Population-level studies have shown consistently that lesbian, gay, bisexual, transgender and other queer (LGBTQ) people have poorer mental health outcomes compared with cisgender heterosexual people [1, 2]. Research has increasingly attributed these disparities to minority stress, or the chronic, unique social stressors experienced by LGBTQ people [2, 3]. Although minority stress is often measured at the individual level through scales of outness, internalized homophobia and perceived discrimination [4, 5], researchers have also acknowledged that experiences of minority stress may differ based on the gender and sexuality norms encountered in different spaces. Due to the substantial time spent at work and the variability of workplace policies and practices that could amplify minority stress , LGBTQ workers could have differential mental health outcomes across industries or workplaces. To date, however, research connecting work and workplace to the mental wellbeing of LGBTQ workers has primarily been limited to qualitative studies [7, 8].
A substantial body of scholarship suggests that employment insecurity, including unemployment and employment in precarious jobs, is detrimental to mental health and wellbeing [9–14]. By extension, the precarity of one’s work situation (e.g., inconsistency of schedules or contracts), also constitutes a social determinant of health . The positive association between employment and mental health often attenuates, however, when the effects of unemployment and precarity are examined together, highlighting the import of work quality to mental health . Studies have also suggested that the link between precarity and poor mental health is mediated by gender and varies by sub-populations based on age, ethnicity, and other characteristics .
Precarity and unemployment are also likely significant determinants of mental health for LGBTQ populations, for reasons that are both similar to and distinct from those among heterosexual, cisgender populations. Experiences of minority stress can both amplify and stem from insecurity and poverty, resulting in poorer mental health among LGBTQ people, but there is less understanding of how characteristics of employment might contribute to this nexus [18, 19]. LGBTQ workers may be more likely to be employed precariously if adverse experiences in the workplace or labour market disrupt pathways to standard work . Additionally, the employment protections and extended health benefits that often accompany standard, full-time employment might mitigate poor mental health by improving access to supports and alleviating fears of job loss or reprisal.
To assess the relationship between work attributes and mental health among LGBTQ people living in economically diverse regions of Canada, we conducted an in-depth survey of 531 LGBTQ-identified workers in two mid-sized cities: Sudbury and Windsor, Ontario. These cities resemble others in North America, characterized by economic decline associated with a shift from industrial to service-based employment and substantial but relatively hidden LGBTQ communities.
Work and mental health in LGBTQ populations
Minority stress theory  suggests that both distal stress in the form of anticipated stigma and discrimination and proximal stress in the form of actual discrimination experiences can increase depression, anxiety, deliberate self-harm, and substance abuse [1, 2, 21]. Social support and other coping structures, however, may protect against adverse outcomes . Work, then, might influence the mental health of minority populations through both adverse experiences that one has in the workplace as well as expectations about opportunities for safe and supportive working environments . Additionally, minority stress inside and outside of work could be exacerbated by work environment, unemployment, or the precarity of work . While previous studies have acknowledged that economic insecurity affects the mental health of bisexual people similarly to that of heterosexual and cisgender individuals , they do not necessarily acknowledge that adverse outcomes at the population level could be exacerbated by the overrepresentation of LGBTQ people in low-wage service work  or unemployment resulting from discrimination in hiring and firing practices .
Several studies have linked workplace climate and mental health among LGBTQ people in useful albeit disparate ways. Research has found heterosexism in the workplace to be associated with psychological distress , and depression specifically , among gay and lesbian workers. Gay, lesbian, and bisexual workers may also face sexuality-specific stressors at work, such as fear of coming out  or experiences of heterosexist discrimination , that can contribute to psychological distress, anxiety, and depression. Workplace harassment has also been linked with increased alcohol consumption for lesbian and bisexual women . Qualitative studies have suggested that these trends differ by sector; whereas normative gender performances in blue collar sectors (e.g., manufacturing) might negatively affect the wellbeing of sexual and gender minorities, public-sector work can be a refuge for sexual and gender minorities [6, 28].
Recent research has sought to document the effects of increasing employment precarity in post-industrial economies on worker wellbeing. This research has found that workers in precarious employment relationships, such as temporary or part-time employment, have greater likelihood of suicidal ideation, depression, poor sleep and psychological distress [22, 29, 30]. The relationship between mental health and precarity, moreover, exists on a continuum, with more precarious jobs leading to poorer mental health compared with less precarious jobs . Gender mediates this relationship; however, studies to date have adopted binary conceptions of gender and overlooked transgender, genderqueer, and non-binary population . Precarious employment may therefore amplify minority stress experienced by LGBTQ workers since it is associated with fewer job protections, less access to extended health benefits, and greater economic insecurity. Sexual minority workers who are unemployed, for example, are more likely to report mental illness . Although the link between unemployment and poor mental health has also been reported in research where sexual orientation is not reported , the reasons for which LGBTQ workers become unemployed (e.g., discrimination, work-related stress) may be different from heterosexual workers. Factors such as low income may also reinforce disadvantage. In Canada, bisexual people situated below the low-income cut-off in Canada were more likely to experience depression and to perceive discrimination due to both early-in-life experiences (e.g., discrimination) that affected financial stability, and difficulties accessing supports and mental health care due to their financial position .
Other studies have focused on factors that are protective to the mental health of gay, lesbian, and bisexual workers, showing how workplaces that are supportive decrease depression and anxiety  and job anxiety specifically . Positive workplace environments, as experienced in terms of employer and co-worker support, can increase job and life satisfaction , as can choosing to come out at work . Individual-level factors may also be protective; the availability of a same-sex partner and employment dyadic coping strategies appears to attenuate the relationship between workplace stress and anxiety .
Collectively, these studies have highlighted the distinct ways in which work affects the wellbeing of LGBTQ workers. Few, however, have been designed specifically to assess mental health outcomes across diverse sociodemographic segments of the LGBTQ community, diverse types of work, or to measure the relative impacts of multiple work-related factors on mental health.
By locating itself in two cities with transitional economies, this study also seeks to better understand the specific challenges faced by LGBTQ workers in post-industrial societies marked by increasing precarity and still-persistent discrimination.