Disparities in the Unmet Mental Health Needs Between LGBTQ+ and Non-LGBTQ+ Populations During COVID-19 in the United States from 21 July 2021 to 9 May 2022

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2022 Nov 25

PMID 36425114

Authors

Shanquan Chen

Yuqi Wang

Rui She

Pei Qin

Wai-Kit Ming

Affiliations

Soon will be listed here.

Abstract

Background: Evidence highlighted the likelihood of unmet mental health needs (UMHNs) among LGBTQ+ than non-LGBTQ+ populations during COVID-19. However, there lacks evidence to accurately answer to what extent the gap was in UMHN between LGBTQ+ and non-LGBTQ+ populations. We aim to evaluate the difference in UMHN between LGBTQ+ and non-LGBTQ+ during COVID-19.

Methods: Cross-sectional data from Household Pulse Survey between 21 July 2021 and 9 May 2022 were analyzed. LGBTQ+ was defined based on self-reported sex at birth, gender, and sexual orientation identity. UMHN was assessed by a self-reported question. Multivariable logistic regressions generated adjusted odds ratios (AODs) of UMHN, both on overall and subgroups, controlling for a variety of socio-demographic and economic-affordability confounders.

Findings: 81267 LGBTQ+ and 722638 non-LGBTQ+ were studied. The difference in UMHN between LGBTQ+ and non-LGBTQ+ (as reference) varied from 4.9% (95% CI 1.2-8.7%) in Hawaii to 16.0% (95% CI 12.2-19.7%) in Utah. In multivariable models, compared with non-LGBTQ+ populations, LGBTQ+ had a higher likelihood to report UMHN (AOR = 2.27, 95% CI 2.18-2.39), with the highest likelihood identified in transgender (AOR = 3.63, 95% CI 2.97-4.39); compared with LGBTQ+ aged 65+, LGBTQ+ aged 18-25 had a higher likelihood to report UMHN (AOR = 1.34, 95% CI 1.03-1.75); compared with White LGBTQ+ populations, Black and Hispanic LGBTQ+ had a lower likelihood to report UMHN (AOR = 0.72, 95% CI 0.63-0.82; AOR = 0.85, 95% CI 0.75-0.97, respectively).

Interpretation: During the COVID-19, LGBTQ+ had a substantial additional risk of UMHN than non-LGBTQ+. Disparities among age groups, subtypes of LGBTQ+, and geographic variance were also identified.

Citing Articles

Prevalence, severity and risk factors of psychiatric disorders amongst sexual and gender diverse young people during the COVID-19 pandemic: A systematic review.

OShea J, James R, Nicholls D, Downs J, Hudson L Clin Child Psychol Psychiatry. 2024; 29(3):1213-1227.

PMID: 38290723 PMC: 11188558. DOI: 10.1177/13591045241229751.

References

Rose S, Garrett S, McKinlay E, Morgan S . Access to sexual healthcare during New Zealand's COVID-19 lockdown: cross-sectional online survey of 15-24-year-olds in a high deprivation region. BMJ Sex Reprod Health. 2021; 47(4):277-284. DOI: 10.1136/bmjsrh-2020-200986. View

Akre E, Anderson A, Stojanovski K, Chung K, VanKim N, Chae D . Depression, Anxiety, and Alcohol Use Among LGBTQ+ People During the COVID-19 Pandemic. Am J Public Health. 2021; 111(9):1610-1619. PMC: 8589058. DOI: 10.2105/AJPH.2021.306394. View

Chaiton M, Billington R, Copeland I, Grey L, Abramovich A . Mental Health and Addiction Services Exclusive to LGBTQ2S+ during COVID-19: An Environmental Scan. Int J Environ Res Public Health. 2022; 19(10). PMC: 9140765. DOI: 10.3390/ijerph19105919. View

Stojanovski K, King E, Bondikjova V, Mihajlov A . Stigma shapes lesbian, gay, bisexual, transgender, and queer person's mental health and experiences with mental health services in North Macedonia. Glob Public Health. 2021; 17(6):857-869. DOI: 10.1080/17441692.2021.1896767. View

Steele L, Daley A, Curling D, Gibson M, Green D, Williams C . LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People. J Womens Health (Larchmt). 2016; 26(2):116-127. DOI: 10.1089/jwh.2015.5677. View

