Religious affiliation and therapy outcomes among sexual minority college students: A multi-site analysis of distress and recovery

Introduction Sexually Minoritized (SM) college students face psychological challenges shaped by institutional and cultural factors. This study explored whether religious affiliation of U.S. universities influences outcomes for SM students engaged in therapy at campus counseling centers.Method We analyzed data from 4,264 SM students across 34 U.S. matched institutions (17 religiously affiliated, 17 non-affiliated). Primary outcomes included pretreatment distress, posttreatment distress, and reliable clinical change.Results SM students at non-religiously affiliated colleges reported higher pretreatment distress and were more likely to achieve reliable clinical recovery. SM students at religiously affiliated colleges reported lower pretreatment distress but were more likely to have no reliable clinical change. Baseline distress varied descriptively across Sexual Orientation groups, with gay students reporting the lowest scores across groups; these differences were attenuated in clustered models. Gender identity was associated with baseline and posttreatment distress levels but not with symptom change or recovery. Race was not a significant predictor of posttreatment outcomes. A modest interaction effect indicated that recovery varied by institution type among students who rated personal religion as highly important.Conclusion Institutional religious affiliation may shape how SM students present to and respond in campus-based therapy. Clinicians working in university settings should assess how institutional culture and personal religiosity may affect engagement, disclosure, and recovery. Context-specific practices—including attention to intersectional identities—are important when supporting SM college students.