Mental disorders and sexual orientation in college students across 13 countries of differing levels of LGBTQ+ acceptance

Roberto Rentería¹, Claes Andersson², Marcus Bendtsen³, Philippe Mortier⁴, Randy P Auerbach⁵, Jason Bantjes⁶, Harald Baumeister⁷, Anne H Berman⁸, Erik Bootsma⁹, Ronny Bruffaerts¹⁰, Irina F Cohut¹¹, Marcelo A Crockett¹², Pim Cuijpers¹³, Oana A David¹⁴, David D Ebert¹⁵, Raúl A Gutierrez-García¹⁶, Penelope A Hasking¹⁷, Xanthe Hunt¹⁸, Petra Hurks¹⁹, Mathilde M Husky²⁰, Ana Lucia Jimenez²¹, Fanny Kählke²², Ann-Marie Küchler⁷, Scarlett Mac-Ginty²³, Arthur D P Mak²⁴, Vania Martínez²⁵, Margaret McLafferty²⁶, Iris R Monroy-Velasco²⁷, Elaine K Murray²⁸, Siobhan O'Neill²⁹, Claudiu C Papasteri³⁰, Priscilla Paz³¹, Codruta A Popescu³², Kealagh Robinson³³, Elske Salemink³⁴, Oi-Ling Siu³⁵, Dan J Stein³⁶, Sascha Y Struijs³⁷, Cristina Tomoiaga³⁸, Sanne van Luenen³⁹, Daniel V Vigo⁴⁰, Angel Y Wang³¹, Reinout W Wiers⁴¹, Samuel Y S Wong⁴², Corina Benjet⁴³; WMH-ICS collaborators

Collaborators, Affiliations

Affiliations

¹ Department of Psychology, University of Massachusetts Boston, Boston, MA, USA. Electronic address: roberto.renteria@umb.edu.
² Department of Criminology, Malmö University, Malmö, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
³ Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
⁴ Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
⁵ Department of Psychiatry, Columbia University, New York, NY, USA; Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.
⁶ Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
⁷ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Faculty of Engineering, Ulm University, Ulm, Germany.
⁸ Department of Psychology, Uppsala University, Uppsala, Sweden.
⁹ Department of Microbiology and Immunology, Rega Institute, KU Leuven, Belgium.
¹⁰ Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
¹¹ Career Counseling and Guidance Center, Technical University of Cluj-Napoca, Romania.
¹² Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.
¹³ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands; International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania.
¹⁴ International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
¹⁵ School of Medicine and Health, Department for Sport and Health Sciences, Technische Universität München, München, Germany.
¹⁶ Facultad de Estudios Superiores, Universidad De La Salle Bajío, Salamanca, Mexico.
¹⁷ School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
¹⁸ Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, South Africa; Africa Health Research Institute (AHRI), Durban, South Africa.
¹⁹ Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
²⁰ Bordeaux Population Health Research Center, ACTIVE Team, INSERM U1219, University of Bordeaux, Bordeaux, France.
²¹ Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada, Mexico.
²² Faculty of Applied Health Sciences, Deggendorf Institute of Technology, Deggendorf, Germany.
²³ Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
²⁴ Cambridge and Peterborough NHS Foundation Trust, Cambridge, United Kingdom; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR.
²⁵ Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
²⁶ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom; Atlantic Technological University, Donegal, Ireland.
²⁷ Facultad de Psicología, Universidad Autónoma de Coahuila, Saltillo, Mexico.
²⁸ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom.
²⁹ School of Psychology, Ulster University, Coleraine, Co. Derry, United Kingdom.
³⁰ Department of Psychology and Cognitive Science, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania.
³¹ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
³² Department of Human Sciences, ''Iuliu Hatieganu'' University of Medicine and Pharmacy, Cluj-Napoca, Romania.
³³ School of Psychology, Massey University, Wellington, New Zealand.
³⁴ Faculty of Social and Behavioural Sciences, Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
³⁵ Department of Psychology, Lingnan University, Hong Kong, Hong Kong SAR.
³⁶ Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.
³⁷ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands.
³⁸ International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania.
³⁹ Faculty of Social and Behavioural Sciences, Department of Clinical Psychology, Leiden University, Leiden, the Netherlands.
⁴⁰ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴¹ Faculty of Social and Behavioural Sciences, Programme Group Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands.
⁴² Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR.
⁴³ Center for Global Mental Health, National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico.

PMID: 40286461
PMCID: PMC12068959 (available on 2026-06-01)
DOI: 10.1016/j.jpsychires.2025.04.021

Mental disorders and sexual orientation in college students across 13 countries of differing levels of LGBTQ+ acceptance

Roberto Rentería et al. J Psychiatr Res. 2025 Jun.

. 2025 Jun:186:331-340.

doi: 10.1016/j.jpsychires.2025.04.021. Epub 2025 Apr 18.

