LGBTQIA+
The Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, Plus (LGBTQIA+*) community represents a diverse range of identities and expressions of gender and sexual orientation. In addition to these identities, members of the community are diverse in terms of race, religion, ethnicity, nationality, and socioeconomic class. This intersectionality — the combined and overlapping aspects of a persons’s identity — brings diversity of thought, perspective, understanding and experience. This complexity is important to understand as a unique and valuable aspect of the LGBTQIA+ community that can result in a strong sense of pride and resiliency.
While belonging to the LGBTQIA+ community can be a source of strength, it also brings unique challenges. For those who identify as LGBTQIA+, it’s important to recognize how your experience of sexual orientation and gender identity relates to your mental health.
Although the full range of LGBTQIA+ identities are not commonly included in large-scale studies of mental health, there is strong evidence from recent research that members of this community are at a higher risk for experiencing mental health conditions — especially depression and anxiety disorders. LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition. Transgender individuals are nearly four times as likely as cisgender (people whose gender identity corresponds with the sex they were assigned at birth) individuals to experience a mental health condition.
LGB youth also experience greater risk for mental health conditions and suicidality. LGB youth are more than twice as likely to report experiencing persistent feelings of sadness or hopelessness than their heterosexual peers. Transgender youth face further disparities as they are twice as likely to experience depressive symptoms, seriously consider suicide, and attempt suicide compared to cisgender lesbian, gay, bisexual, queer and questioning youth.
For many LGBTQIA+ people, socioeconomic and cultural conditions negatively impact mental health conditions. Many in the LGBTQIA+ community face discrimination, prejudice, denial of civil and human rights, harassment, and family rejection, which can lead to new or worsened symptoms, particularly for those with intersecting racial or socioeconomic identities.
Risk Factors of LGBTQIA+ Mental Health
Coming Out
Positive changes in societal acceptance of LGBTQIA+ people act as a protective factor for mental health. However, this shift in acceptance has meant that many LGBTQIA+ youth “come out” or share their sexual orientation or gender identity at younger developmental ages, which can impact their social experiences and relationships. This can have negative mental health impacts, particularly for youth who are not in supportive environments.
Rejection
For many in the LGBTQIA+ community, coming out can be a difficult or even traumatic experience. It can be difficult to cope with rejection of something as personal as one’s identity from family or close friends, within the workplace, or in a faith community.
According to a 2013 survey, 40% of LGBT adults have experienced rejection from a family member or a close friend. A 2019 school climate survey showed that 86% of LGBTQIA+ youth reported being harassed or assaulted at school, which can significantly impact their mental health. And a 2022 report from The Trevor Project found that just 37% of LGBTQIA+ youth identified their home as an LGBTQIA-affirming space.
Trauma
Homophobia, biphobia, transphobia, bullying, and feeling identity-based shame is often traumatic for people.
The LGBTQIA+ community faces many forms of discrimination, including: labeling, stereotyping, denial of opportunities or access, and verbal, mental, and physical abuse. They are one of the most targeted communities by perpetrators of hate crimes in the country.
Such discrimination can contribute to a significantly heightened risk for post-traumatic stress disorder among individuals in the LGBTQIA+ community compared to those who identity as heterosexual and/or cisgender.
Substance Use
Substance misuse or overuse, which may be used as a coping mechanism or method of self-medication, is a significant concern for members of this community. LGB adults are nearly twice as likely as heterosexual adults to experience a substance use disorder. Transgender individuals are almost four times as likely as cisgender individuals to experience a substance use disorder. Illicit drug use is significantly higher in high school-aged youth who identify as LGB or are unsure of their identity, compared to their heterosexual peers.
Homelessness
It is estimated that LGBTQIA+ youth and young adults have a 120% higher risk of experiencing homelessness — often the result of family rejection or discrimination based on gender identity or sexual orientation. This risk is especially high among Black and Indigenous LGBTQIA+ youth. Many members of the LGBTQIA+ community face the added challenge of finding homeless shelters that will accept them, and experience elevated rates of harassment and abuse in these spaces.
Suicide
Many people in this community struggle in silence — and face worse health outcomes as a result.
- The LGBTQIA+ population is at a higher risk than the heterosexual, cisgender population for suicidal thoughts and suicide attempts.
- High school students who identify as lesbian, gay, or bisexual are more than four times as likely to have attempted suicide compared to their heterosexual peers.
- 40% of transgender adults have attempted suicide in their lifetime, compared to less than 5% of the general U.S. population.
Inadequate Mental Health Care
The approach to sexual orientation and gender identity in mental health care often groups together anyone in the LGBTQIA+ community if these communities are even considered at all. This method can be problematic as each sub-community faces unique challenges, rates of mental illness, and experiences.
The LGBTQIA+ community encompasses a wide range of individuals with separate and overlapping challenges regarding their mental health. Other identity factors like race and economic status can affect the quality of care they receive or their ability to access care.
