Large-Scale Survey (N=19.8M) Reveals Extremely High Untreated Rates (60-98%) for LGBTQ+ Mental Health Due to Specialist Shortages; Telepsychiatry Shows Promise During COVID-19

This paper is a secondary analysis of published data from the ”National Study of Mental Health and Wellbe- ing: Summary Results, 2020–2022” conducted by the Australian Bureau of Statistics. The survey subjects were approximately 19,829,600 (100.0%) Australian residents aged 16 to 85. However, very remote areas and parts of Aboriginal and Torres Strait Islander com- munities were excluded from the survey. Sexual orientation was classified into the following four categories: 1) Heterosexual, 2) Gay/Lesbian, 3) Bisexual, 4) Other LGBTQ+. Gender identity was clas- sified into two categories: cisgender and transgender. Mental disorder diagnoses were based on DSM-5 and ICD-10 diagnostic criteria. Major mental disorder categories analyzed included anxiety disorders, affec- tive disorders, and substance use disorders. This paper employed the following analytical meth- ods: 1) Descriptive statistical analysis of mental dis- order prevalence rates by sexual orientation, 2) Re- gional comparison (urban, regional urban, remote ru- ral) of prevalence rates, 3) Stratified analysis by so- cioeconomic status (SEIFA index), 4) Analysis of treat- ment access patterns, 5) Estimated analysis of com- pound risk factors.

The National Study of Mental Health and Wellbe- ing (NSMHW) conducted by the Australian Bureau of Statistics was a large-scale epidemiological sur- vey implemented from 2020 to 2022. This survey was conducted among approximately 19,829,600 Aus- tralian residents aged 16 to 85, providing compre- hensive statistics on mental health issues during the COVID-19 pandemic. A particularly important point is that this survey collected data on sexual orientation. This provides a valuable opportunity for knowledge sharing in understanding the situation of LGBTQ+ in- dividuals, for whom large-scale surveys are considered difficult in many countries. Mental health issues among LGBTQ+ individuals are a serious public health challenge globally. Previous research has also reported that sexual minorities have higher prevalence rates of mental disorders compared to the general population. However, many studies are based on small samples, and comprehensive national- scale understanding has been limited. This large-scale survey in Australia provides an op- portunity to suggest the following important aspects regarding the mental health status of LGBTQ+ indi- viduals. First, accurate understanding of mental disor- der prevalence rates by sexual orientation, and second, clarification of the compound impact of regional dis- parities and socioeconomic disparities, and next, iden- tification of barriers in treatment access. This paper goes beyond conventional prevalence rate comparison analysis to focus on analysis of the com- pound impact of regional disparities, socioeconomic disparities, and untreated conditions. Particularly, from the perspective of intersectionality theory, it aims to suggest the reality of ”compound disadvantage” faced by individuals with multiple minority attributes. The significance of this paper lies in the fact that

Statistical Population and Breakdown Analysis of LGBTQ+ Individuals

The National Study of Mental Health and Wellbe- ing (NSMHW) conducted by the Australian Bureau of Statistics from 2020 to 2022 was implemented among approximately 19,829,600 Australian residents aged 16 to 85. This scale represents one of the world’s largest mental health surveys including LGBTQ+ individuals, serving as an important reference for other countries where large-scale surveys are difficult. This section analyzes detailed population numbers and breakdown of LGBTQ+ individuals indicated by the survey from

multiple perspectives.

Table 3 Number of Mental Disorder Patients Among LGBTQ+ Individuals

Population Distribution by Sexual Orientation

Of the total survey population of 19,829,600, the population distribution by sexual orientation is as follows:

Table 1: Population Distribution by Sexual Orientation.

 

Patient Numbers by Disorder Type

Patient numbers by mental disorder type are as fol- lows:

Table 4: Patient Numbers by Disorder Type Among LGBTQ+ Individuals.

 

Table 2: Population Distribution by Gender Identity Gender Identity.

*Proportion within LGBTQ+ total LGBTQ+ individuals account for 3.7% of the to- tal population, approximately 737,100 people. Of these, gay/lesbian individuals are 380,400 (51.6% of LGBTQ+), and bisexual individuals are 356,700 (48.4% of LGBTQ+).

Distribution by Gender Identity

Analysis of gender identity showed the following distribution:

Estimated Number of Untreated Individuals

Estimated numbers for untreated status among LGBTQ+ individuals were calculated:

Table 5: Estimated Untreated Numbers Among LGBTQ+ Individuals

 

As a particularly important finding, 39.0% (287,500 people) of LGBTQ+ individuals are transgender. This shows that sexual orientation and gender identity over- lap at a high rate.

Detailed Numbers of Mental Disorder Patients

Specific numbers for mental disorder prevalence among LGBTQ+ individuals are as follows:

Estimated Numbers of Compound Disadvantage Populations

Estimated numbers for high-risk groups based on compound factors of region, economic status, and sexual orientation:

LGBTQ+ individuals. Particularly for other countries where large-scale surveys are difficult, it has the fol- lowing significance:

Table 6: Estimated Numbers of Compound Disadvantage Populations.

Table 8: Estimated LGBTQ+ Numbers by Region Regional Classification.

• National-scale statistical documentation of sexual orientation and gender identity
• Objective understanding of mental health status
• Provision of basic data needed for policy planning
• Establishment of reference values for interna- tional comparative research

Regional LGBTQ+ Population Estimates

Estimated LGBTQ+ numbers by region for regional disparity analysis:

Age-stratified LGBTQ+ Population Distribution

Estimated numbers of LGBTQ+ individuals by age group, based on general population distribution:

Service User Numbers and Non-user Numbers

Data Limitations and Importance of Estimation

Estimated user numbers for mental health service ac- cess status:

The following limitations exist regarding the actual sample size of LGBTQ+ individuals in this survey:

Table 9 Estimated Service Utilization Among LGBTQ+ Individuals

• Of the total survey population of 19,829,600, approximately 737,100 (3.7%) responded as LGBTQ+
• Due to the nature of the survey, individuals who have not come out may not be included
• Some remote areas and Aboriginal communities were excluded from the survey
• 287,500 transgender individuals represent a rela- tively small sample

These figures clearly demonstrate the reality that many LGBTQ+ individuals cannot access specialized mental health services. Particularly, the extremely low

