Relationship Between Sexual Orientation, Gender Identity, and Mental Health and Substance Use Disorder Disparities Among Federally Qualified Health Center Adult Patients: A Cross-Sectional Study

Abstract

Sexual and gender minorities (SGMs) are at increased risk of adverse physical and mental health outcomes. Federally qualified health centers (FQHCs) provide healthcare to underserved and vulnerable populations to address socioeconomic health disparities. This study aims to explore whether SGM adult patients at a large, multisite FQHC in Connecticut, USA, are more likely than heterosexual, cisgender (cis) patients to have indications or diagnoses of depression, suicidal thoughts, and/or substance use disorders (SUDs) in their medical charts. We used retrospective data from the electronic health records of FQHC patients with a medical visit between April 2016 and June 2019 who had sexual orientation and gender identity documented in their chart. In addition to demographic variables, the extracted data included patients’ most recent Patient Health Questionnaire-9 and diagnostic codes for depression, suicidal thoughts, and SUDs. We conducted hierarchical logistic regressions and generalized linear and latent mixed models to answer our research questions. In comparison to heterosexual and cis patients, SGM patients had significantly higher odds of reporting severe depression, any depression, and/or suicidal thoughts. Compared to heterosexual women, sexual minority women were more likely to have an SUD in their medical chart. Bisexual men had higher odds of cannabis use disorder compared to heterosexual men. Compared to cis women, transgender women had higher odds of alcohol and opioid use disorders and having one or more SUDs. This study provides evidence of mental health and substance use disparities experienced by SGM patients at FQHCs.