Additionally, members of this community may face harassment or a lack of cultural competency from potential providers. These experiences can lead to a fear of disclosing sexual orientation and/or gender identity due to potential discrimination or provider bias.
Confronting these barriers and mental health symptoms with an LGBTQIA-inclusive mental health provider can lead to better outcomes, and ultimately recovery.
How to Find the Right Mental Health Professional
There are important considerations when seeking LGBTQIA-competent care. Here are a few steps to find a professional.
Step 1: Think About What You're Looking For
While considering the type of mental health professional you are looking for, it is important to consider the following:
- If you want a provider who shares specific parts of their identity with you, you may be able to find out if your provider is LGBTQIA+ by reading their profiles or websites.
- It may be easier to find a provider that has a baseline competency in LGBTQIA+ issues, rather than one who specializes in LGBTQ+ care. If your mental health conditions are not rooted in sexual orientation and/or gender identity, it may not be necessary for the provider to be specialized in LGBTQIA+ issues.
- If you are transgender and are seeking a mental health professional to write a letter of support for gender affirming medical care or for legal documentation change, you should seek a provider who understands the insurance or legal requirements of support letters.
Step 2: Gather Referrals
Many websites that provide mental health professional directory searches, including insurance company websites, have filters that allow you to show only mental health providers who have a specialty or competency in working with LGBTQIA+ patients. Many insurance companies also have information numbers, and they can help find you providers that are in your area, accept your insurance and list LGBTQ+ competency in their profile.
These directories, however, are not the only way to find LGBTQIA+ competent providers. Many LGBTQIA+ organizations and community groups provide directories that have been vetted by other LGBTQIA+ people. You may want to check with:
- Local LGBTQIA+ community centers
- Local LGBTQIA+ health centers
- Affirming places of worship
- LGBTQIA+ community groups such as equality groups, health collectives, social organizations, support groups
Step 3: Make the Call
Some people find it difficult to make an initial call to a mental health provider. Transgender people in particular may feel uncomfortable talking on the phone due to concerns about being misgendered due to their natural voice range. If you find you’re reluctant to call, ask a friend or family member to call for you.
When making the initial call, you may want to ask the provider if they have previous experience with LGBTQIA+ patients or if they are comfortable working with LGBTQIA+ patients. You can wait to ask this during the first appointment, but you may save time and energy by asking from the start.
Step 4: Ask Questions
Providers expect and welcome questions from their patients or clients, since this helps them better understand what is important in their treatment. In your first visit with a mental health provider, be forthright about the fact that you are looking for an LGBTQIA+ competent provider. You should not feel like you need to educate providers about the basic concepts of LGBTQIA+ identities. To prevent that, consider asking the following questions:
- My identity is ______. What experience do you have working with people with that identity?
- What experience do you have with the LGBTQIA+ community?
- Do you have any specific training or certifications that relate to working with LGBTQIA+ clients?
Additionally, to avoid selecting a practitioner that uses the discredited and harmful practice of conversion or reparative therapy — aimed at changing a person’s sexual orientation or gender identity — you may also want to ask, “Do you provide conversion therapy or reparative therapy?” and follow up by asking how they feel about that specific practice to make sure you are not selecting a provider that advocates for this type of treatment.
Step 4: Build a Relationship
It may take several calls to find the right provider for you. If the provider does not have the knowledge or experience that you are looking for, you can move on to the next provider and keep searching.
Remember, you are seeking a person that is going to help you improve your mental health. By stating your needs and asking the right questions, you can find someone who can mindfully address your identity throughout the duration of your treatment.
Societal Stigma
Religion
Some of the current stigma associated with LGBTQIA+ identities has origins in religious beliefs. Although each religion, sect, and place of worship may vary in its beliefs around LGBTQIA+ issues, and there are a growing number of LGBTQIA-affirming denominations and congregations, there are still many religious individuals and communities that believe and promote the idea that being LGBTQIA+ is unnatural, a sin, or goes against God.
Some believe that sex should be reserved for the act of procreation, which is not an option for many LGBTQIA+ people. Others may point out where their religious texts directly call homosexuality or being transgender a sin. Due to early education into shared family values, followers of such beliefs may have a harder time reconciling their sexual orientation or gender identity with those values. These conflicting beliefs can lead to inner turmoil and stress.
Conversion Therapy
Some people believe that a person can change their sexual orientation or gender identity through various interventions, such as talk therapy, physical aversion therapy, prayer, or reconditioning. This concept is sometimes referred to as conversion therapy or sexual orientation/gender identity change efforts.
These practices have been discredited and deemed unethical by many mental health organizations. Conversion therapy has no scientific evidence of actually changing a person’s sexual orientation or gender identity and can cause long lasting mental health issues from the various types of trauma inflicted.