Despite these limitations, this survey is one of the world’s largest mental health surveys including

access rate to psychiatrists (12.0%) may have serious impacts on treatment quality and continuity. The statistical data on LGBTQ+ individuals revealed in this survey represents valuable national-scale sur- vey results even from a global perspective. Even in other countries where large-scale surveys are difficult, these figures can serve as important reference indica- tors and be utilized as the foundation for policy plan- ning and support system construction. Particularly, the high prevalence rate among bisexual individuals (64.4%) and estimated untreated rate (70-85%) need to be recognized as challenges common to countries worldwide.

sis of legal recognition of same-sex relationships show this era’s interest in legal reform. During this period, discussions on same-sex mar- riage also became active. Witzleb (2011) analyzed same-sex marriage as ”the last frontier” in Australia, and Sifris Gerber (2011) positioned same-sex marriage as a ”battlefield” for equality. Richardson-Self (2012) also questioned the goals of same-sex marriage itself, showing its complexity. Health research also advanced, with Leonard et al. (2015) conducting surveys on mental health and well- being of LGBTQ+ Australians, and Skerrett et al. (2014) analyzing suicide registration data in Queens- land to suggest realities of suicide among LGBT popu- lations.

Previous Research on LGBTQ+ in Australia: Historical Development and Themes

Initiatives for the LGBT Community in Australia and Recent Research (2016-2025)

Academic research on LGBTQ+ (lesbian, gay, bisex- ual, transgender, queer, etc.) in Australia has developed remarkably over the past 30 years.

Research from 2016 onwards shows a shift toward new challenges after legal equality achievement includ- ing same-sex marriage legalization in 2017, and fo- cus on more diverse identities and experiences. Ac- cording to Riseman’s (2019) comprehensive research on Australian LGBTI politics and rights history, while LGBTI activism has grown from small local organi- zations to national campaigns over the past 50 years, and strategies have evolved, two patterns consistently emerge: state-based organization and international in- fluence from the UK and US. Research on experiences and rights of transgender and intersex people has also increased. Telfer et al. (2018) developed care standards for transgender and gender diverse children, and Carpenter (2024) analyzed contexts and goals of intersex movements in Australia. COVID-19 pandemic impacts also became an impor- tant theme, with Amos et al. (2024) investigating the mental health impacts of COVID-19 and lockdowns on Australian LGBTQ populations. According to this re- search, participants living in Victoria and New South Wales (states that experienced extensive lockdowns) reported more negative pandemic impacts on mental health compared to other states.

Historical Development of LGBTQ+ Research in Australia: Early Research (1990s to Early 2000s)

Research from the 1990s to early 2000s focused on basic rights acquisition and resistance to discrimina- tion. Mason’s (1993) research on violence against les- bians and gays, and Hurley’s (1995, 1996) surveys on Australian gay and lesbian literature and media are representative studies of this period. Also, Walker’s (2000) research on sexual orientation as refugee sta- tus and Offord’s (2001) analysis of queer activism and rights discourse made important contributions. This period was also when legislative reform move- ments against criminalization of male homosexual- ity, continuing from colonial times, became active. Kendall’s (2003) research on lesbian and gay refugees analyzed situations where ”keeping a low profile” was no longer an option. According to Wikipedia articles on Australian LGBTQ+ history, ”sodomy” between men was criminalized from colonial times in 1788 until 1994, with punishment reduced from death penalty to life imprisonment in 1899.

Mid-period Research (2005-2015)

Research from 2005 to 2015 reflects expansion of le- gal recognition and progress in social acceptance. Mill- bank’s (2006) research on legal recognition of lesbian and gay couples, and Anthony Drabsch’s (2006) analy-

Previous Research on Mental Health of LGBT+ People

This review of previous research encompasses stud- ies on mental health of LGBT+ (lesbian, gay, bisex-

ual, transgender, and other sexual minorities) people. These studies focus on mental health challenges faced by LGBT+ communities, barriers to treatment access, and effective support strategies.

tal health problems arise from interactions between ge- netic factors and stress related to being members of sexual minority groups.

Current Status of Mental Health Among LGBT+ Youth

It is consistently reported that LGBT+ youth are at higher risk for mental health problems. Russell and Fish (2016) point out that LGBT+ youth still have high risk for mental health deterioration despite improve- ments in social support and rights progress. Research shows that LGBT+ youth have higher incidence rates of anxiety, depression, and substance use disorders compared to heterosexual youth, with approximately 3 times higher risk for suicidal ideation and suicidal be- havior.

Table 10: Mental Health Risk Factors for LGBT+ Youth.

 

Older LGBT+ people lived most of their lives during times when LGBT+ rights and acceptance

were not as advanced as today, making them more likely to have experienced discrimination and abuse than younger generations. Timney et al.’s (2015) research details relationships between discrimination faced by older LGBT+ people and mental health, pointing out cumu- lative stress impacts. King and Richardson (2017) advocate for culturally sensitive approaches in providing mental health ser- vices to older LGBT+ adults. Inventor et al. (2022) also emphasize the need for special considerations to address mental health needs of older LGBT+ people.

McDermott et al.’s research indicates that LGBT+ youth do not sufficiently utilize mental health services, often not accessing services until crisis situations arise. A UK survey reports that only one-fifth of LGBT+ youth with mental health problems actually sought medical service support. Fish’s 2020 research discusses future directions for LGBT+ youth mental health research, emphasizing the importance of viewing LGBT+ mental health from a life development perspective and focusing on positive aspects such as wellbeing and resilience.

Effects of Discrimination, Stigma, and Internalized Homophobia

Many studies indicate that discrimination and stigma have serious impacts on mental health of LGBT+ peo- ple. Burgess et al.’s (2007) research shows that LGBT+ people experience greater discrimination than hetero- sexuals and report worse mental health status, though discrimination alone does not fully explain this dispar- ity.

Unique Challenges Faced by Older LGBT+ Adults

Older LGBT+ people face unique mental health challenges different from younger populations. Yarns et al. (2016) point out that there are approximately 1 million LGBT older adults in the US, and their men-

Table 13: Mental Health Service Utilization Among LGBT+ People (Ireland).

Table 12: Mental Health Effects of Discrimination and Stigma.

