Gambling harm in LGBT+ Communities
The impact of gambling-harm on LGBT+ (lesbian, gay, bisexual/pansexual, transgender and other minority gender and sexual identity) communities is one which has been severely under-researched.
Preliminary evidence suggests LGBT+ populations may be more vulnerable to experiencing gambling harm as they are 1.5-2x more likely to be diagnosed with anxiety or mood disorders, and have higher rates of substance use, which are considered risk factors with disordered gambling.  LGBT+ people, particularly the trans and gender-nonconforming community, also experience employment and pay discrimination, which relates to gambling harm as economic deprivation is associated with gambling harm. 
Why is understanding the effects of gambling on LGBT+ Populations important?
Other minority groups, such as minority ethnic populations and veterans, are beginning to become more well-studied in the fields of gambling research. LGBT+ general health outcomes are also gaining greater study. However, there are only a handful of publications specifically investigating the ways in which LGBT+ people engage in gambling activity.
Through the understanding of the ways in which sexual and gender identity affects patterns of gambling and gambling harm, standards of care can be improved and public health prevention efforts can be developed.
The Minority Stress Model
Many studies dealing with minority populations reference the minority stress model, which describes experiences which arise from a conflict between minority group members and the dominant social environment. It was initially designed to focus on sexual minorities but has been expanded in recent years to cover other minority groups. It proposes that factors such as social rejection, prejudice, hiding and concealing aspects of one’s true identity, and ameliorative coping processes leads to stress. This constant background stress coming from the outside world can lead to negatively impacted physical and mental health outcomes, including engaging in more risky behaviour. 
Studies into gambling harm
Sexual minority communities (LGBT+)
Data on the prevalence of gambling in sexual minority communities is somewhat conflicting. Older studies conducted by the Kinsey Institute indicated that gay men gambled less than their heterosexual counterparts, but gay women gambled more than their heterosexual counterparts.  Moreover, a 2021 study on sexual minority men, which indicated that problematic gambling was less severe in sexual minority men than in heterosexual men. 
Studies on the potentially elevated risk for lesbians and sexual minority women were difficult to find, and there were no studies found which were published specifically on this topic. One 2015 study on 605 individuals found there were no significant differences in gambling between heterosexual and homosexual and bisexual populations.  Instead, the study reported that sexual minority participants were more likely to engage in problematic gaming. However, participation in this study was through self-selection, and the survey was presented as a self-test for problematic gaming and gambling, which may lead to sampling errors such as lack of awareness or honesty. The total number of participants who were sexual minorities limiting the applicability of these findings to wider sexual minority populations.
There are also multiple studies which do indicate that overall, sexual minority groups are at elevated risk of problematic gambling. A preliminary study by the University of New South Wales in Australia attempted to study patterns of play in the LGBTI+ community. It was limited by smaller sample size (69), but included a range of ages, with a mean of 32. Within this sample, 20.2% of participants met the diagnostic criteria for problematic gambling – far higher than in the general Australian population, which is between 0.5 and 1%. The motivations for gambling were mostly to improve or elevate mood, for social reasons, or to cope with negative thoughts, and problematic gambling was linked with increased use of substances and less self-control. This study was obviously limited in the fact that it had a small sample size and marketed itself as a study on gambling specifically, which may lead to a higher participation with gambling problems. However, the data it collected on motivations is particularly valuable. 
One of the largest studies - sample size of 23,533 - on gambling-harm in gay, bisexual and lesbian young people focused on symptoms of disordered gambling in collegiate athletes. Results for gay and bisexual people of each gender were combined, as it was found that these two groups did not differ from each other in gambling disorder symptomatology. The findings reflected an elevated presence of gambling disorder symptomatology in gay and bisexual student athletes, when compared to their heterosexual peers. The study found the highest rates of gambling in gay and bisexual men. These findings indicate that gambling rates are a significant risk for young gay, lesbian and bisexual people and that further research into the topic is required.
Transgender and gender-nonconforming communities
Transgender people (those whose gender is different to their sex assigned at birth) and gender-nonconforming (a broader term encompassing those who may not specifically identify as transgender but exist in ways outside of the gender binary) are a group which are particularly vulnerable to minority stress, with 99% of trans people in TransActual’s Trans Lives Survey experiencing social media transphobia, and over 71% experiencing transphobic street harassment. Trans rights are also the current focus of a media culture war, and transphobic hate incidents are becoming more common, which has the potential to amplify the findings of previous studies, and exert a great toll on transgender and gender-nonconforming mental health.
