Krystal Kittle, assistant professor of community health education in the School of Public Health and Health Sciences, has led a new study that sheds light on the community of bi+ (e.g., bisexual, pansexual, queer) dementia caregivers.

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Published in the American Journal of Alzheimer’s Disease and Other Dementias, the study examines a group that has been described as an “invisible majority” among the estimated 11+ million adults in the U.S. who provide unpaid care to family members, friends, and other people living with Alzheimer’s disease and related dementias (ADRD).

ADRD caregivers are already often characterized as “invisible second patients” due to the substantial physical, emotional, and social demands of ADRD caregiving. For ADRD caregivers, the physical, social, emotional and financial tolls are often substantial; for LGBTQ+ caregivers, these tolls are frequently exacerbated by additional stressors and health disparities experienced by minority populations. Taken together, the researchers suggest that bi+ ADRD caregivers can be viewed as a twice hidden population.

With an estimated 1 in 5 LGBTQ+ adults serving as a caregiver to a family member or friend with a disability or health problem, the study reports the importance of understanding the substantial physical, mental, and emotional burdens faced by this population of caregivers. Data indicates LGBTQ+ caregivers report fewer financial and social resources and caregiver supports as well as elevated depressive symptoms and below average health when compared to their non-LGBTQ+ peers. Additionally, they may be caring for someone who does not accept their LGBTQ+ identity, which can increase the psychological impact of caregiving.

Bi+ populations are the largest sexually minoritized group in the U.S., and research suggests they face significant health disparities compared with both monosexual minority (i.e., gay, lesbian) and heterosexual individuals. These elevated levels of minority stress may reflect the compounded negative attitudes bi+ individuals receive from heterosexual people because of their nonconformity to heteronormative standards, as well as from lesbian and gay people because of their nonconformity to monosexual standards.

In their study, Kittle and colleagues from Emory University, the University of Nevada, Las Vegas and the University of Tennessee, Knoxville examined associations between minority stress and stress on global health to determine how these associations differed among bi+ and gay/lesbian (g/l) ADRD caregivers. Their analysis of cross-sectional survey data from LGBTQ+ dementia caregivers revealed that bi+ caregivers reported significantly higher minority stress and lower family quality of life, though better health than g/l caregivers. Additional analyses revealed higher perceived stress predicted worse health for bi+, but better health for g/l; higher family quality of life predicted better health for both groups, with a stronger effect among bi+ caregivers; and more lifetime discrimination predicted worse health for both groups, with a stronger effect among bi+ caregivers.

“This study sheds much-needed light on bi+ ADRD caregivers, a population often overlooked in caregiving and LGBTQ+ health research, highlighting their distinct experiences with minority stress, caregiving, and health,” write the researchers. “These findings underscore the importance of disaggregating sexual minority groups in caregiving and health research and emphasize the need for inclusive and affirming interventions that address the specific challenges bi+ caregivers face.”

The complete study, “Health of Bi+ Dementia Caregivers: Moderation Effects of Minority and Caregiving Stress,” is available online via Sage here.