 

Research in Mexico City (Lozano-Verduzco et al., 2017) indicates that homophobic discrimination or vi- olence, and low community connections show posi- tive correlations with depressive symptoms and alco- hol use. Internalized homophobia (negative attitudes toward one’s own sexuality) is also reported to be re- lated to mental health deterioration. Anderson’s 2018 research analyzes the role of stigma in mental health disparities within LGBT+ com- munities in detail, concluding that stigma reduction is key to eliminating disparities.

McCann and Sharek’s (2014) survey shows that psychiatric diagnosis rates among LGBT+ people in Ire- land reached 77%, with 63% of respondents saying they could disclose their sexuality to mental health spe- cialists, though 64% felt mental health professionals did not have sufficient knowledge about LGBT+ issues. Whaibeh et al. (2020) discuss the potential of telepsychiatry (remote psychiatric care) to reduce bar- riers to mental health service access for LGBT+. Telepsychiatry is considered a beneficial option espe- cially for LGBT+ people with geographical barriers or anonymity needs.

Access to Mental Health Services and Quality of Care

Multiple studies exist on mental health service ac- cess and utilization among LGBT+ people. Research by Rees et al. and McCann et al. focuses on LGBT+ community experiences when accessing mental health services, indicating multiple barriers exist.

Table 14: LGBT+ Response Status at Mental Health Facilities (2020).

A 2020 survey reports that only 12.6% of mental health facilities and 17.6% of substance abuse treat- ment facilities provide LGBT+-specific programs, in- dicating limited availability of culturally appropriate care.

LGBT+ Mental Health in Diverse Regional and Cultural Contexts

attitudes toward LGBT+ people in India and Australia show comparative cultural perspectives.

Literature includes research on LGBT+ mental health in various parts of the world. Br¨anstr¨om et al. (2024) ”Global LGBTQ Mental Health” examines LGBT+ mental health from an international perspec- tive.

COVID-19 Pandemic and LGBT+ Mental Health

Recent research focuses on COVID-19 pandemic impacts on LGBT+ mental health. Ruprecht et al.’s (2024) research ”Being Queer, It Was Really Isolating” examines relationships between pandemic stigma and LGBT+ youth mental health.

Table 15: Examples of Regional/Cultural LGBT+ Mental Health Research.

Table 16: COVID-19 Pandemic Impacts on LGBT+ Mental Health.

 

Dietzel et al. (2023) conducted a scoping review on LGBT+ mental health during the COVID-19 pan- demic, indicating unique pandemic impacts on this population. Amos et al.’s research (2024) targeting LGBT+ people in Australia examines wellbeing during lockdowns. Fang’s (2022) research also focuses on relationships between COVID-19 and LGBT+ mental health, ana- lyzing pandemic-specific stressors and their impacts.

Diversity in Research Methods and Approaches

Literature includes research using various research methods. Wilson and Cariola’s systematic review (2019) focusing on qualitative research analyzed quali- tative studies on LGBT+ youth and mental health, iden- tifying five main themes:

Research focusing on specific cultural contexts in- cludes El Hayek et al.’s systematic review (2022) on mental health of Arab or Arab-descent LGBT+ in- dividuals, and Alibudbuds research (2024) discussing LGBT+ mental health promotion from a Filipino per- spective. Urz´ua et al.’s research (2022) on mental health of Mexico’s LGBT+ community during the COVID-19 pandemic, and Miller et al.’s research (2022) investi- gating relationships between mental health literacy and

Kranz et al.’s (2024) research investigating rela- tionships between community participation and mental health among LGBT+ people in Russia suggests that community connections can serve as protective factors. Pepping et al. (2024) conducted descriptive surveys on LGBT+ mental health peer support, showing peer support’s potential important role in mental health pro- motion.

Table 17 Major Themes in Qualitative Research on LGBT+ Youth Mental Health

 

Table 19: Specialist Education and Clinical Practice Improvement Initiatives.

Specialist Education and Clinical Practice Improve- ment

Multiple studies exist on specialist education and clinical practice for improving mental health care for LGBT+ people. Nowasie et al.’s 2023 COVID-19 re- search reports implementation of national online on- demand LGBT+ mental health training sessions.

Moagi et al.’s integrative review (2021) comprehen- sively analyzes mental health challenges of LGBT+ people. Jonah et al.’s systematic review and meta- analysis (2022) investigates early life adversity impacts on LGBT+ youth mental health. Muir Watt (2022) conducted bibliometric analysis of peer-reviewed literature on LGBT+ adolescent mental health and wellbeing.

Table 19 Specialist Education and Clinical Practice Improvement Initiatives

 

Resilience and Protective Factors in LGBT+ Mental Health

Literature includes studies focusing not only on negative aspects of LGBT+ mental health but also on re- silience and protective factors. Dickinson and Adams (2014) conducted research on resilience and mental health and wellbeing among lesbian, gay, and bisexual people.

Drescher’s 2024 research ”Improving the approach to LGBTQ persons in mental health care settings” dis- cusses LGBT+ mental health care approach improve- ment from clinician perspectives. Vasanth Marar et al.’s 2024 research investigates mental health specialists’ experiences, training, and clinical readiness for providing care to LGBTQIA+ in- dividuals.

 

Policy and Institutional Initiatives

Policy and institutional initiatives for supporting LGBT+ mental health are examined in many studies. Moran et al.’s (2024) research ”LGBTQ+ youth pol- icy and mental health” shows how policies indirectly affect LGBT+ youth mental health through school ex-

periences.

Table 20: Important Areas of Policy and Institutional Support.

 

Table 22: Future Research Challenges Challenge Area Specific Research Needs Longitudinal Follow-up.

Research trends include shifts from pathologi- cal models to strength-based approaches, increased recognition of intersectionality, increased research on COVID-19 impacts, and growing interest in innovative service delivery models like telemental health.

Alibudbuds 2024 research ”Fostering LGBTQ+ Mental Health Promotion in Non-Health Academic Programs” discusses LGBT+ mental health promotion in non-health academic programs from a Filipino per- spective. Ventriglia’s (2022) ”Mental health for LGBTQI peo- ple: a policies’ review” provides policy review on LGBTQI+ mental health. This literature list shows that research on LGBT+ mental health has rapidly developed in recent years. These studies consistently show that LGBT+ people experience mental health problems at higher rates com- pared to heterosexual and cisgender people. Sociocul- tural factors such as discrimination, stigma, and internalized homophobia are indicated as important deter- minants of these health disparities.

