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]
Anxiety
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]
Depression
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]
Post-traumatic stress disorder
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]
Suicide
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]
Substance abuse
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]
Eating disorders
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.
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