Recent researches suggests that loneliness, anxiety, fear of contraction, and limited access to healthcare facilities due to the Covid-19 pandemic might have worsened psychological health with heightened symptoms of depression, anxiety, self-harm, and suicidal ideation among minority groups (1–4, 15). For sexual minority groups, the situation was more compound because of their pre-existing psychological vulnerabilities associated with social inequalities and discrimination (5–8). Research indicates that the Covid-19 pandemic also resulted in changes in the life circumstances of sexual minority groups. For instance, Conron (16) reported that several SGM young adults in the US had to return to their parental house due to the financial crisis, loss of jobs, and complete lockdown of university campuses due to the pandemic. This imposed additional pressure on them as many of them preferred avoiding their families due to non-acceptance by the family members Across the world, the socially disadvantaged SGM group faced unemployment, food insecurity, social discrimination, and severe financial crisis during the Covid-19 pandemic (17). All this resulted in heightened psychological vulnerabilities and declined subjective well-being among these young adults (5, 8, 18). Pre-existing mental health conditions such as depression, anxiety, and addiction problems, further aggravated the situation for them as they were forced to stay at home with very limited social interactions and rejection from family members (9, 19).

Another line of studies pointed out that alcohol use, substance abuse, and drug dependence among SGM young adults is a common practice (20, 21), even before Covid-19. As noted by Bourdieu (22), subtle differences in “cultural and normative markers” (23) like body language, gestures, accent, etc. can interact with demographic identities like gender, race, and ethnicity to produce hierarchical judgments potentially enough to cause discrimination in the society. Contributing factors to the higher incidence of drug dependence and substance abuse among SGM youths have often been attributed to such hierarchical power structures creating and causing inequalities in employment, health care, living conditions, and other social aspects (24–27). Several pieces of research across the globe reported a higher incidence of substance abuse among SGM youths during Covid-19, leading to poorer mental health and self-harm tendencies. For instance, Slemon et al. (27) compared SGM youths with non-SGM youths in a Canadian population. The study found that in comparison to the non-SGM group, the SGM respondents had experienced a higher impact of Covid-19 and substance abuse, which included poorer psychological health, deteriorated coping, self-harm behaviors, suicidal thoughts, and greater dependence on drugs and substance abuse to survive. Similar findings were reported by Salerno et al. (8) in a US population. The researchers found that almost one-third of the SGM respondents had an increased level of substance abuse since the commencement of Covid-19. This increased abuse along with alcohol problems, and drug dependence contributed to ill-psychological health and complicated the situation among SGM youths.

Higher psychological distress among SGM youths and adolescents has been reported by several researchers. Risk factors for increased suicidality among this minority group result from symptoms of depression, hopelessness, substance abuse, psychiatric distress, and recent incidences of suicide by another family member or a friend (28–30). During the pandemic, an elevated level of loneliness was reported in SGM adolescents and young adults (31, 32). Herrmann et al. (33) compared the loneliness and depressive symptoms among transgender and cisgender individuals across the first and second waves of Covid-19 in a German population. The researchers noted a higher level of loneliness among transgenders in comparison to the cisgender respondents. Moreover, it was found that loneliness mediated the symptoms of depression among the SGM respondents. Jacmin-Park et al. (34) found that the buffering effect of perceived loss of social support due to discrimination during the pandemic on depressive symptoms was four times higher among the transgender group than the cisgender respondents. Gonzales et al. (15) found more frequent symptoms of psychological distress and symptoms of anxiety and depression among 60% of American college-going SGM youths. As per the Sexual Minority Stress Model (35), group solidarity and social support are important protective factors for the SGM group against psychological distress associated with stigma and discrimination (34–37).

Mental health issues among the SGM group associated with the Covid-19 pandemic are a crucial concern, although under-explored. Several studies have been conducted to explore the issue in the past couple of years. The present study intends to present a systematic review of the incidences of psychological distress as reported among SGM youths, especially symptoms of depression and anxiety, associated with the isolation and discrimination faced during the Covid-19 pandemic across the world. The review has the following objectives: (a) To explore the impact of Covid-19 stress on the psychological health of the sexual minority group, and (b) To identify the stressors associated with the Covid-19 pandemic that impacts the mental health well-being of the sexual minority individuals. This review will help integrate and understand the overall effect of the Covid-19 pandemic on the psychological health of the SGM youths.