Don't Ask, Don't Tell
From 1993 to 2011, “Don’t Ask, Don’t Tell” was the official position of the U.S. military. Lesbian, gay, and bisexual people were allowed to serve in the military but could not reveal their sexual orientation without risking dishonorable discharge. Today, similar practices are being utilized for transgender people. These practices force people to keep a core part of their identity hidden, unable to pursue romantic relationships or access gender-affirming health care. This internal division between sense of self and sense of duty is not only difficult to maintain, but can lead to further isolation and shame.
Rejection
Rejection, or fear of rejection, from friends or family can reinforce the societal stigma of being LGBTQIA+. People may not disclose their identity for fear of being rejected and losing not only the love and respect of those they are close to, but also fear of losing housing, education, and financial opportunities.
Discrimination, Harassment, and Assault
Trauma can also come from discrimination, harassment, or assault. Either a single event, such as getting assaulted for being gay or being fired by a transphobic employer, or the long-term effects of sustained stress due to discrimination, can lead to post-traumatic stress responses or PTSD.
A majority of LGBTQIA+ people have experienced harassment or discrimination based on their sexual orientation or gender identity. Harassment may include both verbal and physical harassment or physical assault. Being a victim of harassment can cause long-term mental health impacts such as anxiety, depression, lack of concentration, and fatigue. Multiple instances of harassment or severe cases can cause PTSD. Any of these mental health issues can introduce more stress into a person’s life, compounding any existing issues and leading to more severe symptoms.
LGBTQIA+ people also experience discrimination in employment, housing, public accommodations, and while seeking health care. This discrimination can affect a person’s mental health whether it is blatant or merely implied — the fear of discrimination can be just as real as an obvious event. The burden of trying to hide or keep your identity a secret can lead to isolation, low self-esteem, and other mental health issues. It may also make you less likely to seek help due to fear of discrimination from police, medical professionals, and other social supports.
Repression
In order to avoid societal stigma or discrimination, an LGBTQIA+ person may choose to not acknowledge their sexual orientation or gender identity. They may choose to seek out heterosexual relationships or to live as the gender they were assigned at birth despite knowing that these identities are not truly right for them.
Some people may choose celibacy in order to avoid awkward sexual encounters, or to only have sexual or romantic relationships in secret. Transgender people may live their day-to-day lives as the gender they were assigned at birth, but then dress or act their true identity in private. This ongoing discomfort and denial of the authentic self can negatively impact relationships with others and overall well-being, ultimately adding to any sense of stigma and shame you already feel.
How to Cope with Trauma and Shame
As a result of trauma, LGBTQIA+ individuals may turn to negative coping strategies, such as:
- Denying or trying to change their sexual orientation
- Avoiding other LGBTQIA+ people
- Suppressing their emotions (especially romantic or sexual)
- Having multiple or anonymous sex partners
- Developing dependence on alcohol or drugs
- Attempting suicide
While these coping strategies may provide temporary relief, they can also exacerbate problems with maintaining positive self-worth, personal relationships, and overall mental health.
Instead of using negative coping strategies, LGBTQIA+ individuals may consider more positive coping mechanisms such as:
- Advocating for LGBTQIA+ rights:
- Write a letter, email or call your representatives to support affirming legislation
- Educate your community on LGBTQIA+ issues
- Participate in lobby days or days of action planned by LGBTQIA+ organizations
- Engaging with LGBTQIA+ organizations (e.g., arts organizations, sports leagues and book clubs)
- Participating in an affirming place of prayer/worship
- Spending time with or building relationships with people who are openly accepting of LGBTQIA+ people:
- Join a support group in your local area or online — there are many LGBTQIA+ specific recovery groups and group therapy options
- Spend time at LGBTQI-owned and LGBTQIA-friendly businesses
- Mentor LGBTQIA+ young people
Allies to the LGBTQIA+ community can also help support these positive coping strategies by openly and visibly supporting LGBTQIA+ people and issues, advocating for inclusive policies and practices, and interrupting or speaking out against negative remarks and actions taken by other people.
LGBTQIA+ people should not have to suffer from the impact of trauma and internalized shame. Seeking help from supportive friends, mental health professionals, and LGBTQIA+ organizations can be of great help to many people.
Additional Resources
PCOM is the state’s primary source for guidance, education, cultural competency, and services to improve quality of life, especially for LGBTQ+/SGL (same-gender-loving) youth, adults, elders, and allies of all backgrounds, ethnicities, perspectives, genders, sexualities, and cultures.
FreeState Justice is Maryland’s statewide advocacy non-profit that seeks to improve the lives of lesbian, gay, bisexual, transgender, and queer (“LGBTQ”) Marylanders.
The Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE) delivers educational and support resources for LGBTQ individuals, and promotes competency on LGBTQ issues for counseling professionals.
Through health care services, education, training, research, and advocacy, we are working to end the health disparities that exist within LGBTQ communities and give patients worldwide—regardless of how they identify—the opportunity to live the healthiest life possible.