Akobirshoev I, Vetter M, Iezzoni L, Rao S, Mitra M . Delayed Medical Care And Unmet Care Needs Due To The COVID-19 Pandemic Among Adults With Disabilities In The US. Health Aff (Millwood). 2022; 41(10):1505-1512. DOI: 10.1377/hlthaff.2022.00509. View

Williams N, Fish J . The availability of LGBT-specific mental health and substance abuse treatment in the United States. Health Serv Res. 2020; 55(6):932-943. PMC: 7704474. DOI: 10.1111/1475-6773.13559. View

Santoli J, Lindley M, DeSilva M, Kharbanda E, Daley M, Galloway L . Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration - United States, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(19):591-593. DOI: 10.15585/mmwr.mm6919e2. View

Jarrett B, Peitzmeier S, Restar A, Adamson T, Howell S, Baral S . Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people. PLoS One. 2021; 16(7):e0254215. PMC: 8270151. DOI: 10.1371/journal.pone.0254215. View

10.

Burgess C, Batchelder A, Sloan C, Ieong M, Streed Jr C . Impact of the COVID-19 pandemic on transgender and gender diverse health care. Lancet Diabetes Endocrinol. 2021; 9(11):729-731. PMC: 8463012. DOI: 10.1016/S2213-8587(21)00266-7. View

11.

Seo J, Kim S, Lee M, Kang J . Impact of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a tertiary hospital. J Affect Disord. 2021; 290:279-283. PMC: 9754757. DOI: 10.1016/j.jad.2021.04.070. View

12.

Wright M, Wachs S, Gamez-Guadix M . The Role of Perceived Gay-Straight Alliance Social Support in the Longitudinal Association Between Homophobic Cyberbullying and LGBTQIA Adolescents' Depressive and Anxiety Symptoms. J Youth Adolesc. 2022; 51(7):1388-1396. DOI: 10.1007/s10964-022-01585-6. View

13.

Ormiston C, Williams F . LGBTQ youth mental health during COVID-19: unmet needs in public health and policy. Lancet. 2021; 399(10324):501-503. PMC: 8813090. DOI: 10.1016/S0140-6736(21)02872-5. View

14.

Worrell S, Waling A, Anderson J, Lyons A, Pepping C, Bourne A . The Nature and Impact of Informal Mental Health Support in an LGBTQ Context: Exploring Peer Roles and Their Challenges. Sex Res Social Policy. 2022; 19(4):1586-1597. PMC: 8724749. DOI: 10.1007/s13178-021-00681-9. View

15.

Restar A, Jin H, Jarrett B, Adamson T, Baral S, Howell S . Characterising the impact of COVID-19 environment on mental health, gender affirming services and socioeconomic loss in a global sample of transgender and non-binary people: a structural equation modelling. BMJ Glob Health. 2021; 6(3). PMC: 7985976. DOI: 10.1136/bmjgh-2020-004424. View

16.

Sachdeva I, Aithal S, Yu W, Toor P, Tan J . The disparities faced by the LGBTQ+ community in times of COVID-19. Psychiatry Res. 2021; 297:113725. PMC: 7806461. DOI: 10.1016/j.psychres.2021.113725. View

17.

Macias Gil R, Freeman T, Mathew T, Kullar R, Fekete T, Ovalle A . Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Communities and the Coronavirus Disease 2019 Pandemic: A Call to Break the Cycle of Structural Barriers. J Infect Dis. 2021; 224(11):1810-1820. PMC: 9103180. DOI: 10.1093/infdis/jiab392. View

18.

Burgess D, Tran A, Lee R, Van Ryn M . Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons. J LGBT Health Res. 2008; 3(4):1-14. DOI: 10.1080/15574090802226626. View

19.

Schwartz A, Munsell E, Schmidt E, Colon-Semenza C, Carolan K, Gassner D . Impact of COVID-19 on services for people with disabilities and chronic health conditions. Disabil Health J. 2021; 14(3):101090. PMC: 9760298. DOI: 10.1016/j.dhjo.2021.101090. View

20.

Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M . Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry. 2022; 34(3-4):215-229. DOI: 10.1080/09540261.2022.2075256. View