Gay people have 'poorer health' and 'GP issues'

Behind the Headlines

Friday September 5 2014

Lesbians, gays and bisexuals were more likely to report mental health problems

Depression is more common in lesbians, gays and bisexuals

“Lesbians, gays and bisexuals are more likely to have longstanding mental health problems,” The Independent reports, as well as “bad experiences with their GP”. A UK survey found striking disparities in survey responses compared to heterosexuals.

The news is based on the results of a survey in England of more than 2 million people, including over 27,000 people who described themselves as gay, lesbian or bisexual.

It found that sexual minorities were two to three times more likely to report having longstanding psychological or emotional problems and significantly more likely to report fair/poor health than heterosexuals.

People who described themselves as bisexuals had the highest rates of reported psychological or emotional problems. The researchers speculate that this could be due to a “double discrimination” effect; homophobia from the straight community as well as being stigmatised by the gay and lesbian communities as not being “properly gay” (biphobia).

Sexual minorities were also more likely to report unfavourable experiences with nurses and doctors in a GP setting.

Unfortunately this study cannot tell us the reasons for the differences reported in either health or relationships with GPs.

The results of this survey would certainly seem to suggest that there is room for improvement in the standard and focus of healthcare offered to gay, lesbian and bisexual people.

 

You and your GP

Obviously your sexual preference is your business, nobody else’s. Saying that, it's a good idea to tell your GP if you're gay, lesbian or bisexual. If your doctor knows about your sexuality or sexual preferences, it can be easier to discuss your life, relationships and health concerns. They can also keep an eye out for any health problems that might be relevant to you.

 

If you do feel that you have been discriminated against by a healthcare professional due to your sexuality or gender identity you should make a complaint as soon as possible. This type of discrimination is not only unacceptable, it’s illegal.

 

Read more about gay, lesbian and bisexual health issues.

Where did the story come from?

The study was carried out by researchers from the RAND Corporation (a non-profit research organisation), Boston Children’s Hospital/Harvard Medical School and the University of Cambridge. The study was funded by the Department of Health (England).

The study was published in the peer-reviewed Journal of General Internal Medicine. This article is open-access so is free to read online.

The results of this study were well reported by The Independent and The Guardian.

 

What kind of research was this?

This was a cross-sectional study that aimed to compare the health and healthcare experiences of sexual minorities with heterosexual people of the same gender, adjusting for age, race/ethnicity and socioeconomic status.

A cross-sectional study collects data at one point in time so it is not able to prove any direct cause and effect relationships. It can be useful in highlighting possible associations that can then be investigated further.

 

What did the research involve?

The researchers analysed data from the 2009/10 English General Practice Patient Survey.

The survey was mailed to 5.56 million randomly sampled adults registered with a National Health Service general practice (it is estimated that 99% of England’s adult population are registered with an NHS GP). In all, 2,169,718 people responded (39% response rate).

People were asked about their health, healthcare experiences and personal characteristics (race/ethnicity, religion and sexual orientation).

The question about sexual orientation is also used in UK Office of National Statistics Social Surveys: “Which of the following best describes how you think of yourself?:

  • heterosexual/straight
  • gay/lesbian
  • bisexual
  • other
  • I would prefer not to say

Of the respondents 27,497 people described themselves as gay, lesbian, or bisexual.

The researchers analysed the responses to questions concerning health status and patient experience.

People were asked about their general health status (“In general, would you say your health is: excellent, very good, good, fair, or poor?”) and whether they had one of six long-term health problems, including a longstanding psychological or emotional condition.

The researchers looked to see whether people had reported:

  • having “no” trust or confidence in the doctor
  • “poor” or “very poor” to at least one of the doctor communication measures of giving enough time, asking about symptoms, listening, explaining tests and treatments, involving in decisions, treating with care and concern, and taking problems seriously
  • “poor” or “very poor” to at least one of the nurse communication measures
  • being “fairly” or “very” dissatisfied with care overall

The researchers compared the responses from sexual minorities and heterosexuals of the same gender after controlling for age, race/ethnicity and deprivation.

 

What were the basic results?

Both male and female sexual minorities were two to three times more likely to report having a longstanding psychological or emotional problem than heterosexual counterparts. Problems were reported by 5.2% heterosexual men compared to 10.9% gay men and 15% bisexual men and by 6.0% heterosexual women compared to 12.3% lesbian women and 18.8% bisexual women.

Both male and female sexual minorities were also more likely to report fair/poor health. Fair/poor health was reported by 19.6% heterosexual men compared to 21.9% gay men and 26.4% bisexual men and by 20.5% heterosexual women compared to 24.9% lesbian women and 31.6% bisexual women.

Negative healthcare experiences were uncommon in general, but sexual minorities were about one-and-a-half times more likely than heterosexual people to report unfavourable experiences with each of four aspects of primary care:

  • no trust or confidence in the doctor was reported by 3.6% heterosexual men compared to 5.6% gay men (4.3% bisexual men, difference compared to heterosexual men not statistically significant) and by 3.9% heterosexual women compared to 5.3% lesbian women and 5.3% bisexual women
  • poor/very poor doctor communication was reported by 9.0% heterosexual men compared to 13.5% gay men and 12.5% bisexual men and by 9.3% heterosexual women compared to 11.7% lesbian women and 12.8% bisexual women
  • poor/very poor nurse communication was reported by 4.2% heterosexual men compared to 7.0% gay men and 7.3% bisexual men and by 4.5% heterosexual women compared to 7.8% lesbian women and 6.7% bisexual women
  • being fairly/very dissatisfied with care overall was reported by 3.8% heterosexual men compared to 5.9% gay men and 4.9% bisexual men and by 3.9% heterosexual women compared to 4.9% lesbian women (4.2% bisexual women, difference compared to heterosexual women not statistically significant)

 

How did the researchers interpret the results?

The researchers concluded that “sexual minorities suffer both poorer health and worse healthcare experiences. Efforts should be made to recognise the needs and improve the experiences of sexual minorities. Examining patient experience disparities by sexual orientation can inform such efforts”.

 

Conclusion

This study has found that that sexual minorities were two to three times more likely to report having longstanding psychological or emotional problems and significantly more likely to report fair/poor health than heterosexuals.

Sexual minorities were also more likely to report unfavourable experiences with nurses and doctors in a GP setting.

It should also be noted that response rates to the survey were low, with only 39% people responding to the survey. It is unknown whether the results would have been different if more people had responded.

While potential reasons for these disparities may include the stress induced by homophobic attitudes, or the suspicion that a GP disapproves of their patient’s sexuality, these speculations are unproven.

As it stands, this study cannot tell us the reasons for the differences reported. However, it would suggest that healthcare providers need to do more to meet the needs of gay, lesbian and bisexual people.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

Gay people more likely to have mental health problems, survey says. The Independent, September 4 2014

Gay people report worse experiences with GPs. The Guardian, September 4 2014

Links to the science

Elliott MN, Kanouse DE, Burkhart Q, et al. Sexual Minorities in England Have Poorer Health and Worse Health Care Experiences: A National Survey. Journal of General Internal Medicine. Published online September 4 2014

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