The review followed the format of the PRISMA (Preferred Reporting Items for Systematic Reviews) framework. The selection process is illustrated in Figure 1 which depicts the selection process following the inclusion criteria for the review. Chiefly, studies were selected from online databases namely, Google Scholar, PubMed, Eric, and PsychInfo. The keywords used for the search were “Sexual Minority”, “LGBTQ” “Transgender”, “Mental Health”, “Covid-19”, “Pandemic”, and also “Depression” and “Anxiety”, jointly and also in isolation. The review was done during the second week of September 2022. The initial search generated thousands of research out of which 140 searches were relevant in Google Scholar, 50 searches were relevant in PubMed, ERIC yielded six related searches, and PsychInfo yielded 12 searches. Relevance was judged based on the keywords used for the search. For instance, a combination of “Mental Health”, “Covid-19”, “Pandemic”, “Depression” and “Anxiety” keywords yielded hundreds of studies addressing populations other than sexual minority groups. Again, a search with the keyword “Sexual Minority”, and “LGBTQ” yielded research addressing different issues related to this population. Hence only those studies addressing the impact of the “Covid-19” “pandemic” on the “Mental Health” of the “Sexual Minority”/“LGBTQ”/“Transgender” population were included in the current review, yielding a total of 208 studies.

Figure 1 shows the PRISMA framework used for the search process. out of the relevant 208 searches yielded by the database search, 101 studies were retrieved (excluding the duplication).

In the next stage, the 101 studies were reviewed and 57 studies were selected focusing on the impact of Covid-19 on the mental health of the SGM group. The 44 studies rejected in this stage were focusing on intervention, policy-related issues, subjective descriptions of experiences, systematic reviews, general comparisons, and others. This review process was mostly done by analyzing the study abstracts and occasionally looking into the full paper as required. In the next stage, out of the 57 studies, 23 studies were selected after rejecting other studies focusing on methodology issues, comparisons, qualitative research, etc. Studies focusing on subjective descriptions, methodological issues, and systematic reviews were excluded since most of those addressed issues beyond the purview of the current study. Qualitative researches were also excluded because comparing results across quantitative reports using questionnaires with qualitative reports based on interviews is complicated and might invite unnecessary methodological complications.

Subsequently, the 23 studies (full papers) were thoroughly reviewed and finally, 16 studies were selected following the inclusion criteria: (a) Study subjects belonging to Sexual and Gender Minority groups; (b) Subjects are adults; (c) Subjects experiencing symptoms of depression and anxiety; (d) Study reported quantitative assessment (using questionnaires instead of semi-structured interviews); (e) Sample characteristics clearly mentioned; (f) Study objectives focusing on the impact of Covid-19 on the psychological health of SGM group; (g) Details of testing materials discussed clearly;(h) Statistical analysis reported and discussed elaborately; (i) Results indicate a significant impact of the pandemic on the psychological health of SGM group. These 16 studies were independently reviewed by the two authors on these inclusion criteria and then included in the review. All the studies fulfilled the inclusion criteria set for the review and are therefore considered for the present review.

All the 16 studies were quality assessed using the Joanna Briggs Institute (JBI) checklist for analytical cross-sectional studies (38). The checklist consists of eight criteria assessing the quality of the studies included (related to methodological issues). The studies were rated on the checklist by both authors independently. All the studies were found to be meeting the standards of quality assessment.

The studies selected for the review, mostly followed online or web-based cross-sectional survey method, comparing the different sexual minority groups with cisgender heterosexual groups, except three studies that followed a Cohort design/ Longitudinal Cohort study (39–41). For instance, Kamal et al. (41) considered the data collected during Wave 1 of the Covid-19 pandemic through a US-based longitudinal cohort study (CARES: Covid-19 Adult Resilience Experiences Study) for the investigation. Similarly, Chang et al. (40) collected data in three cohorts in 2020, January–March (n = 99), July–September (n = 390), and September–November (n = 305). The second and third cohorts were finally considered for the investigation. On the other hand, the study by Bécares and Kneale (39) was a typical longitudinal cohort research that was a part of the Millennium Cohort Study done among UK infants born between 2000 and 2002. The present research included participants who had responded in the 6th and 7th data collection sweeps and during the 1st wave of the Covid-19 pandemic. Hence, this study provided a comparative view of the mental health of the SGM group during the pre-pandemic phase and the 1st wave of the pandemic. Apart from these three studies, one other study (42) followed a mixed method design, where a quantitative assessment was mixed with a qualitative approach and hence aided in providing a more comprehensive and rich understanding of SGM mental health issues during Covid-19 pandemic. Additionally, the study by Gato et al. (6, 7) did a cross-country exploration among LGBTQ+ individuals from six different nations. This study, therefore, provides a more in-depth insight into the prevalence of psychological distress among the SGM group across different nations. It is important to note that all the studies followed a web-based survey method, considering the physical restrictions imposed during the pandemic. Table 1 provides a comparative view of the study characteristics and demographics of the study participants of all sixteen studies included in the review.

