A consistent level of parental support, even if it’s negative, leads to better mental health outcomes for lesbians and gay men, according to a small new study.
The report, released this week at the American Psychiatric Association’s annual meeting, found that individuals whose parents were initially unsupportive of their sexual orientation but became more accepting with time were most likely to report symptoms of anxiety and depression.
Researchers at the Chicago School of Professional Psychology surveyed 175 cisgender gay men and lesbians about the initial and current levels of parental support they received regarding their sexuality.
Based on their responses, the subjects were divided into three groups: Those whose parents’ reaction was consistently positive, those whose parents’ reaction was consistently negative and those whose parents’ reaction shifted from negative to positive. (A fourth group, individuals whose parents were initially positive but shifted to negative, was excluded because it was too small to analyze.)
The groups were then given two assessments frequently used to determine mental health: the general anxiety disorder-7questionnaire and a patient health questionnaire. The first questionnaire found those with consistently positive support and those with consistently negative support had “mild anxiety,” while those whose parents evolved from negative to positive had “moderate anxiety.” The latter questionnaire, which rates symptoms of depression, found those with static parental reactions exhibited “mild depression,” while those whose parents shifted their support had what is considered “moderate depression.”
Lead author Matthew Verdun, a doctoral candidate in applied clinical psychology at the Chicago School of Professional Psychology and a licensed family therapist, said many factors could be at play, including that family rejection can lead gays and lesbians to find new, healthier support systems.
“In coming out, we learn how to cultivate meaningful relationships and navigate across social context,” he said. “Who are safe people to come out to? How do I identify the people who are going to accept all of me, including my orientation?”
Re-establishing the bond with a previously unaccepting parent could mean ending therapy or abandoning a chosen family, he said. And just because a parent is more accepting doesn’t mean the environment is a positive one.
“If a parent goes from being unsupportive to supportive, are they abandoning some of their relationships that may still be unhealthy?” Verdun said. “Are they part of a faith tradition that rejects their child or says they’re an abomination? If the parent comes around but doesn’t shift out of that belief system, that’s going to affect their child.”
Previous research has generally linked negative responses from family to a higher probability of LGBTQ mental health issues: According to a 2010 study by the Family Acceptance Project, lesbian, gay, bisexual and transgender young adults who reported low levels of family acceptance in adolescence were over three times more likely to have suicidal thoughts and to report suicide attempts, compared to those with high levels of family acceptance.
But those studies, Verdun noted, look at the dynamic at one point in time, usually when the individual has just come out or is still living at home. “I wanted to know what happens over time,” he said.
The findings can be useful for mental health providers, he said, but they shouldn’t be interpreted as meaning that rejecting your gay or lesbian child is a healthy response.
“If I was talking to parents, I’d say supporting your child is key,” Verdun said.
Psychiatrist Jack Drescher, author of “Psychoanalytic Therapy and the Gay Man” and a former editor of the Journal of Gay and Lesbian Mental Health, called the findings “rather surprising.”
“It’s not the result we expect, based on clinical evidence,” Drescher, who was not involved in the study, said. “But when we don’t know the answer, the answer is always to do more study. I’d love to see qualitative research — get narratives of the people involved and see what themes emerge among those who had the experience of having negative and later positive responses.”
Suicide rates among young people have been on the rise in recent years, according to the Centers for Disease Control and Prevention, but gay and bisexual youths are almost five times as likely to have attempted suicide as their straight peers.
And, despite advances in the fight for LGBTQ equality, a new report finds that young gay people today are even more likely to have attempted suicide than in previous generations.
Researchers at the Williams Institute, a sexual orientation and gender identity think tank at UCLA School of Law, found that 30 percent of lesbian, gay and bisexual respondents ages 18 to 25 reported at least one suicide attempt, compared to 24 percent of those 34-41 and 21 percent of those 52-59.
The study, published last month in the journal PLOS One, also revealed that these young adults are experiencing higher levels of victimization, psychological distress and internalized homophobia than older generations.
“We had really expected it would be better for the younger group,” said lead author Ilan H. Meyer, a distinguished senior scholar of public policy at the institute. “But at the same time, we knew data from other studies has shown LGB youth do a lot worse than straight youth — and not much better now than in earlier times.”
Meyer and his colleagues surveyed 1,518 respondents who identified as lesbian, gay or bisexual (trans people were included in a separate study). Participants were divided into three cohorts: the “Pride” generation, those born from 1956 to 1963; the “Visibility” generation, born from 1974 to 1981; and the “Equality” generation, born from 1990 to 1997.
Using the Kessler Scale, a clinical measure of psychological distress, they found that members of the Equality generation reported almost twice as many symptoms of anxiety and depression as the Pride generation. Many factors influenced the data, Meyer said, including the fact that people are coming out younger than ever.
“That can be a positive, of course,” he said. “But it can also backfire and expose you to a lot of harassment and victimization. You might not be prepared for the consequences.”
Members of the Equality generation reported coming out to a family member at age 16 on average, compared to 22 for the Visibility generation and 26 for the Pride generation.
That can put them at risk of rejection at a time when they rely most on family for emotional and financial support, said Amy Green, vice president of research for The Trevor Project, an LGBTQ youth crisis intervention and suicide prevention organization.
According to a survey by the organization last year, 40 percent of LGBTQ youths ages 13 to 24 had seriously considered attempting suicide in the previous 12 months.
