Selene Mezzalira

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minoritised (LGBTQ+) individuals experience significant disparities in mental and physical health compared with their heteros...

Background/Objectives: Individuals with marginalized sexual and gender identities experience mental health disparities arising from chronic minority stress and systemic barriers within healthcare settings. Mental health professionals occupy a central role in addressing these inequities; however, persistent deficits in professional preparation and cultural knowledge continue to undermine affirming, identity-inclusive care. This study explored the cultural knowledge of Italian mental health professionals regarding LGBTQIA+ health needs, focusing on how such knowledge is conceptualized, enacted, and constrained in clinical practice, using the Culturally Competent Compassion Model as a theoretical framework. Methods: A qualitative study was conducted using semi-structured interviews with 14 Italian mental health professionals (psychologists, psychotherapists, and psychiatrists), purposively selected from a broader qualitative dataset of 33 professionals based on clinical specialization in mental health. Data were analyzed using reflexive thematic analysis. Results: Four themes were identified: (1) training as absent structure; (2) knowing without knowing; (3) the paralysis of partial competence; and (4) stigma as institutional climate. Findings showed that professionals often rely on partial and informal knowledge, experience uncertainty in clinical interactions, and encounter difficulties in translating knowledge into practice. Participants demonstrated awareness of explicit and subtle forms of stigma affecting LGBTQIA+ individuals within healthcare settings. Conclusions: The findings highlight a gap between declarative awareness and self-reported preparedness for clinical practice, underscoring the need for structured training programs integrating theoretical knowledge and clinical skill development. Cultivating cultural knowledge and cultural humility among mental health professionals represents a systemic investment in reducing mental health inequities and improving affirming care for LGBTQIA+ populations.

LGBTQ+ individuals experience and anticipate stigma not only within society at large, but also—and critically—in healthcare contexts. Sexual stigma in healthcare services, positive identity, psychological well-being, and mentalization were assessed in 361 LGBTQ+ (lesbian, gay, bisexual, transgender and nonbinary, queer) adults living in Italy. In both LGB cisgender and TNBQ groups, positive identity mediated the association between healthcare stigma and well-being. Mentalization moderated the impact of stigma on well-being only in the TNBQ group. Fostering culturally competent compassion and mentalization capacities can help LGBTQ+ populations’ counteract the detrimental effect of stigma on well-being.

Introduction: LGBTQ+ individuals, especially transgender, nonbinary, and questioning (TNBQ) individuals, experience significant health disparities due to discrimination, stigma, and barriers to care, which undermine their access to services and overall well-being. Epistemic stances—namely epistemic trust (ET), mistrust (EM), and credulity (EC)—have been proposed as key psychological dimensions that shape how individuals respond to interpersonal information, including in healthcare contexts. Methods: This study compared ET, EM, EC, barriers to care, and quality of life between 219 LGB+ cisgender and 152 TNBQ individuals surveyed between 2024 and 2025. Also, the study explored the associations between epistemic stances and quality of life through perceptions of barriers to care within each group. Results: TNBQ individuals reported higher barriers to care and lower quality of life, while no group differences emerged in epistemic stances. Age, education, and disability influenced all main study variables. Across both groups, higher EM and EC were associated with more perceived barriers and lower quality of life. However, mediation models revealed distinct paths of association between variables in the two groups. Conclusions: Findings highlight the need for addressing the impact of healthcare barriers on quality of life through an intersectional lens and gender identity-sensitive interventions. Policy Implications: These findings underscore the need for healthcare policies to prioritize inclusive training for providers that fosters ET and minimizes bias. Structural reforms aimed at reducing systemic barriers—such as improving provider cultural competency, expanding access to affirming care, and enforcing non-discrimination policies—are essential to enhance the well-being of LGBTQ+ populations.

LGBTQ + individuals are well known for mobilizing substantial resilience efforts to confront stigma and discrimination not only within society at large, but also—and more specifically—within healthcare settings. Health disparities affecting LGBTQ+ populations arise from cis-heteronormative assumptions embedded within societal structures—including healthcare systems—together with homo- and trans-negative attitudes and behaviors often exhibited by healthcare providers. These disparities are largely driven by providers’ limited knowledge and inadequate preparedness to care for LGBTQ+ patients, resulting in unmet health needs within these communities. The current article first outlines the literature concerning healthcare providers’ attitudes toward and knowledge of the specific health needs of sexual and gender-marginalized patients, across the fields of primary care, sexual and reproductive health, and mental health. It then presents guidelines for best clinical practice when treating LGBTQ + patients, both in general terms and within the aforementioned healthcare domains. Finally, the article discusses implications for clinical practice and provides recommendations for social policy, emphasizing the importance of fostering sensitive, affirming, and culturally competent care in healthcare contexts to validate LGBTQ + identities and enable sexual and gender-marginalized patients to meet their specific health needs.

Among transgender binary and nonbinary/queer (TNBQ) individuals, perceived stigma has been documented to be significantly associated with health disparities that diminish overall quality of life. The present study examined the serial mediating roles of patient–provider relationship quality and perceived barriers to care in the association between perceived stigma and quality of life among TNBQ individuals residing in Italy. Data were collected from 132 TNBQ participants aged 18–60 years (M = 28.52, SD = 8.57) through an online survey assessing perceived stigma, patient–provider relationship quality, perceived barriers to care, and quality of life. A serial mediation model was analyzed using Model 6 of the SPSS Macro Process, version 29, and separately applied to two subgroups of TNBQ participants (i.e., binary and nonbinary) to detect potential differences. Findings indicated that in both groups (i.e., binary and nonbinary populations), when considered independently, only perceived barriers to care—but not patient–provider relationship quality—mediated the relationship between perceived stigma and quality of life. A serial mediation effect was also observed, wherein the relationship between perceived stigma and quality of life was mediated sequentially through patient–provider relationship quality and barriers to care, but only for the binary group. These findings hold significant clinical relevance, as improving the perceived quality of patient–provider relationships may help reduce perceived barriers to healthcare access. In turn, this may attenuate the detrimental effects of perceived stigma on the quality of life among TNBQ individuals.