Mental Health in the LGBTQIA+ Community

According to a Gallup poll published in 2022, 7.1 percent of adults in the United States identify as members of the lesbian, gay, bisexual, and transgender (LGBTQ) community. The poll assigned answers that didn’t directly match any survey choices – e.g. pansexual, seeking, intersex, queer, questioning – to the LGBTQ total. Therefore, we can say that as of 2022, out of our population of close 260 million adults, around 18.5 million identify as members of the LGBTQIA+ community.

That’s twice the number recorded when Gallup first published population data on this demographic group in 2012.

For the sexual majority in the U.S., that means it’s time to finally accept the truth of the words heard at LGBTQIA+ advocacy rallies, demonstrations, and events for decades:

“We’re here, we’re queer!”

At Relief Mental Health, we’ve always known and accepted this fact. Many of our providers specialize in supporting people who identify as LGBTQIA+ and have for years.

We also know something else: the fact that the number of people willing to identify as LGBTQIA+ doubled in the past decade doesn’t mean there are twice as many LGBTQIA+ people in the U.S. as ten years ago. What it means is that, despite ongoing discrimination in both public and private spaces, these citizens now feel safe enough to both claim and announce their identity.

That’s a positive step forward.

However, despite these strides in the right direction and increasing acceptance of diversity – particularly among youth and young adults – members of the LGBTQIA+ community in the U.S. continue to experience significant challenges simply by living the truth of their sexual and gender identity. In addition to the discrimination we mention above, LBGTQIA+ people report a significantly higher prevalence of mental health diagnoses than people in the sexual and gender majority.

We’ll look at the latest statistics on mental health in the LGBTQIA+ community now, then discuss the factors behind the elevated rates of mental health diagnoses in LGBTQIA+ community, and finish with information on effective treatment for the mental health diagnoses common among members of the LGBTQIA+ community.

Mental Health and the LGBTQIA+ Community: Facts and Figures

We’ll start this section with big-picture data from a large scale meta-analysis published in 2022 called “Mental Health in People With Minority Sexual Orientations: A Meta-Analysis of Population-Based Studies,” which assessed the overall risk of developing a mental health diagnosis for members of the sexual minority compared to members of the sexual majority. Next, we’ll narrow the focus and report on the prevalence rates of mental illness among LGBTQIA+ adults age 18+ as indicated in the 2020 National Survey on Drug Use and Health (2020 NSDUH), then finish this facts and figures section with data on LGBTQIA+ youth published in The Trevor Project 20222 National Survey on LGBTQ Youth Mental Health.

First, the meta-analysis, which pooled the results from 26 studies that contained data on 519,000 heterosexual people, 10,178 lesbian/gay people, and 14,410 bisexual people. The studies compared rates of depressive diagnoses, alcohol use disorder, anxiety diagnoses, and suicidality between heterosexual people, gay/lesbian people, and bisexual people.

Here’s what they found, starting with a comparison of risk of mental health diagnoses for lesbian/gay people compared to heterosexual people.

Lesbian/Gay People Compared to Heterosexual People

• Overall risk of mental health diagnosis:
  • 116% increased risk of any mental health diagnosis
• Depressive disorder:
  • 97% increased risk of depressive disorder
• Anxiety disorder:
  • 124% increased risk of anxiety disorder
• Alcohol use disorder:
  • 97% increased risk of alcohol use disorder
• Suicidality:
  • 189% increased risk of engaging in suicidal ideation, planning suicide, or attempting suicide

Bisexual People Compared to Heterosexual People

• Overall risk of mental health disorders:
  • 178% increased risk of any mental health disorder
• Depressive disorder:
  • 170% increased risk of depressive disorder
• Anxiety disorder:
  • 187% increased risk of anxiety disorder
• Alcohol use disorder:
  • 50% increased risk of alcohol use disorder
• Suicidality:
  • 381% increased risk of engaging in suicidal ideation, planning suicide, or attempting suicide

It’s important to understand the terms we use. For instance, a 100 percent increase in risk means the odds double. Therefore, using the numbers above, we can see that a person who identifies as lesbian or gay has a 116 percent increased risk of developing a mental health diagnosis. In other words, they’re over twice as likely to develop a mental health diagnosis than a person who identifies as heterosexual.

In those two data sets, two things immediately get our attention, aside from the elevated risk profile for people in the sexual minority compared to people in the sexual majority:

1. People who identify as bisexual are significantly more likely than gay/lesbian people to develop depression or anxiety, and less likely to develop an alcohol use disorder than gay/lesbian people.
2. People who identify as bisexual show almost twice the risk of suicidality compared to gay/lesbian people.

That’s important information we can use to inform and prioritize treatment for our patients who identify as lesbian/gay and patients who identify as bisexual.

Now let’s look at the general prevalence of mental health diagnoses among LGBTQIA+ people as reported in the 2020 National Survey on Drug Use and Health (2020 NSDUH).

