LGBTQ+ Identity Disclosure and Mental Health Outcomes: A Systematic Review of Qualitative and Longitudinal Quantitative Studies.

Abstract

Disclosure of sexual orientation and/or gender identity is a complex process that changes over time. While qualitative research captures the nuanced thoughts and emotions of LGBTQ+ individuals, longitudinal quantitative studies provide information on associations with predictors and outcomes of disclosure over time. This systematic review examined the association between LGBTQ+ identity disclosure and mental health outcomes by analysing studies employing both methodologies. This review was registered with PROSPERO (CRD42024542419). A systematic search was conducted across seven databases (MEDLINE, Embase, APA PsycInfo, Cochrane Library, SCOPUS, Web of Science, and all ProQuest databases) using key search terms: mental health, LGBTQ+, disclosure/non-disclosure, qualitative, and longitudinal methodology. Ninety-five studies met the inclusion criteria, comprising 77 qualitative and 18 longitudinal quantitative. Thematic synthesis of qualitative studies identified three key themes: 1) fear as a central emotional experience often leading to non-disclosure, 2) psychological implications of the act of disclosure regardless of reactions, and 3) mental health implications following disclosure. Longitudinal quantitative studies predominantly suggested positive mental health outcomes following disclosure and negative effects of non-disclosure. The link between disclosure and substance misuse remained inconclusive. Sociocultural factors-including race/ethnicity and socioeconomic status-shaped these outcomes, highlighting the need for context-specific support and interventions for LGBTQ+ individuals.