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Findings From the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Theo G. M. Sandfort, PhD; Ron de Graaf, PhD; Rob V. Bijl, PhD; Paul Schnabel, PhD

Arch Gen Psychiatry. 2001;58:85-91.

Background  It has been suggested that homosexuality is associated with psychiatric morbidity. This study examined differences between heterosexually and homosexually active subjects in 12-month and lifetime prevalence of DSM-III-R mood, anxiety, and substance use disorders in a representative sample of the Dutch population (N = 7076; aged 18-64 years).

Methods  Data were collected in face-to-face interviews, using the Composite International Diagnostic Interview. Classification as heterosexual or homosexual was based on reported sexual behavior in the preceding year. Five thousand nine hundred ninety-eight (84.8%) of the total sample could be classified: 2.8% of 2878 men and 1.4% of 3120 women had had same-sex partners. Differences in prevalence rates were tested by logistic regression analyses, controlling for demographics.

Results  Psychiatric disorders were more prevalent among homosexually active people compared with heterosexually active people. Homosexual men had a higher 12-month prevalence of mood disorders (odds ratio [OR] = 2.93; 95% confidence interval [CI] = 1.54-5.57) and anxiety disorders (OR = 2.61; 95% CI = 1.44-4.74) than heterosexual men. Homosexual women had a higher 12-month prevalence of substance use disorders (OR = 4.05; 95% CI = 1.56-10.47) than heterosexual women. Lifetime prevalence rates reflect identical differences, except for mood disorders, which were more frequently observed in homosexual than in heterosexual women (OR = 2.41; 95% CI = 1.26-4.63). The proportion of persons with 1 or more diagnoses differed only between homosexual and heterosexual women (lifetime OR = 2.61; 95% CI = 1.31-5.19). More homosexual than heterosexual persons had 2 or more disorders during their lifetimes (homosexual men: OR = 2.70; 95% CI = 1.66-4.41; homosexual women: OR = 2.09; 95% CI = 1.07-4.09).

Conclusion  The findings support the assumption that people with same-sex sexual behavior are at greater risk for psychiatric disorders.

From Utrecht University (Drs Sandfort and Schnabel), the Netherlands Institute of Social Sexological Research (Dr Sandfort), and the Netherlands Institute of Mental Health and Addiction (Drs de Graaf and Bijl), Utrecht, the Netherlands; and the Social and Cultural Planning Office of the Netherlands, The Hague (Dr Schnabel).

Corresponding author: Theo G. M. Sandfort, PhD, Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, the Netherlands (e-mail: t.sandfort{at}fss.uu.nl).

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