Disparities in healthcare access among sexual and gender minority individuals with generalized anxiety disorder in the US

PURPOSE: We aimed to quantify and compare the prevalence of healthcare access barriers among individuals diagnosed with generalized anxiety disorder (GAD), focusing on differences between sexual and gender minority (SGM) and non-SGM adults. We also examined whether intersecting identities further compounded these barriers to inform equitable healthcare policy. METHODS: We analyzed data (2017-2022) from the All of Us Program, a nationwide database of self-reported surveys, electronic health records, and demographic information. Our sample included 8,841 adults diagnosed with GAD. Participants were classified as SGM if they identified as lesbian, gay, bisexual, transgender, nonbinary, intersex, or another sexual/gender minority identity. We examined eight healthcare access barriers-four cost-related (e.g., delaying mental health or specialist visits due to cost) and four non-cost-related (e.g., lack of transportation, feeling disrespected). Adjusted logistic regression models were used to compare the odds of experiencing each barrier between SGM and non-SGM groups, and stratified analyses considered race/ethnicity and gender. RESULTS: Among 8,841 participants with GAD, 1,267 (14%) were SGM. After adjusting for sociodemographic factors, SGM individuals demonstrated significantly higher odds of all cost-related barriers (e.g., delaying mental health visits: AOR = 1.53, 95% CI [1.30-1.79]) and non-cost barriers (e.g., feeling disrespected: AOR = 1.47, 95% CI [1.29-1.68]). Disparities were pronounced among Hispanic/Latino and non-Hispanic Black SGM adults and SGM women, illustrating multiple intersecting disadvantages. CONCLUSION: SGM individuals with GAD experience substantially greater healthcare access barriers than their non-SGM peers. These challenges are magnified for those with intersecting marginalized identities, highlighting a need for culturally competent, inclusive healthcare policies and practices.