The Role of Therapy in Supporting Racial, Disability, Gender, and Sexuality Identities — With Research & Statistics

Identity affects mental health in many direct and indirect ways. When aspects of identity such as race, disability, gender, or sexual orientation are marginalized, this exposure can lead to measurable disparities in mental health outcomes. In this article, we explore what the research shows — the scale of disparities — and how therapy can respond with informed, affirming care.

Research-Backed Evidence of Disparities

Sexual and Gender Minorities (SGM)

• In the All of Us Research Program (U.S.), individuals in sexual and gender minority groups had significantly higher odds of mental health diagnoses compared to cisgender heterosexual people. For example, SGM people assigned female at birth had higher odds of PTSD (post-traumatic stress disorder) than cis heterosexual men and women; transgender men had higher odds of depression. PubMed

• A study on access to behavioral and mental health (BMH) care found that bisexual women reported much poorer mental health and more barriers to care related to income, stigma, housing, etc., compared to heterosexual men. Gay/lesbian women reported greater reported need for care. PubMed+1

• The KFF (Kaiser Family Foundation) “Racism, Discrimination, and Health” survey found that LGBT adults in the U.S. frequently experience discrimination both in daily life and in healthcare settings. These experiences correlate with poorer mental health outcomes. KFF

Intersection of LGBTQIA+/Disability

• According to a nationally representative JAMA Network Open study, LGBTIA+ adults are about twice as likely to report a disability compared to non-LGBT adults. Among females aged 18–34, the difference is even more extreme (about three times higher). JAMA Network

• Among LGBTQIA+ youth, nearly 30% report a provider-diagnosed disability; this rises to over 33% among trans and gender-expansive youth. The majority of those reported psychiatric or mental health types of disability. HRC

• A study of sexual and gender minority adolescents with disabilities found that youth with any form of disability (physical, cognitive, psychiatric) reported higher depressive symptoms, more sleep concerns, lower self-esteem and overall health ratings than SGM youth without disabilities. PMC+1

Race, Ethnicity, and Identity-Based Stressors

• Research among Black American young people shows that those identifying as LGB or “mostly heterosexual” experience elevated rates of depressive symptoms, suicidal ideation, planning, and substance use compared with their heterosexual peers — in part mediated by experiences of bias-based and cyber victimisation. PubMed

Why These Disparities Matter in Therapy

Therapy practices should be informed by these findings, so that interventions are matched to the scale and kinds of disparity clients may be experiencing.

• High Prevalence of Co-occurring Identifiers: Many individuals hold more than one identity that is marginalized (e.g., an LGBTQIA+ person who also has a disability, or a young person of color who is gender-expansive). Therapy that ignores intersectionality misses key stressors. The statistic that nearly one in five SGM youth report disability is particularly important. PMC+2JAMA Network+2

• Barriers to Access: Disparities in needing care vs. getting care, due to structural issues (insurance, provider bias, cost) are well documented. For example, bisexual women had significantly more barriers to care in studies compared to heterosexual men. PubMed+1

• Increased Risk of Mental Health Conditions: SGM populations show higher rates of mood and anxiety disorders, PTSD, depression, and other psychiatric diagnoses. Therapy must be equipped to address higher baseline vulnerabilities. PubMed+2JAMA Network+2

How Therapy Can Respond: Evidence-Informed Approaches

Based on what research shows, therapy practices can (and should) include:

1. Intersectional Assessment
   Therapists should assess multiple identity dimensions (race/ethnicity, gender identity, sexual orientation, disability status) because they often interact to intensify risk or stress. One study shows the rates of disability among LGBTIA+ people are elevated especially in younger LGBTQIA+ females. JAMA Network

2. Affirmative and Trauma-Informed Care
   Given elevated exposure to discrimination, bias, victimization (including cyber and bias-based victimization), therapy that is trauma-informed can help process those experiences and reduce the ongoing burden. Research among Black LGB+ youth ties higher depression/suicidality to these forms of victimization. PubMed

3. Addressing Barriers to Care
   Barriers like cost, insurance, provider competence, stigma, and lack of access are significant. Therapy practices can look to reduce these via sliding scale, tele-health, outreach to marginalized communities, and ensuring cultural competence. Studies show bisexual women have more access issues, for example. PubMed+1

4. Building Resilience and Support Systems
   Because discrimination is often external, internal supports (peer groups, identity affirming communities, connection to disability justice, racial justice, LGBTQIA+ organizations) are protective. Therapists can help clients connect to these.

5. Monitoring and Prevention
   Elevated risk of suicidal ideation, self-harm, and comorbid conditions means early detection, safety planning, and prevention strategies are crucial. Especially for youth, trans/gender-diverse, or individuals with multiple marginalized identities.

Therapy as a Bridge to Equity

The current body of research makes clear that systemic and identity-based challenges are not marginal — they are central to many people’s lived experience, with measurable mental health consequences.

Therapists and mental health practices that incorporate intersectional, trauma-informed, affirming care are better positioned to serve clients from diverse identities — to not only reduce symptoms but to enhance resilience, self-acceptance, and well-being.

By integrating the findings above into assessment, intervention, and access strategies, therapy becomes part of the solution for closing mental health disparities, not just treating them.