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Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults
  1. Pierre-Julien Coulaud1,
  2. Travis Salway2,3,4,
  3. Nick Adams5,
  4. William Ball5,
  5. Joseph Larmarange6,
  6. Michelle Kelly-Irving7,
  7. Rod Knight1,4,8
  1. 1École de Santé Publique, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada
  2. 2Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  3. 3British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
  4. 4Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
  5. 5School of Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland
  6. 6Centre Population et Développement (UMR 196 Université Paris Cité, IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France
  7. 7Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
  8. 8Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
  1. Correspondence to Dr Pierre-Julien Coulaud, École de Santé Publique, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada; pierre-julien.coulaud{at}


While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (eg, depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (eg, attractions, identities and behaviour) with various patterns (eg, directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (eg, gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people.


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  • Contributors All authors contributed conceptually to this essay. PJC wrote the first draft with insights and contributions from TS, NA, WB, JL, MKI and RK. All authors reviewed and approved the final version of the essay. PJC is guarantor for the work.

  • Funding PJC is supported by a Postdoctoral Fellowship Award from the Canadian Institutes of Health Research (Grant # MFE-176609). MKI receives funding from the Gendhi project (Horizon 2020 European Research Council, Gendhi-Synergy Grant Agreement SGY2019-856478). RK holds a Junior 2 Research Scholar Award from the Fonds de Recherche du Québec–Santé (2023-2024 CB 330116).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.