LGBTQ+ College Students’ Exposure to Discrimination and Relationships to Mental Health and Healthcare Utilization: Findings from a National Survey

Abstract

Abstract Compared to their cisgender heterosexual peers, LGBTQ+ emerging adults consistently experience poorer mental health outcomes and utilize health care at lower rates. Disparities during emerging adulthood set the trajectory for lifelong health risks. These disparities have been linked to experiences of discrimination, including both interpersonal discrimination from peers as well as from institutions and service providers. It is unknown how common these experiences are in a college setting. Using the 2024–2025 Healthy Minds Study—a large national dataset that includes 17,942 LGBTQ+ students—we examined three types of discriminatory experiences: interpersonal discrimination on campus, and past denials of healthcare or other services based on sexual orientation and/or gender identity. We then assessed how these discriminatory experiences were associated with mental health outcomes (flourishing, depression, anxiety, suicidal ideation) and healthcare utilization (counseling utilization, healthcare avoidance). We used logistic regression, clustered at the school level, to analyze associations for all LGBTQ+ students as well as disaggregating sexual minority (LGBQ+) from gender minority (transgender and nonbinary, TNB) students. Interpersonal discrimination was associated with higher odds of depression, anxiety, and suicide. Healthcare denials and denial of services were associated with markedly higher odds of suicidal ideation and healthcare avoidance. Any experience of discrimination was associated with higher odds of counseling uptake, suggesting a potential inroad to reaching at-risk students and coordinating care for universities. Addressing interpersonal experiences of discrimination, including health care and service denials, remains a critical lever for improving LGBTQ+ disparities. PUBLIC HEALTH SIGNIFICANCE Discrimination affected 1 in 10 LGBTQ+ college students surveyed nationwide in the last year, worsening mental health and leading many to avoid needed care. Addressing discrimination is essential for colleges to support student wellbeing, close mental health gaps, and ensure all students have access to care in higher education settings.