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Abstract

Background
Sexual minorities and individuals with mental health conditions (MHC) often report poorer healthcare experiences, but evidence on inequalities at their intersection remains limited.

Methods
We analysed data from 1,277,383 respondents to the 2022–23 English General Practice Patient Survey using survey-weighted logistic regressions. Sexual orientation and self-reported long-term MHC were fully interacted to estimate adjusted predicted probabilities for six indicators of primary care experience: recognition of mental health needs, confidence and trust in healthcare professionals (HCP), HCP interpersonal skills, involvement in care decisions, overall needs met, and help-seeking before appointments.

Findings
Sexual minorities with MHC accounted for 1.2% of our analytical sample and reported the lowest satisfaction with involvement in care decisions (89.8% [89.3–90.2]), and HCP interpersonal skills (8.9% [8.4–9.3]) compared to all other groups. Interaction effects indicated partially protective patterns among sexual minorities with MHC for recognition of mental health needs (81.7% [80.6–82.7]), confidence/trust in HCP (93.3% [92.8–93.9]), and overall needs met (91.3% [90.7–91.9]), with the interaction effects corresponding to positive departures from additivity of 0.8 to 2.1 percentage-points. For these outcomes, sexual minorities with MHC exhibited moderate levels of positive primary-care experience, falling between the highest- and lowest-positive endorsement groups.

Interpretation
Sexual minority orientation and long-term MHC independently related to lower primary care satisfaction. However, their intersection was associated with both disadvantage and relative protection across different domains. Recognising these patterns is essential for reducing inequalities and better tailoring primary care services.

Publication Type:	Article
Additional Information:	© 2026 The Authors. Published by Elsevier Ltd. This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	Public health, Primary care, Sexual minority orientation, Long-term mental health conditions, Intersectionality, England
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	School of Policy & Global Affairs School of Health & Medical Sciences School of Health & Medical Sciences > Department of Psychology & Neuroscience
SWORD Depositor:	Symplectic Administrator

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