“It’s not that the world isn’t making progress for LGBTQ people, it’s that recent progress has resulted in an amazing community of young people who understand who they are but still live in a world where others may be unkind to them, reject them, bully them or discriminate against them,” Green said in an email. “And we know these experiences of victimization can compound and produce negative mental health outcomes.”
The advent of social media and the internet has also greatly affected the Equality generation’s sense of identity.
“When we asked them about other people in the community, the younger group’s answers were always — always — about social media, not about real-life encounters,” Meyer said. “People are very cruel online, whether it’s Twitter or Grindr.”
Meyer said that before he examined interviews accompanying the survey, he expected to hear people in their teens and 20s present “a different way of being gay.”
“But one of the first narratives I listened to was from an 18-year-old Latino from San Francisco, and his narrative was the same as we’ve heard for generations — homophobia, exclusion, shame. The evolution [in LGBTQ rights] hadn’t impacted his life as much as you’d expect.”
Members of the Equality generation reported more anti-LGBTQ victimization than their older counterparts, Meyer said. Nearly 3 out of 4 (72 percent) said they had been verbally insulted about their identity, and almost half (46 percent) said they had been threatened with violence. More than a third (37 percent) reported having been physically attacked or sexually assaulted.
“I believe in the power of institutions and social structures changing. I really do,” Meyer said. “But I think real progress takes longer than we think. Just because we’re seeing change doesn’t mean every gay kid’s parents are accepting or that their friends are embracing them.”
There were some silver linings: Of the three groups, members of the Equality generation most reported feeling connected to the LGBTQ community.
“That was actually surprising, because we hear so much about people feeling like they don’t belong,” Meyer said. “But this suggests there is still pride, despite the difficulties and negativity, sometimes even from within our own community.”
Coming out younger has also given them more resiliency, he added.
“Coming out earlier gives you a great start on life, even if you face hardships,” he said. “This generation is already out when they get to college. They have a better sense of who they are. Older generations had to wait longer to live their authentic lives.”
If you are an LGBTQ young person in crisis, feeling suicidal or in need of a safe and judgment-free place to talk, call the TrevorLifeline now at 1-866-488-7386.
With the inauguration of President Joe Biden, I hope we may now see the kind of leadership on LGBTQ issues we need. As a gay African-American man living with HIV, I have lived through two pandemics. Under both HIV/AIDS and COVID-19, LGBTQ people have had to shoulder the burden of discrimination while fighting to survive. I hope that 2021 is the year that changes.
I was diagnosed with HIV in 1984, in the early years of the epidemic. I lost many friends in the years that followed. So many of us in that time never expected to live a full life ourselves. After watching our friends die, it became hard to imagine that we’d ever make it to our 40th birthday — let alone retirement. The discrimination we experienced and the looming threat of the virus made it difficult to build careers and save for the golden years we never thought we’d see. I’ve lost jobs due to discrimination myself, and the stress of it nearly killed me. That’s why today, I help advocate for LGBTQ elders and folks on social security.
I have seen every stage of the HIV/AIDS crisis, from the pandemic, to its aftermath, to the present day. I know how much work it takes to survive and thrive in the face of this virus. As the administrator of a group home for folks recovering from HIV-related hospital stays, a member of the local HIV Planning Council, and a care outreach specialist for a community clinic, I’ve seen the kind of discrimination people still face. I once worked with a pregnant woman who was turned away from a local hospital for being HIV-positive. Because our clinic existed, she got the care she needed and her baby was born healthy.
In recent years, advances in prevention and access to testing and treatment have led to encouraging declines in new diagnoses. But stigma and anti-LGBTQ bias continue to have consequential effects on testing decisions. Time and again, I have spoken with clients who choose to hide their condition or status to avoid ostracization and discrimination. According to a recent research report by the Williams Institute at the University of California, Los Angeles, 44 percent of Black LGBTQ adults have either never been tested, tested when they felt at risk, or once every two years or less. It’s an alarming statistic that falls far too short from CDC recommendation for testing frequency for HIV, which is at least once a year or more frequently.
Despite these challenges, it’s possible to live a full and healthy life with HIV/AIDS. As Americans, we should be able to participate in all aspects of daily life with dignity and respect, and without fear of discrimination. If we wholeheartedly want to end the HIV epidemic in the United States, we must seize the moral high ground and ensure LGBTQ Americans are provided with equal rights, better access to care, and increased secure housing. Federal nondiscrimination legislation will help us get there.
Although it’s important to celebrate how far we’ve come, right now, 50 percent of LGBTQ people live in the 29 states that lack comprehensive statewide laws explicitly prohibiting discrimination against LGBTQ people, including here in my home state of Georgia. And in the midst of a pandemic and the accompanying economic crisis, it’s inhumane that millions of us can still be denied housing or medical care just because of who we are or who we love. Situations like these enable the spread of HIV.
Our nation is going through a profound change, but our values of treating others as we would want to be treated remains the same. The Equality Act would ensure that all LGBTQ Americans can live, work, and access public spaces and medical care free from discrimination, no matter what state we call home. It’s the right thing to do — which is why this type of legislation has broad and deep support across lines of political party, demographics, and geography. Public support is at an all-time high, with 83 percent of Americans saying they favor LGBTQ nondiscrimination protections, including 68 percent of Republicans and a majority in every state in the country.
