Characterizing non-monosexual women at risk for poor mental health outcomes: A mixed methods study

Lori E. Ross, Melissa H. Manley, Abbie E. Goldberg, Alia Januwalla, Keisha Williams, Corey E. Flanders


OBJECTIVES: Non-monosexual women – those who report attraction to or sexual relationships with individuals of more than one gender – have elevated risk for poor mental health outcomes. We aimed to examine which elements of non-monosexual experience are associated with this elevated risk.

METHODS: We conducted a sequential exploratory mixed methods analysis of qualitative interview and survey data from 39 non-monosexual women recruited consecutively through prenatal care providers. Qualitative analyses identified distinguishing features, and quantitative analyses tested associations between these features and mental health symptoms.

RESULTS: Nine qualitative themes were identified to describe distinguishing features of non-monosexual women. Of these, current and past five years partner gender, lack of LGBTQ community connection, and low centrality of sexual minority identity were associated with anxiety symptoms. Latent class analysis revealed significantly higher levels of anxiety symptoms among non-monosexual women partnered with men relative to those partnered with women.

CONCLUSION: Sexual minority women who partner with men may be particularly at risk for poor mental health. Considering this group’s invisibility in public health research and practice, interventions are needed to address this disparity.


Bisexuality; mental health; qualitative research; questionnaire design

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