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People who are LGBT are significantly more likely than those who are not to experience depression, PTSD, and generalized anxiety disorder.
The minority stress model takes into account significant stressors that distinctly affect the mental health of those who identify as lesbian, gay, bisexual, transgender, or another non-conforming gender identity. [1] Some risk factors that contribute to declining mental health are heteronormativity, discrimination, harassment, rejection (e.g., family rejection and social exclusion), stigma, prejudice, denial of civil and human rights, lack of access to mental health resources, lack of access to gender-affirming spaces (e.g., gender-appropriate facilities), [2] and internalised homophobia. [1] [3] The structural circumstance where a non-heterosexual or gender non-conforming individual is embedded in significantly affects the potential sources of risk. [4] The compounding of these everyday stressors increase poor mental health outcomes among individuals in the LGBT community. [4] Evidence shows that there is a direct association between LGBT individuals' development of severe mental illnesses and the exposure to discrimination. [5]
In addition, there are a lack of access to mental health resources specific to LGBT individuals and a lack of awareness about mental health conditions within the LGBT community that restricts patients from seeking help. [3]
There is limited research on mental health in the LGBT community. Several factors affect the lack of research on mental illness within non-heterosexual and non-conforming gender identities. Some factors identified: the history of psychiatry with conflating sexual and gender identities with psychiatric symptomatology; medical community's history of labelling gender identities such as homosexuality as an illness (now removed from the DSM); the presence of gender dysphoria in the DSM-V; prejudice and rejection from physicians and healthcare providers; LGBT underrepresentation in research populations; physicians' reluctance to ask patients about their gender; and the presence of laws against the LGBT community in many countries. [5] [6] General patterns such as the prevalence of minority stress have been broadly studied. [1]
There is also a lack of empirical research on racial and ethnic differences in mental health status among the LGBT community and the intersection of multiple minority identities. [4]
There is a significantly greater stigmatization of LGBT individuals with more severe conditions. The presence of the stigma affects individuals' access to treatment and is particularly present for non-heterosexual and gender non-conforming individuals with schizophrenia. [5]
LGBT individuals are nearly three times more likely to experience anxiety compared to heterosexual individuals. [7] Gay and bisexual men are more likely to have generalized anxiety disorder (GAD) as compared to heterosexual men. [8]
Individuals who identify as non-heterosexual or gender non-conforming are more likely to experience depressive episodes and suicide attempts than those who identify as heterosexual. [5] Based solely on their gender identity and sexual orientation, LGBT individuals face stigma, societal bias, and rejection that increase the likelihood of depression. [3] Gay and bisexual men are more likely to have major depression and bipolar disorder than heterosexual men. [8]
Transgender youth are nearly four times more likely to experience depression, as compared to their non-transgender peers. [2] Compared to LGBT youth with highly accepting families, LGBT youth with less accepting families are more than three times likely to consider and attempt suicide. [2] As compared to individuals with a level of certainty in their gender identity and sexuality (such as LGB-identified and heterosexual students), youth who are questioning their sexuality report higher levels of depression and worse psychological responses to bullying and victimization. [4] Transgender youth who report higher feelings of internalized transphobia are found to be more likely to meet the diagnostic criteria for depression. On the other hand, those who report their perceived physical appearance are consistent with their internal gender identity are less likely to be diagnosed with depression. [9]
31% of LGBT older adults report depressive symptoms. LGBT older adults experience LGBT stigma and ageism that increase their likeliness to experience depression. [7]
LGBT individuals experience higher rates of trauma than the general population, the most common of which include intimate partner violence, sexual assault and hate violence. [10] Compared to heterosexual populations, LGBT individuals are at 1.6 to 3.9 times greater risk of probable PTSD. One-third of PTSD disparities by sexual orientation are due to disparities in child abuse victimization. [11]
As compared to heterosexual men, gay and bisexual men are at a greater risk for suicide, attempting suicide, and dying of suicide. [8] In the United States, 29% (almost one-third) of LGBT youth have attempted suicide at least once. [12] Compared to heterosexual youth, LGBT youth are twice as likely to feel suicidal and over four times as likely to attempt suicide. [2] Transgender individuals are at the greatest risk of suicide attempts. [7] One-third of transgender individuals (both in youth and adulthood) has seriously considered suicide and one-fifth of transgender youth has attempted suicide. [2] [7]
