The influence of a hostile environment on a syndemic of depression, stress and chronic limiting illness among LGBTQ+ people during the COVID-19 pandemic.

Lesbian, Gay, Bisexual, Transgender, Queer, Questioning (LGBTQ+) are at greater risk of poorer COVID-19 prognosis due to higher levels of chronic disease and a greater impact on mental health from pandemic mitigation strategies due to worse pre-pandemic mental health. We examine how a hostile social system contributes to LGBTQ+ people's negative health experiences during the pandemic through adopting a syndemic framework and using data from The Queerantine Study, a cross-sectional, web-based survey (n = 515). Identification of a health syndemic is based on depressive symptoms, perceived stress and limiting long-term illness. We used Latent Class Analysis to identify latent classes based on experiences of a hostile social system. A syndemic was identified among a third of respondents (33.2%), with transgender/gender-diverse and younger participants at higher risk. Latent Class Analysis identified five groups based on experiences of hostile social systems using psychosocial and socioeconomic indicators. Classes reflecting psychosocial hostility were predictive of a health syndemic and worsening health. This study emphasises (i) mental and physical health issues are intertwined among LGBTQ+ people; (ii) experiences of hostile social systems can account for part of variation in health across LGBTQ+ groups; (iii) that psychosocial hostility continued and was exacerbated throughout the pandemic, and (iv) experiences of psychosocial hostility in particular were associated with a greater likelihood of experiencing a syndemic.