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The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples

Published online by Cambridge University Press:  17 February 2021

Alexandra Pitman
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
Louise Marston
UCL Research Department of Primary Care and Population Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
Gemma Lewis
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
Joanna Semlyen
Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
Sally McManus
NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK School of Health Sciences, City University, Northampton Square, London, EC1V 0HB, UK
Michael King
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
E-mail address:



Evidence on inequalities in mental health in lesbian, gay, and bisexual people arises primarily from non-random samples.


To use a probability sample to study change in mental health inequalities between two survey points, 7 years apart; the contribution of minority stress; and whether associations vary by age, gender, childhood sexual abuse, and religious identification.


We analysed data from 10 443 people, in two English population-based surveys (2007 and 2014), on common mental disorder (CMD), hazardous alcohol use, and illicit drug use. Multivariable models were adjusted for age, gender, and economic factors, adding interaction terms for survey year, age, gender, childhood sexual abuse, and religious identification. We explored bullying and discrimination as mediators.


Inequalities in risks of CMD or substance misuse were unchanged between 2007 and 2014. Compared to heterosexuals, bisexual, and lesbian/gay people were more likely to have CMD, particularly bisexual people [adjusted odds ratio (AOR) = 2.86; 95% CI 1.83–4.46], and to report alcohol misuse and illicit drug use. When adjusted for bullying, odds of CMD remained elevated only for bisexual people (AOR = 3.21; 95% CI 1.64–6.30), whilst odds of alcohol and drug misuse were unchanged. When adjusted for discrimination, odds of CMD and alcohol misuse remained elevated only for bisexual people (AOR = 2.91; 95% CI 1.80–4.72; and AOR = 1.63; 95% CI 1.03–2.57 respectively), whilst odds of illicit drug use remained unchanged. There were no interactions with age, gender, childhood sexual abuse, or religious identification.


Mental health inequalities in non-heterosexuals have not narrowed, despite increasing societal acceptance. Bullying and discrimination may help explain the elevated rate of CMD in lesbian women and gay men but not in bisexual people.

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Copyright © The Author(s), 2021. Published by Cambridge University Press

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