Mental Illness Among LGBTQI+ People: 2020 NSDUH

Serious Mental Illness in the Past Year

• Age 18-25: 29.7% (1.7 million)
  • 20% higher than the national average
• Age 26-49: 19.7% (1.6 million)
  • 13.7% higher than the national average
• Age 50+: 8.3% (265,000)
  • 4.9% higher than the national average

Major Depressive Episode in the Past Year

• 18-25: 43.1% (2.4 million)
  • 26.4% higher than the national average
• 26-49: 20.9% (1.7 million)
  • 11.8% higher than the national average
• 50+: 13.2% (418,000)
  • 7.8% higher than the national average

Major Depressive Episode with Severe Impairment in the Past Year:

• 18-25: 33.7% (1.9 million)
  • 21.6% higher than the national average
• 26+: 14.5% (1.6 million)
  • 9.4% higher than the national average

Suicidality in the Past Year: Suicidal Ideation, Suicide Plans, Suicide Attempts

• 18-25:
  • Serious thoughts of suicide: 26.9% (1.4 million)
    • 15.6% higher than the national average
  • Made a suicide plan: 12.1% (668,000)
    • 8.1% higher than the national average
  • Attempted suicide: 5.4% (298,000)
    • 3.5% higher than the national average
  • 26-49:
    • Serious thoughts of suicide: 15.9% (1.3 million)
      • 10.6% higher than the national average
    • Made a suicide plan: 4.2% (338,000)
      • 4.9% higher than the national average
    • Attempted suicide: 2.1% (165,000)
      • 1.7% higher than the national average

In that data set, we address the major issues we see in the bullet points themselves. Across all metrics, people in the sexual minority report higher rates of mental illness, depression, and suicidality compared to the overall national averages. When we discuss national averages, the figures involve millions of people.

That’s why data like this is important for us to review and share. Millions need support, and we’re here for them.

We’ll finish this section by offering the latest data on mental health diagnoses and suicidality among LGBTQIA+ youth and adolescents from The Trevor Project, beginning with the figures on suicidality.

LGBTQIA+ Youth: Suicidal Behavior and Mental Health Diagnoses

Suicidality

• 45% seriously considered suicide:
  • Gay: 35%
  • Lesbian: 46%
  • Bisexual: 43%
  • Queer: 48%
  • Questioning: 48%
  • Asexual: 39%
• 14% attempted suicide:
  • Gay: 11%
  • Lesbian: 13%
  • Bisexual: 13%
  • Queer: 14%
  • Questioning: 17%
  • Asexual: 11%

Anxiety

• 73% reported symptoms of anxiety:
  • Gay: 63%
  • Lesbian: 75%
  • Bisexual: 71%
  • Queer: 77%
  • Questioning: 73%
  • Asexual: 74%

Depression

• 58% reported symptoms of depression:
  • Gay: 49%
  • Lesbian: 57%
  • Bisexual: 55%
  • Queer: 60%
  • Questioning: 64%
  • Asexual: 58%

Those figures – like the figures for adults – tell a clear story. LGBTQIA+ youth are at an elevated risk of suicidality, and report staggeringly high prevalence rates of anxiety and depression compared to people in the gender/sexual majority. In 2022, close to half considered suicide, over one in ten attempted suicide, almost three-quarters reported anxiety, and over half reported depression. Out takeaway is simple. We need to do all we can to support LGBTQIA+ youth, because they need help and support.

What Causes the High Rates of Mental Health Diagnoses and Suicidality?

According to The Trevor Project and Mental Health America (MHA) the primary causes are discrimination and bullying. Discrimination and bullying can happen anywhere, at any age, to any person who identifies as LGBTQIA+.

Data from MHA shows the following statistics on discrimination and bullying:

• 57% of LGBTQ+ people report being threatened or harassed
• 51% report being sexually harassed
• 51% report experiencing violence because of their LGBTQIA+ identity
• 59% report fewer employment opportunities
• 50% report being paid less than heterosexual peers
• 38% of transgender people report hearing slurs against their identity
• 36% of LGBTQIA+ youth report being physically threatened or harmed because of their gender identity
• 37% of trans/nonbinary youth report being physically threatened or harmed because of their sexual orientation
• 31% of LGBTQIA+ youth report being physically threatened or harmed because of their sexual orientation
• 28% of transgender people report hearing insensitive or offensive comments because of their LGBTQIA+ identity

In addition, in a study called “Health Care Providers’ Implicit And Explicit Attitudes Toward Lesbian Women And Gay Men,” researcher indicate:

• Stigma, lack of cultural sensitivity, reluctance to address sexuality may reduce quality of care
• Implicit preferences for heterosexual patients over lesbian and gay patients is common among heterosexual health care providers

Those last two points – we’ll be honest – are a significant source of frustration for us. First, because it’s our calling to give anyone who asks for help the best possible care available.

