Depression and anxiety rates are “alarmingly high” among LGBTQ Southerners, according to a new survey.

Those figures are even higher for people who experienced abuse “due to their LGBTQ identity,” according to a report released this month from the Campaign for Southern Equality.

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The North Carolina-based organization asked 5,617 adults questions about their mental and physical health. They lived in 13 states, spanning from West Virginia to Texas.

About half of all respondents thought “being in the South makes it always or often harder to access quality medical care for LGBTQ individuals.”

And throughout the region, people living in rural areas reported lower physical and mental health ratings than urban residents, according to the results.

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In the realm of physical health, most respondents reported being “good” or “excellent,” the survey found. But there were disparities for respondents who were transgender or had lower incomes.

“This stratification of experience suggests that LGBTQ-friendly health care exists in the South, but is not universally available,” the study says.

Another divide was related to mental health, as more than half of transgender Southerners reported having suicidal thoughts. Among all survey respondents, the rate was 26%.

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In all, 54% of people reported having depression, and 46% reported having anxiety. The survey said the rates are “disproportionately high when compared to the general population.”

Throughout the United States, about 7% of adults had a “major depressive episode” within the last year, according to the 2018 National Survey on Drug Abuse and Health.

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The Campaign for Southern Equality in its survey also examined comfort with seeking medical care and living with HIV. To help LGBTQ Southerners, the organization recommends people be welcoming and advocate for accessible health care resources.

Western North Carolina Community Health Services was a survey partner, officials said.