Anxiety, Depression, and Access to Mental Health Care by Sexual Orientation and Rurality


Disparities in mental health and access to care are well-documented by both sexual orientation and rural/ urban location. However, little research has examined the mental health of rural lesbian, gay, and bisexual (LGB) populations—mostly due to the lack of credible data on sexual orientation and rurality. Of the available research, qualitative evidence and convenience samples of sexual and gender minorities (often combined for easier recruitment strategies) suggests elevated levels of psychological distress and substance use among rural LGB adults with barriers to mental health care. The purpose of this policy brief is to illustrate the differences in two of the most common mental health disorders (anxiety and depression) and in access to mental health care by sexual orientation and rurality.

Key Findings
  • Rural LGB adults reported the highest rates of depression and anxiety disorder diagnosis, as well as the highest levels of depressed feelings, compared with urban LGB adults and rural and urban heterosexual adults.
  • Urban LGB adults reported the most barriers to accessing health care.
  • Both rural and urban LGB adults were more likely to have delayed mental health care in the past 12 months because of cost, compared with their heterosexual counterparts.
University of Minnesota Rural Health Research Center
Carrie Henning-Smith, Courtney Sarkin, Mariana Tuttle, Gilbert Gonzales