King's College London

Sexual and gender minority individuals have substantially higher risk for poorer health and wellbeing, and higher rates of adverse health-related behaviours. In Europe, most of this evidence comes from studies conducted on White individuals. Less is known about health in individuals who identify with sexual and ethnic minority identities.

Two studies by King’s College London researcher Dr Amal Khanolkar, one conducted with Dr Victoria Redclift at UCL and another with PhD student Erica Mattelin at Linköping University, seek to better understand the health-related experiences and behaviours of people with multiple minority identities.

Both studies highlight that despite significant sociocultural changes in acceptance of sexual minority rights in the UK and Sweden, LGBTQ+ individuals continue to report higher levels of mental ill-health, general health, and higher rates of adverse health-related behaviours.

Earlier this year Khanolkar and Redclift released a briefing report summarising findings from the qualitative component of their study. Now, findings from the quantitative component have been published in the journal LGBT Health. Using an intersectional framework, they examined whether dual sexual- and ethnic-identities are associated with a range of health and health-related behaviours in a nationally representative population of 9,789 adolescents aged 17 years from the UK-wide Millennium Cohort Study.

They found that sexual minority individuals had increased odds for all indicators of mental ill-health (see figure) when compared to heterosexual individuals, but those with both ethnic and sexual minority identities did not report worse outcomes than White sexual minority individuals. The study also found that individuals who identified as mostly heterosexual had increased odds for mental ill-health and higher rates of adverse health-related behaviours compared to exclusively heterosexuals but lower than exclusively sexual minority (lesbian, gay and bisexual) peers. This gradient was largely observed in White individuals.

The second study, authored by Mattelin and Khanolkar (Lancet eclinicalMedicine), examined health and health-related behaviours separately in migrant and refugee individuals who identify as sexual or gender minority, as well as in comparison to their heterosexual peers. This study included 168,952 individuals who answered the Swedish National Public Health Survey in 2018 and 2020.

Irrespective of ethnicity, sexual or gender minority individuals had worse general- and mental ill-health compared to heterosexual peers. Ethnic minorities (heterosexual and sexual/gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling. Transgender refugees had very high odds for exposure to physical violence and risk gambling compared to cisgender peers. This is the first study to examine health in refugee and migrant transgender individuals using a national probability sample.

Considering the outcomes of both studies the authors argue that public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals. They recommend increasing access and use of mental healthcare services and sensitising healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities. Further, adequately powered longitudinal data is required to better understand pathways and mechanisms leading to adverse health in unique ethnic and sexuality/gender subgroups.

 

^{Title for figure: Risk for mental health difficulties, wellbeing and general health based on dual ethnic- and sexual identities in 9,789 individuals aged 17 from the Millennium Cohort Study. *Components of the Strengths and Difficulties Questionnaire. EM: ethnic minority; SM: sexual minority.}