Prevalence of elevated mental health symptoms, hazardous alcohol and other drug use, and their co-occurrence across sexual and gender identity in a national probability sample.

OBJECTIVE: This study examined heterogeneity in the prevalence estimates of mental health, alcohol, and drug use outcomes across cisgender heterosexual subgroups and sexual and gender minority subgroups using a national probability sample. METHOD: = 1,436). We calculated prevalence estimates of serious psychological distress, suicidal ideation and attempts, elevated posttraumatic stress disorder symptoms, hazardous alcohol use, hazardous drug use, and co-occurring outcomes across subgroups using cutoffs from common screening measures (e.g., three-item Alcohol Use Disorder Identification Test). We then assessed disparities between sexual and gender minority subgroups and cisgender heterosexual men and women across outcomes and co-occurring outcomes. RESULTS: Suicidality was significantly higher across all sexual and gender minority subgroups compared with cisgender heterosexual subgroups. Cisgender sexual minority women, transgender sexual minority men and women, and nonbinary sexual minority people-subgroups with both oppressed sexual and gender identities who likely experience both sexual- and gender-based forms of oppression (e.g., homophobia, transphobia, sexism)-were significantly more likely than cisgender heterosexual subgroups to report most outcomes, including serious psychological distress, elevated posttraumatic stress disorder symptoms, and hazardous drug use. Nonbinary sexual minority people and cisgender sexual minority women consistently exhibited the largest disparities compared with cisgender heterosexual subgroups across most outcomes and co-occurring outcomes. CONCLUSIONS: Findings highlight the importance of disaggregating across sexual and gender identity in probability samples to understand heterogeneity in prevalence estimates of mental health, alcohol, and drug use outcomes and identify subgroups in need of targeted health equity efforts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).