At Somnova, we're in the business of having candid discussions of mental
health. Awareness and understanding are the first steps toward resolving mental
health issues, and even basic knowledge of community problems can go a long way
toward promoting better outcomes. It's natural, then, that we should discuss
the mental health situation of LGBTQ+ individuals for pride month. Before we
proceed, I'll warn that the following discussion contains mentions of sexual
assault, suicide, homophobia, and transphobia. We'll jump right in.
That there is a mental health crisis in the LGBTQ+ (Lesbian, Gay,
Bisexual, Transgender, Queer, and otherwise “queered”) population is no
controversy. The Human Rights Campaign Foundation reports, in one study of
LGBTQ+ youth, that 28% of youth report feeling depressed “most or all of the
time” during the previous 30 days, as compared to 12% of other youth [1]. In a
different study, those in the LGBTQ+ population were found to have a 250%
greater risk of attempting suicide, and 150% greater risk of depression and
anxiety [2]. Prevalence of substance abuse is also two to three times the
general population baseline [3]. Moreover, across the board, the numbers
indicate that transgender individuals are at greater risk for mental illness,
substance abuse, and suicide than non-transgender LGBTQ+ people [1]. Experience
of sexual assault is also prevalent and, for certain demographics such as
bisexual women, reported by a majority [4].
This is all very grim, of course. Worse yet, these same statistics are often
misrepresented to depict the LGBTQ+ population as mentally ill just because
of their LGBTQ+ status. This is misleading and flies in the face of existing
science on the social factors that result in mental illness; it’s those social
factors that we’re concerned with today.
Consider that LGBTQ+ people who experience family rejection are, as one would expect, at
higher risk for depression, drug use, unsafe sex, and attempted suicide [2]. In
Ontario, half of trans individuals reported living on less than $15 000
annually; poverty is clearly implicated in poor mental health outcomes [2]. In
the United States, LGBTQ+ children and youth at schools with specific policies
against bullying targeted to sexual orientation or gender are half as likely to
report suicide attempts in the past year [5]. In other words: LGBTQ+
individuals are treated poorly, and so they feel poorly. This is no surprise.
But we aren’t here just to tell sad stories. The point of all this is that
there are very concrete things that anyone can do to promote better mental
health outcomes among LGBTQ+ individuals. For a stark example, observe that
when a young trans person is able to live life under their own name, their
self-reported depression decreases substantially; suicidal ideation decreases
by 29%, and risk of suicidal behaviour decreases by 56% [6]. Thus, using the
correct name for a trans person is suicide prevention.
One study demonstrates that family support is associated with substantially
improved mental health outcomes among LGB individuals in particular [7].
Another shows that positive reactions to coming out result in a lower risk of
substance abuse [8]. An Ontario study shows that social inclusion and access to
desired medical transition procedures is associated with a significantly lower
suicide risk in trans individuals [9]. The moral of these is clear: being
lesbian, gay, bisexual, trans, queer, etc., is not a mental illness;
discrimination against each of these minorities, however, results in
mental illness, and actively combating that discrimination will contribute to
better mental health outcomes.
LGBTQ+ individuals experience discrimination in work, healthcare, and
interpersonal relationships, and each of these is associated with poorer
outcomes. A study by the American Foundation for Suicide Prevention and the
Williams Institute found an overall suicide attempt rate of 41% among trans
individuals. This is already a horrifying statistic – if you know even one
trans person, odds almost are that they’ve attempted suicide. But the
relationship between socioeconomic exclusion and suicide is also clear: being
denied housing, access to appropriate washrooms, correct gendering, a
relationship with parents, or access to medical care all are associated
with a greater-than-50% risk of attempted suicide [10]. Ensuring that trans
people are permitted to participate in society to the same degree as cis people
is essential to positive life outcomes.
For non-trans LGBQ+ individuals, living in a more stigmatizing community is
associated with a life expectancy that is 12 years shorter than LGBQ+
people in communities self-reported as the least discriminating [11]. Whether
through the physiological effects of anxiety and depression, the burden
substance abuse puts on bodies, or suicide, these people die more than a whole
decade sooner because of the discrimination they experience. This
discrimination is often legal: after a wave of state bans on marriage equality
in 2004 and 2005, LGBQ+ people in those states reported a 30% increase in mood
disorders; those in states without these bans reported a 20% decrease [11].
