Qualitative examination of coping motives, microaggressions, and psychological distress among bisexual+ women survivors
Background: Bisexual+ (bi+; attraction to more than one gender) women report elevated rates of heavy drinking (4+ drinks/occasion) relative to heterosexual women. Women with sexual assault histories (vs those without) also report elevated rates of heavy drinking. We conducted a qualitative examination of factors that may influence heavy drinking from the perspectives of bi+ and heterosexual women with histories of sexual assault.
Methods: Semi-structured 60-minute interviews were conducted with 45 women living in the US, ages 18-29, who identified as bi+ (n=24) or heterosexual (n=21) and endorsed lifetime history of sexual assault. Interviews focused on understanding potential heavy drinking antecedents (i.e., coping motives, psychological distress, and microaggressions[intentional or unintentional slight about someone’s minority identity]). A priori codes were developed, and the codebook was refined following the coding of two transcripts. Transcripts were double-coded, and thematic analyses were conducted by subgroup (bi+ vs. heterosexual).
Results: Thematic analyses revealed five themes: Theme (1) indicated that most participants reported they only drank for enhancement/social motives, but they also reported coping motives when asked directly. Theme 1 was more common among bi+ women. Theme (2) indicated that psychological distress may increase drinking among both bi+ and heterosexual women but appeared to have a larger impact on drinking among bi+ women. Theme (3) indicated that some bi+ women intended not to drink when they became more distressed but struggled more often than heterosexual women to effectively restrict themselves from drinking. Theme (4) indicated that frequency, identity (sexual identity, race/ethnicity, gender) that is being targeted by the microaggression, and the relationship of the perpetrator play a role in whether or how women will react (and how it may indirectly impact their decision to drink). Overall, theme (5) indicated that coping motives, psychological distress, and microaggressions appear interrelated; women reported that when their cognitive load was too high or they were experiencing a lot of psychological distress, experiencing a microaggression on that same day made them more willing to drink (to cope with distress related to the microaggression).
Conclusion: Findings highlight differences in heavy drinking antecedents among bi+ and heterosexual women with histories of sexual assault. Informing preventative work for bi+ women with histories of sexual assault is important as they are an underserved population that experiences mental health disparities in the United States. Further understanding heavy drinking antecedents may inform targeted intervention and prevention to meet the unique needs of bi+ women and decrease elevated rates of heavy drinking among bi+ women.
