Exploring Relationships Between State-Level LGBTQ Inclusivity and BRFSS Indicators of Mental Health and Risk Behaviors: A Secondary Analysis

Abstract

Objectives: Minority Stress Theory suggests that repeated exposure to enacted stigma adversely affects mental health. States have wide authority to enact policies affecting the level of inclusivity experienced by lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) residents. The purpose of this study was to explore relationships between states’ level of LGBTQ inclusivity and indicators of mental health/risk behaviors among an LGBTQ sample. Methods: The 2018 Human Rights Campaign State Equality Index (SEI) and the 2018 Behavioral Risk Factor Surveillance Survey (BRFSS) were used to examine relationships between states’ levels of LGBTQ inclusivity (predictor variable) and indicators of mental health/risk behaviors (outcome variables). Relationships were explored using descriptive statistics and survey-weighted logistic regression. Results: Lower state inclusivity increased odds of fair/poor general health (adjusted odds ratio [AOR]: 1.22, 95% confidence interval [CI]: 1.01–1.48), increased odds of poor mental health days (AOR: 1.34, 95% CI: 1.11–1.62), increased odds of smoking (AOR: 1.62, 95% CI: 1.27–2.07), and increased odds of heavy drinking (AOR: 1.54, 95% CI: 1.26–1.86) and binge drinking (AOR: 1.23, 95% CI: 1.01–1.49). State inclusivity did not influence odds of a depressive disorder diagnosis or driving under the influence of alcohol. Conclusions: LGBTQ persons in restrictive states had increased odds of experiencing several indicators of mental health and risk behaviors. More research is needed to determine whether state policies affect other domains of LGBTQ persons’ health. Health care providers should be mindful of LGBTQ persons’ mental health/risk behaviors and the state policy environment, and should seek to implement mitigating health care strategies such as the use of validated assessment.