Discrimination linked to depression, anxiety and suicidal thoughts in LGBTQ+ college students

One in ten LGBTQ+ college students reported experiencing discrimination on campus during the previous year, and those students were substantially more likely to meet criteria for depression and anxiety, report suicidal thoughts, and avoid needed health care, according to the largest national study to date of how discrimination shapes the mental health and health care experiences of this population. The research, conducted by Columbia University Mailman School of Public Health, Boston University School of Public Health and Harvard Pilgrim Health Care Institute, drew on responses from 17,942 LGBTQ+ students ages 18 to 24 at 119 colleges and universities across 34 states. The findings are published in the journal Behavioral Medicine, in an article titled “LGBTQ+ College Students’ Exposure to Discrimination and Relationships to Mental Health and Healthcare Utilization: Findings from a National Survey.”

The analysis relied on the 2024–2025 Healthy Minds Study, an annual national survey of college student mental health. Researchers examined three distinct types of discriminatory experiences: interpersonal discrimination on campus, past denials of health care, and past denials of other services on the basis of sexual orientation and/or gender identity. They then assessed how these experiences related to four mental health outcomes—flourishing, depression, anxiety, and suicidal ideation—as well as to health care utilization. The study is the first of its kind to assess these associations during and immediately following a national election year, a period the researchers describe as marked by heightened political debate over LGBTQ+ rights. Because the data are cross-sectional, the findings describe associations between reported discrimination and reported outcomes rather than demonstrating that discrimination causes those outcomes.

The magnitude of the associations was considerable. Students who experienced discrimination on campus during the previous year were 84 percent more likely to meet criteria for depression, 87 percent more likely to meet criteria for anxiety, and 78 percent more likely to report suicidal thoughts in the past year compared with students who did not report such discrimination. Students who reported discrimination in the form of health care or service denial faced even greater risks: among LGBTQ+ students overall, denial of health care was associated with a more than 200 percent higher likelihood of suicidal ideation. “Addressing discrimination among college students is essential to support student well-being, reduce mental health disparities, and ensure all students have equitable access to care,” said Sarah McKetta, MD, PhD, assistant professor of Epidemiology at Columbia Mailman and co-first author of the study.

Beyond the contrasts between students who did and did not report discrimination, the study documented striking overall levels of psychological distress among LGBTQ+ college students. More than half of all participants met criteria for depression. Nearly half of LGBQ+ students and more than half of transgender and nonbinary students met criteria for anxiety. Suicidal thoughts during the previous year were reported by nearly one in five LGBQ+ students and by more than one in four transgender and nonbinary students. These baseline figures indicate that the mental health burden in this population is high even before accounting for discriminatory experiences, and that distress is unevenly distributed across sexual orientation and gender identity subgroups within the LGBTQ+ sample.

Health care avoidance emerged as a closely related concern. Although more than half of participants sought mental health counseling, many continued to avoid health care because of concerns about discrimination. Nearly 5 percent of LGBQ+ students and 13 percent of transgender and nonbinary students reported avoiding needed medical care. The researchers also found that transgender and nonbinary students were more than twice as likely as LGBQ+ students to report being denied health care. Because many transgender people rely on medical services for gender-affirming care, the authors note that such barriers may carry especially serious consequences for both physical and mental health during a stage of life when students are newly responsible for navigating adult health care systems on their own.

The timing of these barriers matters, the researchers argue, because emerging adulthood is a pivotal period for lifelong health. It is also when many young adults transition from pediatric to adult health care, often losing established providers and facing new barriers to care at the same moment they leave familiar support structures. “Behavioral health during emerging adulthood is a strong predictor of health later in life,” said McKetta. “Improving access to affirming health care and reducing discrimination during this transition can have lasting benefits.” In this framework, the college years represent both a window of heightened vulnerability to discrimination-related distress and an opportunity for institutions to intervene before patterns of avoidance and untreated distress become entrenched.

The study’s findings arrive against a policy backdrop the authors describe as increasingly hostile. “In addition to an increasingly hostile federal climate, many states have enacted legislation aiming to curtail LGBTQ+ rights,” said McKetta. “In 2025 alone, more than 1,000 bills were introduced that would limit transgender people’s access to health care, education, or legal recognition.” The researchers note that assessing discrimination and mental health during and immediately following a national election year is a methodological first for research of this scale, allowing the survey to capture students’ experiences during a period of intensified political contestation over the very rights that shape their access to care and legal recognition.

Among the study’s most sobering results was the consistency of the association between discrimination and suicidal thinking. “Particularly troubling were our findings on suicidal ideation,” noted McKetta. “Across every subgroup of students and every type of discrimination we examined, experiencing discrimination increased the likelihood of suicidal thoughts. These findings highlight the urgent need for colleges to address discrimination as part of comprehensive suicide prevention efforts.” The data also point to a practical avenue for intervention: LGBTQ+ students reported utilizing therapy and counseling services from mental health professionals at high rates, suggesting that campus counseling settings offer an opportunity to identify psychological distress, provide affirming care, and connect students with broader health services they might otherwise forgo.

The authors emphasize several concrete steps flowing from the results. “Improving training in LGBTQ+ health for clinicians and campus providers can reduce discriminatory experiences, strengthen trust in health care systems, and improve outcomes for students during this pivotal stage of life,” said McKetta. The researchers also stress the importance of continuing to support large-scale, high-quality research on LGBTQ+ health. “Understanding how discrimination affects health depends on rigorous data collection and sustained investment in research,” said McKetta. “Without these resources, it becomes much more difficult to identify disparities and develop effective solutions.” The work was supported by the National Institutes of Health under grants R61HD117134, which was terminated in March 2025, R00AA031316, and K01MH121515, along with the William T. Grant Foundation Scholars Program.

Co-authors of the study are Sarah K. Lipson, co-first author, Allegra R. Gordon, Sangeeta Subedi, and Alexa L. Bowerfind of Boston University School of Public Health; Erin Voichoski of the University of Michigan; Adison Hicks of Boston University Chobanian & Avedisian School of Medicine; Kimberly M. Nelson of Boston University School of Public Health and Boston University Chobanian & Avedisian School of Medicine; and Brittany M. Charlton of Harvard Medical School and Harvard Pilgrim Health Care Institute. The article was published online on October 22, 2026, with the digital object identifier 10.1080/08964289.2026.2633344. With nearly 18,000 respondents spanning 119 institutions in 34 states, the study’s scale allows subgroup contrasts—between LGBQ+ and transgender and nonbinary students, and across types of discriminatory experiences—that smaller surveys cannot reliably resolve, while its cross-sectional design means the reported percentages describe heightened likelihoods associated with discrimination rather than measured causal effects.

Subject of Research: Associations between discrimination, mental health and health care utilization among LGBTQ+ college students in a national survey

Article Title: Mental health disparities persist for LGBTQ+ college students nationwide, largest study of its kind finds

Article References: Mental health disparities persist for LGBTQ+ college students nationwide, largest study of its kind finds. Original publication (Bibliographic details unavailable.)

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Keywords: LGBTQ+ health, college students, discrimination, mental health, depression, anxiety, suicidal ideation, health care access, Healthy Minds Study, transgender and nonbinary students, emerging adulthood, public health