Most surveys of the prevalence of psychiatric disorders among lesbians and gay men find no increased risk in comparison with heterosexuals. However, the majority of this work has relied on convenience samples drawn from the visible lesbian and gay community. The authors examined differences in 1-year prevalence of six psychiatric syndromes among sexually active individuals in the 1996 National Household Survey of Drug Abuse who reported either exclusive heterosexuality (n = 9,714) or having any same-gender sex partners (n = 194) in the prior year. Although nearly three quarters of homosexually active individuals did not meet criteria for any of the six syndromes assessed, in multivariate logistic regression analyses, homosexually active men were more likely than other men to evidence major depression and panic attack syndromes. In contrast, homosexually active women were more likely than other women to be classified with alcohol or drug dependency syndromes. Both men and women reporting any same-gender sex partners were more likely than others to have used mental health services in the year prior to interview. These findings suggest a small increased risk among homosexually active populations in 1-year psychiatric morbidity and use of mental health care services. Keywords health surveys; homosexuality; mental disorders; psychiatry; substance-related disorders Perspectives on possible relations between homosexuality and psychiatric disorders have changed remarkably over the last half of this century (1). While homosexuality was once viewed as a psychiatric disorder or as a strong indicator of one, beginning in the late 1950s, empirical studies using small, nonclinical samples repeatedly found no elevation in rates of general psychiatric morbidity among lesbians or gay men when they were compared with similar heterosexuals (2-8). More recently, however, research examining psychiatric symptoms among gay men and lesbians has emphasized the role of social stigmatization in creating a chronic social stressor in the lives of many gay men and lesbians (9)(10)(11)(12)(13)(14). Over the last decade in particular, research focusing on the possible psychiatric sequelae of social stigmatization and, for gay men, the stress of coping with the human immunodeficiency virus (HIV) epidemic, increasingly has found evidence that lesbians and gay men may be at greater-than-expected risk for several stress-related disorders, including drug and/or alcohol abuse (9,(15)(16)(17), suicide attempts during adolescence and young adulthood (18)(19)(20) One or the difficulties in interpreting the body of empirical evidence in this arena is that the majority of the studies carried out to date have used convenience-based samples drawn from the visible lesbian and gay community. As a result, findings may have been distorted by the selection bias inherent in using highly motivated volunteer samples (24). Population-based psychiatric surveys that identify individuals who may differ in terms of sexual orientation are extremely rare. To our...