Needs include longitudinal follow-up studies, evi- dence expansion in culturally diverse populations, de- velopment and validation of effective interventions, and translational research linking policy and practice. These studies are essential for developing evidence- based policies and practices to address LGBT+ mental health needs. Based on findings from previous research, the fol- lowing recommendations can be made:

• Mental health specialists need to enhance cul- tural competency regarding diverse experiences and needs of LGBT+ people
• Mental health services should develop and imple- ment LGBT+-specific programs and affirmative

Prevalence Rates by Mental Disorder Type

care approaches

• Innovative service delivery models like telemental health show promise in reducing access barriers

Table 23: 12-Month Mental Disorder Prevalence by Type (2020-2022).

• Policymakers should prioritize school-based pro- grams and comprehensive policies supporting LGBT+ youth mental health
• Researchers should conduct studies for deeper un- derstanding of diversity within LGBT+ people (age, culture, geography, intersecting attributes, etc.)

Implementing these recommendations is expected to contribute to improving mental health and wellbeing of LGBT+ people. Particularly, providing culturally appropriate care is essential for creating environments where LGBT+ people can receive treatment with con- fidence. Additionally, it is important to build compre- hensive support systems from both policy-level initia- tives and clinical practice.

Among anxiety disorders, social phobia (7.3%) and post-traumatic stress disorder (5.6%) show high preva- lence rates. For affective disorders, depressive episodes (4.9%) are most common.

National Study of Mental Health and Wellbeing (2020-2022 Discussion)

Age and Gender Differences

This dataset presents results from the National Study of Mental Health and Wellbeing (NSMHW) conducted by the Australian Bureau of Statistics from 2020 to 2022. The survey was conducted among Australian residents aged 16 to 85, providing comprehensive statistics on mental health issues during the COVID-19 pandemic.

Age-based analysis indicates high mental disorder prevalence in younger populations:

Table 24 12-Month Mental Disorder Prevalence by Age Group

Statistical Results

Findings indicated from this survey are as follows:

• 9% of Australians aged 16 to 85 have experi- enced mental disorders at some point in their lives
• 5% (approximately 4.3 million people) had mental disorders in the past 12 months, with anx- iety disorders being most common at 17.2%
• 12-month mental disorder prevalence rate is par- ticularly high in youth aged 16-24, reaching 38.8%
• Women’s percentage with 12-month mental disor- ders (24.6%) significantly exceeds men’s (18.3%)

Gender differences are also an important character- istic. Women show higher mental disorder prevalence rates than men across all age groups. Particularly no- table gender differences appear in anxiety disorders (women 21.1% vs men 13.3%) and affective disorders (women 8.6% vs men 6.5%).

These factors interact with each other, making LGBTQ+ community partnership formation difficult and consequently reducing mental health protective ef- fects.

Bisexual-Specific Partnership Challenges

The bisexual community faces particularly complex challenges within the LGBTQ+ community. Bisexual- specific partnership issues are mainly classified into three domains:

Special Challenges in LGBTQ+ Partnership For- mation

Challenges faced by the LGBTQ+ community in partnership formation are multi-layered, contributing to high mental disorder rates. Major constraint factors include:

• Identity recognition complexity

– Social categorization changes based on part- ner’s gender: Treated as ”heterosexual” with opposite-sex partners, ”homosexual” with same-sex partners

• Social constraint factors

– Matching pool limitations: Constraints on LGBTQ+ population ratios limit potential partner candidates

– Need for continuous coming out: Required to explain sexual orientation with each part- ner change

– Regional differences in social acceptance: Acceptance disparity between urban and ru- ral areas, countries/regions

– Questions about identity legitimacy: Need to respond to ”which are you really?” questions

– Legal status instability of same-sex mar- riage: Regional differences in marriage sys- tem application

• Community affiliation fluidity

– Alienation from LGBTQ+ community with opposite-sex partners: Criticism for having ”heterosexual privilege”

• Intra-community factors

– Partnership formation difficulties within nar- row communities: Limitations in options and impacts of relationship breakdown

– Exclusion from heterosexual society with same-sex partners: Recognition as ”not het- erosexual”

– Constraints from differing coming out sta- tuses: Mismatches in disclosure levels among potential partners

– Instability of belonging in both communi- ties: Absence of fully accepting spaces

• Additional burdens in relationship maintenance

– Intergenerational consciousness and value differences: Barriers to relationship forma- tion across age groups

– Difficulty gaining understanding from both communities: Dealing with prejudice from both sides

• Economic constraint factors

– Burden of explaining identity to partners: Need to explain bisexuality concept

– Reduced dual-income household formation rates: Economic disadvantage due to part- nership shortage

– Complexity in explaining relationships to family/friends: Social accountability for partner changes

– Systemic discrimination in housing loans and insurance: Restricted access to financial services

These challenges make stable partnership mainte- nance more difficult for bisexual individuals, presum- ably contributing to the high mental disorder rate of 64.4%.

– Risks of discrimination in work environ- ments: Disadvantages from public disclo- sure as couples

– Restrictions in promotion/advancement op- portunities

Economic Protective Effects of Partnership Analy- sis

Economic factors play important roles in partner- ship’s impact on mental health. Economic status-based mental disorder rate analysis confirmed higher rates among those in economically disadvantaged environ- ments.

– Narrowed options in job market

• Restricted access to financial services

– Disadvantaged treatment in mortgage as- sessments

– Higher insurance premiums or coverage ex- clusions

Table 25: Mental Disorder Rates by Economic Status and Partnership Effects.

– Restricted access to asset management ser- vices

Due to these economic disadvantages, LGBTQ+ couples, particularly bisexual couples, cannot fully benefit from partnership’s economic protective effects, suggesting potentially increased mental disorder risk.

Quantitative Assessment of Improvement Potential

Quantitative assessment was conducted on improve- ment effects if ideal partnership environments were es- tablished. Considering partnership’s protective effect (8.4 percentage points) observed in the general popula- tion, plus additional effects from removing LGBTQ+- specific barriers, maximum 12.6 percentage point im- provement is estimated for the bisexual community.

