Syndemic Approach and Mental Health in the LGBTQ+ Community

The clustering of mental health issues, social isolation, and substance use is a syndemic[1] with a unique expression in the LGBTQ+ community, and is profoundly affected by discrimination, stigma, and unequal access to care.

In both the 2021 and 2025 LGBTQ+ Health and Human Services Needs Assessment Community Surveys, over three-quarters of the respondents reported being affected by mental health issues. Of these, 82% sought services for mental health care, with 94% who sought services receiving them. As reported in the 2021 Community Survey[2] [hyperlink to resource], substance use in the LGBTQ+ community is higher than national averages recorded in SAMHSA’s National Survey of Drug Use and Health (NSDUH). The risk of social exclusion and a loss/lack of social support from family and others is higher in the LGBTQ+ community. In some communities, especially transgender and other gender non-conforming individuals, the interaction of mental health burden and anxiety contributes to lower levels of prevention behavior and a lack of engagement with healthcare providers.[3]

As well, the mental health and substance use syndemic has socioeconomic consequences that contribute to unemployment and limit educational advancement for many in the LGBTQ+ community. This is especially pronounced for transgender and younger community members. Respondents with lower levels of education and income are at the poor end of almost every outcome or concern measured in the Community Survey. Employment support and workforce development will be crucial resources for LGBTQ+ youth and young adults.

The disparate impact of education and income on health outcomes and wellbeing is deeply evident in the data from the 2021 and 2025 surveys. Added to this socio-economic pattern is its association in both the 2021 and 2025 surveys with youth, specifically those under 35 (with disparities growing the younger the respondent). Considering a syndemic approach in policy would include support for behavioral health (item 4, above) with supportive employment to enhance the economic opportunities of LGBTQ+ community members most affected by the behavioral health and wellness syndemic.[4]

Mental health: Over three-quarters of LGBTQ+ respondents reported being affected by mental health issues. In 2021, 77% of respondents stated that mental health was a major concern. Although 69% of respondents sought and received services for mental health, 23% did not seek services, even though they needed help. Over half the time in the previous year, half of survey respondents reported anxiety, while 37% reported depression, 33% a lack of motivation and 12% feeling “scared for their lives” ².

Substance use: Substance use in the LGBTQ+ community is higher than national averages recorded in SAMHSA’s National Survey of Drug Use and Health (NSDUH). About 89% respondents reported using at least one substance, including alcohol, cannabis, and tobacco. Half of respondents reported using only one or two substances, while almost 40% reported using three or more substances.

Social isolation: In the LGBTQ+ community, many face social exclusion and a loss or lack of social support from family. Respondents in New York City and other urban areas were more likely to say they often or mostly lack companionship, feel “left out” and feel isolated compared to those living in rural areas. Urban and suburban areas also highly reported feeling “never” or “rarely” supported by others compared to rural areas.