Purpose: Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals face mental health disparities, and these disparities may be more extreme in southern regions of the United States. This study assesses the role of outness on probable serious mental illness (SMI) among LGBTQ southerners and how discrimination may affect this association.

Methods: This study uses the data from the 2017 LGBT Institute Southern Survey, a cross-sectional convenience sample of 6502 LGBTQ-identified adults living in 14 southern states. Multivariable logistic regression was performed to examine differences between those with and without probable SMI.

Results: A higher proportion of transgender respondents had probable SMI compared to cisgender participants (40.3% vs. 21.8% for cis women and 16.3% for cis men). A higher proportion of bisexual respondents had probable SMI (34.8%) compared to lesbian (17.3%) and gay people (17.1%). Outness was associated with a lower likelihood of probable SMI (OR: .625 (.511, .764), p≤.001), especially when controlling for discrimination in the past 12 months (OR: .615 (.488, .774), p≤.001) and lifetime discrimination (OR: .582 (.428, .791), p=.003). Lifetime discrimination was associated with a higher likelihood of probable SMI (OR: 2.006 (1.367, 2.943), p=.001) as was discrimination experienced in the past 12 months (OR: 1.770 (1.396, 2.244), p≤.001).

Conclusion: These results underscore the importance of the relationships between outness, discrimination and probable serious mental illness among LGBTQ southerners. Policies that address discrimination against sexual minorities should be expanded. Further research on how outness can improve mental health is warranted.