After all, equality is not a Democratic or Republican value, it’s an American value. It’s also the smart thing to do as we work to end the HIV epidemic in America.
Nathan Townsend is a 66-year-old Black gay man living and thriving with HIV for 36 years. He devotes his time and efforts helping to promote health equity and equal access to care for his community.
Bisexual men are more likely to experience eating disorders than either heterosexual or gay men, according to a new report from the University of California San Francisco.
Numerous studies have indicated that gay men are at increased risk for disordered eating — including fasting, excessive exercise and preoccupation with weight and body shape. But the findings, published this month in the journal Eating and Weight Disorders, suggest that bisexual men are even more susceptible to some unhealthy habits.
In a sampling of over 4,500 LGBTQ adults, a quarter of bisexual men reported having fasted for more than eight hours to influence their weight or appearance, compared to 20 percent of gay men. Eighty percent of bisexual men reported that they “felt fat,” and 77 percent had a strong desire to lose weight, compared to 79 percent and 75 percent of gay men, respectively.
Not everyone who diets or feels fat has an eating disorder, said a co-author of the study, Dr. Jason Nagata, a professor of pediatric medicine at UCSF. “It’s a spectrum — from some amount of concern to a tipping point where it becomes a pathological obsession about body weight and appearance,” Nagata said.
Of all the respondents, 3.2 percent of bi males had been clinically diagnosed with eating disorders, compared to 2.9 percent of gay men. That stacks up to 0.6 percent of heterosexual men, according to research from the Yale University School of Medicine.
Nagata said the discrepancies highlight the need to conduct eating disorder research on various sexual identities independently. “Prior studies on eating disorders in sexual minority men have grouped gay and bisexual men together, so it was difficult to understand the unique characteristics in bisexual men.”
Several factors may be at play, he said, including “minority stress,” the concept that the heightened anxiety faced by marginalized groups can manifest as poor mental and physical health outcomes.
“LGBTQ people experience stigma and discrimination, and stressors can definitely lead to disordered eating,” Nagata said. “For bi men, they’re not just facing stigma from the straight community but from the gay community, as well.”
The bisexual advocate and author Zachary Zane said this “double discrimination” often leads to loneliness, depression and a fear of coming out.
“We face ostracization from both sides, or if we’re embraced by the LGBTQ world, it’s because we’re hiding our authentic selves,” Zane said. “When you feel everything is out of control, [food] is something you can have control over. I can understand how that would be appealing.”
Thirty percent of bi men in the survey reported being afraid of losing control of their eating, and nearly a third said they had difficulty focusing on work or other activities because they were thinking about food, eating or calories.
While binge eating was similar among gay and bi men in this report, a 2018 American Psychiatric Association study of university students found that bisexual men were three times as likely to binge eat as their gay classmates and five times as likely as heterosexual male students.
Subjects for the report were chosen from the Pride Study, the first large-scale, long-term national health study of sexual and gender minorities, sponsored by UCSF and other institutions.
It relies on self-identification for sexual orientation and allows respondents to choose multiple identities or even write in their own. For the sake of the report, Nagata’s team categorized cisgender men who identify as bisexual, pansexual, polysexual or otherwise attracted to more than one gender as “bisexual-plus.”
Bisexuals, the largest demographic in the LGBTQ community, face numerous health disparities, including higher rates of obesity, substance abuse, binge drinking, sexually transmitted illnesses, cardiovascular disease and even some forms of cancers. Thirty-nine percent of bisexual men say they have never told a doctor about their sexual orientation, three times the percentage of gay men, according to a 2012 study by the Williams Institute.
A recent study in JAMA Pediatrics found that, in the first three years after having come out, bisexuals were twice as likely to start smoking as lesbians or gay men.
Bisexual youth are at an elevated risk for self-harm: Forty-four percent of bi high schoolers have seriously considered suicide, compared to a quarter of gay teens and less than 10 percent of heterosexual students, according to a 2011 study from the University of IllinoisCollege of Education. And a 2013 report in the Journal of Adolescent Health found that suicidal thoughts did not decrease as they entered adulthood, as they did for gay and straight people.
But few diagnostic tools or treatment programs make adequate distinctions, Nagata said, even for gender: Most assessment tools for eating disorders, for example, were devised for cisgender women, and they can overlook behaviors more common among men, like eating more to gain mass. While only 3 percent of the bisexual male study subjects had been diagnosed with eating disorders by clinicians, nearly a quarter met the criteria based on their answers.
“Raising awareness of these differences is the first step,” he said. “Having tailored interventions for LGBTQ people, for bisexual people, is just common sense. It’s not a one-size-fits-all treatment program.”
Zane said that if researchers want to help bi men with eating disorders, they need to address the unique roots of bi men’s depression, anxiety and need for control.
“When researchers lump bi and gay men together, it not only contributes to bi erasure — implying that bi men have the same struggles and identity as gay men — it also leads to ineffective treatments,” he said. “If the goal is to actually help bisexual men, then all research needs to parse them out from gay men, period.”
Bullying used to be depicted as kids being shoved into lockers and coerced out of their lunch money by the older, more popular rulers of the school. Nowadays, the focus on bullying has shifted to those hiding behind computer screens and taunting others in the virtual world. While in-school bullying is on the rise, technology and social media have created alternate avenues for bullies to wreak havoc. Whether bullying is done on school grounds or over the phone, the consequences can be lifelong and even life-ending.
