This study examined rates of mental health outcomes between LGBTQ+ students and their straight/heterosexual and cisgender peers. The participants included undergraduate students (n = 77,635) from 142 institutions of higher education in the United States who completed the Spring 2024 National College Health Assessment (NCHA). Cross-tabulations with the Pearson X2 test examined differences between queer (those who identified their sexual orientation as asexual, bisexual, gay, lesbian, pansexual, queer, or questioning) students and their straight/heterosexual peers, and between trans students and their cisgender peers. In every case, LGBTQ+ students reported negative mental health outcomes; problems and challenges with stressors, relationships, and experiences; and the negative impact of these variables on their academic performance at rates significantly higher than their peers. In addition, LGBTQ+ students described the campus climate as less supportive of their mental health and well-being than their peers. This study documents disparities between LGBTQ+ students and their non-LGBTQ+ peers. Given that health and well-being are foundational to college student success, campuses should increase efforts to provide culturally supportive education and services to better support these marginalized communities. The authors offer a number of resources to help improve the campus environment for LGBTQ+ students.