Mental Health Disparities by Sexual Orientation and Gender Identity in the All of Us Research Program

Importance Limited research explores mental health disparities between individuals in sexual and gender minority (SGM) populations and cisgender heterosexual (non-SGM) populations using national-level data. Objective To explore mental health disparities between SGM and non-SGM populations across sexual orientation, sex assigned at birth, and gender identity within the All of Us Research Program. Design, Setting, and Participants This cross-sectional study used survey data and linked electronic health records of eligible All of Us Research Program participants from May 31, 2017, to June 30, 2022. Exposure Self-identified SGM status. Main Outcomes and Measures Prevalence of common mental health conditions identified from linked electronic health records. Logistic regression adjusted for age, race and ethnicity, educational level, income, employment status, and geographic region was used to assess the association between SGM status and mental health conditions. Results Among 413 457 participants, 269 947 (65.3%) were included in the analysis (median age, 59 [IQR, 43-70] years), with 22 189 (8.2%) self-identified as SGM. Men with cisgender sexual minority identity had higher odds of bipolar disorder (adjusted odds ratio [AOR], 1.87; 95% CI, 1.70-2.56) compared with cisgender heterosexual men. Women with cisgender sexual minority identity had higher odds of bipolar disorder (AOR, 2.09; 95% CI, 1.95-2.25) compared with cisgender heterosexual women. Gender diverse people assigned female sex at birth had higher odds of posttraumatic stress disorder (PTSD) compared with both cisgender heterosexual men (AOR, 3.67; 95% CI, 2.99-4.50) and cisgender heterosexual women (AOR, 2.77; 95% CI, 2.26-3.40). Gender diverse individuals assigned male sex at birth had higher odds of bipolar disorder (AOR, 2.35; 95% CI, 1.66-3.33) compared with cisgender heterosexual men and higher odds of attention-deficit/hyperactivity disorder (AOR, 2.19; 95% CI, 1.48-3.23) compared with cisgender heterosexual women. Transgender men had higher odds of depression (AOR, 2.11; 95% CI, 1.80-2.49) compared with cisgender heterosexual men, while transgender women had higher odds of any personality disorder (AOR, 2.71; 95% CI, 1.84-3.99) compared with cisgender heterosexual women. Conclusions and Relevance In this cross-sectional study of participants in the All of Us Research Program, there were significant mental health disparities between participants in SGM and non-SGM groups. These findings underscore the need for tailored mental health interventions to improve the well-being of SGM populations, while noting that the associations do not imply causality but reflect the stigma and minority stress experienced by these individuals.