Work can be a place of identity and belonging, but it can also be a source of stress that undermines mental health, especially when the workplace culture is unsupportive or hostile.
For LGBTQ+ workers, there are additional risk factors, including experiences of exclusion, stigma, and discrimination that continue to shape daily working lives. National surveys show that nearly 40% of LGBTQ+ employees in the UK still hide their identity at work for fear of negative consequences (Stonewall, 2025), while four in ten report experiencing workplace conflict such as humiliation, verbal abuse, or discrimination (CIPD, 2021).
Trans workers are particularly disadvantaged, with over half reporting harassment and fewer than half describing their workplace as inclusive (LGBT Health & Wellbeing, 2021). Recent UK reports highlight persistent barriers to LGBTQ+ career progression, from bias in hiring and promotion to a lack of visible role models (The Pride and Leadership Report, 2025).
While these national surveys provide valuable insights into workplace experiences, academic research offers another perspective by examining mental health outcomes in a more systematic way. Tomic et al. (2025) set out to review the available quantitative evidence on LGBTQ+ workers’ mental health, mapping what is currently known and identifying where further research is needed.
National surveys highlight ongoing barriers for LGBTQ+ workers, but what does international research evidence show about their mental health?
Methods
The authors consulted with a group of LGBTQ+ individuals at the conceptualisation stage and then conducted a preregistered PRISMA-compliant systematic review. They searched five major databases from 2000–2024 for quantitative or mixed-methods studies that reported mental health outcomes among LGBTQ+ workers.
The inclusion criteria were fairly strict: studies had to focus on workers and report ICD-10 mental health conditions such as depression, anxiety, PTSD, or suicidality and had to be published in the English language. Studies that included students or military personnel, as well as qualitative studies, commentaries, or measures of workplace wellbeing that didn’t map onto psychiatric diagnoses (e.g. burnout, job stress) were excluded. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools.
The authors systematically searched the literature between 2000-2024 to identify English-language studies of mental health outcomes among LGBTQ+ workers.
Results
Who was studied?
The review included 32 studies from 33 papers with a total of 8,369 LGBTQ+ workers. Almost all were cross-sectional, and over a third focused on sex workers. The rest were spread thinly across occupations such as healthcare, teaching, farming, emergency services, and veterinary practice.
What mental health problems were studied?
Depression and anxiety were the most commonly measured outcomes, with prevalence estimates varying widely depending on the study (24–87% for depression; 0–80% for anxiety). Suicidality was another consistent concern, with especially high rates among emergency service workers and veterinary professionals. Other conditions, including alcohol and substance use, PTSD, and eating disorders, were reported less often.
What factors were linked to risk?
The review highlighted workplace heterosexism, job stress, internalised stigma, and low supervisor support as contributors to poor mental health. Few studies explored protective factors, but those that did suggested that stronger support networks may buffer risk.
What comparisons where made?
Out of the 32 studies included in the review, only 16 actually compared LGBTQ+ workers with heterosexual or cisgender colleagues, or with other subgroups. Where comparisons were made, the pattern was generally consistent: LGBTQ+ workers tended to report worse outcomes. For example, a large US survey found that LGBTQ+ employees were almost twice more likely than heterosexual workers to report depression and anxiety.
In Australia, LGBQ+ emergency service personnel were nearly six times more likely to attempt suicide than their heterosexual colleagues. In the UK, junior doctors who identified as LGB were also at greater risk of suicidality than their heterosexual colleagues. By contrast, some subgroup comparisons within LGBTQ+ workers, such as differences between lesbian and gay couples, or between sex workers and non–sex workers produced more mixed results that cannot lead to specific conclusions.
Worrying results emerged, with LGBTQ+ depression ranging from 24–87%. Where comparisons were made, LGBTQ+ workers reported poorer mental health.
Conclusions
The review identified a limited number of studies that showed worrying results with regards to the self-reported mental health of LGBTQ+ workers, suggesting increased risk of depression, anxiety, alcohol use and suicidality among LGBTQ+workers, compared to non-LGBTQ+ workers.
Strengths and limitations
The authors highlight several strengths of their review. The work was prospectively registered on PROSPERO and conducted in line with PRISMA guidelines, which helps to ensure methodological transparency and minimise bias.
Importantly, the team made an attempt to consult with LGBTQ+ individuals at the conceptualisation stage, which is a positive step towards grounding the review in community perspectives and ensuring that terminology and scope were appropriate; though more detail could have been provided on how this public involvement helped share the design of the study. While consultation with LGBTQ+ stakeholders was limited to the early stages, the willingness to embed co-design elements at all is still notable in a field where such practices are rarely attempted.
