Health inequalities in sexual minority adolescents other than gay, lesbian and bisexual – consequences of exclusion. Findings from a national cross-sectional study

Background Research demonstrates that sexual minority individuals who identify with sexual identities other than lesbian, gay, bisexual (LGB) have increased risk for poor mental health. However, traditionally most health research focuses on the LGB groups and other sexual minority identities are often excluded. There is limited knowledge on health and health-related behaviours in other sexual minority identities (OSI, including those who do not disclose their sexual identity) and in comparison, to LGB and heterosexual peers. Methods This study included 9,966 adolescents (53% males, 19.8% LGB and 2% OSI) aged 17 years from the UK-wide Millennium Cohort Study. Sexual identity was self-reported, and individuals were grouped into heterosexual [reference], sexual minority [LGB] and OSI (other sexual minorities, did not disclose, not known). Multinomial logistic regression examined sociodemographic characteristics (sex, gender, ethnicity and socioeconomic position [SEP]) of the OSI group. Associations between sexual identity and a range of mental and general health, and health related behaviours were analysed using multivariable logistic regression. Outcomes included mental (like psychological distress, self-harm, attempted suicide) and general (like obesity) health, and health-related behaviours (like smoking, alcohol frequency, risky sex). Results OSI individuals were more likely to be female (Relative risk ration [RRR]2.62, 95% CI 1.81–3.77) and from families with lower parental income, compared to heterosexuals. OSI individuals had increased odds for all mental health (example, OR3.7, 2.55–5.35 for psychological distress, OR2.73, 1.71–4.35 for attempted suicide), and general health indicators (example, OR1.77, 1.22–2.57 for obesity), most often similar in strength to LGB peers. OSI individuals had lower odds for most health-related behaviours (example, OR0.46, 0.32–0.67 for ever smoking, OR0.60, 0.39–0.93 for ever drug use, OR0.25, 0.17–0.39 for ever had sex). Conclusions Adolescents who identify with ‘other’ sexual identities have significant and substantially increased odds for a wide range of mental and general health problems. Future studies should include these individuals in research on sexual minority health. There also needs to be increased efforts to recruit more or oversample sexual minority individuals in future research studies and surveys, to ensure better representation of all sexual identities facilitating more effective research to reduce health inequalities.