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Mental Health Struggles Higher Among LGBT Adults Than Non-LGBT Adults in All Age Groups

Regardless of age, lesbian, gay, bisexual, and transgender (LGBT) adults have consistently reported higher rates of symptoms of both anxiety and depression than non-LGBT adults during the COVID-19 pandemic, according to a new analysis of the U.S. Census Bureau’s experimental Household Pulse Survey (HPS). Previous Census Bureau research showed that LGBT adults – both those living alone and with others – experienced more mental health challenges than non-LGBT respondents. The current research expands that analysis by also examining LGBT and non-LGBT respondents by age.

Household Pulse Survey and Mental Health

The Household Pulse Survey provides insight into respondents’ mental health and well-being. Since the HPS began in April 2020, it has asked two questions related to symptoms of anxiety and two questions about symptoms of depression. In July 2021, it added questions about sexual orientation and gender identity (SOGI).

This analysis relies on data from two different collection phases of the survey to assess the pandemic’s mental health toll on U.S. adults 18 years and older: Phase 3.2: July 21–October 20, 2021 (approximately 6.2 million invitations sent, 382,908 responses, response rate of 6.1%). Phase 3.5: June 1–August 8, 2022 (approximately 3.1 million invitations sent, 167,931 responses, response rate of 5.3%).

The reason these collection cycles were selected: Phase 3.2 was the first one to include SOGI questions and Phase 3.5 covered a period about a year later and further from the onset of the COVID-19 pandemic.

Mental Health Challenges and Age

LGBT respondents to the HPS are younger on average than non-LGBT respondents. Approximately 40% of LGBT respondents in Phase 3.5 were between ages 18 and 29 compared with only about 13% of non-LGBT respondents.

Conversely, adults ages 65 and older made up only about 7% of LGBT respondents but nearly a quarter of non-LGBT respondents. According to the survey, younger respondents, whether they are LGBT or non-LGBT, struggled more with both anxiety and depression symptoms, but younger LGBT respondents struggled the most.

In Phase 3.5, about 35% of non-LGBT respondents ages 18 to 29 reported symptoms of anxiety, compared with 61% of LGBT respondents in this age group. In contrast, only about 14% of non-LGBT and 19% of LGBT respondents ages 65 and up reported anxiety symptoms.

LGBT respondents reported higher levels of anxiety symptoms than non-LGBT respondents in all age groups. The survey’s findings were similar for those who reported symptoms of depression. Half of LGBT respondents ages 18-29 reported symptoms of depression, compared with about 29% of non-LGBT respondents in this age group.

Depression symptoms also declined with age – about 16% of LGBT respondents and 11% of non-LGBT respondents ages 65 and up in this group reported feeling depressed. LGBT adults reported higher levels of anxiety and depression symptoms than non-LGBT respondents in both Phases 3.2 and 3.5 of the survey, indicating the persistence of these disparities over time, even multiple years into the COVID-19 pandemic (Figure 3).

As Figure 3a illustrates, younger LGBT respondents (about 60%) in both phases were more likely to report anxiety symptoms than older LGBT respondents. Anxiety symptoms among LGBT respondents 65 and up abated somewhat as the pandemic progressed: about 26% reported anxiety symptoms in Phase 3.2, compared to only 19% in Phase 3.5.

Figure 3b shows results for depression symptoms. In both phases of the survey, at least half of young LGBT respondents reported depression symptoms but the share of those 65 and up with depression symptoms decreased from about a quarter during Phase 3.2 to about 16% during Phase 3.5.

Taken together, these findings reveal how symptoms of anxiety and depression vary across age groups by LGBT status and over time. Younger adults, especially LGBT adults, were the most susceptible to both conditions. Conversely, older, non-LGBT adults were less likely to report either anxiety or depression symptoms.

Defining LGBT

The HPS initially asked respondents to identify only their sex (male or female). Since July 2021, the survey has included three SOGI questions. The first asks about assigned sex at birth: What sex were you assigned at birth on your original birth certificate? (Choice of answers: Male or Female.)

The next question asks about current gender self-identification:

Do you currently describe yourself as male, female, or transgender? (Choice of answers: Male, Female, Transgender, or None of these.)

The latest version of the survey now also asks about sexual orientation:

Which of the following best represents how you think of yourself? (Choice of answers: Gay or lesbian; Straight, that is not gay or lesbian; Bisexual; Something else; or I don’t know.) Survey respondents are categorized as LGBT if they report a sex at birth that does not align with their current gender identity; report a sexual orientation of gay, lesbian or bisexual; or if they currently identify as transgender.

Respondents whose sex at birth aligns with their current gender identity and who select Straight on the sexual orientation question are categorized as non-LGBT. Respondents who select None of these on the current gender question and either Something else, I don’t know, or Straight on the sexual orientation question are categorized as “Other.”

Additionally, respondents whose sex at birth aligns with their current gender identity but who select either Something else or I don’t know on the sexual orientation question are also categorized as “Other.” Survey questions related to sexual orientation and gender identity aim to understand the effect of the pandemic across different subpopulations. However, because the HPS is designed to rapidly produce experimental estimates, exercise caution when using these results as standalone markers of the prevalence of LGBT adults in the general population.

Measuring Anxiety and Depression Symptoms

The survey asks four mental health questions, two relating to symptoms of anxiety and two about symptoms of depression. These questions were developed in partnership with the National Center for Health Statistics (NCHS). This analysis follows an approach outlined by NCHS, which categorizes individuals based on how frequently they reported feeling anxious or depressed, consistent with diagnoses of generalized anxiety disorder or major depressive disorder.

Near Real-Time Data

The HPS is designed to provide near real-time data on how the pandemic has affected people’s lives. Information on the methodology and reliability of these estimates can be found in the Source and Accuracy statements for each data release. These statements also include information on the invitations and response rates. Data users interested in state-level sample sizes, the number of respondents, weighted response rates and occupied housing unit coverage ratios can review the quality measures file, available on the Household Pulse Survey Technical Documentation webpage.

In comparison to other Census Bureau surveys, HPS response rates are low and data users should exercise caution when interpreting estimates from the survey, especially with regard to the impact of potential non-response bias. As a part of the Census Bureau’s experimental data series, the HPS was designed to have low respondent burden, provide quick turnaround on product releases and produce estimates that meet urgent public needs. All estimates discussed here were calculated from public-use microdata files.