Homophobia is stressing out gay and bisexual men and women making them more likely to hit the bottle and smoke, a new study found.

Lesbians, gays and bisexuals are more likely to have poor physical and mental health because of the discrimination they face.

But bisexual men and women fared the worst because they are “marginalised” by heterosexuals and experiencing “stigma” from gay and lesbian adults.

In effect they are shunned by everyone and as a result are up to two-and-a-half times more at risk of psychological distress, researchers at Vanderbilt University in , Nashville suggested.

Professor Gilbert Gonzales said: “Findings from our study indicate LGB adults experience significant health disparities – particularly in mental health and substance use – likely due to the minority stress LGB adults experience as a result of their exposure to both interpersonal and structural discrimination.

“As a first step toward eliminating sexual orientation-based health disparities it’s important for health care professionals to be aware and mindful of the increased risk of impaired health, alcohol consumption and tobacco use among their LGB adult patients.”

The first study of its kind into the well-being of sexual minorities published by JAMA Internal Medicine compared 1,664 lesbian, gay and bisexual adults with 67,150 heterosexual peers.

It used data from the 2013 and 2014 National Health Interview Survey (NHIS) in the US which for the first time included a question on sexual orientation.

While 16.9 per cent of heterosexual men had moderate or severe psychological distress 25.9 per cent of gay men and 40.1 per cent of bisexual men did so.

Bisexual men reported the highest prevalence of heavy drinking at 10.9 per cent compared with heterosexual (5.7 per cent) or gay (5.1 per cent) men.

Gay and bisexual men were more likely to be smokers compared with heterosexual men.

But bisexual men were most like to be heavy smokers (9.3 per cent) compared with heterosexual (6.0 per cent) and gay (6.2 per cent) men.

About a fifth (21.9 per cent) of heterosexual women showed symptoms of moderate and severe psychological distress compared with lesbian (28.4 per cent) and bisexual (46.4 per cent) women.

Bisexual women had the heaviest alcohol consumption (11.7 per cent) compared with their lesbian (8.9 per cent) and heterosexual (4.8 per cent) peers..

Both lesbian and bisexual women (greater than 25 percent) were more likely to be smokers compared with heterosexual women (14.7 percent).

But lesbians (5.2 per cent) were more likely to be heavy smokers than heterosexual (3.4 percent) and bisexual (4.2 per cent) women.

Lesbian women were more likely to report poor or fair health and multiple chronic conditions compared with heterosexual women.

Bisexual women were more likely to report multiple chronic conditions than heterosexual women.

Dr Mitchell Katz, editor of the journal, said: “Health care professionals can help by creating environments that are inclusive and supportive of sexual minority patients.

“As with discussion of other personal issues, such as religious beliefs or sexual function, the important thing is to ask open-ended questions that do not prejudge responses.

“For example, asking a new patient whether he or she has sex with men, women or both indicates openness and acceptance.

“Whatever the answer, following up by asking of the patient has a special partner shows interest and willingness to discuss intimate issues.

“In caring for people who have experienced bias and discrimination, support is a very potent medicine.”

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