Et Tu, Sweden? More Needed to Support LGBTQ+ Mental Health

LISBON, PORTUGAL — Almost half of surveyed LGBTQ+ people born in Sweden have experienced perceived discrimination and more than a third have mental health symptoms, according to data presented here at the 17th European Public Health Conference (EPH) 2024.

Researchers at the Karolinska Institutet explored the unmet mental health needs of Swedish-born and immigrant LGBTQ+ and heterosexual populations in Sweden. Their findings highlight the need to improve the mental well-being of LGBTQ+ people, even in a country that outperforms many others in quality-of-life indices.

Mental Health Symptoms 

Prior studies have shown a higher prevalence of mental disorders, psychological distress, and suicidal thoughts in lesbian, gay, and bisexual people than in heterosexuals.

Richard Bränström, PhD, associate professor in the Division of Psychology, Karolinska Institutet, Solna, Sweden, wanted to investigate how mental health symptoms and psychiatric treatment for common mental disorders varied among Swedish-born and immigrant LGBTQ+ people in Sweden compared with heterosexuals. He also explored the role played by interpersonal and social stress in explaining these disparities.

“Stigma and minority stress often operate at the individual as well as the interpersonal and structural [systems] levels, such as concealing sexual orientation, receiving threats, and discriminatory legislation,” he explained.

More than 100,000 participants (n = 104,652; age, 16-84 years) were drawn from the Swedish Public Health Survey and six groups were compared based on sexual orientation (heterosexual or sexual minority) and migration status (Swedish-born, European-born, or non-European). Data were gathered on participants’ sexual and gender identity, demographics, mental health status, and psychiatric treatment.

The study found the prevalence of mental health symptoms was approximately:

• 15%,17%, and 19% in heterosexuals from Sweden, Europe, and outside of Europe, respectively.
• 37%, 26%, and 35% in sexual minorities from Sweden, Europe, and outside of Europe, respectively.

Mental health treatment was received by:

• 18%,19%, and 12% of heterosexuals from Sweden, Europe, and outside of Europe, respectively.
• 31%, 17%, and 14% of sexual minorities from Sweden, Europe, and outside of Europe, respectively.

The second part of the research considered whether interpersonal and social stress variables explained some of the disparities found in symptoms and treatment.

Swedish sexual minorities demonstrated the highest prevalence of exposure to interpersonal and social stress, with 49% saying they had experienced perceived discrimination.

On the other hand, perceived discrimination was experienced by 37% of sexual minorities from Europe, 30% of those from outside of Europe, 20% of heterosexuals from Sweden and Europe, and around 23% of heterosexuals from outside of Europe.

Low social trust was also high among Swedish sexual minority groups at 36% but was higher still in sexual minority groups from Europe (43%) and from outside of Europe (39%). Interestingly, low social trust was also prevalent among heterosexuals from Sweden (24%), heterosexuals from Europe (31%), and heterosexuals from outside of Europe (36%).

Societal Pressures and Mental Health Service Use

Bränström further explored with colleagues how common mental health problems and minority-specific stressors affect the use of mental health services in Sweden.

Luis Roxo, PhD, also of the Karolinska Institutet Division of Psychology, explained that evidence is scarce on the factors driving differences in the use of mental health services as related to sexual orientation.

Bränström, Roxo, and John Pachankis of Yale School of Medicine, New Haven, Connecticut, conducted a longitudinal survey of 1137 people in Sweden (639 sexual minority and 498 heterosexual individuals; age, 18-36 years) asking questions about their use of mental health services for symptoms such as depression, anxiety, social anxiety, and alcohol abuse. They also asked about general stressors such as low social support, loneliness, and perceived stress.

They found that 26.4% of LGBTQ+ participants had used mental health services compared with 12.8% of heterosexual participants.

Roxo explained that they found that common mental health problems were significant mediators of the increased use of mental health services by sexual minority groups but that they do not explain all the differences in the use of mental health services compared with heterosexuals.

He said that “sexual minority–specific stressors contributed to the use of mental health services among sexual minority individuals, over and above common mental health problems. In particular, the difficult process of coming out may make individuals more aware of their feelings and emotions and the family reaction such that seeking mental health services may be a way of dealing with lack of acceptance from families.”

Elena Petelos, PhD, global health president of the European Public Health Association, commented on the studies and the session as a whole, which also discussed treatment and outcome gaps in the mental health of LGBTQ+ people in the Czech Republic, and results of a mixed-methods study with LGBTQ+ people in Rwanda and Kenya, examining access to and use of healthcare services.

She asked if questions around LGBTQ+ use of mental health services should be introduced into large European-wide public health surveys.

This was welcomed, but co-chair, Kristefer Stojanovski, PhD, assistant professor and research director of Partners for Advancing Health Equity at Tulane University, New Orleans, said, “This is a very Global North conversation and would be nearly impossible to do in Uganda. Literally speaking about LGBQT+ issues is a crime. The only way to do surveys in Uganda is via underground means and networks that we cannot be connected to directly. Getting government on board to do this type of work in many regions of the world is nearly impossible, so we need to look at other ways of doing this work in very high stigma environments.”

Bränström, Roxo, Petelos, and Stojanovski have disclosed no relevant financial relationships.