An Intersectional Examination of Anxiety and Depression in Sexual and Gender Minorities

Extensive evidence demonstrates higher rates of anxiety and depression in sexual and gender minorities (SGM) compared to the general population. However, few studies have examined the intersection of sexual orientation and gender identity. Status as a multiple minority may further increase the risk for anxiety and depression. The goal of this study was to assess the extent to which anxiety or depression diagnosis, clinical cutoff, or symptom severity differed by gender identity, sexual orientation, or the intersection of the two. A sample of 554 US adults (75.6% White, between 18 and 65 years) were recruited through social media to complete an online survey. Of the sample, 44.2% were sexual minorities and 35.6% were gender minorities. Results from logistic regression analyses indicated that heterosexuals were 41% more likely to be diagnosed with anxiety, but sexual minorities were nearly three times more likely to be diagnosed with depression and 20 times more likely to meet PHQ-9 cutoffs. Based on analyses of covariance, gender minority participants reported significantly greater depression severity than cisgender participants. Sexual orientation and gender identity interacted in the depression, but not the anxiety symptom severity model. Cisgender sexual minorities had greater depression severity than cisgender heterosexuals, but lower depression severity than gender minorities who were also sexual minorities. These findings suggest that dual minorities experience greater minority stress, which worsens depression symptom severity. This has important clinical implications for nurses caring for SGMs. Future studies should consider intersectional analysis to elucidate further the compounding effects of dual minority status on SGMs.