Members of the LGBT+ community experience both mental and physical health inequalities at all stages of life as well as poorer access to health and care services, according to Glasgow-led research.

In a scoping review of 200 recent research studies, Glasgow Centre for Population Health (GCPH) researchers have revealed unmet health needs can be linked to discrimination, microaggressions and distress from being part of a minority group.

The research looked to identify the social determinants of the health of lesbian, gay, bisexual, transgender and other identity (LGBT+) groups from available evidence and clarify themes for future work.

Rebecca Hoffman, National Policy Lead for LGBT Health and Wellbeing explained this diminished access further reinforces physical and mental health inequalities experienced by the LGBT community, adding:

“The themes in our review paint a vivid picture: discrimination, mental health struggles, physical health risks and barriers to health services.”

A key finding highlighted in the ‘Examining the social determinants of LGBT+ health and wellbeing’ review is the impact of bullying and discrimination on young people’s mental wellbeing.

Researchers refer to a 2022 survey of Scotland’s young people finding that 60% of trans participants and 70% of gay and lesbian participants experienced bullying due to their identity at school.

Other studies examined by the Glasgow team found several-fold increases in depression, anxiety, self-harm and suicidality in comparison to heterosexual and cisgendered peers.

The GCPH researchers, backed by LGBT Health and Wellbeing, said there is a need to better track the public health of LGBT+ health and inequalities and to develop public education campaigns highlighting the barriers people face in accessing services.

Mark Kelvin, Chief Executive at LGBT Health and Wellbeing, said:

“Public health has long investigated health inequalities between social groups.

“However, understanding the building blocks of health within the LGBT+ community in comparison to the wider population has occupied lower importance within public health research and policy agendas.”

This comes after Scotland’s very first LGBTQIA+ mental health network was launched earlier this year, with the aim of forging closer collaboration between academia, service providers, policymakers and the community.

Writing in his foreword to the new review, Mr Kelvin said research into the intersections of inequalities is ‘severely lacking and needs investment’, adding:

‘This comprehensive review goes a long way to demonstrating this need, whilst also effectively utilising the research and evidence that does exist.

‘To achieve optimal public health outcomes for all, it is essential to adopt a comprehensive and inclusive approach that addresses the specific needs and challenges of the LGBT community. An approach that promotes acceptance, inclusivity, and equitable access to healthcare services for all, regardless of sexual orientation or gender identity.’

Priority unmet needs include inadequate public health oversight of these health and wellbeing inequalities, discrimination against transgender individuals, against LGBT+ young people and resulting mental health impacts, and higher rates of chronic diseases and risk factors.

Poor mental health among LGBT+ young people and adults is compounded by barriers to accessing healthcare and other services, the researchers have found.

The review also outlined the way poor mental health can lead to unhealthy coping mechanisms, such as higher rates of drug and alcohol use and other risk behaviours among LGBT+ populations.

The Glasgow team explain that while sexual orientation is not always immediately apparent, gender identity is often expressed through physical appearance and presentation, with this simple visibility leading to unwanted attention and scrutiny.

As a result, transgender people face some of the worst forms of societal, political, institutional, and interpersonal discrimination, exclusion, and microaggressions.

The GCPH says that this can then lead to adverse physical health seem among LGBT+ groups, including increased obesity, cardiovascular disease, and some cancers.

Chris Harkins, Public Health Programme Manager at the GCPH says:

“We must be clear that many NHS clinicians and staff work in ways which are sexual and gender minority inclusive and affirming – and are supported to do so.

“However, the evidence is clear that this is not universal and challenges do still remain.”

In addition to identifying and analysing knowledge gaps within the current evidence base, the  review provides insights to guide future research on this topic.

Policy recommendations include improving public health surveillance of LGBT+ health and inequalities and developing national and public education campaigns highlighting these inequalities and discrimination.

The review also calls for further development of preventative mental health support specifically for LGBT+ adolescents and older people, and embedding adequate, regular and up-to-date training on LGBT+ health inequalities across public services to help tackle barriers to accessing services.

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