Sexual Orientation Disparities in Access to Healthcare Services and Social Determinants of Mental Distress: Analysis of 2022 BRFSS

Persistent interpersonal and structural discrimination related to heteronormativity exacerbates adverse mental health outcomes among sexual minority individuals. This secondary data analysis study, grounded in minority stress, social determinants of health, and healthcare access theories, aimed to examine mental distress in relation to sociodemographic, health behaviors, healthcare access, disability, social determinants of health, and sexual orientation. Using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys, weighted logistic regression models were applied. Among participants aged 18+ (Crude N = 114,247, estimated population N = 46,680,310), 2.4% were gay and lesbian, 4.3% were bisexual, 15.1% reported mental distress in the past 30 days with significantly higher prevalence among bisexual individuals (38.9%) compared to heterosexual peers (13.5%, p < 0.001). Bisexual participants consistently experienced elevated odds of distress compared to their heterosexual peers, even after adjusting for sociodemographic, healthcare access, disability, and social determinants of health. These findings highlight the disproportionate mental health burden faced by bisexual individuals and emphasize the need for targeted interventions to address their unique vulnerabilities, including improving healthcare access and strengthening social support systems.