A study on 80,929 students, 2168 of which identified themselves as transgender or “gender diverse” reported that trans people assigned male at birth (transfeminine) had elevated risks of screening positive for problem gambling, with had higher rates of participation in all gambling behaviours than the trans people assigned female at birth (transmasculine) and cisgender female participants, except that transgender men and cisgender men had similar rates of casino gambling. Transgender participants, particularly transfeminine participants, reported a much greater risk of screening positive for problem gambling, with 8.9% of transfeminine youth screening positive for problem gambling compared to rates of 1-2.1% for cisgender youth. Data for transmasculine youth indicated that the rates of problem gambling were higher, but this was not statistically significant, likely due to the small sample size. Transgender participants were also more likely to report having gambled via lottery tickets, casino, or online gambling, indicating potential patterns of play. The survey was limited due to its sampling of students, for several reasons, including that transgender participants are more likely to skip school and therefore likely to not be included, and the fact that not all students who will eventually understand themselves as transgender will report so on the survey. However, its large sample size make it a study which provides a lot of useful insights into the fields of youth and LGBT+ gambling research.
Limitations of current studies and further research needs:
The dearth of research involving LGBT+ stratification is an issue. Most studies into harm in sexual minorities also tend either to aggregate LGBT+ identities, limiting our understanding somewhat, or have small sample sizes. Many of the largest-scale studies carried out into the effects of gambling-harm are on adolescent or young adult populations. Adolescence is a time associated with a lot of difficulty for many LGBT+ people, as the differences between them and their peers become more evident, and as such diminishes the generalisability of research findings to older LGBT+ populations. Older LGBT+ people may be affected by trauma associated with the HIV/AIDS crisis, as well as having their identities treated as more of a pathological issue than the way most people view sexuality and gender identity today.  These stressors which are more common in older generations may or may not impact rates of mental health issues, or influence the ways in which they are dealt with.
There has been little research into how LGBT+ people interact with recovery services for disordered gambling, and they are excluded from much analysis on patterns of play. Adding a single question on sexuality and gender identity in more widespread studies on these issues would allow for a lot of beneficial data to be obtained, even if LGBT+ identities are not the central point of research.
Barriers to adequate care
When seeking care or treatment for disordered gambling, LGBT+ people may face particular difficulties which their cisgender, heterosexual counterparts may not face.
Poor conduct of mental health providers - Mental health care providers have been found to have the misconception that mental health disorders stem from sexual minority status, even when there is evidence indicating that simply being a member of a minority group has no effects on mental health. 
In a literature review which studied 14 published works on the topic, a significant barrier to accessing these essential health services for the gay population, was the heteronormative attitudes imposed by health professionals. The LGBT+ population generally is more likely to self-medicate and seek support from non-professional sources due to discrimination, and fear assumptions about their sexual orientation. The fear of having your real health concerns dismissed or linked back to your sexual or gender identity is a very present one.
In a recent survey of almost 700 UK-based participants by the group TransActual, 70% of participants reported being impacted by transphobia in non-trans-related healthcare settings.  This shows the rates at which poor conduct by health providers is impacting transgender and gender-nonconforming communities today. Transgender clients are often not referred to by their chosen names by providers, as well as treated in accordance with negative stereotypes around transgender people – i.e. that they are predatory, confused, or a danger to themselves.
Better training for mental health providers, specifically those who deal with gambling harm, is something which would hopefully improve participation and engagement in mental health services overall.
Stigma in group spaces: Many group therapy and support spaces, such as Gamblers Anonymous, are open to everyone, and in their statement, mention the inclusion and support of people regardless of their marginalised identity.
However, stigmas which the general public in the form of other compulsive gamblers in the same group, or those who chair the groups, may hold, could be expressed to LGBT+ participants. In vulnerable spaces, such experiences may be potentially retraumatising. In a study which conducted interviews on members of Alcoholics Anonymous, a group which shares some structural similarities with Gamblers Anonymous, LGBT+ participants reported a generally heterocentrist language being used that they found alienating, as well being victim to passive-aggression from the group leaders.  Whether or not the groups themselves are welcoming, fear of engaging in spaces may cause LGBT+ participants to be reluctant to engage with them.
Gendered recovery spaces: Many recovery spaces are gendered, either directly (through gender-specific rehabilitation programmes) or indirectly (through a group being composed largely of one specific gender). This is likely to have negative consequences for LGBT+ people, as many people report homophobic, biphobic or transphobic experiences in single-gender spaces. Many trans people would likely be afraid to enrol in these courses for fear of facing transphobia.
