June 2022

How does the experience of sexual orientation and gender identity relate to mental health and what are the reasons for these disparities? 

Dr. Christina Athineos: Nothing about being LGBTQ+ is inherently harmful for one’s mental health. The main contributor to differences in wellbeing is that our society assumes heterosexuality and cisgender identities. Meaning, LGBTQ+ individuals frequently don’t fit the dominant culture’s expectations and thus experience a greater degree of stress and discrimination.

LGBTQ+ individuals also seek less help. Clearly stigma and trauma contribute. What other barriers do your clients speak of? 

Tied in with stigma and trauma are barriers of outright discrimination and lack of access to appropriate services and properly trained professionals. This includes being denied services, not having relationships recognized as legitimate, needing to educate providers about their identity or having their identity questioned or denied. In my work, I’ve come across fear about potential breaches of confidentiality. Many queer and trans youth are scared their parents will access things discussed in session.

The LGBTQ+ population is at high risk for suicidal thoughts and attempts. LGB high school students are 4 times as likely as hetero peers to have attempted suicide. Can this improve? 

Traumatic experiences of simply being a child in the world (parental divorce, death, abuse, etc.) are increased for LGBTQ+ youth, including overt hate crimes, bullying and parental rejection or abandonment, as well as more subtle microaggressions. At a systemic level, psychologists can support efforts to decrease stigma and advocate for legislation that protects and asserts the validity of people and their relationships. At an individual level, early intervention is key to preventing suicide in LGBTQ+ youth. This means recognizing emotional disturbance in children, like irritability, withdrawal or isolation, expressions of hopelessness or changes in sleep. Similarly, friends and family members should know talking about suicide doesn’t trigger suicidal behavior. Rather, speaking openly can alleviate the stigma associated with suicidal thoughts and make it safer to discuss.

Transgender adults are nearly 4 times as likely as cisgender adults to have mental health problems and 9 times more likely to have attempted suicide. How has training and treatment evolved to help this population?

One of the biggest barriers to mental and physical healthcare for trans and non-binary individuals is a lack of providers knowledgeable and trained in these issues. Fortunately, new research is being added to a growing collection of evidence-based resources for healthcare providers. The World Professional Association for Transgender Health is a particularly good resource for current standards of care and relevant trans public policy.

Talk about coming out. We can all imagine the risk of rejection they take on. But what are the positives in how this can be experienced now?

This is a great question and a nuanced topic. Feeling safe to come out entails a level of privilege that not everyone has access to. Yet, research shows coming out and living authentically reduce suicidality and decrease biomarkers associated with stress (think blood pressure, cortisol and adrenaline). Living one’s life honestly allows for greater self-esteem, closer relationships and connection to the LGBTQ+ community and resources.

What is the therapeutic response to harassment, discrimination and the other challenges we’ve been discussing? Does the therapist need to share an LGBTQ identity to be effective? 

No, in the same way a clinician doesn’t need to have experienced every client’s symptoms to be effective. Being a member of the LGBTQ+ community does not inherently entail a shared experience, so we shouldn’t assume this will automatically lead to greater insight. That being said, hetero/cis clinicians serving an LGBTQ+ population should do their research about sexuality and gender identity factors that may intersectionally affect their clients.

Given a reluctance to seek mental healthcare, how do you counteract those barriers, to create comfort and safety? 

Little gestures have a big impact in fostering feelings of safety. Small acts, like including my pronouns in my email signature, demonstrate I won’t assume your gender. At a more systemic level, inclusions like these can destigmatize conversations about gender identity and make it more inviting for trans and non-binary people to share their true pronouns. The same goes with catching heterosexual assumptions. When speaking to a client about intimate relationships, for example, I use “partner” as opposed to “boyfriend” or “girlfriend.”

How can family and friends help someone who might be struggling? How can we be more respectful of people who identify as LGBTQ? 

First, respect people’s right to privacy. You don’t expect a straight or cis individual to share intimate details of their sexual life or body, nor are you entitled to these details about queer, trans and gender-diverse people. Second, remember this person is not responsible for educating you. Have a question? Google it. Your friend, family member, colleague or classmate is not an ambassador for all things LGBTQ+.

How do we educate ourselves on how best to build a close and loving relationship with an LBGTQ+ child, sibling or good friend? 

There are great resources for allies to learn more about the history of queer and trans activism, trends in language use and ongoing policy debates affecting LGBTQ+ civil liberties. In particular, GLAAD has compiled a resource list, linking to: The Trevor Project (focused on suicide prevention for LGBTQ+ youth), PFLAG (supporting LGBTQ+ allies, parents and families) and SAGE (serving LGBTQ+ elders). The Safe Zone Project hosts a number of workshops and webinars.