LGBT youth are four times more likely to attempt suicide than heterosexual youth. [7] Youth who are questioning their gender identity and/or sexuality are two times more likely to attempt suicide than heterosexual youth. [7] Bisexual youth have higher percentages of suicidality than lesbian and gay youth. [4] As compared to white transgender individuals, transgender individuals who are African American/black, Hispanic/Latinx, American Indian/Alaska Native, or Multiracial are at a greater risk of suicide attempts. [7] 39% of LGBT older adults have considered suicide. [7]
In the United States, an estimated 20-30% of LGBT individuals abuse substances. This is higher than the 9% of the U.S. population that abuse substances. In addition, 25% of LGBT individuals abuse alcohol compared to the 5-10% of the general population. [3] Lesbian and bisexual youth have a higher percentage of substance use problems as compared to sexual minority males and heterosexual females. [4] However, as young sexual minority males mature into early adulthood, their rate of substance use increases. [4] Lesbian and bisexual women are twice as likely to engage in heavy alcohol drinking as compared to heterosexual women. [7] Gay and bisexual men are less likely to engage in heavy alcohol drinking as compared to heterosexual men. [7]
Substance use such as alcohol and drug use among LGBT individuals can be a coping mechanism in response to everyday stressors like violence, discrimination, and homophobia. Substance use can threaten LGBT individuals' financial stability, employment, and relationships. [8]
The average age for developing an eating disorder is 19 years old for LGBT individuals, compared to 12–13 years old nationally. [13] In a national survey of LGBTQ youth conducted by the National Eating Disorders Association, The Trevor Project and the Reasons Eating Disorder Center in 2018, 54% of participants indicated that they had been diagnosed with an eating disorder. [14] An additional 21% of surveyed participants suspected that they had an eating disorder. [14]
Various risk factors may increase the likelihood of LGBT individuals experiencing disordered eating, including fear of rejection, internalised negativity, post-traumatic stress disorder (PTSD) or pressure to conform with body image ideals within the LGBT community. [15]
42% of men who experience disordered eating identify as gay. [15] Gay men are also seven times more likely to report binge eating and twelve times more likely to report purging than heterosexual men. Gay and bisexual men also experience a higher prevalence of full-syndrome bulimia and all subclinical eating disorders than their heterosexual counterparts. [15]
Research has found lesbian women to have higher rates of weight-based self-worth and proneness to contracting eating disorders compared to gay men. [16] Lesbian women also experience comparable rates of eating disorders compared to heterosexual women, with similar rates of dieting, binge eating and purging behaviours. [16] However, lesbian women are more likely to report positive body image compared to heterosexual females (42.1% vs 20.5%). [16]
Transgender individuals are significantly more likely than any other LGBT demographic to report an eating disorder diagnosis or compensatory behaviour related to eating. [17] Transgender individuals may use weight restriction to suppress secondary sex characteristics or to suppress or stress gendered features. [17]
There is limited research regarding racial differences within LGBT populations as it relates to disordered eating. [18] Conflicting studies have struggled to ascertain whether LGBT people of colour experience similar or varying rates of eating disorder proneness or diagnosis. [18]
Each individual has its own way to deal with difficult emotions and situations. Oftentimes, the coping mechanism adopted by a person, depending on whether they are safe or risky, will impact their mental health. These coping mechanisms tend to be developed during youth and early-adult life. Once a risky coping mechanism is adopted, it is often hard for the individual to get rid of it.
Safe coping-mechanisms, when it comes to mental disorders, involve communication with others, body and mental health caring, support and help seeking. [19]
Because of the high stigmatization they often experience in school, public spaces and society in general, the LGBT community, and more especially the young people among them are less likely to express themselves and seek for help and support, because of the lack of resources and safe spaces available for them to do so. As a result, LGBT patients are more likely to adopt risky coping mechanisms then the rest of the population.
These risky mechanisms involve strategies such as self-harm, substance abuse, or risky sexual behavior for many reasons, including; "attempting to get away from or not feel overwhelming emotions, gaining a sense of control, self-punishment, nonverbally communicating their struggles to others." [20] Once adopted, these coping mechanisms tend to stick to the person and therefore endanger even more the future mental health of LGBT patients, reinforcing their exposure to depression, extreme anxiety and suicide.
Transphobia consists of negative attitudes, feelings, or actions towards transgender people or transness in general. Transphobia can include fear, aversion, hatred, violence or anger towards people who do not conform to social gender roles. Transphobia is a type of prejudice and discrimination, similar to racism, sexism, or ableism, and it is closely associated with homophobia. People of color who are transgender experience discrimination above and beyond that which can be explained as a simple combination of transphobia and racism.
