# A multilevel analysis of LGBT-relevant laws and sexual and gender minority mental health: evidence for the protective role of inclusive policies

## TL;DR

Inclusive LGBTQ policies at the state level can reduce mental health stress in sexual and gender minorities.

## Contribution

This study shows that inclusive LGBTQ policies buffer the mental health effects of stress in SGM populations.

## Key findings

- Inclusive state LGBTQ policies weaken the link between stress and depression/anxiety in SGM individuals.
- The protective effect of inclusive policies is stronger for divorced SGM individuals compared to married ones.

## Abstract

Sexual and gender minority (SGM) individuals experience elevated rates of depression and anxiety, largely attributed to chronic exposure to stigma, discrimination, and social exclusion. Less is known about whether state-level policy climates may buffer the mental health impacts of stress among SGM populations.

We used data from the All of Us Research Program (2020–2022) to examine whether state-level LGBTQ policy climates; measured using the Movement Advancement Project (MAP) Total Tally Score (range: –18.5 to 38.5), moderated associations between general perceived stress (PSS-10) and symptoms of depression and anxiety. Multilevel modeling assessed within- and between-state associations and cross-level interactions between policy climate and stress. Subgroup analyses tested whether moderation effects varied across demographic groups (e.g., marital status, gender identity). Final samples included N = 6,430 (depression) and N = 6,392 (anxiety).

A more inclusive state LGBTQ policy climate significantly moderated the association between perceived stress and mental health symptoms, reflecting a weaker stress–depression association (β = –.023, SE = .010, p = .020) and a weaker stress–anxiety association (β = –.032, SE = .009, p < .001). Moderation was stronger for divorced SGM individuals compared with married individuals (β = –.091, SE = .033, p = .006).

State-level LGBTQ policy climates were statistically associated with variation in the strength of stress–mental health relationships among SGM adults. These findings highlight the relevance of structural environments for SGM mental health. Future longitudinal research should evaluate how changes in policy climates shape stress processes and mental health trajectories over time.

The online version contains supplementary material available at 10.1186/s12889-026-26309-4.