Furthermore, if they did apply, they may be rejected on the basis of their gender identity. Across the world, many single-gender spaces reject transgender applicants. In other support spaces, such as homeless shelters, this has occurred, leading to individuals having to go back onto the streets, or seek shelter in the housing spaces for their assigned sex at birth, which can lead to higher rates of assault and sexual abuse. Negative health outcomes are also likely to occur if someone is rejected from a rehabilitation course. Residential courses are often intensive ones, and therefore people experiencing high levels of disordered gambling for whom they may be beneficial would be either actively excluded from engaging with this mental health resource through rejection on the basis of gender identity, or passively, by facing homophobia, biphobia or transphobia and therefore not getting the same benefits as a cisgender, heterosexual participant due to the ongoing minority stress.
Financial barriers. A higher percentage of LGBT+ people are unemployed, with a Stonewall report suggesting almost 1 in 5 LGBT+ people who were looking for work being discriminated against because of their sexual orientation or gender identity.  Issues around work also involve being fired for LGBT+ status, or experiencing workplace discrimination, including physical assaults. The TransActual 2021 study reported 63% of respondents had experienced transphobia while seeking employment, and there has been studies indicating a potential LGBT+ pay gap of up to 16%.  These statistics are generally also impacted by being part of a minority ethnicity in the UK, as well as disability. In countries which require specific health insurance for therapy, trans people are also less likely to be insured. 
This means that paid-for services may be financially harder to access for LGBT+ people suffering gambling harm, making their inclusion in free services and therapies all the more critical.
Recommendations for further study and improvement in standards of care
Include questions about sexuality and gender identity in studies on gambling which are undertaken in the future
Conduct more specific research into gambling disorders in LGBT+ communities
Improve LGBT+ sensitivity training in recovery spaces, and include questions about sexuality and gender identity in intake for these spaces.
Offer LGBT+ specific gambling harm reduction programmes.
Include mentions of the LGBT+ specific increase in gambling risk and the potential increased risk when someone is multiple marginalised identities in early intervention and educational programmes
 Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100(3), 468–475  Richard, J., Martin-Storey, A., Wilkie, E., Derevensky, J.L., Paskus, T. and Temcheff, C.E., 2019. Variations in gambling disorder symptomatology across sexual identity among college student-athletes. Journal of gambling studies, 35(4), pp.1303-1316.  https://www.mckinsey.com/featured-insights/diversity-and-inclusion/being-transgender-at-work  Dentato, M.P., 2012. The minority stress perspective. Psychology and AIDS Exchange Newsletter, 3.  Hershberger, S.L. and Bogaert, A.F., 2005. Male and female sexual orientation differences in gambling. Personality and Individual Differences, 38(6), pp.1401-1411.  Bush, R., Russell, A.M., Staiger, P.K., Waling, A. and Dowling, N.A., 2021. Risk and protective factors for the development of gambling-related harms and problems among Australian sexual minority men. BMC psychology, 9(1), pp.1-18.  Broman, N. and Hakansson, A., 2018. Problematic gaming and internet use but not gambling may be overrepresented in sexual minorities–a pilot population web survey study. Frontiers in psychology, 9, p.2184.  Gambling Statistics Australia February 2022: Do we have a gambling problem? (finder.com.au)  Birch, P., Ireland, J.L., Strickland, C. and Kolstee, J., 2015. Examining Gambling & Mental Health in LGBTI Communities: Executive Summary of Findings from a Preliminary NSW Study.  Gendron, T.L., Pendleton, T. and White, J.T., 2016. Mental health counseling of LGBT elders. In Handbook of LGBT elders (pp. 455-471). Springer, Cham.  Bockting, W., Robinson, B., Benner, A., & Scheltema, K. (2004). Patient satisfaction with transgender health services. Journal of Sex & Marital Therapy, 30(4), 277–294. doi:10. 1080/00926230490422467  Ojeda-Leitner, D. and Lewis, R.K., 2019. Assessing health-related stereotype threats and mental healthcare experiences among a LGBT sample. Journal of prevention & intervention in the community, pp.1-15.  Trans lives survey 2021 — TransActual  "What Barriers to Treatment and Recovery Do LGBT Individuals with Alcoh" by April Smith (jefferson.edu)  LGBT in Britain - Work (stonewall.org.uk)  LGBT+ workers paid £6,700 per year less than straight workers, survey suggests | The Independent | The Independent  Full article: Healthcare Needs of the Transgender Homeless Population (tandfonline.com)