Background
Previous studies have indicated increased risk of mental disorder symptoms, suicide and substance misuse in lesbian, gay and bisexual (LGB) adults, compared to heterosexual adults. Our aims were to determine an estimate of the association between sexual orientation identity and poor mental health and wellbeing among adults from 12 population surveys in the UK, and to consider whether effects differed for specific subgroups of the population.

Methods
Individual data were pooled from the British Cohort Study 2012, Health Survey for England 2011, 2012 and 2013, Scottish Health Survey 2008 to 2013, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12. Individual participant meta-analysis was used to pool estimates from each study, allowing for between-study variation.

Results
Of 94,818 participants, 1.1 % identified as lesbian/gay, 0.9 % as bisexual, 0.8 % as ‘other’ and 97.2 % as heterosexual. Adjusting for a range of covariates, adults who identified as lesbian/gay had higher prevalence of common mental disorder when compared to heterosexuals, but the association was different in different age groups: apparent for those under 35 (OR = 1.78, 95 % CI 1.40, 2.26), weaker at age 35–54.9 (OR = 1.42, 95 % CI 1.10, 1.84), but strongest at age 55+ (OR = 2.06, 95 % CI 1.29, 3.31). These effects were stronger for bisexual adults, similar for those identifying as ‘other’, and similar for 'low wellbeing'.

Conclusions
In the UK, LGB adults have higher prevalence of poor mental health and low wellbeing when compared to heterosexuals, particularly younger and older LGB adults. Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and service delivery. These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups.


Of the 94,818 participants in the analytic sample (those with available data on sexual orientation identity, mental health and covariates), 97.2 % as heterosexual, 1.1 % identified as lesbian/gay, 0.9 % as bisexual and 0.8 % as ‘other’ (Table 1). People meeting the threshold of common mental disorder or low wellbeing were significantly different across all study variables (using bivariate t-test or chi-square tests): they were younger, comprised more females, and had lower levels of educational attainment, more current smokers, more longstanding illness/disability and fewer married/co-habiting participants than those below the threshold (Table 2). Significantly higher proportions of those who identified as lesbian/gay, bisexual and ‘other’ were found among those who met the mental disorder threshold

Conclusions
Adults identifying as lesbian, gay, bisexual or ‘other’ are at increased risk of poor mental health and low wellbeing compared to those identifying as heterosexual.

The association varies across the life course, with the lowest relative risks seen in midlife and the highest among older adults

Our study used cross-sectional data suitable for estimating prevalence, but future studies should consider longitudinal patterns (such as onset and persistence of new mental health problems) and clarify mechanisms

Reference
Office of National Statistics. Measuring Sexual Identity: An Evaluation Report. London: ONS; 2010.

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Hayes J, Chakraborty A

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