So how many kids are experiencing cyberbullying and how do their parents feel about it? To get a better idea of technology’s role in bullying, we surveyed more than 1,000 parents of children over the age of five and asked about their children’s cyberbullying experiences. Continue reading to see what we learned.
Unfortunately, the issue of failure to intervene is also directed at schools. While schools have some authority over what occurs on school grounds, cyberbullying can take place anywhere and usually occurs off campus. Multiple states have laws allowing schools to punish students involved in cyberbullying, but free speech issues can make it difficult to hold students accountable for off-campus acts. The pushback doesn’t sit well with the majority of parents, though.
Almost 66 percent of parents thought schools should hold kids accountable for off-campus cyberbullying – and their desires are supported by research. Studies have shown that cyberbullying is usually not completely off campus, with social media and internet harassment often being an indicator of in-school bullying. Even if the school doesn’t do anything to intervene, 35 percent of parents said they notified the school about a cyberbullying incident.
The discrepancy between parental concerns and actual data may be due to parents’ increased presence on Facebook over Instagram. If parents aren’t actively using Instagram, they may be less likely to see the bullying or understand the increased risk.
Tech for Teens
Technology can be both helpful and harmful regarding children’s safety, and development. With numerous pros and cons, there doesn’t seem to be a magic answer for when children should be introduced to technological devices and how much time they should spend on them. However, when children get technology seems to depend on the type of technology.
Kids between the ages of six and 10 were more likely to have tablets compared to every other age group and significantly less likely to have smartphones.Smartphones jumped in popularity for kids aged 11 to 13, with 73 percent of parents reporting their middle school-age children having at least one device each.
While the average age at which kids got their first personal tech device was 9.8 years old, studies have shown cyberbullying is linked to the amount of time spent on social media rather than the age at which kids begin using technology. The more time children spend on social media, the higher their risk for cyberbullying. Parents reported their children spent an average of 1.8 hours a day on their personal devices. For the majority of children 18 and younger, parents had access to their devices. Ninety-six percent of parents with children aged six to 10 had access to their kids’ devices, a number that only dropped to over 82 percent for children aged 14 to 18. Significantly fewer parents with children aged 19 and older said they had access – almost a third, despite their kids being legal adults.
Having access to kids’ devices or limiting their screen time is less about overprotectiveness and more about helping children navigate the harm technology can bring. Even the leader of the technology world, Bill Gates, sets strict rules for his children regarding smartphone use, ultimately banning them until age 14.
However, a significant portion of parents with kids from all age groups reported their children had Instagram accounts. Remember, Instagram is now considered a playground for cyberbullying, and despite the minimum age requirement of 13 to create an account, over 11 percent of parents with children aged 6 to 10 reported their youngsters used the platform. Of course, every parent is different, and some children may be more prepared for the digital world than others, but here are some tips to consider before allowing your child onto social media.
Bullying is still ever-present on school grounds and is increasingly problematic online, especially on social media. Kids may get access to technology and sign up for social media at younger ages (sometimes even before the minimum age requirement), but our study revealed that parents are continuing to monitor their children’s use. From limiting their time to having access to their accounts, parents seem to be aware of the threats that technology and the internet possess and are working to protect their children as much as they can.
Parents shouldn’t depend on social media companies to step in and police themselves. As an alternative, parental monitoring software can help parents keep track of what their kids do on their phones and manage their activity accordingly. Some tools parental control tools may be included with your device, and a range of third-party vendors offer easy-to-use dashboards from which parents can filter content. Comparitech has detailed reviews and tutorials on the best parental control apps and software.
We surveyed 1,011 people. To qualify for the survey, people had to report having at least one child over the age of 5. If they had more than one child, respondents were asked to answer the survey based on their experiences with their oldest child.
Respondents were 59.3 percent women and 40.7 percent men. The average age was 42.1 with a standard deviation of 11.
Parts of this project include calculated averages. These were computed to account for outliers. This was done by finding the initial average and the standard deviation. The standard deviation was multiplied by three and added to the initial average. Any data point above this sum was excluded from the calculation of the final average.
When asked which social media accounts their children had, respondents were given the choices that appear in the final visualization, as well as the options of Tumblr, “I don’t know what accounts my child has,” and “Other.” These were excluded from the final visual due to low sample sizes. In the visual about which social media platforms posed the biggest risk for cyberbullying, Reddit and “Other” were also choices given to respondents, but they were excluded from our final visualization of the data.
Limitations
Respondents answered the survey based on their experiences with their oldest children. It’s possible that respondents with multiple children had different or more acute experiences with their other children. Also, this survey is based on parents’ perspectives. Therefore, they may not have knowledge of all their children’s internet activities.
Sydney Duncan, 44, an attorney in Alabama, has been so focused on managing the increased legal needs of her clients that she rarely has time to address her own mental health needs, including her anxiety.
Since the start of the coronavirus pandemic, Duncan has devoted nearly her whole waking day to her work at Birmingham AIDS Outreach, an Alabama nonprofit. Helping her transgender clients obtain vital name changes has become a prolonged process due to court backlogs piling up, helping them acquire driver’s licenses has become harder while Social Security offices are closed, and increased unemployment among the community she serves has complicated a variety of services her nonprofit provides.
