Study explores how sexual minority status and mental health relate to experiences of primary care in England

People from sexual minority groups with a reported long-term mental health condition experience particular inequalities in some aspects of primary care, including involvement in decisions about their care and healthcare professionals’ interpersonal skills, according to new research from City St George’s, University of London.

Published in eClinicalMedicine, the study examined how sexual orientation and reporting a long-term mental health condition relate to patients' experiences of GP services in England.

The researchers analysed responses from 1.27 million GP patients who took part in the 2022-23 General Practice Patient Survey. The likelihood of reporting a positive experience in NHS primary care ranged from 62.5 per cent to 94.3 per cent depending on the measure, indicating an overall moderate to high satisfaction with the services. Nonetheless, satisfaction varied by sexual orientation and mental health status. The researchers found that sexual minority people with a reported long-term mental health condition were significantly less likely than other patients to feel involved in decisions about their care and treatment, and more likely to rate healthcare professionals' interpersonal skills negatively.

At the same time, the study showed an unexpected pattern for other aspects of primary care evaluation, including whether people felt that their mental health needs were recognised, their confidence and trust in healthcare professionals, and whether they felt their overall needs had been met. For these outcomes, people from sexual minority groups with a long-term mental health condition reported slightly better experiences than would have been expected based on the effects that were observed in the sexual minority participants without long-term mental health conditions or individuals who reported a long-term mental health condition and were part of the heterosexual majority.

The researchers argue that these findings suggest that the intersecting stigmatised characteristics are not only associated with the accumulation of disadvantages but also with potential protective or buffering effects. The study also found that sexual minority people with long-term mental health conditions were the most likely to seek information or support before attempting to book a GP appointment.

The researchers suggest this pattern might reflect dissatisfaction with previous healthcare experiences or that it could indicate greater mental health awareness and a more proactive approach to seeking help. They conclude that improving inclusivity, communication and patient-centred care in primary care settings could help address persistent inequalities experienced by sexual minority people and those with long-term mental health conditions.

Arthur Gomes-Mendes, a PhD researcher in the Centre for Clinical, Social & Cognitive Neuroscience at City St George's and lead author of the study, said:

“Our findings address a critical gap in the literature and suggest that sexual minority orientation and the presence of long-term mental health conditions intersect in complex ways in shaping healthcare experiences. While both characteristics relate to lower satisfaction, we observed both negative and protective intersectional effects across different care-quality outcomes.” 

Dr Anne-Kathrin Fett, Co-Director of the Centre for Clinical, Social & Cognitive Neuroscience at City St George’s and co-author of the paper, said:

"We expected that people who were members of a sexual minority group and also reported a long-term mental health condition would have more negative primary care experiences than sexual minority people, or heterosexual individuals with or without long-term mental health difficulties. While this was indeed the case with respect to some of the primary care experiences we looked at, we also saw patterns that suggested potential buffering effects. Understanding the mechanisms behind these will be important for reducing inequalities and tailoring primary care services to the needs of different patient groups."