Estimating the Association Between Mental Health and Disability Among Sexual and Gender Minority Populations

Background: While nationwide health surveys commonly assess the prevalence of mental health conditions and disability status at the population level, they often fail to elucidate the relationship between mental health and disability. The aim of this study is to estimate the association between past-month poor mental health days and two indicators of disability (difficulty doing errands alone and difficulty making decisions) among sexual and gender minority (SGM) respondents to the 2021 BRFSS survey. Methods: A secondary analysis was conducted on the publicly accessible 2021 BRFSS data to estimate the association between past-month poor mental health days and indicators of disability among SGM. Logistic regression models were used to report odds ratios and 95% confidence intervals. We then examined potential effect modification by gender, sexual orientation, race, and SES factors, and present stratified estimates as indicated. Results: We observed increasing difficulty of completing errands alone with increasing past-month poor mental health days (OR 2.64, 95% CI 2.194, 3.178 at moderately poor mental health; OR 5.025, 95% CI 4.289, 5.889 at severely poor mental health). This association is modified by gender and SES. We also observed increasing difficulty of making decisions alone with increasing past-month poor mental health days (OR 3.298, 95% CI 2.871, 3.787 at moderately poor mental health; OR 6.792, 95% CI 5.979, 7.716 at severely poor mental health). This association is modified by sexual orientation, gender and race. Conclusions: There are clear dose response relationships between mental health and the two disability outcomes that are modified by socioeconomic status, gender and sexual identity.