Reacción a "A comprehensive scientific review confirms inequalities in mental health amongst LGBTQIA+ people"

This study highlights the importance of recognising that the mental health of LGBTQIA+ people is not explained solely by individual factors, but by the social and structural context in which they live. The authors emphasise the role of structural stigma (laws, cultural norms and institutional policies), interpersonal discrimination — such as bullying or rejection by family — and barriers within the healthcare systems themselves, at a time when established rights are being eroded in several countries. In my view, sexual orientation and gender identity are still not systematically captured or analysed in much of the mental health research, which contributes to rendering these inequalities invisible. This umbrella review, which re-analyses 22 meta-analyses comprising 398 studies, helps to organise the existing evidence on the subject to date. Its most robust findings confirm that lesbian, gay and bisexual people are approximately twice as likely to experience depressive disorders and more than twice as likely to attempt suicide as the heterosexual population, and that gay adolescents exhibit more dieting and purging behaviours than their heterosexual peers. Within this group, bisexual people report higher levels of anxiety and non-suicidal self-harm than lesbians and gay men.

However, it should be borne in mind that the methodological quality of the included meta-analyses is low or critically low according to AMSTAR-2, a standard tool for assessing the quality of systematic reviews. This limits the reliability of some of the conclusions. Around 90 per cent of the studies are cross-sectional, which prevents inferring causality or trajectories, and the evidence comes mainly from North America and focuses more on lesbian, gay and bisexual people than on trans and non-binary people. There are no quantitative data on access to or quality of care, and almost none on severe mental disorders. Furthermore, these are differences between groups, not a risk applicable to every individual. Nevertheless, the findings support the need for early detection and clinically sensitive care that is responsive to diversity, for measures to combat stigma and discrimination, and for further longitudinal studies to clarify the mechanisms involved. This could help in designing measures to reduce social and structural stigma.