Although lesbian, gay, bisexual, trans and queer identified (LGBTQ) people are as diverse as the general Canadian population in their experiences of mental health and well-being, they face higher risks for some mental health issues due to the effects of discrimination and the social determinants of health.
This information was compiled by Rainbow Health Ontario and CMHA Ontario and originally appeared on the CMHA National Website.
What factors impact on mental health?
Socio-economic factors (or determinants) play a key role in mental health and wellbeing for all of us, and are particularly important for marginalized populations. Three significant determinants of positive mental health and wellbeing are: social inclusion; freedom from discrimination and violence; and access to economic resourcesi.
All three factors impact LGBTQ individuals and communities in Ontario:
- Bisexual and trans people are over-represented among low-income Canadians
- An Ontario-based study found that half of trans people were living on less than $15,000 a yearii
LGBTQ people experience stigma and discrimination across their life spans, and are targets of sexual and physical assault, harassment and hate crimesiii
- Hates crimes motivated by sexual orientation more than doubled in Canada from 2007 to 2008, and were the most violent of all hate crimesiv
- An Ontario-based study of trans people found that 20 per cent had experienced physical or sexual assault due to their identity, and that 34 per cent were subjected to verbal threats or harassmentv
- Trans people in both Canada and the US report high levels of violence, harassment, and discrimination when seeking stable housing, employment, health or social servicesv
Additional factors that may impact on mental health and well-being for LGBTQ people include the process of “coming out” (sharing one’s LGBTQ identity with others), gender transition, internalized oppression, isolation and alienation, loss of family or social support, and the impact of HIV and AIDS.vii
LGBTQ individuals may experience multiple forms of marginalization or disadvantage at the same time. For example, an individual’s experience may be shaped at the same time by their sexual orientation, racialization, gender, disability and income (e.g. a bisexual South Asian woman may have an anxiety disorder and be living in poverty).
Intersectionality refers to an approach by which intersecting experiences of marginalization and the needs of the whole person are considered.
There are multiple ways that intersectionality impacts the mental health of LGBTQ people. For example, LGBTQ people may experience other forms of marginalization – such as racism, sexism, poverty or other factors – alongside homophobia or transphobia that negatively impact on mental health. Additionally, an individual with a mental health condition who is also an LGBTQ person may face added challenges in accessing mental health services that are appropriate and inclusive and may face discrimination on the basis of both disability and sexual orientation.
LGBT people and the DSM
Due to homophobia and transphobia, LGBTQ identities have been included in the Diagnostic and Statistical Manual of Mental Disorders (the DSM). The DSM is a classification of mental health conditions (termed mental disorders) published by the American Psychiatric Association (APA) . The first edition of the DSM was published in 1952, and multiple revised editions have been released since.
In 1973 and 1974, due to growing evidence and protest, a majority of APA membership agreed to remove homosexuality from the manual. Although homosexuality was delisted in the 1980 edition (the DSM-III), variations of the listing remained until 1986. Since 1980, Gender Identity Disorder, or trans identity, has been listed as a disorder. The fifth edition of the DSM, released in 2013, introduces the term ”Gender Dysphoria” to replace previous terms.
Facts and figures
LGBTQ people face:
- Higher rates of depression, anxiety, obsessive-compulsive and phobic disorders, suicidality, self-harm, and substance use among LGBT peoplex
- Double the risk for post-traumatic stress disorder (PTSD) than heterosexual peoplexi
LGBTQyouth and trans people face increased risk. For example:
- LGBTQ youth face approximately 14 times the risk of suicide and substance abuse than heterosexual peersxii
- 77% of trans respondents in an Ontario-based survey had seriously considered suicide and 45% had attempted suicide
- Trans youth and those who had experienced physical or sexual assault were found to be at greatest riskxiii
There is also evidence that LGBTQ people are at higher risk for substance use issues than the general populationxiv:
- Some research suggests that use of alcohol, tobacco and other substances may be 2 to 4 times higher among LGBT people than heterosexual peoplexv
- A Toronto-based study found significantly higher rates of smoking among LGBT adults (36%) than other adults (17%) xvi
- American studies report higher rates of alcohol-related problems among lesbian and bisexual women than other women xvii
Promoting positive mental health and wellbeing
Key factors for positive mental health and wellbeing for LGBTQ individuals include:
- Support from family and friends, particularly for youthxvii
- Supportive workplaces and neighbourhoodsxix
- Low levels of internalized homophobia (homophobia adopted by the LGBT person themself)xx, which can be fostered and supported through identification or community building with other LGBT individualsxxi
- Experiencing positive responses to coming outxxii
- Addressing the social determinants of health
Information for health providers
Rainbow Health Ontario, a provincial organization which seeks to promote the health of Ontario’s LGBTQ communities, recommends the following steps be taken by providers working with LGBTQ individuals:
- Increase awareness of the broader social and legal context in which LGBTQ clients live
- Become familiar with the degree to which internalized discrimination can impact on health
- Develop understanding of the social determinants of both physical and mental health
- Promote family acceptance of LGBTQ adolescents and encourage them to connect with LGBTQ communities
- Provide appropriate equity training to ensure that suicide response and crisis intervention staff approach LGBTQ clients without stereotypes or discrimination, and that gender of trans clients is not misidentified
- Improve recognition that individuals who belong to multiple marginalized communities may face additional barriers to maintaining good mental health
- Increase familiarity with resources to support LGBT people at greatest risk for suicide, including youth and trans people (see below)
It Gets Better Campaign – In response to publicized suicides by LGBT youth, author Dan Savage initiated the It Gets Better campaign (http://www.itgetsbetter.org) through which supportive LGBT people and allies share supportive messages through online videos.