These numbers repeat again and again in the cases of ability to live as openly
LGBTQ+ [3], support of LGBQ+ sexuality [13], trans access to desired transition
resources [12], family acceptance [2], and so on. Over and over, greater levels
of acceptance, equal treatment, and tolerance are associated with lower risks
of mental illness, substance abuse, and suicide.
The takeaway from this pride month, then, is that the situation is serious, but
it isn’t without hope. Listening to LGBTQ+ people about their experiences,
supporting them in any environment, advocating for their inclusion and equal
legal status, are all ways anyone can support a population which is continuing
to experience intense ostracization. Voting toward inclusive policies is
important; so is protesting unfair, discriminatory treatment. Comprehensive
sexual education is critical to fostering safe sex practices and positive
self-image, as is accessible medical care. And, as always, there’s an abundance
of easy to find information on the internet. Just a glance at one of the
sources below can be very illuminating.
Happy
Pride!
Sources
[1] Mental
Health and the LGBTQ Community. Human Rights Campaign Foundation. https://suicidepreventionlifeline.org/wp-content/uploads/2017/07/LGBTQ_MentalHealth_OnePager.pdf
[2] LGBTQ
Mental Health. Rainbow Health Ontario. https://www.rainbowhealthontario.ca/wp-content/uploads/woocommerce_uploads/2011/06/RHO_FactSheet_LGBTQMENTALHEALTH_E.pdf
[3] Lesbian/Gay/Bisexual/Transgender
Communities and Mental Health. Mental Health America. https://www.mentalhealthamerica.net/lgbt-mental-health
[4] Sexual
Assault and the LGBTQ Community. Human Rights Campaign Foundation. https://www.hrc.org/resources/sexual-assault-and-the-lgbt-community
[5]
Hatzenbuehler ML, Keyes KM. Inclusive anti-bullying policies and reduced
risk of suicide attempts in lesbian and gay youth. J. Adolesc. Health.
2013;53:S21–26
[6]
Russell ST, Pollitt AM, Li G, Grossman AH. Chosen Name Use Is Linked to
Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behaviour Among
Transgender Youth. J. Adolesc. Health. 2018;63:S503-505
[7]
Benibgui M. Mental health challenges and resilience in lesbian, gay and
bisexual young adults: Biological and psychological internalization of minority
stress and victimization. 2011
[8]
Rosario M, Schrimshaw EW, Hunter J. Disclosure of sexual orientation and
subsequent substance use and abuse among lesbian, gay, and bisexual youths:
Critical role of disclosure reactions. Psychology of Addictive Behaviour. 2009;
23(1):175-184.
[9] Bauer
GR, Scheim AI, Pyne J, Travers R, Hammond R. Intervenable factors associated
with suicide risk in transgender persons: a respondent driven sampling study in
Ontario, Canada. BMC public health. 2015 Dec;15(1):525.
[10] Suicide
Attempts Among Transgender and Gender Non-Conforming Adults. American
Foundation for Suicide Prevention & the Williams Institute. 2014. https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf
[11]
Hatzenbuehler, M.L., McLaughlin, K.A., Keyes, K.M. and Hasin, D.S., 2010. The
impact of institutional discrimination on psychiatric disorders in lesbian,
gay, and bisexual populations: A prospective study. American journal of
public health, 100(3), pp.452-459.
[12]
McNeil J, Bailey L, Ellis S, Morton J, Regan M. Trans Mental Health Study
2012. 2012. https://www.gires.org.uk/wp-content/uploads/2014/08/trans_mh_study.pdf?fbclid=IwAR2Dzp_m0OD5Wg-NKiQuSb3mnoyLRz33zm7k0gOB9-7oLba45Fck6bvM28E
[13]
Russell, S.T. and Fish, J.N., 2016. Mental health in lesbian, gay, bisexual,
and transgender (LGBT) youth. Annual review of clinical psychology, 12,
pp.465-487.