ArticleEpidemiology and psychiatric sciences2026
Mental health and sexual identity inequalities in individuals with past experiences of homelessness: findings from a nationally representative survey.
Article in Epidemiology and psychiatric sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsHomelessness is increasing and associated with poor mental health (MH). Few studies have examined how experiences of homelessness and sexual identity intersect to effect MH. We used an intersectional approach to examine MH inequalities related to sexual identity and past homelessness in a nationally representative private household sample, and whether associations were explained by discrimination.
methodsAnalysis of the 2007 and 2014 Adult Psychiatric Morbidity Surveys included 10,428 individuals aged 16-64 (58% female/3.8% non-heterosexual). The Clinical Interview Schedule-Revised (CIS-R) identified common mental disorders (CMDs). Self-harm, attempted suicide, alcohol dependence, substance use, sexual identity, discrimination/bullying, past homelessness and health behaviours were self-reported. Associations between sexual identity and homelessness were examined using multivariable Poisson regression. Prevalence ratios (PRs) for MH and health behaviours by intersectional sexual identity-past homelessness were examined using Poisson regression and adjusted for age, sex, area-level deprivation and further for discrimination/bullying.
resultsBisexual (adjusted PR [aPR]: 2.52, 95% CI: 1.48-4.29) and gay/lesbian (aPR: 1.76, 0.97-3.19) individuals were more likely to report past homelessness than heterosexual peers. Sexual minority (SM) and heterosexual individuals with past homelessness had higher prevalence of all MH outcomes compared to heterosexual peers without homelessness, with associations strongest in the SM-homelessness group (e.g., CMD: aPR: 2.67 [2.37-3.01] for heterosexual-homeless, aPR: 4.11 [3.00-5.63] for SM-homeless, aPR: 1.82 [1.45-2.28] for SM-not homeless groups), and similarly for depression/self-harm/attempted suicide. Likewise, the SM-homeless group had highest prevalence for drug dependence (aPR, 7.38 [3.15-17.29]) compared to the heterosexual-homeless (aPR, 4.03 [3.00-5.42]) and SM-not homeless (aPR, 2.19 [1.27-3.79]) groups. Adjustment for discrimination and bullying substantially attenuated point estimates, with the greatest attenuation (30-50%) in the SM-homeless compared to the heterosexual-homeless groups.
conclusionsIndividuals with past experiences of homelessness have significantly worse MH than heterosexuals without homelessness, with associations highest in the SM-homeless group. Considering experiencing homelessness and SM identity together identifies a group facing particular adversity, which is often lost when examined separately. Discrimination and bullying explained much of the worse MH in SM- and heterosexual-homeless groups, but especially the former. Investigation into the mechanisms leading to MH inequalities is needed, alongside policies and services to support this group.
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