In our world, anyone means everyone.

The stigma also frustrates us because at Relief Mental Health, we provide cutting-edge treatment for depressive diagnoses, anxiety diagnoses, suicidality, and other mental health diagnoses that works when most other treatments don’t.

Innovative Techniques for Treating Mental Health Diagnoses: Transcranial Magnetic Stimulation (TMS), SPRAVATO®, IV Ketamine Infusions

Traditional treatment for depressive diagnoses, anxiety, and suicidality includes a combination of medication, psychotherapy, counseling, lifestyle changes, and peer/community support. At Relief Mental Health, we’re experienced in all these traditional modes of treatment. However, in recent years, three new approaches to mental health treatment have been approved by the Food and Drug Administration (FDA), and evidence shows these treatments can reduce mental health symptoms when other approaches to treatment have failed.

We’re approved to administer transcranial magnetic stimulation (TMS), SPRAVATO®, and IV ketamine infusions. We’ll describe each of those treatment approaches now, beginning with TMS.

Transcranial Magnetic Stimulation (TMS)

• TMS is a safe, effective, non-invasive therapy. Evidence shows it can reduce symptoms related to:
  • Treatment-resistant depression
  • Depression with suicidal behavior
  • Suicidal ideation
  • Anxious depression
  • Obsessive-compulsive disorder (OCD)
  • Bipolar disorder
• TMS is approved for off-label use for patients under age 18, however, insurance coverage for this age group may not be available

SPRAVATO®

• SPRAVATO® (esketamine) is a safe and effective medication that belongs to a new category of psychiatric treatment called psychedelic therapy. SPRAVATO® is FDA-approved for the treatment of:
  • Major depressive disorder
  • Treatment-resistant depression
  • Suicidal ideation
  • Suicidal behavior
• Evidence shows SPRAVATO® can also help reduce symptoms related to:
  • Bipolar disorder
  • Anxiety disorders
  • Post-traumatic stress disorder (PTSD)

IV Ketamine Infusions

• Ketamine is the medication scientist used to formulate SPRAVATO®, and also belongs to the new category of psychiatric treatment called psychedelic therapy
• Off-label use of ketamine is approved for the treatment of:
  • Treatment-resistant depression (TRD)
  • Major depressive disorder (MDD)
  • Major depressive disorder with suicidal ideation and suicidal behavior
  • Bipolar disorder (BD-I/BD-II)
  • Anxiety disorders
  • Post-traumatic stress disorder (PTSD)
  • Other trauma-related mental health disorders

Those three new treatments are important because they have characteristics that the previous generation of treatment and therapy do not. In comparison to traditional psychiatric medications and techniques, TMS, SPRAVATO®, and IV ketamine infusions:

• Work quickly to relieve symptoms:
  • In some cases, symptom relief begins right away
• Last longer:
  • The effects of TMS, SPRAVATO®, and IV ketamine infusions persist after the course of treatment ends
• Have fewer side effects:
  • Some traditional antidepressants have significant negative side-effects, including increased suicide risk, whereas the side-effects of TMS, SPRAVATO®, and IV ketamine infusions are minimal, and, when present, fade within hours

We’re proud to be among the few treatment centers to offer these innovative therapies to patients with mental health diagnoses and treatment-resistant mental health diagnoses. We’re also proud to welcome all members of the LGBTQIA+ community to our family. While these new approaches to treatment offer relief to patients with treatment resistant diagnoses, we also provide traditional therapy when indicated.

Therapy for the LGBTQIA+ Community

As we mention in the introduction to this article, over 20 million people in the U.S. identify as members of the LGBTQIA+ community. And as we describe in detail in the body of this article, people in the gender and sexual minority report rates of depression, anxiety, and suicidality at higher rates than people in the gender and sexual majority.

That means we need to pay close attention to the unique needs of this community, which are informed by decades of discrimination and barriers to care. To be one hundred percent clear, we’re LGBTQIA+ friendly.

We have one message for any LGBTQIA+ person seeking mental health treatment: 

We welcome you with open arms and an open heart.

We’ll greet you with kindness, treat you with compassion and empathy, and work to help you move from where you are to where you want to be. We employ the new approaches we describe above, but we’re also skilled and experienced in traditional modes of psychotherapy, including:

• Cognitive behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Acceptance and commitment therapy (ACT)
• Exposure and response prevention (ERP)
• Eye Movement Desensitization and Reprocessing (EMDR)

If you identify as LGBTQIA+ and need mental health support, please reach out to us. We’ll create a customized treatment plan that works for you. If you’ve tried treatment before without success, we can help you rediscover hope and the belief that you can heal, grow, and thrive. If you’ve never engaged in treatment before and are ready to start, we’re here for you. We can help you take your first steps on the path to full recovery, total health, and overall wellbeing.