Out of the 16 studies, seven studies presented a comparative account across heterosexual and SGM respondents (5, 8, 39, 32, 33, 44, 46), while three more studies included heterosexual respondents although in very small percentages (6, 7, 49). The rest of the studies included only the SGM group for the investigation. Participants of all the studies were adults with mostly young age groups included in the research. Additionally, the studies considered for the review include participants from across a wide range of race/ethnic groups. Eight studies were conducted on the US population (5, 8, 31–33, 44, 46, 49), although the US population included in the studies was a heterogenous mix of Asian American, Latin American, African American, and multiracial origins along with White Americans. Two studies were conducted among the UK population (39, 45), also a heterogeneous group of white individuals, mixed racial groups, and Asian individuals. The rest of the studies included participants representing several different countries like Israel (43), Hong Kong (47), Portugal (7), Chile (48), and Canada (50). Gato et al. (6, 7) included participants from six different countries namely, Portugal, the UK, Italy, Brazil, Chile, and Sweden. Hence, the study results are representative of the mental health scenario of the SGM group across a wide geographical region.

All the studies included in the review assessed the psychological distress related to Covid-19 and the associated symptoms of depression and anxiety among SGM individuals. While the measures for assessing depression and anxiety were all standardized instruments (for instance, 8-item Patient Health Questionnaire (PHQ-8), Kroenke, et al. (51) and 7-item Generalized Anxiety Disorder scale (GAD-7) (52); Depression Anxiety Stress Scales (DASS-21), Lovibond and Lovibond (53), most studies used customized questions to assess the Covid-19 related stress (for instance (31, 43, 46, 47, 50). The chief reason cited for this practice was a lack of a standardized scale for measuring stress related to Covid-19 among SGM individuals, although Tabler et al. (33) used the Pandemic Stress Scale developed by Taylor et al. (54).

Apart from anxiety, depression, and psychological distress, several studies also measured perceived social support (39, 32–43, 46). The most commonly used measure was the modified Medical Outcomes Study Social Support Survey (8-items) (55), although Kamal et al. (32) and Oren (43) used the 12-item Multidimensional Scale of Perceived Social Support (57) for measuring the same. Some of the studies also studied variables like Loneliness, Rumination, and Quality of relationships in addition to the stress and psychological symptoms related to Covid-19. Additionally, Hart et al. (49) and Tabler et al. (33) measured eating disorder symptoms as well using the Eating Disorder Examination-Questionnaire (58) and Eating Disorder Examination—Questionnaire Short (EDE-QS) (12 items) (59, 60) respectively. Akre et al. (44) and Goodyear et al. (50) measured problem drinking using the Patient-Reported Outcomes Measurement Information System (PROMIS) and substance use through a set of semi-structured questions. Table 2 presents a detailed account of the measures used in the studies.

Almost all the studies highlighted the significance of the impact of Covid-19 related stress on the psychological health of minority individuals. It can be noted that the studies identified potential Covid-19 stressors that contribute to an increased level of psychological distress among SGM individuals.

Increased levels of anxiety and depression were found to be associated with the perceived stress related to the Covid-19 pandemic. Most of the researchers reported such elevated symptoms during the first wave of the pandemic and also during the subsequent waves. Severe symptoms of depression and anxiety were also found to be associated with Covid-19 related physical symptoms (46), psychological distress (c), loneliness (5, 39), and poor quality of life (5). Kamal et al. (32) additionally, reported symptoms of post-traumatic stress disorder associated with higher levels of depression among SGM youths.

Most commonly such experience of psychological distress was attributed to stressors like perceived social support (39, 32–43, 46), family-related issues (8), social discriminations (32) and non-affirmation of one's identity (43).

