Mental Health Outcomes, Associated Factors, and Help-Seeking Among Rural LGBTQ+ Populations in the United States: A Scoping Review

Background and Purposes

LGBTQ+ individuals living in rural areas of the United States experience distinct mental health challenges due to geographic isolation, limited resources, and pervasive societal stigma. Restricted access to affirming care, coupled with conservative sociopolitical environments, can intensify psychological distress and create substantial barriers to accessing support. Although research on LGBTQ+ mental health has expanded, the majority of studies center on urban populations, leaving rural communities underrepresented in the literature. This scoping review aims to address this gap by synthesizing existing research on mental health outcomes and associated factors among rural LGBTQ+ populations, with a particular focus on understanding the barriers and facilitators to mental health help-seeking within these contexts.

Methods

This scoping review was conducted following the five-stage methodological framework developed by Arksey and O’Malley, along with the PRISMA Extension for Scoping Reviews reporting guideline. A systematic search of six electronic databases was performed to identify peer-reviewed articles. Studies were eligible for inclusion if they focused on LGBTQ+ individuals residing in rural areas of the United States and reported on mental health outcomes (e.g., depression, anxiety, suicidality), associated individual or contextual factors, and/or help-seeking behaviors. Titles, abstracts, and full texts were independently screened by five reviewers. Data were extracted using a standardized charting form that captured key study characteristics and findings, and then analyzed thematically to identify patterns, themes, and gaps in the literature.

Results

Of the 536 records initially identified, 46 studies met the inclusion criteria and were included in the final synthesis. Most studies did not specify the geographic region of focus; however, among those that did, nine (19.6%) were conducted in the South, seven in the Northeast (15.2%), four in the Midwest (8.6%), and one in the West (2.2%). The majority of studies employed quantitative methods (n = 36, 78.3%), followed by mixed-methods (n = 6, 13.0%) and qualitative approaches (n = 4, 8.7%). Included studies reported high rates of depressive symptoms and anxiety among rural LGBTQ+ individuals, while fewer studies addressed loneliness, suicidal ideation or suicide-related behaviors. Factors associated with poor mental health outcomes included internalized stigma, minority stress, family rejection, lack of LGBTQ+ community support, and inadequate access to care and limited provider availability. Help-seeking behaviors were hindered by fear of being outed, mistrust of healthcare providers, and lack of culturally competent care. Conversely, facilitators of help-seeking included affirming social networks, availability of telehealth services, and integrated care models. A small but growing number of studies explored the promise of eHealth and telehealth-based interventions in improving access and engagement among rural LGBTQ+ populations.

Conclusions and Implications

This scoping review highlights significant mental health disparities among rural LGBTQ+ populations and identifies key individual, social, and structural factors that influence mental health and help-seeking. Despite growing research interest, substantial gaps remain, particularly regarding suicidality, intervention research, and geographic specificity. Future studies should prioritize community-engaged approaches, develop culturally responsive interventions, and leverage technology-based solutions to address unmet mental health needs and improve access to affirming care in rural settings.