Economic benefits from couple households are mul- tifaceted. First, dual-income effects can increase household income to 1.5-2 times that of single house- holds, significantly reducing economic stress. Second, sharing fixed costs like housing and utilities substan- tially reduces individual economic burden. Third, ac- cess to partner’s health insurance may improve access to mental health services. However, LGBTQ+ couples may not equally enjoy these economic benefits. Main issues include:

Table 26: Estimated Mental Health Improvement Effects for Bisexual Individuals.

• Unequal legal protection

– Regional variations in marriage law applica- tion

– Non-application or restrictions on tax benefits

– Legal constraints on inheritance rights, cus- tody rights, etc.

• Employment discrimination risks

– Workplace discrimination due to public dis- closure as couples

Complex Relationship Between Age Groups and LGBTQ+ Mental Health

This improvement effect corresponds to reduction of approximately 44.9 thousand bisexual mental disor- der patients, representing 19.6% relative improvement. This indicates that partnership environment improve- ment could significantly contribute to mental health im- provement in the bisexual community.

Mental health challenges within LGBTQ+ com- munities show different characteristics by age group. Challenges faced by each generation differ signifi- cantly based on social environment changes, coming out timing, presence of social support.

Relationship Between Gender Experience and Mental Health Disorders

Table 28 Primary Mental Health Challenges for LGBTQ+ Individuals by Age Group

It was confirmed that within the LGBTQ+ commu- nity, not only sexual orientation but also gender expe- rience (experiences related to gender identity) signifi- cantly impacts mental health.

Table 27: Mental Health Disorder Rates by Gender Experience.

Transgender individuals’ 12-month mental health disorder rate is 33.1%, showing 1.6x higher than cis- gender individuals’ 21.3%. This indicates transgen- der people face social prejudice/discrimination, med- ical access issues, etc. regarding gender identity in ad- dition to sexual orientation. Particularly important discovery is that 39.0% of LGBTQ+ community are transgender (287.5 thou- sand/737.1 thousand). This high percentage suggests those with overlapping sexual orientation and gender experience have higher likelihood of facing more com- plex and serious mental health challenges. Transgender LGBTQ+ individuals face following compound stresses:

Impact of Household Structure and Living Environ- ment on Mental Health

For LGBTQ+ communities, household structure and living environment are important factors determining balance between psychological safety and social pres- sure, not merely living conditions.

• Dual experience of discrimination based on sexual orientation and gender identity
• Difficulty accessing appropriate treatment due to lack of understanding in medical institutions
• Need for multiple ”coming outs” at work- place/school/family settings
• Social life difficulties due to insufficient legal pro- tection
• Alternative choice when partner cohabitation isn’t socially accepted

Table 29: Mental Health Disorder Rates by Household Structure.

• Potential for serious isolation with aging

Special Situation of Single-parent Households

In single-parent households (32.6% disorder rate), LGBTQ+-specific challenges manifest:

• Legal and social difficulties in child-rearing by lesbian couples
• Insufficient legal protection regarding cus- tody/parenting rights
• Prejudice toward family structure in school/community settings
• Compound impact of economic burden and mi- nority stress
• Psychological burden from consideration for chil- dren’s social adaptation

Significance of Group Living Environments

Group living households show the highest disorder rate (34.9%), holding complex meaning for LGBTQ+:

Considerations for Compound Factors

This analysis indicates that LGBTQ+ community mental health challenges form through complex inter- actions of gender experience, age, and living environ- ment, not single factors.

• Possibility of forming LGBTQ+-friendly shared housing environments
• Mutual support networks among community members

Table 30: Estimated Risk Groups by Compound Factors.

• Coexistence of social pressure for coming out and opportunities
• Relationship between economic necessity and psychological vulnerability
• Function as temporary refuge for young LGBTQ+ individuals

Characteristics of Single-person Households

Single-person households (24.3% disorder rate) hold following significance for LGBTQ+:

• Safe space freed from family pressure and surveil- lance
• Freedom of self-expression alongside risk of so- cial isolation
• Additional psychological stress from increased economic burden

Relationship Between Social Support Networks and Treatment Gaps

ness becomes major barriers preventing early symptom recognition and appropriate treatment selection.

In mental health treatment gaps, social support lev- els become more crucial determinants than economic factors or functional impairment. Treatment access rates show dramatic differences based on social support degrees, with especially severe treatment gaps among those receiving only limited support.

Table 32: Treatment Gap and Recognition Ability by Health Literacy Level.

Table 31: Treatment Gap and Related Factors by So- cial Support Level.

Treatment gaps among low health literacy groups reach approximately 5 times that of high literacy groups (42.3% vs 8.2%). This difference mainly arises from symptom recognition ability (84.3% vs 32.8%) and lack of understanding regarding appropriate treat- ment selection (82.5% vs 23.7%).

Treatment gaps among limited support groups reach 45.7%, approximately 4 times that of strong support groups (11.5%). This disparity directly relates to social isolation degrees, with 72.9% of limited support groups experiencing severe social isolation compared to only 12.3% of strong support groups. Major social isolation factors include ”no close friends” (58.7%), ”disconnection from community” (48.2%), and ”family non-involvement” (42.3%). These factors work compositely, creating significant treatment access difficulties. Relationships between social connection strength and treatment outcomes are also clear. People with strong social connections show 83.2% treatment uti- lization rates, while socially isolated individuals show only 48.6%. Furthermore, treatment continuation rates show 33.7% large differences, indicating social support decisively influences treatment sustainability.

Digital Mental Health Support Utilization Trends

Analysis of rapidly expanding digital mental health support utilization by age group confirmed clear inter- generational disparities.

Table 33: Digital Mental Health Support Utilization by Age Group.

Health Literacy and Treatment Recognition Chal- lenges

While 42.8% of young people aged 16-24 use digital mental health support, only 6.2% of those 45+ do. This reflects not only digital literacy differences but also intergenerational disparities in help-seeking methods.

Health literacy levels constitute important factors de- termining treatment gap magnitude. Particularly, lack of knowledge and understanding regarding mental ill-

All age groups show female utilization rates ex- ceeding males, suggesting need for developing male- targeted digital support content and measures to pro- mote male support utilization. Types and utilization status of digital services include:

Table 34: Characteristics and Treatment Response by Severity.