The authors acknowledge several limitations. First the findings were summarised narratively, which limits the strength of the conclusions. They also note that the majority of studies were cross-sectional, providing only a snapshot of the prevalence or comparisons, limiting our ability to draw potentially causal inferences.
Another limitation is the uneven focus on occupational groups, with a large proportion of studies examining sex workers and only a small number on other professions such as healthcare, education, or emergency services. Finally, the authors highlight that excluding military populations, while methodologically justified, leaves out an important occupational group where mental health risks are known to be high.
It is important to highlight that the review also reflects the fact that research in this area is still at a very early stage. Only half of the included studies offered any comparison with heterosexual or cisgender workers, which makes it hard to quantify the scale of the disparity. Even among those with comparators, the evidence is spread thinly across countries and occupations.
We cannot yet say whether the higher risks observed in, for example, US healthcare workers or Australian emergency services staff would look the same in other settings. The restriction to English-language studies adds another layer of uncertainty, especially since many of the countries where same-sex relationships are criminalised – and where risks to LGBTQ+ workers may be even greater – are absent from the evidence base.
Taken together, these limitations remind us that this is an emerging evidence base: the findings are important and concerning, but they are best understood as the start of a research agenda.
The review was well conducted and designed with some LGBTQ+ community input, but there were significant gaps in the distribution of occupational populations and geographic areas studied, suggesting the evidence base remains underdeveloped.
Implications for research and practice
Only half of the included studies compared LGBTQ+ workers with heterosexual or cisgender colleagues, and most were small, cross-sectional, and concentrated in certain groups such as sex workers. Without consistent comparisons, prevalence figures lack context so future research should aim to establish the scale of disparities more systematically.
As captured by Talen Wright in the 2021 Mental Elf Blog, microaggressions among trans people can seriously harm mental health. Future workplace studies should capture these day-to-day stressors alongside clinical diagnoses and self-reported mental health outcomes.
Early consultation with LGBTQ+ stakeholders needs to become the norm, but remains thin on the ground, with recent criticisms being levelled at UK research and reports that ostensibly affect LGBTQ+ communities themselves, e.g. the Cass Report (Noone et al, 2025). Meaningfully co-designed research will help ensure that research questions and outcomes reflect real workplace concerns, not just clinical categories.
Although the evidence base is uneven, the evidence so far indicates a clear need for action at work: strengthening anti-discrimination policies and providing visible managerial support and targeted mental health resources for high-risk groups.
In the UK, while there is a legal framework in place, including the Equality Act and enhanced harassment laws, policies often fall short in practice. Many workplaces still lack explicit protections or inclusive initiatives. Where structured guidance exists, like from Mind, ACAS, or NHS leadership, it offers strong models, but uptake varies widely.
Policy doesn’t always translate into culture, practice, or legal safety for LGBTQ+ workers; highlighting real gaps between what should and what really happens at work day-to-day. One-off diversity workshops risk being performative and meaningful change comes when leadership accountability, structural policies, and intersectional awareness are embedded into workplace culture.
From the Equality Act to NHS inclusion frameworks, the UK has structures to support LGBTQ+ workers, but we need to move from policy on paper to supporting people in workplace practice, especially when rollbacks of rights are evident.
Statement of interests
I have no competing interests to declare.
Links
Primary paper
Tomic, S., Carlucci, M., Baiocco, R., & Fiorillo, A. (2025). Mental health of LGBTQ+ workers: A systematic review. BMC Psychiatry, 25, 129. https://doi.org/10.1186/s12888-025-06556-2
Other references
Chartered Institute of Personnel and Development. (2021). Inclusion at work: Perspectives on LGBT+ working lives. CIPD.
LGBT Health and Wellbeing. (2021). Trans people and work: Survey report (PDF).
Noone C, Southgate A, Ashman A, Quinn É, Comer D, Shrewsbury D, Ashley F, Hartland J, Paschedag J, Gilmore J, Kennedy N, Woolley TE, Heath R, Biskupovic Goulding R, Simpson V, Kiely E, Coll S, White M, Grijseels DM, Ouafik M, McLamore Q. Critically appraising the Cass Report: methodological flaws and unsupported claims. BMC Med Res Methodol. 2025 May 10;25(1):128. doi: 10.1186/s12874-025-02581-7. PMID: 40348955; PMCID: PMC12065279.
Stonewall. (2025, January). New research shows almost 40% of LGBTQ+ employees still hide their identity at work.
The Pride and Leadership Report. (2025). LGBTQ+ career barriers in the UK.