The LGBTQ community is a loosely defined grouping of lesbian, gay, bisexual, transgender, and queer or questioning individuals united by a common culture and social movements. These communities generally celebrate pride, diversity, individuality, and sexuality. LGBTQ activists and sociologists see LGBTQ community-building as a counterweight to heterosexism, homophobia, biphobia, transphobia, sexualism, and conformist pressures that exist in the larger society. The term pride or sometimes gay pride expresses the LGBTQ community's identity and collective strength; pride parades provide both a prime example of the use and a demonstration of the general meaning of the term. The LGBTQ community is diverse in political affiliation. Not all people who are lesbian, gay, bisexual, or transgender consider themselves part of the LGBTQ community.
Biphobia is aversion toward bisexuality or people who are identified or perceived as being bisexual. Similarly to homophobia, it refers to hatred and prejudice specifically against those identified or perceived as being in the bisexual community. It can take the form of denial that bisexuality is a genuine sexual orientation, or of negative stereotypes about people who are bisexual. Other forms of biphobia include bisexual erasure. Biphobia may also avert towards other sexualities attracted to multiple genders such as pansexuality or polysexuality, as the idea of being attracted to multiple genders is generally the cause of stigma towards bisexuality.
The field of psychology has extensively studied homosexuality as a human sexual orientation. The American Psychiatric Association listed homosexuality in the DSM-I in 1952 as a "sociopathic personality disturbance," but that classification came under scrutiny in research funded by the National Institute of Mental Health. That research and subsequent studies consistently failed to produce any empirical or scientific basis for regarding homosexuality as anything other than a natural and normal sexual orientation that is a healthy and positive expression of human sexuality. As a result of this scientific research, the American Psychiatric Association removed homosexuality from the DSM-II in 1973. Upon a thorough review of the scientific data, the American Psychological Association followed in 1975 and also called on all mental health professionals to take the lead in "removing the stigma of mental illness that has long been associated" with homosexuality. In 1993, the National Association of Social Workers adopted the same position as the American Psychiatric Association and the American Psychological Association, in recognition of scientific evidence. The World Health Organization, which listed homosexuality in the ICD-9 in 1977, removed homosexuality from the ICD-10 which was endorsed by the 43rd World Health Assembly on 17 May 1990.
LGBTQ culture is a culture shared by lesbian, gay, bisexual, transgender, and queer individuals. It is sometimes referred to as queer culture, LGBT culture, and LGBTQIA culture, while the term gay culture may be used to mean either "LGBT culture" or homosexual culture specifically.
A sexual minority is a demographic whose sexual identity, orientation or practices differ from the majority of the surrounding society. Primarily used to refer to lesbian, gay, bisexual, or non-heterosexual individuals, it can also refer to transgender, non-binary or intersex individuals.
Sex is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.
The questioning of one's sexual orientation, sexual identity, gender, or all three is a process of exploration by people who may be unsure, still exploring, or concerned about applying a social label to themselves for various reasons. The letter "Q" is sometimes added to the end of the acronym LGBT ; the "Q" can refer to either queer or questioning.
Timeline of events related to sexual orientation and medicine
The Think Before You Speak campaign is a television, radio, and magazine advertising campaign launched in 2008 and developed to raise awareness of the common use of derogatory vocabulary among youth towards lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) people. It also aims to "raise awareness about the prevalence and consequences of anti-LGBTQ bias and behaviour in America's schools." As LGBTQ people have become more accepted in the mainstream culture, more studies have confirmed that they are one of the most targeted groups for harassment and bullying. An "analysis of 14 years of hate crime data" by the FBI found that gays and lesbians, or those perceived to be gay, "are far more likely to be victims of a violent hate crime than any other minority group in the United States". "As Americans become more accepting of LGBT people, the most extreme elements of the anti-gay movement are digging in their heels and continuing to defame gays and lesbians with falsehoods that grow more incendiary by the day," said Mark Potok, editor of the Intelligence Report. "The leaders of this movement may deny it, but it seems clear that their demonization of gays and lesbians plays a role in fomenting the violence, hatred and bullying we're seeing." Because of their sexual orientation or gender identity/expression, nearly half of LGBTQ students have been physically assaulted at school. The campaign takes positive steps to counteract hateful and anti-gay speech that LGBTQ students experience in their daily lives in hopes to de-escalate the cycle of hate speech/harassment/bullying/physical threats and violence.