• Self-help apps: 22.1% of mental disorder patients
• Online counseling: 18.7%
• Chat consultation: 15.3%
• Telemedicine: 12.4%
• Online peer support: 9.8%
• VR therapy: 2.1% (emerging field)

From effectiveness and satisfaction perspectives, 67% of users responded that digital therapy ”helped improve symptoms,” while digital therapy (78% treat- ment continuation rate) showed high continuation rates compared to face-to-face therapy (85% treatment con- tinuation rate). By severity, improvement reports in- cluded 80% for mild, 65% for moderate, and 45% for severe cases, with best results achieved through com- bined face-to-face and digital approaches.

Severity differences are notably reflected in medical utilization patterns. Severe group hospitalization rates reach approximately 10x that of mild groups, empha- sizing the importance of early intervention to prevent severity progression. Major risk factors for severity progression include delayed treatment initiation, social isolation, co-occurring substance use, economic hard- ship, and overlapping multiple stress events.

Life Function Difference Analysis by Severity

Mental disorder severity brings major differences not only in symptom intensity but also in social function- ing, treatment responsiveness, and medical utilization patterns.

Synergistic Treatment Gap Deterioration by Com- pound Factors

When multiple factors exist simultaneously, treat- ment gaps worsen synergistically. Particularly, combinations of sociocultural factors, psychological- cognitive factors, and systemic-personal factors create extremely serious situations.

Table 35: Treatment Gap Deterioration by Compound Factors.

Table 36: Mental Disorder Prevalence by Cultural Background.

Religious/spiritual influences function as protective factors. Religious activity participants show 20% lower prevalence rates, meditation/mindfulness practitioners show 25% lower rates. Religious community support reduces isolation feelings by 45%. Media/SNS impacts are bidirectional. Over 3 hours daily SNS use increases depression risk 1.7x, cyberbul- lying experience increases suicidal ideation 3.5x, while online support communities reduce isolation feelings by 50%.

Annual Course Patterns and Recovery/Relapse Analysis of Mental Disorders

Course patterns of mental disorders are diverse, with patient prognosis significantly influenced by initial re- sponses and continuous treatment. Analysis results classify mental disorders into four typical course pat- terns: single episode, recurrent, chronic, and progres- sive types.

Most serious combinations include ”low efficacy + lack of hope” creating 78.3% treatment gaps. Follow- ing are ”avoidant style + social isolation” (76.2%) and ”access barriers + low literacy” (75.6%). These com- binations show synergistic effects far exceeding single factor impacts.

Multi-faceted Analysis of Cultural/Social Factors and Mental Health

Cultural and social factors significantly influence mental health, constituting risk factors for mental dis- order risks and treatment access barriers in specific populations. Prevalence rate differences by cultural background are notable.

are particularly serious among socially vulnerable pop- ulations. Particularly sexual minorities and transgen- der individuals have significantly higher likelihood of experiencing psychological distress.

Table 37: Mental Disorder Course Pattern Classification.

 

Service Utilization Status

Important trends regarding mental health service uti- lization are indicated:

12-month remission rates by disorder show anxiety disorders most likely to remit (45%), followed by mood disorders (38%), and substance use disorders (28%). Multiple mental disorder co-occurrence shows lowest remission rates (15%), indicating high treatment diffi- culty. Average time to relapse is shortest for substance use disorders (6 months), followed by compound types (12 months), anxiety disorders (18 months), and mood dis- orders (24 months). These results reflect the chronicity and dependence strength of substance use disorders.

45.1% of people with 12-month mental disorders sought some form of professional assistance, while the remaining 54.9% received no support. This suggests challenges in accessing mental health services.

Prescription Status of Mental Health Related Med- ications

Prevalence Rates in Specific Populations

Large disparities in mental disorder prevalence rates were confirmed among specific population groups:

According to Pharmaceutical Benefits Scheme (PBS) data, prescription status of mental health-related medications is as follows:

Table 38: 12-Month Mental Disorder Prevalence in Specific Populations.

Table 40: Mental Health Medication Prescription Rates (12 months).

These results indicate that mental health problems

33.3% of people with 12-month mental disorders were prescribed at least one type of mental health med- ication, indicating pharmaceutical treatment as an im- portant component of mental health care.

Table 42: 12-Month Mental Disorder Prevalence by State/Territory.

 

Suicidal Ideation and Self-harm

Analysis of suicidal ideation and self-harm behavior revealed the following serious reality:

Table 41: Lifetime and 12-Month Prevalence of Suicidal Ideation and Self-harm.

Northern Territory shows the highest 12-month men- tal disorder prevalence rate (28.8%), while Tasmania shows the highest lifetime mental disorder prevalence rate (52.9%). Behind these regional characteristics, compound factors including population density, so- cioeconomic factors, and service access are considered relevant.

74.9% of people who experienced suicidal ideation or self-harm in the past 12 months had concurrent 12-month mental disorders, showing a strong asso- ciation between mental health problems and suicide risk. Regarding self-harm, 27.9% of women aged 16- 24 have experienced it in their lifetime, highlighting the seriousness of mental health problems among young women.

Co-occurrence of Mental and Physical Disorders

Important correlations were confirmed regarding co- occurrence of mental and physical disorders:

Table 43: Co-occurrence Patterns of Mental and Phys- ical Disorders (Overall).

State and Regional Differences

State and regional analysis confirmed geographical factors causing differences in mental disorder prevalence rates:

39.1% of people with mental disorders also have co- occurring physical disorders, indicating that physical and mental health problems mutually influence each other. Such co-occurrence likely leads to treatment complications and reduced quality of life.

Comprehensive Analysis Results of Mental Health Data

This analysis represents comprehensive analysis re- sults targeting 11 Excel files based on the ”National Study of Mental Health and Wellbeing: Summary Re- sults” conducted by the Australian Bureau of Statis- tics from 2020-2022, implemented using JavaScript.

Demographic Characteristics

Analysis particularly focused on time series analysis (comparing lifetime and 12-month prevalence rates) and characteristic differences between mental health patients and non-patients.

Age-stratified analysis revealed highest prevalence rates in young populations (16-24 years). Gender differences were also notable, with women showing higher prevalence rates for anxiety and mood disor- ders, while men showed higher prevalence rates for substance use disorders.

