Mental health trends among sexual minority youth in Stockholm County, 2010 to 2021

Abstract Background In Sweden, gender-neutral marriage was legalized in 2009, and antidiscrimination protections have progressively expanded. Public support for lesbian, gay, or bisexual (LGB) rights has remained above 90%. In Stockholm County, the proportion of young people identifying as LGB more than doubled between 2010 and 2021. In light of these legal and social changes, improved mental health might be expected among LGB youth. This study examined temporal trends in mental health outcomes in this population from 2010 to 2021. Methods We analyzed three cross-sectional surveys from the Stockholm Public Health Cohort (2010, 2014, 2021), including 10,594 participants aged 16-29. Self-administered questionnaires assessed sexual identity, recent psychological distress, lifetime cannabis use, and lifetime suicidal ideation and attempts. Antidepressant and anxiolytic use were obtained by survey year from the National Prescribed Drug Register. Results are presented as weighted prevalence with 95% confidence intervals (CIs). Results Overall, 10,077 (95.1%) participants reported sexual identity. Across all years, bisexual youth generally had the highest prevalence of mental health outcomes, followed by homosexual youth, relative to heterosexual youth. By 2021, among bisexual youth: psychological distress was 56.3% (95% CI: 49.3%-63.1%), cannabis use 43.2% (36.4%-50.1%), suicidal ideation 47.1% (40.2%-54.0%), suicide attempts 13.7% (9.6%-18.7%), antidepressant use 21.4% (16.1%-27.6%), and anxiolytic use 6.8% (3.7%-11.3%). From 2010 to 2021, psychological distress doubled among homosexual youth (26.8% to 53.1%), and antidepressant use among bisexual youth rose from 14.0% to 21.4%. Conclusions Despite a favorable legal and social climate, mental health disparities persist among sexual minority youth in Stockholm County, most notably among bisexual youth. These findings highlight the need for targeted mental health support and affirming services for LGB youth. Key messages • Despite progressive legal and social changes, mental health disparities persist among sexual minority youth in Sweden, underscoring continued challenges. • Bisexual youth, amid rising visibility, face the greatest mental health risks, highlighting the urgent need for targeted and affirming public health interventions.