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Introduction: While accumulating evidence shows that sexual orientation change efforts (SOCE) are harmful and ineffective, SOCE is still highly prevalent in some regions where homosexuality is heavily stigmatized. This study investigated the experiences, motivations, and impacts of SOCE among sexual minorities in Hong Kong and examined the mediating role of sexual identity distress in the relationship between SOCE and mental health. Methods: A total of 219 sexual minority individuals completed a questionnaire on SOCE in 2020–2021. They were asked to report their experiences, motivations, perceived effectiveness, benefits, and harms of SOCE. They were also assessed on sexual identity distress, depressive and anxiety symptoms, and suicidality. Results: Religious beliefs and interpersonal concerns were the primary motivations for SOCE. Participants who had experienced SOCE showed significantly higher levels of internalized homonegativity, identity uncertainty, and difficult process than their counterparts who had not experienced SOCE. They were also at a greater risk of developing depressive symptoms and suicidal ideation. Such discrepancy in mental health could be explained by heightened levels of sexual identity distress experienced by individuals who had experienced SOCE. Conclusions: This study was the first to characterize the experiences and impacts of SOCE in Hong Kong and provided empirical evidence for the role of sexual identity distress as a key mechanism mediating the relationship between SOCE and mental health. Policy Implications: The study concludes with recommendations for legislation, psychological interventions, and public education in Hong Kong to reduce the prevalence and negative impacts of SOCE. [ABSTRACT FROM AUTHOR]