Sydney Duncan.Courtesy Sydney Duncan
“We’re so busy trying to resolve other people’s issues — which objectively are more pressing than anything I have going on in my life — that it’s hard to slow down and feel the weight of the problems in your own life,” Duncan said.
Duncan, who is transgender, is among many LGBTQ Americans grappling with the added strain of the coronavirus crisis as they continue to adjust to a “new normal.” Meanwhile, the United States is poised to deal with a third spike in Covid-19 cases and hospitalizations, nine months into the pandemic.
Prior to the global crisis, lesbian, gay, bisexual, transgender and queer Americans were already at greater risk of mental health problems, according to the Centers for Disease Control and Prevention. This elevated risk — due to a host of factors, including stigma and discrimination — combined with a global health crisis that has upended life as we once knew it, is presenting unique challenges for LGBTQ people.
“The physical distancing, economic strain and housing instability caused by Covid-19 have the potential to exacerbate these barriers among LGBTQ young people,” Dr. Amy Green, vice president of research at The Trevor Project, an LGBTQ youth crisis intervention and suicide prevention organization, told NBC News.
‘Barely making it by’
Duncan had hoped to begin the year by supplementing her nonprofit salary by working as a comic-book writer. She made her debut with Dark Horse Comics at the end of last year but said her family is now “barely making it by” as opportunities have dried up.
“I feel like I’m better off than most, so don’t want to take someone else’s place if they need it more,” said Duncan, who added that she has been having “more sleepless nights” amid the pandemic. However, “opportunities seem fewer,” she added, which has affected more than just her finances.
“I’ve buried myself in working constantly to not pay attention to anything, but at some point it’s going to crash, and I don’t know what I’ll do then.”
REBECCA MIX
“To make it to a level and have it erode from beneath you — the loss feels more profound,” she said. “Second chances for someone like me feel further away.”
Many LGBTQ people work in industries that have been disproportionately affected by Covid-19, according to research by the Human Rights Campaign. These industries include jobs that have been contracted due to the pandemic, as well as other industries that have put workers at direct risk of exposure to the virus.
The report found that in addition to being at risk for precarious employment conditions, LGBTQ people were less likely to have health insurance, putting them further at risk from Covid-19.
On the other side of the coin, as many work remotely, the lines between work and home life have evaporated, putting an additional strain on mental health.
Rebecca Mix, 25, a queer author from Michigan, said that being overworked has just become a normal part of her routine with little sign of that changing.
“I think I’m barreling towards burnout,” Mix told NBC News. “I’ve buried myself in working constantly to not pay attention to anything, but at some point it’s going to crash, and I don’t know what I’ll do then. But I feel like I don’t have any other option.”
Loss of community
One of the biggest losses Covid-19 has robbed Duncan of is her sense of community. Seeing friends and colleagues on video conferencing has become exhausting, she said, and a poor substitute for having a community to help lift one another up.
“For me, community is support,” Duncan said. “Without community, I feel less supported, less confident in my place in the world. I feel this underlying anxiety every day.”
Many around the country have begun feeling “zoom fatigue,” while working to implement social distancing measures at work and with friends.
There is also worry about the long-term impact that the loss of in-person connections could have on LGBTQ people coming into their own with their sexual orientation and gender identity and presentation. A lack of a supportive community could stunt that formative time for many, according to research from Boston University’s School of Public Health.
A recent poll conducted by The Trevor Project showed that 40 percent of LGBTQ youth across the country said that “Covid-19 impacted their ability to express their LGBTQ identity,” with that number jumping to 56 percent for transgender and nonbinary youth. In addition, another report found that 2 in 5 LGBTQ youth in the United States have “seriously considered” suicide in the past year, highlighting the direness of the situation for many this year.
Access to therapy
The combination of economic strain and lack of available space to express themselves has also conspired against LGBTQ Americans by blocking access to a vital mental health resource: therapy.
Green, of the Trevor Project, said many LGBTQ youth have lost their job amid the pandemic and the health insurance that came with it.
“Finding providers who are not only affordable and available but also well versed in LGBTQ youths’ identities and unique mental health challenges can prove incredibly difficult in many areas of the country,” she said. “And concerns around parental permission, being outed and privacy could be heightened for LGBTQ youth who find themselves confined to unsupportive home environments and isolated from affirming LGBTQ communities.”
One of the silver linings of the pandemic has been the increased access to teletherapy as health care providers shift to remote work. This has been particularly helpful for those who had little access to affirming mental health care in their physical area.
“By and large, I have found it has worked really well,” Dr. Alex Keuroghlian, director of the Fenway Institute’s National LGBT Health Education Center and Massachusetts General Hospital’s Psychiatry Gender Identity Program, told NBC News this year. “I’ve had almost no no-shows in my schedule, and patients are answering the phone very appreciative that we can give them care despite what’s happening.”
Remote therapy, while easier to access in some respects, still does not make it accessible for everyone. Mix, for example, began teletherapy during the pandemic, but then had to quit once the costs started piling up.
“At one point, I felt so spiraling-out-of-control depressed and anxious, but I had to stop because I couldn’t afford it,” Mix said. “I’ve noticed everything is harder and more exhausting — things as simple as phone calls to household tasks like laundry and dishes.”
