Mental health disparities in LGBTQIA+ populations: an umbrella review of systematic reviews and meta-analyses.

Abstract

Lesbian, gay, bisexual, transgender, questioning, intersex, asexual (LGBTQIA+) populations face unique social, political, psychological and health care-related challenges that contribute to marked mental health disparities. However, the overall strength and credibility of evidence across mental disorders, mental disorder-related symptomatology, suicidal or self-harm behaviors, and access to mental health care have not been systematically assessed in these populations. We conducted an umbrella review of systematic reviews with meta-analyses (SRMAs) of observational studies investigating mental health outcomes in LGBTQIA+ populations. PubMed, Scopus and PsycINFO were searched from inception to April 23, 2025, with no language restrictions. Eligible SRMAs compared LGBTQIA+ populations with cisgender heterosexual populations (primary aim), or subgroups within LGBTQIA+ populations (secondary aim). Outcomes were categorized as diagnosed mental disorders, disorder-related symptomatology, suicidal or self-harm behaviors, and access to mental health care. The credibility of each association was evaluated according to standardized criteria, classifying evidence as convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV), or not significant. We included 22 SRMAs encompassing 398 individual studies and 162 unique meta-analytic associations. Among these, eight associations reached convincing evidence (class I). Compared with cisgender heterosexual populations, LGB populations had a higher risk of depressive disorders (risk ratio, RR=2.05, 95% CI: 1.69-2.48) and suicidal behaviors, including suicide attempts (RR=2.51, 95% CI: 2.14-2.94) and suicidal ideation or attempts combined (odds ratio, OR=3.20, 95% CI: 2.65-3.86). Among adolescents, gay populations showed higher odds of eating disorder-related behaviors compared with heterosexual peers, including dieting (OR=3.10, 95% CI: 2.69-3.58) and purging (OR=5.40, 95% CI: 4.72-6.17). Within LGBTQIA+ populations, bisexual individuals had higher odds of anxiety symptoms (OR=1.73, 95% CI: 1.56-1.92) and non-suicidal self-injury (OR=2.24, 95% CI: 1.91-2.63) compared with lesbian and gay individuals. In addition, gay populations showed significantly lower body image disturbance than lesbian populations (standardized mean difference, SMD=-0.25, 95% CI: -0.32 to -0.19). Considering both class I and II evidence, body image disturbance showed a consistent gradient across sexual orientation, with higher levels among heterosexual women, followed by lesbian women, gay men, and heterosexual men. We conclude that mental health disparities affecting LGBTQIA+ populations are supported by highly credible evidence, particularly for depressive disorders, suicidality, and eating disorder symptoms, underscoring the urgent need for inclusive prevention strategies, targeted interventions, and structural reforms addressing stigma and discrimination in health care.