



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.



