Age-Varying Sexual Orientation Disparities in Mental Health, Treatment Utilization, and Social Stress: A Population-Based Study

An increasing number of studies show a substantial increased risk of stress-sensitive mental health problems among sexual minority individuals compared with heterosexual individuals. However, existing data regarding the age patterning of this disparity in sparse and sometimes inconsistent. We therefore examined the age patterning of the sexual orientation disparity in mental health using a population-based survey with linkage to national health care registries. We also examined if social stressors might explain the sexual orientation disparities in mental health across ages. Data came from the Swedish National Public Health Survey 2018 (Public Health Agency of Sweden 2022; ages 16 to 84 years) and national health care registries, and the sample consisted of 5,115 self-identified sexual minority individuals (M age = 40.3, SD = 19.5) and 103,526 heterosexual individuals (M age = 48.5, SD = 18.3). Sexual minority individuals were more likely to report symptoms of depression and anxiety and to have received treatment for these conditions compared with heterosexual individuals, but they were not more likely to report high-risk alcohol use. The elevated risk of depression and anxiety among sexual minority individuals was strongest in early ages but the disparity remained significantly elevated among sexual minority individuals until about age 70. The risk of exposure to discrimination and victimization was consistently elevated among sexual minority individuals across age groups, and the sexual orientation disparity in social isolation increased with age. The increased risk of exposure to social stressors among sexual minority individuals fully or partially mediated the sexual orientation disparity in depression and anxiety across ages. Our results highlight that the sexual orientation disparity in depression and anxiety exists across ages and is at least partially explained by disparities in social stress across ages. Public Significance Statement Many studies report a substantial increased risk of mental health problems among sexual minority individuals compared with heterosexual individuals. However, existing data regarding the age patterning of this disparity is sparse and sometimes inconsistent. In a population-based sample, this study highlights that the sexual orientation disparity in depression and anxiety exists across ages and is at least partially explained by disparities in social stress across ages.