Various issues in medicine relate to lesbian, gay, bisexual, transgender and queer (LGBTQ) people. According to the US Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBTQ health include breast and cervical cancer, hepatitis, mental health, substance use disorders, alcohol use, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."
Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, transgender and queer (LGBTQ) youth are significantly higher than among the general population.
Minority stress describes high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status; well understood causes of minority stress are interpersonal prejudice and discrimination. Indeed, numerous scientific studies have shown that when minority individuals experience a high degree of prejudice, this can cause stress responses that accrue over time, eventually leading to poor mental and physical health. Minority stress theory summarizes these scientific studies to explain how difficult social situations lead to chronic stress and poor health among minority individuals.
Research shows that a disproportionate number of homeless youth in the United States identify as lesbian, gay, bisexual, transgender or queer, or LGBTQ. Researchers suggest that this is primarily a result of hostility or abuse from the young people's families leading to eviction or running away. In addition, LGBTQ youth are often at greater risk for certain dangers while homeless, including being the victims of crime, risky sexual behavior, substance use disorders, and mental health concerns.
The following outline offers an overview and guide to LGBTQ topics:
LGBTQ psychology is a field of psychology of surrounding the lives of LGBTQ+ individuals, in the particular the diverse range of psychological perspectives and experiences of these individuals. It covers different aspects such as identity development including the coming out process, parenting and family practices and support for LGBTQ+ individuals, as well as issues of prejudice and discrimination involving the LGBTQ community.
Due to the increased vulnerability that lesbian, gay, bisexual, transgender and queer (LGBTQ) youth face compared to their non-LGBTQ peers, there are notable differences in the mental and physical health risks tied to the social interactions of LGBTQ youth compared to the social interactions of heterosexual youth. According to the article "Social Media: A double-edged sword for LGBTQ+ Youth", the study showed that "in comparison to cisgender youth, transgender and gender binary youth had a higher risk of depression and anxiety" from social media exposure. Youth of the LGBTQ community experience greater encounters with not only health risks, but also violence and bullying, due to their sexual orientation, self-identification, and lack of support from institutions in society.
Sexual assault of LGBT people, also known as sexual and gender minorities (SGM), is a form of violence that occurs within the LGBT community. While sexual assault and other forms of interpersonal violence can occur in all forms of relationships, it is found that sexual minorities experience it at rates that are equal to or higher than their heterosexual counterparts. There is a lack of research on this specific problem for the LGBT population as a whole, but there does exist a substantial amount of research on college LGBT students who have experienced sexual assault and sexual harassment.
The health access and health vulnerabilities experienced by the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA) community in South Korea are influenced by the state's continuous failure to pass anti-discrimination laws that prohibit discrimination based on sexual orientation and gender identity. The construction and reinforcement of the South Korean national subject, "kungmin," and the basis of Confucianism and Christian churches perpetuates heteronormativity, homophobia, discrimination, and harassment towards the LGBTQI community. The minority stress model can be used to explain the consequences of daily social stressors, like prejudice and discrimination, that sexual minorities face that result in a hostile social environment. Exposure to a hostile environment can lead to health disparities within the LGBTQI community, like higher rates of depression, suicide, suicide ideation, and health risk behavior. Korean public opinion and acceptance of the LGBTQI community have improved over the past two decades, but change has been slow, considering the increased opposition from Christian activist groups. In South Korea, obstacles to LGBTQI healthcare are characterized by discrimination, a lack of medical professionals and medical facilities trained to care for LGBTQI individuals, a lack of legal protection and regulation from governmental entities, and the lack of medical care coverage to provide for the health care needs of LGBTQI individuals. The presence of Korean LGBTQI organizations is a response to the lack of access to healthcare and human rights protection in South Korea. It is also important to note that research that focuses on Korean LGBTQI health access and vulnerabilities is limited in quantity and quality as pushback from the public and government continues.
Bisexual can most clearly be described as an individual who feels romantic and/or sexual attraction towards more than one gender. Victimization is any damage or harm inflicted by one individual onto another. In the United States, bisexual women are more prone to various types of victimization. They tend to experience rape, stalking, and partner-perpetrated contact sexual violence at significantly higher rates than heterosexual women. Bisexual women of color reported these forms of violence at much higher rates than white bisexual women, lesbians of all races, and heterosexual women in general.
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