Time Series Analysis: Comparison of Lifetime and 12-Month Prevalence Rates

Analysis results of lifetime and 12-month prevalence rates provide important findings indicating chronicity and recurrence of mental disorders. Below are compar- ative analysis results for major mental disorders.

Table 45: Prevalence Patterns by Age Group and Gender.

Table 44: Comparison of Lifetime and 12-Month Prevalence Rates for Major Mental Disorders.

Socioeconomic Factors

Socioeconomic factors were found to be closely re- lated to mental health status. Particularly important factors include:

From these analysis results, lifetime prevalence was found to be an average of 2.0 times the 12-month preva- lence. Substance use disorders showed the highest ratio at 2.4x, reflecting dependence strength. Anxiety disor- ders showed a relatively low ratio of 1.6x, suggesting a potentially more temporary nature compared to other mental disorders. This 2x ratio indicates that more than half of peo- ple who have experienced mental disorders may ex- perience recurrence or chronicity. This suggests that mental disorders should be understood as chronic dis- eases requiring long-term health management rather than temporary problems.

• Employment status: Unemployed individuals show approximately 2x higher prevalence than employed
• Income level: Low-income groups show 1.5-2x higher prevalence than high-income groups
• Household composition: Single-person house- holds show higher prevalence than family house- holds
• Education level: Slightly higher prevalence among those without tertiary education

Health-related Factors

Characteristic Differences Between Patients and Non-patients

Co-occurrence of mental disorders and physical dis- eases is very common, with mental disorder prevalence 2-3x higher among those with chronic physical condi- tions compared to healthy individuals.

Notable differences were observed in multiple do- mains between mental health patients and non-patients. Major differences are detailed below.

While regional differences in prevalence rates are relatively small in the general population, LGBTQ+ individuals (58.7%) face the following additional dif- ficulties due to rural/remote residence:

Table 46 Relationship Between Health Behaviors and Mental Disorders

 

• Absolute shortage of LGBTQ+ specialist mental health professionals
• Severe social isolation in local communities
• Increased risks related to coming out
• Continued psychological stress from discrimina- tion and prejudice
• Increased economic and time costs for receiving specialized treatment

Due to these factors, the actual mental health preva- lence rate of rural LGBTQ+ individuals may far exceed the statistical 58.7%. Particularly, the lack of LGBTQ+ community support in remote areas functions as a fac- tor exacerbating mental health problems.

Structural Analysis of Mental Health Issues Among LGBTQ+ Individuals

Based on data from the Australian Bureau of Statis- tics ”National Study of Mental Health and Wellbe- ing 2020-2022,” an analysis was conducted on mental health issues among LGBTQ+ individuals, focusing on the compound effects of regional disparities, socioeco- nomic disparities, and untreated conditions. The pur- pose was to go beyond conventional prevalence com- parisons and age group analyses to suggest the reality of ”compound disadvantage” arising from overlapping multiple social factors.

Compound Impact Analysis with Socioeconomic Disparities

Analysis using the Socio-Economic Indexes for Ar- eas (SEIFA) confirmed that low socioeconomic status strongly correlates with increased mental health chal- lenges. For LGBTQ+ individuals, these socioeconomic disparities work compositely with difficulties as sexual minorities:

Compound Disadvantage Created by Regional Dis- parities

Table 48: Compound Impact of Socioeconomic Dis- parities and LGBTQ+ Mental Health.

Regional disparities in mental health challenges have special significance for LGBTQ+ individuals. Analy- sis of mental disorder prevalence rates by region in the general population revealed the following trends:

 

Table 47: Regional Mental Disorder Prevalence Rates (Overall, 12 months, %).

For low-income LGBTQ+ individuals, the following compound treatment access barriers exist:

• Social denial of identity legitimacy
• Lack of understanding in specialized support
• Restrictions on private health insurance enroll- ment due to economic constraints

Compound Treatment Access Barriers Analysis

Treatment access barriers faced by LGBTQ+ indi- viduals interact across multiple dimensions.

• Difficulty bearing high costs of LGBTQ+ special- ized counseling

Structural Barriers

• Geographic travel costs for specialist consultation
• Absolute shortage of professionals capable of pro- viding LGBTQ+ affirmative care
• Worsening of mental health problems due to eco- nomic stress
• Non-coverage items such as gender-affirming care in public health insurance systems
• Progression of social isolation due to employment difficulties
• Geographic distribution of mental health services

Due to these factors, the prevalence rate among low- income LGBTQ+ individuals may reach 70-80%, far exceeding the 58.7% for LGBTQ+ overall. Particu- larly, among bisexual low-income individuals, preva- lence rates may exceed 80%.

• Lack of LGBTQ+ perspective in diagno- sis/treatment guidelines

Social Barriers

• Need for coming out in medical settings

Serious Reality of Untreated Conditions

• Lack of understanding or potential bias among healthcare providers

The most important finding in this analysis is the existence of extremely high untreated rates among LGBTQ+ individuals. Estimated untreated rates for LGBTQ+ individuals were calculated based on general population treatment access rates:

• Risk of disclosure to workplace/school
• Family opposition to treatment or refusal of sup- port

Personal and Psychological Barriers

Table 49 Estimated Untreated Rates Among LGBTQ+ Individuals

• Internalized stigma toward psychiatric care
• Difficulty continuing treatment due to economic hardship
• Identity self-denial or shame
• Personalization of problems and delayed help- seeking

Intersectional Analysis of Compound Risk Factors

Individuals with multiple minority attributes face the most serious mental health challenges - ”intersectional” individuals.

Reasons for particularly high untreated rates among bisexual individuals include:

• Invisibilization from heterosexual communities
• Exclusion and dismissal from gay/lesbian com- munities

Mental Health Prevalence Disparity Analysis

Table 50 Compound Risk Assessment by Intersec- tional Attributes

Analysis of mental health statistics by sexual orienta- tion revealed significant disparities between LGBTQ+ individuals and heterosexuals. The following results were obtained for 12-month mental disorder prevalence rates:

Table 51: Mental Disorder Prevalence Rates by Sex- ual Orientation (12 months, %).

