Associations between health care access and posttraumatic stress disorder symptoms among rural and urban lesbian, gay, bisexual, transgender, and queer adults.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience elevated rates of trauma exposure, minority stress, and posttraumatic stress disorder (PTSD). Yet, research examining how geographic location and LGBTQ+ identity shape PTSD outcomes is scant, particularly studies considering structural facilitators and barriers, such as health care access. This cross-sectional, secondary study investigated associations between several individual- and structural-level factors and PTSD symptoms in LGBTQ+ adults (N = 131) recruited from urban and rural U.S. regions, most of whom identified as non-Hispanic White, bisexual, cisgender women. Analyses examined whether intersecting demographic characteristics, urban or rural location, perceived health care access, LGBTQ+ identity disclosure to providers, and experiences of LGBTQ+ discrimination were associated with PTSD symptom severity and probable PTSD diagnosis. Approximately 62% of participants reported experiencing a DSM-5 Criterion A traumatic event; of these individuals, 24.4% met the criteria for probable PTSD. General health care access, β = -.27, 95% CI -.45, -.09, p = .003, and LGBTQ+ identity disclosure, β = -.19, 95% CI -.31, -.07, p = .039, were significantly associated with PTSD symptom severity. Higher health care access was associated with 50.0% lower odds of probable PTSD, ORadj = 0.50, 95% CI 0.29, 0.84, p = .009. Bisexual cisgender women had 4-times higher odds of a probable PTSD diagnosis compared to LGQ+ participants, ORadj = 3.96, 95% CI 1.15, 13.7, p = .030. Improving access to health care and supporting identity disclosure may reduce PTSD risk among LGBTQ+ adults, especially for bisexual cisgender women and rurally situated individuals.