Exploring mental health disparities across gender and sexuality diversity in Australia.

OBJECTIVE: Gender- and sexuality-diverse populations experience stigma, discrimination, and barriers to healthcare that may contribute to poorer mental health. This study examined mental health disparities across gender and sexuality diversity in Australia, including diagnosed and subthreshold mental disorders. METHODS: We analysed cross-sectional data from the National Study of Mental Health and Wellbeing 2020-2022. Exposure groups were defined using self-reported gender identity and sexual orientation. Outcomes included Kessler Psychological Distress Scale categories, World Health Organisation Disability Assessment Schedule 2.0 summary scores, mental disorders, and subthreshold mental disorders. Weighted prevalence was estimated, and associations were examined using multinomial logistic regression models, reported as relative risk ratios, and generalised linear models adjusted for sociodemographic variables. RESULTS: Compared with cisgender heterosexual participants, cisgender non-heterosexual participants had higher relative risk of moderate (relative risk ratio = 1.904, 95% confidence interval: 1.455-2.490) and high/very high distress (relative risk ratio = 3.568, 95% CI: 2.716-4.686). Transgender participants had a higher relative risk of high/very high distress (relative risk ratio = 1.823, 95% CI: 1.201-2.766). Disability scores and relative risk of any mental disorder were higher in both groups. Subthreshold disorders were less common among cisgender non-heterosexual participants (relative risk ratio = 0.538, 95% CI: 0.361-0.801). CONCLUSIONS: Gender- and sexuality-diverse Australians experience substantial mental health disparities. The lower prevalence of subthreshold disorders among cisgender non-heterosexual participants, alongside higher prevalence of diagnosable disorders, warrants cautious interpretation and further longitudinal research.