Research has shown that lesbian, gay and bisexual (LGB) populations manifest inequalities in physical and mental health. Minority stress theory proposes that LGB people are more likely to experience internal and external manifestations of prejudice, victimization, and discrimination which can lead to health problems because these experiences are internalized.
The stress brought about by this may lead people who identify as non-heterosexual to experience poorer mental-health and wellbeing, manifest unhealthy behaviors, and experience worse physical health.
Building on previous work
The main limitation of existing research in this area is that LGB participants are not taken from representative samples of the population.
The main limitation of existing research in this area is that LGB participants are not taken from representative samples of the population. Historically, much LGB health research was done in community settings, dominated by convenience samples, surveys at gay pride events, or in bars or clubs.
Until recently sexual orientation was not recorded routinely in UK population health surveys. Following the recommendation by the Office of National Statistics (ONS) for a standardized method of recording sexual orientation identity in surveys, this has now changed and sexual orientation identity is recorded in a number of health surveys.
These survey studies took samples from clearly defined populations, making the results more generalizable. The proportion of adults who identify as lesbian, gay, bisexual or ‘other’ but not heterosexual is relatively low (around 1%, compared to 2.6% who reported same-sex sexual behaviour in the last five years in the National Survey of Sexual Attitudes and Lifestyles in 2000). This low proportion might reflect anxieties about disclosure of sexual orientation identity that apply less to disclosure about same-sex sexual behaviour.
By pooling all the surveys together, the available sample of LGBs is increased greatly allowing us to carry out our analysis.
What we found
Lesbian, gay or bisexual are up to two times as likely as heterosexual adults to suffer from anxiety or depression or experience lower well being.
Lesbian, gay or bisexual are up to two times as likely as heterosexual adults to suffer from anxiety or depression or experience lower well being. These findings echo those that emerged from an earlier systematic review that also showed lesbian, gay and bisexual populations experience higher rates of suicidality and substance misuse than heterosexuals.
Importantly the study is the first to show that the inequalities are worse for younger (age under 35) and older (age 55+) LGBs. At midlife (age 35-54.9), LGBs are still at greater risk of poor mental health, but less so than for the younger and older adults.
Understanding the findings
The data report an association between LGB or ‘other’ identity and symptoms of poor mental health, but do not provide an explanation for these findings. Minority stress theory suggests that LGB people are more likely to experience prejudice, victimization, and discrimination because of their sexuality and that this can lead to health problems because these experiences are internalized.
The stress brought about by this may lead people who identify as non-heterosexual to experience poorer mental-health and wellbeing, unhealthy behaviors, and worse physical health.
They may be more prone to risky behavior such as smoking, hazardous drinking, and substance abuse – all of which have been pointed to as being particularly prevalent among the LGB community in other recent studies and literature.
These possible mechanisms were not considered in the study, but could be considered in future research.
Possible implications of our research
Mental health inequity may emerge in early adulthood and persist. The study considered only the prevalence of current mental health problems, but it is possible that for many adults these persisted.
It is not clear at this stage why the difference between LGB or ‘other’ adults was stronger for younger and older adults.
It is not clear at this stage why the difference between LGB or ‘other’ adults was stronger for younger and older adults. Older adults belong to a different generation and may have experienced worse minority stress.
Younger adults may have additional stressors that midlife offers some protection from. The cross-sectional nature of the data however, mean that the contribution of ‘generation’ or ‘age’ is not possible to tease apart.
Fear of discrimination may mean that many LGB people choose to not disclose their sexual orientation to health care professionals or delay in attending mental health services. Failure to disclose or attend may delay access to treatments for mental health.
The study highlights the need for policymakers to address the mental health needs of adults who do not identify as heterosexual. It suggests that clinicians should ensure that they provide health and well-being services in which LGB patients can disclose their sexual orientation and receive supportive and integrated care.
What are the next steps?
- Further research into understanding the causes of these health disparities is necessary to allow addressing how to try and reduce this increased incidence in poor mental health in LGB individuals.
- Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and delivery. This will increase the amount of data available and greatly improve future research.
- Future surveys should consider collecting sexual attraction and sexual behaviour along with sexual orientation identity to encompass all three components of ‘sexual orientation’ and evaluate its relationship with mental health.
These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups.
First of all, thanks Jo and Gareth for the research and the article. Having worked with LGBTs, especially LGBT young people, over many years I would say there are several factors making young LGB (and Ts) more vulnerable now than ever before: Firstly, homophobic (and transphobic) bullying is rife in schools, social media and on the streets: I do not know at what point this happened: I realise there has always been bullying and gay people have been bullied but nowhere near like the situation now. Secondly, LGB young people are identifying and coming out at much younger ages than before, making them even more vulnerable because of their age, isolation and lack of support. Both of these result from greater visibility of LGBTs in the media and in general. And thirdly, middle aged LGBTs are benefiting more from the relatively recent legislation – getting rid of discriminatory laws and replacing them with anti-discrimination laws – perhaps this group are less isolated!
Another important point I want to make is that in most places in the UK there are not the mental health services to respond appropriately to LGBTs with mental health problems (not substance misuse services) because most ‘professionals’ have not been trained in the issues and do not understand the effects of internalised homophobia/transphobia, even more so when a person is dealing with several layers of minority stress and especially when they are lower class. Middle class LGBTs can afford to pay for private therapy where they are more likely to access services that are both LGBT-friendly and can meet their needs.
It is crucial bullying is tackled in schools and there is support available for young people coming to terms with being LGBT; it is also crucial that services such as CAMHS are fully trained and aware the problems facing young LGBTs and especially in regard to their families who are often a key problem: if a young person cannot turn to their parents (or knows that their parents are homophobic/transphobic) and is experiencing homophobic/transphobic bullying at school where on earth can they turn for support? Many LGBT youth groups have been forced to close due to service cuts.
I do wish someone with some power would grasp this problem and do something about it: far too many LGBT people have died, often by their own hand, or had their lives ruined because of discrimination.