Temporal trends in mental health among sexual minorities in Stockholm County, 2010 to 2021

Abstract Background Mental health among sexual minority populations is shaped by stigma and systemic disadvantage. Despite progressive LGBTQ+ rights in Sweden, including gender-neutral marriage in 2009, disparities remain underexamined. Amid rising non-heterosexual identification-particularly bisexual-in Stockholm County, this study examined temporal trends in mental health disparities by sexual identity from 2010 to 2021. Methods We analyzed three cross-sectional surveys from the Stockholm Public Health Cohort (2010, 2014, 2021), including 76,083 (48.7%) participants aged ≥16. 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 reported as weighted prevalence with 95% confidence intervals (CIs). Results Overall, 72,414 (95.2%) participants reported sexual identity. Across all years, bisexual individuals had the highest prevalence of poor mental health, followed by homosexual individuals, relative to heterosexual individuals. In 2021, among bisexual individuals: psychological distress was 47.2% (95% CI: 42.5%-51.9%), cannabis use 39.2% (34.7%-43.9%), suicidal ideation 38.6% (34.2%-43.2%), suicide attempts 11.2% (8.6%-14.4%), antidepressant use 19.9% (16.3%-23.9%), and anxiolytic use 5.9% (3.9%-8.6%). Bisexual women consistently had higher prevalence than bisexual men across years; in 2021, 51.1% vs 37.0% for psychological distress, 40.3% vs 34.3% for suicidal ideation, 12.1% vs 9.1% for suicide attempts, and 23.1% vs 12.5% for antidepressant use. Conclusions Mental health disparities by sexual identity persist in Stockholm County, with bisexual individuals-particularly women-most affected. Little evidence of narrowing was observed between 2010 and 2021. These findings highlight the need for targeted public health efforts for sexual minorities. Key messages • Mental health disparities by sexual identity persist in Sweden despite progressive legal reforms, with bisexual individuals - especially women - experiencing the greatest burden. • Despite legal and social progress, little evidence exists that mental health disparities have diminished over the past decade, highlighting the need for targeted interventions beyond legal equality.