults: Results from the Brazilian National Health Survey, 2019

Abstract

Purpose: To compare the prevalence of depression and substance use/abuse according to sexual orientation and sex among Brazilian adults. Methods: Data were obtained from a national health survey (PNS 2019). This study included participants aged 18 and over (N=85,859). Prevalence ratios were estimated using Poisson models stratified by sex, for the association between sexual orientation, depression, daily tobacco use, alcohol abuse and both substance use/abuse. Results: After controlling for covariates, gay men showed a higher prevalence of depression (APR=1.92, 95% CI 1.32; 2.80), daily tobacco use (APR=1.93, 95% CI 1.45; 2.56) and multiple substances use/abuse (APR=1.73, CI95% 1.14;2.62) than heterosexuals. Bisexual men showed higher prevalence of depression (APR=2.91, 95% CI 1.54; 5.53). Estimated prevalence ratios were even higher among women. Lesbians showed higher prevalence of binge drinking (APR=2.52, 95% CI 1.94; 3.27), heavy drinking (APR=3.36, 95% CI 2.39; 4.72), daily tobacco use (APR=2.66, 95% CI 1.74; 4.07) and multiple substances use/abuse (APR=4.35, 95% CI 2.35;8.07) than among heterosexuals. Among bisexual women, results were significant for all analyzed outcomes: depression (APR=2.32, 95% CI 1.72; 3.13), binge drinking (APR=2.52, 95% CI 1.94; 3.27), heavy drinking (APR=2.53, 95% CI 1.68; 3.81), daily tobacco use (APR=1.82, 95% CI 1.12;2.96) and multiple substances use/abuse (APR=3.23, 95% CI 1.72;6.05). Conclusions: Our results indicate that sexual minorities are more vulnerable to mental illness and substance use/abuse. This finding draws attention to the need for specific public policies aimed at this population and for a greater recognition and better management of these disorders by health professionals.