Increased risks for mental disorders among LGB individuals: cross-national evidence from the World Mental Health Surveys

WHO World Mental Hlth Survey Colla, Jan-Ole H. Gmelin*, Ymkje Anna De Vries, Laura Baams, Sergio Aguilar-Gaxiola, Jordi Alonso, Guilherme Borges, Brendan Bunting, Graca Cardoso, Silvia Florescu, Oye Gureje, Elie G. Karam, Norito Kawakami, Sing Lee, Zeina Mneimneh, Fernando Navarro-Mateu, Jose Posada-Villa, Charlene Rapsey, Tim Slade, Juan Carlos StagnaroYolanda Torres, Ronald C. Kessler, Peter de Jonge

*Corresponding author for this work

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Purpose Lesbian, gay, and bisexual (LGB) individuals, and LB women specifically, have an increased risk for psychiatric morbidity, theorized to result from stigma-based discrimination. To date, no study has investigated the mental health disparities between LGB and heterosexual AQ1individuals in a large cross-national population-based comparison. The current study addresses this gap by examining differences between LGB and heterosexual participants in 13 cross-national surveys, and by exploring whether these disparities were associated with country-level LGBT acceptance. Since lower social support has been suggested as a mediator of sexual orientation-based differences in psychiatric morbidity, our secondary aim was to examine whether mental health disparities were partially explained by general social support from family and friends. Methods Twelve-month prevalence of DSM-IV anxiety, mood, eating, disruptive behavior, and substance disorders was assessed with the WHO Composite International Diagnostic Interview in a general population sample across 13 countries as part of the World Mental Health Surveys. Participants were 46,889 adults (19,887 males; 807 LGB-identified). Results Male and female LGB participants were more likely to report any 12-month disorder (OR 2.2, p < 0.001 and OR 2.7, p < 0.001, respectively) and most individual disorders than heterosexual participants. We found no evidence for an association between country-level LGBT acceptance and rates of psychiatric morbidity between LGB and heterosexualAQ2 participants. However, among LB women, the increased risk for mental disorders was partially explained by lower general openness with family, although most of the increased risk remained unexplained. Conclusion These results provide cross-national evidence for an association between sexual minority status and psychiatric morbidity, and highlight that for women, but not men, this association was partially mediated by perceived openness with family. Future research into individual-level and cross-national sexual minority stressors is needed.

Original languageEnglish
Pages (from-to)2319–2332
Number of pages14
JournalSocial Psychiatry and Psychiatric Epidemiology
Early online date19-Jul-2022
Publication statusPublished - Nov-2022


  • Epidemiology
  • Health status disparities
  • Mental disorders
  • Cross-national
  • Sexual orientation
  • GAY

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