Authors

Affiliations

¹ Department of Psychology, University of Massachusetts Boston, Boston, MA, USA. Electronic address: roberto.renteria@umb.edu.
² Department of Criminology, Malmö University, Malmö, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
³ Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
⁴ Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
⁵ Department of Psychiatry, Columbia University, New York, NY, USA; Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.
⁶ Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
⁷ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Faculty of Engineering, Ulm University, Ulm, Germany.
⁸ Department of Psychology, Uppsala University, Uppsala, Sweden.
⁹ Department of Microbiology and Immunology, Rega Institute, KU Leuven, Belgium.
¹⁰ Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
¹¹ Career Counseling and Guidance Center, Technical University of Cluj-Napoca, Romania.
¹² Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.
¹³ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands; International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania.
¹⁴ International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
¹⁵ School of Medicine and Health, Department for Sport and Health Sciences, Technische Universität München, München, Germany.
¹⁶ Facultad de Estudios Superiores, Universidad De La Salle Bajío, Salamanca, Mexico.
¹⁷ School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
¹⁸ Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, South Africa; Africa Health Research Institute (AHRI), Durban, South Africa.
¹⁹ Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
²⁰ Bordeaux Population Health Research Center, ACTIVE Team, INSERM U1219, University of Bordeaux, Bordeaux, France.
²¹ Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada, Mexico.
²² Faculty of Applied Health Sciences, Deggendorf Institute of Technology, Deggendorf, Germany.
²³ Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
²⁴ Cambridge and Peterborough NHS Foundation Trust, Cambridge, United Kingdom; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR.
²⁵ Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile; Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
²⁶ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom; Atlantic Technological University, Donegal, Ireland.
²⁷ Facultad de Psicología, Universidad Autónoma de Coahuila, Saltillo, Mexico.
²⁸ Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom.
²⁹ School of Psychology, Ulster University, Coleraine, Co. Derry, United Kingdom.
³⁰ Department of Psychology and Cognitive Science, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania.
³¹ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
³² Department of Human Sciences, ''Iuliu Hatieganu'' University of Medicine and Pharmacy, Cluj-Napoca, Romania.
³³ School of Psychology, Massey University, Wellington, New Zealand.
³⁴ Faculty of Social and Behavioural Sciences, Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
³⁵ Department of Psychology, Lingnan University, Hong Kong, Hong Kong SAR.
³⁶ Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.
³⁷ Faculty of Behavioural and Movement Science, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands.
³⁸ International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania.
³⁹ Faculty of Social and Behavioural Sciences, Department of Clinical Psychology, Leiden University, Leiden, the Netherlands.
⁴⁰ Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴¹ Faculty of Social and Behavioural Sciences, Programme Group Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands.
⁴² Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR.
⁴³ Center for Global Mental Health, National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico.

PMID: 40286461
PMCID: PMC12068959 (available on 2026-06-01)
DOI: 10.1016/j.jpsychires.2025.04.021

Abstract

Mental health disparities have been reported among sexual minority individuals; minority stress theory posits that such disparities are a result of stigma and discrimination. We estimated the prevalence of mental disorders across sexual orientation groups among first-year college students and whether differences across sexual orientation groups varied by gender and country-level LGBTQ+ (lesbian, gay, bisexual, transgender, queer) social acceptance. Using data (N = 53,175; 13 countries) from the World Mental Health Surveys International College Surveys, we performed multilevel logistic regressions to estimate the associations between sexual orientation (i.e., heterosexual, heterosexual with same-gender attraction [SGA], gay/lesbian, bisexual, asexual, questioning, and other) and five twelve-month DSM-5 disorders (major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Heterosexual students with SGA (AORs 1.30-2.15), gay/lesbian (AORs 1.49-2.70), bisexual (AORs 2.26-3.49), questioning (AORs 1.38-2.04), and "other" (AORs 1.76-2.94) students had higher odds of all disorders compared to heterosexual students with no SGA; asexual students did not. Significant interactions with gender show that the gender difference in prevalence was greater among bisexual individuals for most disorders and among all sexual minorities (except "other") for drug use disorder. Significant interactions with country level LGBT+ social acceptance showed some sexual minority groups had lower odds (AORs 0.83-0.95) of disorder as country-level acceptance increased. These findings provide further evidence of mental disorder disparities across a wide range of sexual orientations and how these disparities vary by gender and societal LGBTQ+ acceptance in students from diverse countries.

Keywords: College student; Cross-national; DSM-5; Mental disorder; Sexual orientation; Social acceptance.

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Conflict of interest statement

Declaration of competing interest All other authors reported no conflict of interest.

References

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Mental disorders and sexual orientation in college students across 13 countries of differing levels of LGBTQ+ acceptance

Collaborators

Affiliations

Mental disorders and sexual orientation in college students across 13 countries of differing levels of LGBTQ+ acceptance

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical