Perceived Healthcare Discrimination and Its Impact on Mistrust and Delayed Care Among Sexual and Gender Minority Young Adults in Spain

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Sexual and gender minority (SGM) individuals face discrimination in health care, compromising both well-being and access to services. Such experiences may foster expectations of mistreatment and mistrust of health care professionals, contributing to delays in care with potentially adverse consequences. This study examined perceived discrimination, mental and physical health, trust in providers, and care-seeking behavior among young adults in Spain, comparing SGM participants with their cisgender heterosexual peers. A cross-sectional online survey was conducted with 217 participants (M = 21.5 and SD = 4.6), of whom 144 identified as cisgender heterosexual and 73 as SGM. Qualitative open-text responses were analyzed using reflexive thematic analysis. Data were collected between January and April 2025. SGM participants reported higher levels of perceived discrimination, greater psychological distress, lower trust in providers, and more delays in seeking care than cisgender heterosexual participants. Although perceived discrimination was associated with psychological distress, trust, and delayed care at the bivariate level, discrimination did not emerge as an independent predictor of health outcomes in multivariate regression models. Qualitative findings illustrated that discrimination (including misgendering, medical paternalism, and moral judgement) was experienced in everyday clinical encounters and linked to identity concealment and erosion of trust. These findings suggest that universal health coverage and legal protections are insufficient to ensure equitable care in the absence of affirming, culturally competent care. Structural reforms, inclusive protocols, and provider training are essential to reduce health disparities affecting SGM populations.