Therapy in addition to medication helped stem feelings of spiraling out of control and depression, but the longer the pandemic rages on the harder it will be to stay on top of certain tasks and remain motivated in day-to-day life, Mix said.
Others, who are sheltering in place with people unsupportive of their LGBTQ identity, may not have a space to privately participate in a mental health video visit. And some may be skeptical of a new platform for accessing health services altogether.
Housing precariousness
A combination of unemployment, unsupportive families and reduced in-person services at LGBTQ centers have created an acute crisis of housing precariousness for the community.
Wren.Courtesy Wren
Wren, 20, who is nonbinary and uses ze/hir pronouns and asked that hir surname not be published to protect hir privacy, has spent the past year moving to different parts of the country to avoid infecting family members, to keep job prospects alive and have space to finish college classes. For Wren, this involved moving in with hir partner on a farm in Appalachia, working in exchange for rent.
For around two months, Wren returned home to see hir family, but that only brought old traumas and threats of violence. Wren is back on the farm with hir partner, trying to navigate an uncertain future amid the pandemic.
“The uncertainty about where I would be living, the worry I felt for my community in the city who were at higher risk for Covid and were facing violence from police during the protests this summer, and stressed family relationships compounded pre-existing mental health issues I have been dealing with for years,” Wren said.
Mental health investment
The implications of the Covid-19 pandemic on the state of mental health care won’t be known for some time, the Trevor Project’s Green added, but the disparities in our current system show that urgent investment is needed before more LGBTQ people get left behind without access to care.
“Investing in mental health and social services is the best strategy for proactively preventing worse mental health consequences in the future,” Green said.
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.
If you are an LGBTQ young person in crisis, feeling suicidal or in need of a safe and judgment-free place to talk, call the TrevorLifeline now at 1-866-488-7386.
Clinton, CEO of the Transgender Health and Wellness Center in Cathedral City, California, said she has been working 70-hour weeks providing services to the LGBTQ community, which has been hit especially hard as the Covid-19 pandemic rapidly spreads across the U.S.
She said she’s seen a rise in transgender people seeking the center’s help after they have lost their homes or jobs and have had to go back to sex work to make ends meet.
The social and economic disparities are hitting the transgender community “very hard,” Clinton said in a phone interview with CNBC, adding transgender people already faced extra obstacles before the pandemic. “I’ve also noticed a growth in mental health issues, basically suicidal thoughts and attempt.”
Doctors are concerned the pandemic, which has shuttered businesses and schools and left people without jobs, may hit the LGBTQ community harder than most others.
According to the U.S. Gay and Lesbian Medical Association, the LGBTQ community, a diverse group of people that includes a variety of socioeconomic and ethnic backgrounds, tends to face higher rates of cardiovascular diseases, obesity and other health problems that research suggests can make a coronavirus infection more severe. They also experience higher rates of illicit drug use, homelessness, isolation, anxiety, depression and suicide and often face barriers to health care, medical experts say.
“All the issues that existed prior to the pandemic still exist but are even worse. They’ve been amplified by the pandemic,” said Dr. Scott Nass, GLMA’s president.
But doctors and health experts are unsure how severe the impact on the LGBTQ community is because data is so limited. Most state health officials responsible for collecting data on coronavirus cases often report information such as race, age and sex but not other details like sexual orientation and gender identity, health advocates and experts point out.
“In many places across the world and U.S., we don’t have good data collection,” said Dr. Jesse Ehrenfeld, the American Medical Association’s former board chair. “Because LGBTQ people are often invisible when it comes to data collection in a variety of contexts, including health care, that has really limited our ability to get out information about what’s going on.”
Doctors fear the impact on LGBTQ people could be substantial when considering the social, economic and health risk factors the community already faces.
Dr. Sarah Ketchen Lipson, a professor at Boston University’s School of Public Health, said the pandemic is likely putting significant stress on young LGBTQ people, particularly those heading to college with a smaller group of friends and social distancing measures.
“The college years, like age 18 to 24, are a really key time for gender identity development and general psychosocial development,” she said in a phone interview. “And many young people find or have a stronger sense of community when they arrive at the campus, and that’s particularly true for sexual and gender minorities.”
“One thing I’m really worried about for that population is how the pandemic is making it much more difficult for students to find a sense of community on campus,” she added.
Lipson, co-principal investigator of the Healthy Minds Study, a national survey on mental health among college students, said the pandemic has also limited LGBTQ students’ access to mental health services and gender-affirming services, like hormone replacement therapy.
“This is a key time for higher education to not be cutting back on the availability of mental health services, and schools obviously have to make really difficult decisions in terms of their budgets,” she said. “Schools may end up paying for that in a much bigger way if they are not tending to their students’ mental health needs.”
Dr. Barbara Taylor, who treats HIV patients and is a professor of infectious diseases in San Antonio, said there has been a drop nationwide in people getting tested for HIV and other sexually transmitted diseases since many outreach programs were forced to suspend services because of the pandemic. The result could lead to a rise in people who don’t realize they have HIV, a virus that disproportionately impacts gay and bisexual men.
Taylor, a provider within University Health System, said many clients are “very nervous” about coming into a health-care setting where they might get exposed to Covid-19. She said marginalized patients, like those she treats, already face barriers to care such as lack of health insurance, lack of transportation and stable housing. She added data on the impact on LGBTQ people is “just not there.”