Kids Help Phone – Children and youth ages 5 to 20 can speak with trained cousellors at Kids Health Phone (1-800-668-6868).
Lesbian, Gay, Bi & Trans Youthline – The Lesbian, Gay, Bi & Trans Youthline offers free peer support for youth aged 26 and under (1-800-268-9688).
iiM. Tjepkema. Health care use among gay, lesbian and bisexual Canadians. Statistics Canada. Canada: Statistics Canada,2008; G. Bauer, Boyce M, Coleman T, Kaay M, Scanlon K, Travers R. Who are trans people in Ontario? Toronto: Trans PULSE E-Bulletin; 2010. Report No.: 1(1).
iiiI.H. Meyer. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin. 2003; 129(5):674-697.
ivM. Dauvergne. Police reported hate crime in Canada, 2008. Juristat [Internet]. 2010; 30(2). Available from: http://www.statcan.gc.ca/pub/85-002-x/2010002/article/11233-eng.pdf.
vBauer et al. Suicidality among trans people in Ontario: Implications for social work and social justice. Service social, 2013; 59 (1): 35-62.
viSee: S. Gapka and R. Raj. Trans health project: A position paper and resolution adopted by the Ontario public health association. Toronto: OPHA; 2003; EL Lombardi, G. Van Servellen. Building culturally sensitive substance use prevention and treatment programs for transgendered populations. Journal of Substance Abuse Treatment. 2000; 19:291-296; JSI Research & Training Institute, Inc. Access to health care for transgendered persons in greater Boston. Boston: Report for GLBT Health Access Project; 2000; LJ Moran, AN Sharpe. Violence, identity and policing. Criminal Justice. 2004; 4(4):395-417; V. Namaste. Invisible lives: The erasure of transsexual and transgendered people. Chicago: University of Chicago Press; 2000.
viiCentre for Addiction and Mental Health. “ARQ2: Asking the Right Questions 2”. Toronto: Centre for Addiction and Mental Health: 2007. http://www.camhx.ca/Publications/Resources_for_Professionals/ARQ2/index.html
viiiSee American Psychiatric Association website: http://www.psych.org/MainMenu/Research/DSMIV.aspx
ixKE Bryant. The Politics of Pathology and the Making of Gender Identity Disorder. University of California, Santa Barbara: 2008
xAL Diamant, C. Wold. Sexual orientation and variation in physical and mental health status among women. Journal of Womens’ Health. 2003; 12(1):41-49; SD Cochran, VM Mays. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: Results from the California quality of life survey. American Journal of Public Health. 2007; 91(11):2048-2055; S. McCabe, WB Bostwick, TL Hughes, BT West, CJBoyd. The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States American Journal of Public Health. 2010; 100(10):1946-1952.
xiRoberts AL, Austin SB, Corliss HL, Vendermorris AK, Koenen KC. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health. 2010; 100(12):2433-2441.
xiiGibson P. Gay and lesbian youth suicide. In: Fenleib MR, editor. The Secretary’s Task Force on Youth Suicide, United States Government Printing Report of the Secretary’s Task Force on Youth Suicide, United States Government Printing Office, 1989; Benibgui M. Mental health challenges and resilience in lesbian, gay and bisexual young adults: Biological and psychological internalization of minority stress and victimization. 2011.
xiiiBauer et al.
xivCanadian Centre for Substance Abuse. Lesbian, Gay, Bisexual, Transsexual, Transgender, Two-Spirit, Intersex and Queer (LGBTTTIQ). http://www.ccsa.ca/Eng/Topics/Populations/LGBTTTIQ/Pages/default.aspx
xvQueensland Association for Healthy Communities. “Alcohol, Tobacco & Other Drug Use in Lesbian, Gay, Bisexual and Transgender (LGBT) Communities.” Available at: http://www.qahc.org.au/files/shared/l__Tobacco___Other_Drug_Use_LGBT_factsheet-p.pdf.
xviClarke, M et al. The Toronto Rainbow Tobacco Survey: A report on Tobacco Use in Toronto’s LGBTTQ Communities, 2007. Available from: http://www.sherbourne.on.ca/PDFs/TRTS-Report.pdf
xviiEliason, M. Best Practices for Lesbian/Bisexual Women with Substance Use Disorders. 2009. Available at: http://gilgerald.com/storage/research-papers/09%20report%20women.pdf
xviiiBenibgui M. Mental health challenges and resilience in lesbian, gay and bisexual young adults: Biological and psychological internalization of minority stress and victimization. 2011; Ryan C, Russell ST, Huebner D, Sanchez DR. Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing. 2010; 23(4):205-213; Ryan C, Hueber D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009; 1:346-352.
xixGoldberg E, Smith JZ. Stigma, social context, and mental health: Lesbian and gay couples across the transition to adoptive parenthood. Journal of Counselling Psychology. 2011; 58(1):139-150.
xxGoldberg et al.
xxiCox N, Berghe WV, Dewaele A, Vincke J. Acculturation strategies and mental health in gay, lesbian, and bisexual youth. Journal of Youth and Adolescence. 2009; 39(10):1199-1210.
xxiiRosario 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.