Social Support and LGB Health Disparities in the Era of Marriage Equality and COVID-19: A Population-Based Australian Study (2012-2023)
Melbourne Institute Working Paper No. o5/25
Date: July 2025
Author(s):
Abstract
Background: Sexual minority individuals experience persistent health disparities compared to heterosexuals, yet limited longitudinal evidence exists on how disparities evolve over time or how key mechanisms such as social support might influence these trends. Methods: We analysed data from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) Survey from 2012 to 2023. Health outcomes included mental health, general health, and life satisfaction. We estimated yearly disparities between heterosexual and lesbian, gay, and bisexual (LGB) individuals, using ordinary least squares regression models and adjusting for sociodemographic covariates. We further stratified analyses by levels of social support to examine its potential buffering role. Results: LGB individuals reported poorer mental health, general health, and life satisfaction than heterosexuals across all 12 years (p < .05), with disparities widening substantially over time. Among individuals with high social support, disparities were notably smaller in nearly every year, often statistically insignificant, and typically followed constant, non -widening trends when significant, suggesting a strong buffering effect. In contrast, disparities among the low social support group remained large and continued to widen over time. For the high social support group, the onset of the COVID-19 pandemic in 2020 marked a sharp narrowing of general health disparities to non-significant levels, with mental health disparities also narrowing, although remaining statistically significant. The low social support group, in contrast, displayed widening disparities across all health measures in 2020, reversing previously narrowing pre-pandemic trends. There was some evidence that the introduction of marriage equality in 2017 may have contributed to stabilising or slightly improving outcomes for the low social support group. However, there was no clear association between marriage equality and outcomes for the high social support group. Conclusion: Health disparities between LGB and heterosexual Australians are persistent and have widened over time, particularly among those with limited social support. Furthermore, high levels of social support are strongly associated with reduced or eliminated disparities, especially at the onset of the COVID-19 pandemic. These findings underscore the importance of fostering supportive environments and implementing targeted interventions to strengthen the social networks of sexual minority populations as a means of promoting health equity.
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