In connection to the issue of social support, Meyer (35) proposed the Minority Stress Model in association with lesbian, gay, and bisexual (LGB) health. As per the minority stress model, stressors can be distal or proximal. Distal stressors are characterized by the actual experiences of discrimination, prejudices, harassment, and even violence, while the proximal stressors include the occurrence of internalized homophobia, the need for acceptance by others, and the suppression of one's own sexual identity (43). Several researchers have provided evidence for the fact that such minority distal and proximal stressors lead to elevated levels of psychological distress, a relationship mediated by the development of pathological cognitive processes, and conflictual social and interpersonal relationships (43, 81). In contrast, perceived social support works as a buffer against the negative effects of minority stressors and therefore can be considered an important resource in protecting SGM mental health (35, 43, 82).

Tabler et al. (33) noted that social support plays an important role as a potential protective safeguard against the elevated risks of disordered eating symptoms associated with Covid-19 stress. These findings were further validated by the work of Bécares and Kneale (39) who noted a significantly poorer level of perceived social support associated with lower levels of self-rated health and poor psychological health among the SGM respondents. Moore et al. (46), in a comparison study among SGM and non-SGM adults, noted significantly lower perception (p < .001) of emotional support, tangible support, affectionate support, and positive social interaction support among the SGM respondents in comparison to their non-SGM counterparts. The study also reported significantly heightened symptoms of depression and anxiety among the SGM adults in comparison to the non-SGM respondents. Such findings, therefore, suggest that lack of perceived social support acted as a potential stressor for the SGM individuals under the impact of the Covid-19 pandemic.

There is no dearth of studies reporting a lack of family support among sexual minority groups (32, 83, 84). Kamal et al. (32) found that SGM respondents experienced a significantly decreased level of family support (p < .001) in comparison to the non-SGM respondents, and this in turn is associated with significantly increased levels of depression (p = .003), post-traumatic stress disorder symptoms (p = .013), higher levels of worries related to Covid-19 pandemic (p < .001) and grief related to the pandemic (p = .032) among the sexual minority individuals than among the non-SGM individuals. Moreover, the mandate of staying at home due to quarantine had a more debilitating effect on the mental health of the minority group (85, 86). Gato et al. (7) noted that individuals staying at home might be experiencing elevated risks of depression and anxiety, provided the fact that the associated home climate is hostile and non-affirming of the sexual identity of the individuals. Hence, staying at home although, provided a sense of security to most individuals during the pandemic, for the SGM group the response was different, owing to the associated discrimination and parental rejections. These findings were also confirmed by Salerno et al. (8). The researchers noted that sexual minority youths who went back to their parental house during the post-onset of the pandemic experienced significantly higher levels of psychological distress and decreased well-being in comparison to the others who were already staying before, the reasons being the same.

Covid-19 stress is often associated with weight stigmatizing in social media messaging (87), which in turn can contribute to increased perceptions of weight gain and disordered eating behavior (88, 89). Disordered eating behavior among sexual minority groups is a common problem and is often associated with negative experiences of stigma and discrimination (90–92). Such problem behavior is considered a coping mechanism for minority individuals in the face of minority stress (33).

The current review also found that Covid-19 stress among SGM individuals is associated with elevated risks of disordered eating behavior and increased perception of weight gain among them (33). Hart et al. (49) noted that most of their study participants reported an increase in the urge and frequency of engaging in disordered eating behavior. Moreover, they found an association between disordered eating behavior and increased levels of psychological stress due to Covid-19 and the quality of relationships at home and non-acceptance of one's sexual identity by family members. Tabler et al. (33) noted that nearly one out of three participants presented clinically significant symptoms of disordered eating.

Sexual and gender minority individuals are at an increased level of abusing substances and alcohol in comparison to non-SGM individuals even before the onset of the pandemic (16, 93–95). More often, negative experiences of psycho-social stresses contribute to heavy alcohol consumption and other substance abuse among SGM individuals, which in turn leads to elevated risks of psychological distress (96, 97).

In the present review, Goodyear et al. (50) reported increased alcohol use among 24.5% of the study participants and increased cannabis use among 18.5% of the respondents due to the pandemic stress. furthermore, they reported that higher levels of alcohol consumption were associated with poor coping skills, and lower levels of self-rated psychological health, while increased use of cannabis was associated with suicidal thoughts. Along the same line, Fish et al. (5) reported that in comparison to heterosexual men, gay men, and bisexual men experienced a significant decrease in psychological health, quality of life, higher levels of stress, feelings of loneliness, and alcohol consumption. Lesbian individuals also reported significantly higher levels of alcohol consumption in their study.