Outcomes of an Evidence-Based Telemental Health Program Across Sexual Orientation and Gender Identity

The effectiveness of evidence-based mental health programs across sexual orientation and minoritized gender identity groups is not well-understood.

To evaluate outcomes of an employer-offered, evidence-based telemental health program (video-based psychotherapy sessions supplemented by asynchronous, guided practice sessions) across gender identity and sexual orientation groups.

This retrospective cohort analysis included 29,860 U.S.-based adults with clinically elevated anxiety and/or depression symptoms, who began a culturally responsive, telemental health program between April 2021 and April 2023. The primary outcomes were changes in anxiety (Generalized Anxiety Disorder-7) and depression symptoms (Patient Health Questionnaire-9) during, and at the end of, care.

Participants self-identified as female (63.7%), male (31.5%), and transgender and gender diverse (1.4%); participants also self-identified as bisexual (5.5%), gay or lesbian (4.1%), additional sexual orientation groups (5.4%), and straight (78.0%). Rates of end-of-care reliable improvement or recovery in anxiety or depression symptoms ranged from 82.4 - 87.5% across gender identity groups, and 84.3 - 86.9% across sexual orientation groups. In growth curve models, anxiety and depression symptoms significantly decreased during treatment. Compared with straight adults, bisexual adults and adults reporting additional sexual orientation groups exhibited statistically significantly less steep initial reductions in anxiety and depression symptoms. Compared with female adults, male adults had statistically significantly steeper initial reductions in anxiety and depression symptoms. Across these outcomes, statistically significant differences by gender identity and sexual orientation groups were small.

This employer-offered telemental health program provided clinically beneficial services to populations with diverse gender identities and sexual orientations, suggesting a potential pathway for accessing equitable mental health care.