“This is a structural thing. Everything about this pandemic has highlighted existing structural inequities. This pandemic is highlighting inequities in the LGBTQ community just like it’s highlighting inequities in communities of color,” she said. “Covid just shines a spotlight on the injustices in our system.”
Ehrenfeld, a professor at the Medical College of Wisconsin, said he is also worried about a rise in domestic abuse, which sexual and gender minorities are more likely to experience than their heterosexual counterparts. Domestic abuse is on the rise, studies have shown, as more people have to stay at home.
“We know that LGBTQ people are often more likely to be homeless, but there is another component of domestic abuse that should be discussed,” he added.
He said there are great resources for LGBTQ people struggling at this time, including in his own state, where online support groups have been formed for transgender people.
GLMA’s Nass echoed the need for resources for LGBTQ people. He said the organization has renewed its call for health services, federal agencies and programs to be open to all communities, including LGBTQ.
“It’s a huge first step for a lot of organizations, especially those who have not seen this as a priority in the past,’” he said.
Clinton of the Transgender Health and Wellness Center said she’s been focusing on keeping the LGBTQ connected through Facebook groups and private Zoom chats that allow young people in the community to come together while staying safe.
“LGBTQ kids are struggling right now,” she said.
Editor’s note: If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255.
Landmark research marking Asexual Awareness Week (25-31 October) has found that one in ten queer youth in America identify as asexual or on the ace spectrum.
Asexual people are often overlooked within the LGBT+ community, but using data from its 2020 National Survey on LGBTQ Youth Mental Health, The Trevor Project found that in a sample of more than 40,000 LGBT+ youth, 10 per cent identified as asexual or on the ace spectrum.
Myeshia Price-Feeney, PhD, a research scientist at The Trevor Project, said: “Asexual youth are often forgotten in both research and outreach efforts, so we’re hoping to provide much-needed data on this important group of youth.”
Ace youth in the survey often used other words as the main descriptor of their orientation, for example “romantic attraction labels such as panromantic, biromantic, and aromantic”, said Price-Feeney, which suggests “a desire to represent their sexuality in more nuanced ways”.
Asexual young people were also more likely to be trans or non-binary. While overall a quarter of LGBT+ youth surveyed said they were trans or non-binary, and nine percent were questioning whether they were, 41 per cent of ace youth identified as trans or non-binary, and 13 per cent were questioning.
Worryingly, the data also showed that ace youth were more likely to suffer from depression and anxiety compared to LGBT+ youth overall.
Price-Feeney said: “With asexual youth reporting rates of depression and anxiety at rates higher than LGBT+ youth who are not asexual, efforts must be made to include asexual youth in suicide prevention and intervention efforts.”
More than half (56%) of LGBTQ adults and 70% of those who are transgender or gender non-conforming report experiencing some form of discrimination, including the use of harsh or abusive language, from a health care professional. The first American Heart Association Scientific Statement to address LGBTQ heart health, “Assessing and Addressing Cardiovascular Health in Lesbian, Gay, Bisexual, Transgender and Queer (or Questioning) Adults,” published today in the Association’s flagship journal Circulation, suggests improving the cardiovascular health of the LGBTQ population will require a multi-faceted approach that includes researchers, clinicians and public health experts.
In terms of health, LGBTQ orientation is considered a “sexual minority,” and transgender or gender non-conforming is considered a “gender minority.”
The statement examines existing research about LGBTQ-specific links to cardiovascular health disparities, identifies gaps in the body of knowledge and provides suggestions for improving cardiovascular research and care of LGBTQ people.
“This is particularly important now, at a time when there is increased awareness of health inequities related to unequal treatment and discrimination in the U.S.,” says Billy A. Caceres, Ph.D., R.N., FAHA, chair of the writing group for the statement and an assistant professor at the Columbia University School of Nursing in New York City. “LGBTQ individuals are delaying primary care and preventative visits because there is a great fear of being treated differently. Being treated differently often means receiving inadequate or inferior care because of sexual orientation or gender identity.”
LGBTQ populations face unique stressors, such as family rejection and anxiety over concealment of their sexual orientation or gender identity. Multi-level minority stressors and general stressors often interact in complicated ways to impair LGBTQ health. In addition, LBGTQ adults in historically underrepresented racial or ethnic groups experience higher poverty levels, insecure housing and fewer health care options compared to their white LGBTQ peers.
The writing group noted trust toward health care professionals is still lacking among many members of the LGBTQ community, and health care professionals need more education on how to provide appropriate care for LGBTQ patients. Caceres says, “It is paramount to include content about LGBTQ health in clinical training and licensure requirements in order to address these cardiovascular health disparities.”
Accrediting bodies and organizations responsible for health care professional curricula have not specifically required LGBTQ-related content, thus very little exists in health professional education training. A 2018 online survey of students at 10 medical schools found approximately 80% of students did not feel competent to provide care for transgender patients. Another study of more than 800 physician residents across 120 internal medicine residencies in the U.S. found no difference in knowledge between the baseline and post-graduate years when it came to LGBTQ-specific health topics. The statement notes that the Accreditation Review Commission on Education for the Physician Assistant began requiring LGBTQ curricular content in September 2020.
