The Trevor Project recently released its 2025 survey results on LGBTQI youth mental health in the US. It sent me searching for what European data shows, particularly in France, where I live.
Something I keep coming back to in my health data studies is how many of the health outcomes we measure turn out to be downstream consequences of poor treatment within systems meant to help people.
This week I spent time in the European Union Agency for Fundamental Rights LGBTI Survey data, looking at French respondents specifically. 41% reported feeling depressed or downhearted some of the time in the last two weeks. That figure sits differently when you look at it alongside the disclosure data: 46% of LGBTI people across the EU did not disclose their identity to any healthcare provider, and 66% said none or only a few of their health providers know they are LGBTI.
The workplace numbers tell a similar story about where people feel safe being known. 72% are not out to clients or customers, and 55% are not out to supervisors. That drops to 33% for colleagues, a gap that points to real concern about how disclosure affects relationships where power is unequal.
The hand-holding figure landed especially hard. A majority of LGBTI respondents in France said they avoid holding hands with a same-sex partner in public, with rates notably higher among gay and bisexual men than women.
Concealment is a chronic stressor with measurable mental health consequences. A 2020 meta-analysis across 193 studies found consistent associations between sexual orientation concealment and depression, anxiety, and psychological distress (Pachankis et al.). When concealment extends into healthcare settings, it creates specific barriers. Patients may withhold information that is directly relevant to care or avoid care altogether in contexts where their identity makes them feel unsafe. For the cases where identity is relevant to care, the consequences are clinical, not just social as is often assumed.
Both the BRFSS and ESS datasets I’ve been working with this summer either excluded sexual orientation variables entirely or lacked sufficient coverage to draw meaningful conclusions about LGBTQI populations. The absence of data is never neutral; it shapes who gets studied and whose health is treated as a policy priority.
For us working in healthcare, creating explicitly affirming spaces where patients have reason to believe disclosure is safe is a care quality decision that is entirely within reach.