June marks LGBTQ+ pride month in countries across the world, celebrating individuals who identify as lesbian, gay, bisexual, transgender, and queer, among other identities. As more and more members of this community feel encouraged to speak out about their identities, research into this group as a whole has increased – particularly LGBTQ+ youth and adolescents, who are at a critical time in their development. While there has been general growing acceptance and visibility of LGBTQ people, resulting in youth feeling more comfortable disclosing their identities, a significant amount of research has still found alarming differences in mental health outcomes between cisgender/heterosexual and LGBTQ+ youth. Not only are conditions like anxiety and depression more prevalent in LGBTQ+ youth, but there are also higher rates of suicidal thoughts and suicide attempts, as well as misuse of substances like drugs and alcohol. This may make one wonder – in what should be a “better” age of acceptance and support of LGBTQ+ youth, where are these mental health concerns coming from and why are they so urgent?
A potential way to understand this disparity in health outcomes is through minority stress theory. This proposes that minority groups – including racial or ethnic minorities, as well as gender and sexual identity minorities like LGBTQ+ individuals – experience ongoing psychosocial stress simply for existing as a minority. Because they are not part of the majority social demographic, they experience unique social marginalization, whether explicitly or not, which can create or lead to mental health problems. For example, a transgender person who comes out in high school may experience support from some peers, but from others may receive verbal assaults, lose friends who are uncomfortable with their transition, not know any other trans people and thus not know who to talk to about their experiences, or simply be more aware of whispers behind their back. All of these stressors as a result of their minority status may seem small in isolation, but when combined and occurring everyday, can have significant detrimental impacts on one’s mental health. It may not be surprising, then, that LGBTQ+ individuals are more at risk for depression, anxiety, traumatic stress disorders, and suicidality. These negative effects are exponentially increased the more minority statuses one holds, as they may experience not only homophobia or transphobia, but sexism or racism. For example, Black and Hispanic people report higher suicide attempts than white LGBTQ+ individuals, and lesbian and bisexual women of colour had the greatest risk of lifetime substance abuse compared to White lesbian and bisexual women.
This difficulty is compounded in adolescence, when LGBTQ+ individuals are more likely to come out, but also more likely to face exclusionary or discriminatory behaviors from their peers. Adolescence, typically defined as between 13-18 years of age in research, is already a vulnerable time for individuals’ social, physical, emotional and mental development. In adolescence, peers’ opinions are more valuable than at any other time in life, and when adolescents are trying to formulate their identity, it is more critical than ever to have strong social relations in the form of supportive family, peers, and friends. This social support is what allows them to develop positive self-esteem and growth, leading to more successful transitions to adulthood. When this social support is absent, or even more dramatically, shifts to harassment or exclusion, it can have significant impacts on adolescents’ development into adulthood and beyond. While coming out is possible for youth and even commonplace in certain areas, it coincides with a time in their lives where conformity and fitting in is more important than ever, self-consciousness is at an all-time high, and peers tend to have the strongest opinions, and thus, be most likely to act on those opinions. Adolescents, for example, can be more likely to act discriminatory than an adult who has developed greater empathy, perspective taking, and understanding of the consequences of their actions. This has been shown to result in higher victimization of LGBTQ+ youth – meaning that they are frequent victims of verbal or physical harassment regarding their identity, or of exclusionary behavior. This could mean while they’re not actively being bullied, they are being ignored or actively excluded by peers. LGBTQ+ youth may also be anticipating rejection or victimization from their peers, so be less likely to come out or be less expressive of their identity if they do come out. They may also internalize negative social attitudes like homophobia or transphobia from their peers, and feel that they need to hide their identity, or that it is somehow wrong because it doesn’t fit the norm. For example, a 2015 study found that approximately 85% of LGBTQ+ high school youth were verbally abused and 27% were physically harassed but 58% of victims didn’t even report it as they feared retaliation or didn’t feel their needs would be met. In fact, 64% of the students who did report victimization were ignored.
This leads us to another factor contributing to high levels of mental illness in the LGBTQ+ community – a lack of appropriate and effective care. LGBTQ+ youth are more likely to report a need for support and more likely to seek professional help. Thus, they may access mental health care more often than heterosexual youth, and even receive more diagnoses, but are also more likely to report low levels of satisfaction and of feeling their needs have actually been met. This is likely because it may be difficult for LGBTQ+ individuals to access adequate mental health services, particularly if they come from a family or culture that doesn’t encourage seeking professional help, if they face financial barriers, or if they have had negative or discriminatory experiences with practitioners in the past. Many professionals may not have had adequate training to support the needs of LGBTQ+ people, particularly if they have been practicing for decades and may not have the cultural competency that allows them to understand the specific needs that LGBTQ+ patients may have that heterosexual or cisgendered patients do not. If, for example, a lesbian woman of color was seeking treatment for her depression from a white practitioner who had no lived experience with LGBTQ+ patients, she may not feel that her practitioner will understand or be able to sufficiently meet her needs, and may even fear her concerns will be belittled or misunderstood. This has led to greater utilization of informal support networks through friends or family, and even seeking help through social media sites, both of which can be less effective, and even harmful, compared to professional care.
It is undeniable that there is a mental health crisis among LGBTQ+ youth that is having severe impacts from adolescence into adulthood. So what are some solutions, and what can we do? As with any social issue that is ingrained into every level of society, we need change at every level of society. On an individual and school level, this could include more social support networks for LGBTQ+ individuals including school clubs, policies and supports that prevent peer victimization of LGBTQ+ youth and provide a safe space to build community. On a clinical and health care level, this could mean training culturally competent practitioners equipped to meet LGBTQ+ individuals’ needs like they are any other minority and specialized treatment plans. On a broader community and policy level, this could mean evidence-based community supports and interventions; and state policies that protect LGBTQ+ youth and encourage positive social attitudes around LGBTQ+ individuals.
It is clear that on a broader social level, we’ve made progress. But while most Americans report being supportive of the LGBTQ+ community, there is more work to do to ensure that this support translates to positive and equitable health outcomes.
References:
https://doi.org/10.1007/978-3-030-70060-7 Assessed and Endorsed by the MedReport Medical Review Board