Mental health inequities affecting sexual and gender diverse individuals during the early COVID-19 period in Massachusetts

While the COVID-19 pandemic negatively affected population-level mental health, research on mental health among sexual and gender minority (SGM) individuals and intersectional identities is limited. We evaluated associations between gender, sexual, racial, and ethnic identities and moderate to severe psychological distress (≥15 days of self-reported poor mental health during the last 30 days) among adult residents of Massachusetts (n = 26,889) from September-November 2020. We used multivariable logistic regression with propensity score weighting and considered intersectional identities by race, ethnicity, sexual orientation and gender. Results: Respondents identifying as lesbian, gay, bisexual, queer, asexual, or questioning (LGB+) experienced 83% increased odds of psychological distress compared to heterosexual/straight individuals (OR: 1.83 (1.34, 2.50); p < 0.001). Respondents identifying as transgender and/or nonbinary (TNB) had the highest prevalence of psychological distress and experienced 57% increased odds of psychological distress compared to the referent group (OR: 1.57 (1.21, 2.04); p < 0.001). Respondents identifying as Hispanic/Latinx, Black non-Hispanic (NH), or Asian NH reported reduced odds of psychological distress (Hispanic (OR: 0.75 (0.67, 0.84); p < 0.001), Black NH (OR: 0.75 (0.64, 0.88); p < 0.001), and Asian NH (OR: 0.61 (0.51,0.73); p < 0.001). We observed reduced odds of psychological distress among LGB+ respondents of color (OR: 1.03 (0.82, 1.29); p = 0.83) and TNB respondents of color (OR: 1.27 (0.73, 2.20); p = 0.39) compared to LGB+ and TNB estimates alone, although neither interaction was statistically significant. Mental health inequities among SGM individuals in Massachusetts were exacerbated during the early pandemic period. Social and structural inequities experienced by SGM individuals may contribute to higher risk of psychological distress. Public health policies and practices to address the root causes of inequities and promote mental health among SGM communities are warranted.