# Differences in mental health symptoms and treatment by sexual orientation and migration background in a population-based sample

## TL;DR

This study finds that sexual minorities, especially those with migration backgrounds, face higher mental health risks and treatment disparities in Sweden.

## Contribution

The study identifies mental health disparities among individuals with dual minority statuses based on sexual orientation and migration background.

## Key findings

- Swedish-born and non-European sexual minorities have higher odds of mental health symptoms compared to Swedish-born heterosexuals.
- Swedish-born sexual minorities are more likely to receive treatment for mental disorders than non-European heterosexuals.
- Perceived discrimination partially explains mental health disparities linked to migration background.

## Abstract

Although sexual minorities are consistently found to be at excess risk of poor mental health, less is known about the mental health of individuals with dual minority statuses based on sexual orientation and migration background. This study aimed to examine prevalence of and disparities in mental health symptoms and treatment for common mental disorders (CMD) among sexual minority migrants; and to explore the potential mediating role of interpersonal and social stress.

Participants were drawn from the Swedish Public Health Survey, 2018. The analytic sample included 104,652 individuals with complete records on all study variables (37.1%). The survey assessed mental health symptoms and interpersonal and social stress and was complemented with information on psychiatric treatment from comprehensive nationwide registries. Using logistic regression and mediation analyses, six groups were compared based on sexual orientation and migration background.

Greater risk of mental health symptoms was found among Swedish-born and non-European sexual minorities (adjusted odds ratios (OR) = 2.20, 95% confidence intervals (CI): 1.89–2.57, and OR = 2.10, 95% CI 1.34–3.29, respectively) compared to Swedish-born heterosexuals. Swedish-born sexual minorities were at greater risk of receiving treatment for CMD (OR = 2.58, 95% CI 2.20–3.01), while non-European heterosexuals showed lower risk (OR = 0.61, 95% CI 0.52–0.72). Perceived discrimination was less common among non-European sexual minorities compared to their Swedish-born counterparts and partially mediated the association between migration background and mental health symptoms.

Sexual minority migrants are at greater risk of mental health symptoms compared to Swedish-born heterosexuals but not compared to Swedish-born sexual minorities. Providing mental health care for sexual minorities, including sexual minority migrants, and targeting sexual orientation discrimination, should be a priority.

The online version contains supplementary material available at 10.1007/s00127-025-02848-w.