The extremely high untreated rates among these in- tersectional individuals should be recognized as a so- cial crisis. Particularly, individuals with triple com- pound disadvantage of rural residence, low income, and bisexuality may have almost all unable to receive appropriate treatment.

From this data, the following particularly important findings emerged:

• The proportion with any mental disorder reached 58.7% for LGBTQ+ overall, approximately 3 times that of heterosexuals (19.9%)

Serious Consequences of Untreated Conditions

Long-term untreated conditions lead to the following serious consequences for LGBTQ+ individuals:

• The situation for bisexual individuals is most seri- ous, with 64.4% having any mental disorder
• Chronicity and severity of psychiatric symptoms
• For affective disorders, LGBTQ+ overall (28.2%) is more than 4 times heterosexuals (6.7%)
• Increased self-harm and suicidal ideation
• For anxiety disorders, LGBTQ+ individuals’ prevalence rate is also more than 3 times hetero- sexuals
• Significant decline in social functioning (employ- ment/educational difficulties, etc.)
• Concurrent physical health problems

Special Vulnerability of the Bisexual Commu- nity

• Worsening economic hardship
• Progression of social isolation

Detailed analysis of bisexual individuals revealed that this subgroup carries particularly high mental health risks. The disorder type-specific prevalence rates for bisexual individuals are as follows:

• Intergenerational transmission of trauma

These consequences extend beyond individual suf- fering to increased economic and social costs for soci- ety as a whole. Improving untreated conditions is both an LGBTQ+ rights issue and a public health challenge for society overall.

• Anxiety Disorders: 57.2% (41.3 percentage points higher than heterosexuals)
• Affective Disorders: 29.6% (22.9 percentage points higher than heterosexuals)
• Substance Use Disorders: 9.7% (6.7 percentage points higher than heterosexuals)
• Absolute shortage of treatment programs address- ing bisexual-specific experiences
• Insufficient response even in LGB-specific ser- vices

Factors contributing to higher mental disorder rates than LGBTQ+ average among the bisexual community include ”double prejudice” (prejudice from both het- erosexual and LGB communities) and isolation due to lack of identity recognition and understanding.

Regarding estimated treatment status, the proportion of bisexual mental disorder patients (229.8 thousand) receiving appropriate treatment may be lower com- pared to the general population.

Double Alienation Phenomenon and Identity Visi- bility Issues

Partnership’s Mental Health Protective Effect

One of the most serious challenges faced by the bisexual community is the ”double alienation” phe- nomenon. This refers to the inability to receive un- derstanding or acceptance from both heterosexual and LGB communities. Analysis results confirmed the fol- lowing characteristic patterns:

Analysis results revealed that presence or absence of partnership significantly influences mental disorder rates. Average mental disorder rate for couples was 18.0%, while non-couples (single-person households, group homes, etc.) averaged 26.4%, showing a notable 8.4 percentage point difference.
Treated as ”homosexual” by heterosexual commu- nities, unable to receive appropriate understandingViewed as having ”heterosexual privilege” by LGB communities, unable to receive full accep- tance

• External assumptions changing based on partner’s gender, requiring constant coming out
• Identity legitimacy questioned, misunderstood as ”transitional homosexuality” or ”indecisiveness”

Due to these factors, bisexual individuals find it dif- ficult to find safe and comfortable places in both com- munities, resulting in increased mental disorder rates.

Special Barriers in Treatment Access
Analysis of treatment access revealed unique chal- lenges specific to bisexual individuals. Comparison with general population treatment rate data revealed that the bisexual community faces the following spe- cial barriers:
Lack of appropriate treatment due to healthcare providers’ insufficient understanding of bisexual- ity

This 8.4 percentage point difference demonstrates the protective effect partnership has on mental health. Lower mental disorder rates among couples suggest mutual social, economic, and emotional support plays important roles. Particularly, ”couples only” house- holds showed the lowest mental disorder rate at 16.7%, clearly demonstrating the direct effect of partnership.

• Potential for misdiagnosis as ”transitional homo- sexuality” or ”confusion”
• Anxiety about risks associated with sexual orien- tation disclosure in treatment settings

Partnership Conditions and Mental Health by Sex- ual Orientation

erosexuals’ 19.9%. Particularly noteworthy is bisexual individuals’ prevalence rate at 64.4%, highest among all groups, exceeding even LGBTQ+ average by 5.7 percentage points. Analysis by mental disorder type showed LGBTQ+ individuals with high prevalence rates across all cate- gories.

Sexual orientation-based analysis confirmed markedly higher mental disorder rates among the LGBTQ+ community, particularly bisexual individu- als, compared to heterosexuals. While heterosexuals showed a mental disorder rate of 19.9%, bisexual individuals showed 64.4%, and LGBTQ+ overall showed 58.7%, representing large disparities.

Table 55: Prevalence Rate Comparison by Mental Disorder Type.

Table 53: Mental Disorder Rates and Partnership Ef- fects by Sexual Orientation.

Closing
This disparity suggests the impact of special con- straints faced by the LGBTQ+ community in partner- ship formation. While partnership’s protective effect is relatively equally enjoyed by heterosexuals, for the LGBTQ+ community, various social and institutional barriers may prevent full realization of this effect.

This paper comprehensively analyzed the reality of LGBTQ+ mental health issues using large-scale epi- demiological survey data of approximately 20 million people in Australia, revealing compound disadvantage structures not captured by conventional research. Major findings included LGBTQ+ mental disorder prevalence rate of 58.7% reaching 3 times that of het- erosexuals, with particularly bisexual individuals’ ex- tremely high 64.4% quantitatively demonstrating the seriousness of ”double alienation” phenomenon. Re- gional disparity analysis revealed serious situations be- yond conventional recognition with rural LGBTQ+ in- dividuals showing estimated prevalence rates of 65- 75% and untreated rates of 75-90%. Furthermore, in- tersectional analysis revealed social crisis-level reali- ties with estimated untreated rates reaching 90-98% for individuals with multiple minority attributes (rural × low income × bisexual). New findings regarding treatment access included 60-80% of LGBTQ+ individuals not receiving appro- priate treatment, with notable gender disparity where male help-seeking behavior remains at 63% of females. Additionally, while partnership has important protec- tive effects on mental health (8.4 percentage points), re- ality showed LGBTQ+ individuals cannot sufficiently