Document Type


Publication Date


Publication Title

LGBT Health







Publisher Name

Mary Ann Liebert



This study aimed to examine how configurations of sexual identity and attraction are associated with mental health outcomes.


Data came from the 2015, 2016, and 2017 waves of the National Survey on Drug Use and Health, one of the few nationally representative surveys to ask about sexual attraction. Sexual identity and attraction were combined into groups that are coincident (heterosexual-opposite gender attraction, gay/lesbian-same gender attraction, or bisexual-any multiple gender attraction) or branched (heterosexual-any same gender attraction, gay/lesbian-any opposite gender attraction, bisexual-only same or opposite gender attraction). The association between these configurations and various measures of mental health and well-being—severe psychological distress, major depressive episodes, suicidal ideation, and suicide plan or attempt—was examined.


Heterosexual coincidence—being heterosexual and only attracted to the opposite gender—was associated with lower mental health risks than all other configurations of sexual identity and attraction. In addition, bisexual with coincident attraction was often associated with worse mental health outcomes than other configurations of identity and attraction, while bisexual with branched attraction did not necessarily follow this pattern. Finally, heterosexual with branched attraction was associated with worse mental health outcomes than heterosexual with coincident attraction, but better mental health outcomes than some of the other sexual identity and attraction configurations.


Including one question on sexual attraction and its intersection with sexual identity adds nuance to our understanding of disparities in mental health and well-being among previously identified sexual minority and majority groups.


Author Posting © Mary Ann Liebert, Inc.,2021. This is the accepted version of the following article: The Survey Measurement of Sexual Orientation: Configurations of Sexual Identity and Attraction and Associations with Mental Health, which has now been formally published in final form at LGBT Health, VOL. 8, ISS.4, (June 1, 2021) at This original submission version of the article may be used for noncommercial purposes in accordance with the Mary Ann Liebert, Inc., publishers’ self-archiving terms and conditions.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.