The impact of employment loss on mentally unhealthy days among LGBTQ+ cancer survivors during the COVID‐19 pandemic: Findings from the OUT National Survey

OBJECTIVE: Lesbian, Gay, Bisexual, Transgender, Queer, and all other sexual and gender minority (LGBTQ+) populations made up 7.1% of the US population in 2021. LGBTQ+ cancer survivors face a variety of economic and mental health disparities; however, the determinants of poor mental health among LGBTQ+ cancer survivors are understudied. METHODS: This analysis utilized the OUT National Survey which consists of N = 2233 LGBTQ+ cancer survivors (complete cases). Multivariable negative binomial and logit regression models were used to generate predicted values, predicted probabilities, and average marginal effects (AME) to assess the association between COVID-19 related employment loss and mentally unhealthy days (MUDs) and frequent mental distress among LGBTQ+ cancer survivors. Predicted values and marginal effects were generated with interaction terms (demographics interacted with employment loss) to explore the heterogeneity of the effect of employment loss among LGBTQ+ sub-populations. RESULTS: In bivariate analyses employment loss was associated with a higher number of MUDs (10.3, SD = 9.9 vs. 8.4, SD = 9.6; p-value<0.001) and frequent mental distress (34% vs. 26%; p-value = 0.001). AME from a multivariable negative binomial model revealed that employment loss was associated with 1.42 more MUDs (95%CI: 0.33-2.86). Demographic factors such as some sexual orientations, cis-female and non-binary gender, younger age, and a current cancer diagnosis were also associated with significant expected increases in the number of MUDs. When assessing the heterogeneity of the effect of employment loss some sub-populations experienced changes in the number of MUDs that pushed them over the threshold of frequent mental distress while others did not. Furthermore, identifying with multiple sexual orientations (AME: 0.19, 95%CI: 0.11-0.27), cis-female and non-binary genders (AME: 0.07, 95%CI: 0.2-0.12; AME: 0.18, 95%CI: 0.07-0.28), American Indian and Alaska Native race (AME: 0.17, 95%CI: 0.03-0.31), and a current cancer diagnosis (AME: 0.14, 95%CI: 0.09-0.19) were associated with an increase in the probability of experiencing frequent mental distress. CONCLUSIONS: COVID-19 related employment loss negatively impacted the mental health of LGBTQ+ cancer survivors. LGBTQ+ specific supportive services as well as equity-based employment and income interventions are needed.