The writing committee suggests assessment and documentation of sexual orientation and gender identity information in electronic health records could provide an opportunity to address specific health concerns for LGBTQ patients, and to strengthen our ability to examine cardiovascular health of LGBTQ adults more broadly. They also note basic understanding of the terminology of LGBTQ identities is important. The statement includes a glossary to detail and clarify the various key words and terms used to describe members of the LGBTQ community such as bisexual, transgender, gay, gender nonbinary, etc.
“Health care systems need to play a significant role – to enact policies to encourage and support researchers and health care professionals to ask these questions in a respectful manner and to implement structures that emphasize the clinical importance of understanding the many layers related to caring for people with a minority sexual orientation or gender identity,” said Caceres.
The statement also notes that while there’s limited information on the cardiovascular health of LGBTQ people, a few risk factors stand out from existing data. They identify areas that require specific cardiovascular health efforts focused on the LGBTQ population:
LGBTQ adults are more likely to report tobacco use than their cisgender heterosexual peers.
Transgender adults had lower physical activity levels than their cisgender counterparts, according to a systematic review.
The statement suggests gender-affirming care might play a role in promoting physical activity among transgender people.
Transgender women may be at increased risk for cardiovascular disease due to behavioral and clinical factors (such as the use of gender-affirming hormones like estrogen).
Transgender women and non-binary persons are more likely to binge drink.
Lesbian and bisexual women have a higher prevalence of obesity than heterosexual women.
Future research is needed across the entire spectrum of the LGBTQ community to better understand the complex and multiple levels of psychological and social stressors that can impact the cardiovascular health of LGBTQ people and to develop and implement appropriate interventions that support improved cardiovascular health and overall well-being.
In addition, data is also lacking about differences in risk for cardiovascular disease by race and ethnicity and by socioeconomic level for persons who are members of the LGBTQ community. This is because most previous studies have relied heavily on samples from white, educated LGBTQ adults.
“There is much work to be done to understand and improve the cardiovascular health of LGBTQ adults,” Caceres said. “We need more robust research that allows us to draw stronger conclusions, as well as initiatives to increase clinicians’ knowledge, thereby improving care and health outcomes for LGBTQ adults.”
The Scientific Statement was developed by the writing group on behalf of the American Heart Association’s Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; and the Stroke Council.
Co-authors are Carl G. Streed, Jr., M.D., M.P.H., FACP, Vice Chair; Heather L. Corliss, M.P.H., Ph.D.; Donald M. Lloyd-Jones, M.D., Sc.M., FAHA; Phoenix A. Matthews, Ph.D.; Monica Mukherjee, M.D., M.P.H.; Tonia Poteat, Ph.D., PA-C, M.P.H.; Nicole Rosendale, M.D.; and Leanna M. Ross, Ph.D. Author disclosures are in the manuscript.
The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association’s overall financial information is available here.
About the American Heart Association The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
A majority of LGBTQ youth reported experiencing symptoms of anxiety or depression amid the pandemic, according to poll released Friday by Morning Consult and The Trevor Project, an LGBTQ youth suicide prevention and crisis intervention organization.
The poll surveyed 1,200 people across the U.S. between the ages of 13–24 in late July, including 600 lesbian, gay, bisexual, transgender and queer youth and 600 non-LGBTQ youth.
Stay-at-home orders have led to some LGBTQ youth being stuck inside in unsupportive households, which could lead to adverse mental health affects, as well as limited opportunities to get needed care, according to the survey. Nearly 1 in 4 LGBTQ youth who responded said they were unable to access mental health care because of the pandemic.
Three-fourths of LGBTQ respondents said they were suffering from increased loneliness since the pandemic began, with 55 percent reporting symptoms of anxiety and 53 percent reporting symptoms of depression in the two weeks preceding the poll. The survey found non-LGBTQ respondents were 1.75 times more likely than LGBTQ youth and 2.4 times more likely than trans and nonbinary youth to exhibit no signs of either anxiety or depression.
Over one-third of LGBTQ youth surveyed said they were unable to be themselves at home, and nearly one-third of transgender and nonbinary youth reported feeling unsafe in their living situation since the start of the pandemic.
“This year has been difficult for everyone, but it has been especially challenging for LGBTQ youth, and particularly Black LGBTQ youth, who have found themselves at the crossroads of multiple mounting tragedies,” Amit Paley, CEO and executive director of The Trevor Project, said in a statement.
Paley said that since the onset of the pandemic, the volume of youth reaching out to his organization’s crisis services programs has, at times, been double its pre-Covid-19 volume.
“We’ve known that LGBTQ youth have faced unique challenges because of the countless heartbreaking stories we’ve heard on our 24/7 phone lifeline, text, and chat crisis services; but these findings illuminate the existence of alarming mental health disparities that must be addressed through public policy,” he stated.
Compounding the negative effects of stay-at-home orders related to the public health crisis are the ongoing news reports and social media videos of violence against Black Americans and reports of police violence against people of color.
A majority of LGBTQ youth said the ongoing unrest had negatively affected their well being, with 78 percent of Black LGBTQ youth saying they had been negatively affected. Of that, 44 percent of Black LGBTQ youth said their well being had been negatively affected “a lot.”
Only 8 percent of Black LGBTQ youth said police in their neighborhood were there to protect them, which reflected a larger trend of 71 percent of LGBTQ youth in total reporting that they deeply distrust the police.
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.
If you are an LGBTQ young person in crisis, feeling suicidal or in need of a safe and judgment-free place to talk, call TrevorLifeline now at 1-866-488-7386.
