Psychological therapy outcomes by sexual orientation and gender: A retrospective cohort study

Abstract

Background Lesbian, gay, and bisexual (LGB) individuals are more than twice as likely to experience anxiety and depression compared with heterosexuals. Minority stress theory posits that stigma and discrimination contribute to chronic stress, potentially affecting clinical treatment. We compared psychological therapy outcomes between LGB and heterosexual patients by gender. Methods Retrospective cohort data were obtained from seven NHS talking therapy services in London, from April 2013 to December 2023. Of 100,389 patients, 94,239 reported sexual orientation, 7,422 identifying as LGB. The primary outcome was reliable recovery from anxiety and depression. Secondary outcomes were reliable improvement, depression and anxiety severity, therapy attrition, and engagement. Analyses were stratified by gender and employed multilevel regression models, adjusting for sociodemographic and clinical covariates. Results After adjustment, gay men had higher odds of reliable recovery (OR: 1.23, 95% CI: 1.13-1.34) and reliable improvement (OR: 1.16, 95% CI: 1.06-1.28) than heterosexual men, with lower attrition (OR: 0.88, 95% CI: 0.80-0.97) and greater reductions in depression (MD: 0.51, 95% CI: 0.28-0.74) and anxiety (MD: 0.45, 95% CI: 0.25-0.65). Bisexual men (OR: 0.67, 95% CI: 0.54-0.83) and bisexual women (OR: 0.84, 95% CI: 0.77-0.93) had lower attrition than heterosexuals. Lesbian and bisexual women, and bisexual men, attended slightly more sessions (MD: 0.02-0.03, 95% CI: 0.01-0.04) than heterosexual patients. No other differences were observed. Conclusions Despite significant mental health burdens and stressors, LGB individuals had similar, if not marginally better, outcomes and engagement with psychological therapy compared with heterosexual patients.