sexual orientation excludes those respondents not sexually active in the 5 years prior to the interview.

Cochran and colleagues (2003) later analyzed data from the MacArthur Foundation National Survey of Midlife Development in the United States (MIDUS) to examine possible sexual orientation–related differences in morbidity, distress, and use of mental health services. The sexual orientation of 2,917 adults (aged 25–74) was based on self-report as heterosexual (n = 2,844), homosexual (n = 41), or bisexual (n = 32). The samples of individuals who identified as homosexual and those who identified as bisexual were combined for analysis. The results revealed that gay/bisexual men had a higher prevalence of panic attacks than heterosexual men, while lesbian/ bisexual women had a higher prevalence of generalized anxiety disorder than heterosexual women. However, the authors note the limited number of participants who reported a homosexual or bisexual orientation.

More recently, Bostwick and colleagues (2010) used data from the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653) to examine lifetime and past-year mood and anxiety disorders among different sexual orientation groups. Identity, attraction, and behavior measures were used to assess sexual orientation. The authors found mental health disparities among some sexual-minority groups. Self-identified lesbian, gay, or bisexual individuals had higher rates of mood and anxiety disorders than self-identified heterosexual individuals. Women who reported exclusively same-sex sexual behavior and women who reported exclusively same-sex attraction were found to have some of the lowest rates of mood and anxiety disorders. With the exception of these women, however, individuals reporting any same-sex sexual behavior or same-sex attraction were found to have higher rates of most mood and anxiety disorders than those reporting exclusively different-sex sexual behavior or exclusively different-sex attraction. Bisexual behavior was found to be associated with the highest incidence of mood or anxiety disorders.

There have been relatively few studies on the prevalence of mood and anxiety disorders among transgender adults. In a study previously mentioned, Derogatis and colleagues (1978) found significantly higher levels of anxiety and depression among a sample of male-to-female transsexuals in comparison with nontransgender men. More recent literature on depression among transgender adults is presented in the next section.

Depression

Some evidence is available from population studies on differences in rates of major depression between homosexually and heterosexually active men and women. Cochran and Mays (2000b) examined possible differences in psychiatric syndromes between homosexually active and heterosexually



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