Assessing Changes in LGBTQ+ Overall Physical and Mental Health Status 2016-2020

Background and Purpose:

LGBTQ+ people historically have had worse mental and physical health compared with their cisgender and heterosexual counterparts. During Trump’s presidency, many new laws and regulations that discriminate against LGBTQ+ people were passed including the consciousness clause, which allows healthcare providers to deny services for moral or religious reasons. The administration also actively opposed the Equality Act, a bill that seeks to protect LGBTQ+ people from discrimination broadly, including access to health care. The discriminatory policy emphasis could have further marginalized and stigmatized LGBTQ+ persons, thereby further worsening their mental or physical health. Accordingly, this study sought to examine if there have been corresponding changes in the mental and physical health statuses of LGBTQ+ populations over the past four years, specifically if there have been declines in health status.

Methods:

This secondary analysis used data from the 2016-2017 and 2019-2020 Behavioral Risk Factor Surveillance Survey. Data from 17 states were selected because they administered the core survey as well as the supplement on gender and sexual identity in both waves, yielding an analytic sample of 230,265 participants. The dependent variables were physical and mental health, assessed as dichotomous indicators with persons reporting at least one bad day in the past month (coded as 1) and those reporting no bad days (coded as 0). Separate predictor variables reflecting transgender (yes—trans woman/trans man/non-binary, no/unsure) and sexual identity (heterosexual, gay/lesbian, bisexual, other) status were included as predictors along with demographic covariates and an indicator for survey year. To test difference-in-differences effects interaction terms were included for year and sexual and gender identity. Models were estimated using mixed effects OLS regressions with state as the random intercept term.

Results:

Compared with heterosexuals, sexual minority participants had higher odds of worse physical (gay/lesbian aOR=1.15, p<.001; bisexual aOR=1.52, p<.001) and mental health (gay/lesbian aOR=1.56, p<.001; bisexual aOR=2.09, p<.001; other aOR=1.17, p<.01). Transgender persons also reported poorer physical (aOR=1.18, p<.05) and mental health (aOR=1.37, p<.001) relative to cisgender persons. However, these differences were consistent across the two survey waves. Of the difference-in-difference interaction terms tested, the mental health effects of time by sexual identity for bisexual persons was the only statistically significant result (aOR=1.17, p<.05). Tests of the random intercept terms indicated significant cross-state differences in health outcomes (mental health LR(1) = 199.2, p<.001; physical health LR(1) = 338.7, p<.01)

Conclusions and Implications:

While this study did not find worsened mental or physical health for most LGBTQ+ people over the past four years, our results affirm existing disparities, with poorer mental and physical health of these populations persisting. In particular, mental health disparities appear especially acute for bisexual persons, with worse outcomes in 2019-2020 compared with 2016-2017. Thus, while improved mental and physical health care are needed for the LGBTQ+ community, results indicate better mental health care for bisexual persons is especially needed. Lastly, although not a focus of this study, health research on the intersectionality of LGBTQ+ and other marginalized groups such as racial/ethnic minorities and reasons underlying state variations would be especially valuable.