Closing Gaps in LGBTQ+ Mental Healthcare Research
By Nicole, NAMI Dane County Intern
When I told my senior project professor that I wanted to write about mental health interventions for the LBGTQ+ community, she expressed concern that I wouldn’t find enough research on the topic. I understood that psychology studies tended to focus on easily accessible groups, but I figured with the increasing awareness of social justice issues in the past decade, I would find enough studies to make a paper out of. But after a few keyword searches for LGBTQ+ mental health interventions on the university library page, it became clear why my professor had offered some words of caution.
There is an abundance of research illustrating the mental health disparities experienced by LGBTQ+ individuals. 40% of transgender adults have attempted suicide in their lifetime, in contrast to 5% of the general population. 40% of LGBTQ+ young people have considered suicide in the last year. 68% of LGBTQ+ youth report symptoms of anxiety in the last two weeks (SAGE). It is clear that the LGBTQ+ community is overrepresented in mental illness and trauma exposure statistics. These numbers are startling, but what’s perhaps more shocking is that despite the knowledge of these statistics, tested interventions for LGBTQ+ individuals remain far and few between. Many of the studies done on the effectiveness of mental health interventions for LGBTQ+ individuals are pilot studies or include only a small number of participants. The bottom line? There is not substantial research on how to help LGBTQ+ folks facing mental health challenges.
Luckily, we do have research that can explain why LGBTQ+ individuals experience higher rates of mental health conditions. Transphobia and homophobia cause LGBTQ+ individuals to have heightened risk for experiencing traumatic events, which have significant impacts on mental health outcomes. One research team concluded that within their sample of LGBTQ+ participants, higher rates of interpersonal trauma and discrimination predicted a higher likelihood of engaging in self-injury and having attempted suicide (House et. al., 2011). The potentially traumatic events that occur at higher rates in the LGBTQ+ community increase vulnerability to mental health conditions. In another study, researchers concluded potentially traumatic event exposure in LGBTQ+ individuals was associated with higher rates of shame, which may be especially present within the community due to social ostracism (Scheer et. al., 2020).
LGBTQ+ identity is a significant factor in an individual’s life, and addressing this identity directly is crucial in meeting their mental health needs. The importance of minority identity was demonstrated by a study of LGBTQ+ participants who were asked to identify what would be important to them in order to create positive change in therapy. The participants in this study described a variety of experiences with mental healthcare, having both supportive and affirming therapists, as well as therapists that did not display cultural competency and invalidated client identity. Some common themes in what the participants found beneficial in therapy included being able to express oneself authentically, use of affirmation, an understanding of intersectionality, and a common sense of identity or values with their mental health provider (Berke et. al., 2016).
We see the impact of being able to positively address LGBTQ+ identity reflected in already-existing studies on mental health interventions specifically developed for this community. Despite the small number of studies done, the outcomes of these interventions are promising and demonstrate the need for more research of its type. Understanding what we do know about mental health interventions for LGBTQ+ individuals informs future directions for research on this topic. Here are a few studies that have illustrated the importance of directly addressing LGBTQ+ identity in mental health interventions:
Pachankis et. al. (2020): Researchers recruited 108 LGBTQ+ youth in a high-stigma, low-resource community in Tennessee. The youth were assigned to one of two writing interventions: self-expressive or affirming. The self-expressive writing prompts gave participants common stressors related to LGBTQ+ identity and allowed them to write about those stressors. In the self-affirming intervention, participants read vignettes about LGBTQ+ individuals dealing with challenges related to their identities that were based on the actual experiences of the participants. They were then asked to write about what they would say to that person. The youth doing the expressive writing sessions experienced significantly less depression and psychological distress, and those doing the self-affirming writing prompts experienced significantly less suicidal ideation and drug misuse than the control group.
Austin et. al. (2018): This study adapted cognitive behavioral therapy (CBT) for transgender individuals. This therapy is named AFFIRM, as it is focused on affirming transgender identities in order to change harmful thoughts that transgender individuals have about themselves that have been shaped by transphobia. The researchers concluded that AFFIRM was effective in decreasing symptoms of depression. While the study only included 8 participants, its results are promising. It shows the utility of addressing how transphobia affects thought processes.
Ross et. al. (2008): This study also adapted CBT to include modules specific to the LBGT community. The researchers focused on LGBT individuals that were experiencing depression. Alongside traditional cognitive behavioral therapy aimed at reducing depression, this intervention also included modules on coming out and internalized homophobia. The participants reported significantly less depression symptoms, as well as increased self-esteem post-intervention.
The results from these studies are promising — they prove the power in adapting interventions to meet the needs of the community they serve. Encouraging self-expression and affirmation of identity seemed to be effective in creating change. Directly addressing oppression also made a significant impact on mental health outcomes. We have a long way to go — many of the existing studies are preliminary and have limited sample sizes. Regardless, these studies show the power that exists in the willingness to address LGBTQ+ issues, rather than ushering individuals into generalized treatments not developed with gender and sexuality diversity in mind.
References:
Austin, A., Craig, S. L., & D'Souza, S. A. (2018). An AFFIRMative cognitive behavioral intervention for transgender youth: Preliminary effectiveness. Professional Psychology: Research and Practice, 49(1), 1-8. http://dx.doi.org.ezp1.lib.umn.edu/10.1037/pro0000154
Berke, D. S., Maples-Keller, J. L., & Richards, P. (2016). LGBTQ perceptions of psychotherapy: A consensual qualitative analysis. Professional Psychology: Research and Practice, 47(6), 373-382. http://dx.doi.org.ezp1.lib.umn.edu/10.1037/pro0000099
House, A. S., Van Horn, E., Coppeans, C., & Stepleman, L. M. (2011, June 1). Interpersonal Trauma and Discriminatory Events as Predictors of Suicidal and Nonsuicidal Self-Injury in Gay, Lesbian, Bisexual, and Transgender Persons. SAGE Journals. https://journals.sagepub.com/doi/full/10.1177/1534765610395621.
Pachankis, J. E., Williams, S. L., Behari, K., Job, S., McConocha, E. M., & Chaudoir, S. R. (2020). Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context. Journal of Consulting and Clinical Psychology, 88(5), 429-444. http://dx.doi.org.ezp1.lib.umn.edu/10.1037/ccp0000497
Ross, L. E., Doctor, F., Dimito A., Kuehl, D. Armstrong M. S. (2008, October 11). Journal of Gay & Lesbian Social Services. https://doi-org.ezp2.lib.umn.edu/10.1300/J041v19n01_01
SAGE. (2020, September 11). Startling mental health statistics among LGBTQ are a wake-up call. Sage USA. https://www.sageusa.org/news-posts/startling-mental-health-statistics-among-lgbtq-are-a-wake-up-call/.
Scheer, J. R., Harney, P., Esposito, J., & Woulfe, J. M. (2020). Self-reported mental and physical health symptoms and potentially traumatic events among lesbian, gay, bisexual, transgender, and queer individuals: The role of shame. Psychology of Violence, 10(2), 131-142. http://dx.doi.org.ezp1.lib.umn.edu/10.1037/vio0000241