General mental health and well-being
Project STRIDE: Stress, Identity, and Mental Health, New York City, 2004-2005, is a study that was conducted to gather data on the effect of stress and minority identity related to sexual orientation, race/ethnicity, and gender on mental health in a three-year span in New York City. Alessi et al. (2013), used a mixed-method study to examine correlation between prejudice events and posttraumatic stress disorder (PTSD) among a sample of LGB people who participated in Project STRIDE. Their study indicated that prejudiced events, regardless of whether they were life-threatening, were associated with major life changes and compromised participants’ sense of safety. Such events can shift ones’ existing cognitive schemas or one’s way of viewing the world. The authors argued that post-traumatic stress occurs not just because of experiencing fear and terror but also by destroying a person’s assumptions about the world.
A recently published article by Holm et al. (2021) assessed the relationship between sex, race/ethnicity and sexual orientation, as well as depressive symptoms using Project STRIDE data. In this intersectional research, the authors used ‘discrimination’ as a mediator between identity and depressive symptoms. The analysis showed some paradoxical findings, though. For example, while both in the past and today, Black men (especially those who identify as a sexual minority) experience more difficulty in their day-to-day life, the study found that gay and bisexual Black men reported fewer depressive symptoms than straight White men. Also, it showed that despite the relatively high rates of depressive symptoms, discrimination did not mediate the impact of identity status on depression for the LGB Latinx group. The authors argued that ‘discrimination’ cannot solely predict depressive symptoms. Other factors (e.g., lack of social support, income and education opportunity, etc.) play roles to predict disparities in depressive symptoms. In addition, the authors conclude that traditional approaches to health disparities research are not enough, and intersectional approaches are needed to better understand disparities beyond the sexual/racial identities.
Some of the more recently collected data about sexual minorities’ health and well-being distributed at ICPSR is Generations: A Study of the Life and Health of LGB People in a Changing Society, United States, 2016-2019. This 5-year study meant to examine health and well-being in three generations of LGB populations, for example, how older and younger cohorts’ differences in stress experience affect their mental health and well-being, including depressive and anxiety symptoms, substance and alcohol use, suicide ideation and behavior, and utilization of LGB-oriented social and health services.
Using Generations data, Assink et al. 2021 examined the mental health of lesbian, bisexual, and other-identified parents and non-parents. They found that lesbian/gay non-parent women had a higher community connectedness and less psychological distress compared to bisexual or other-identified non-parent women. The authors also found that bisexual parents, compared to lesbian and other-identified parents, experienced more psychological distress and lower life satisfaction and happiness, and are less connected to the LGBT community. In another study, Carone et al. (2021) examined the quality of life and several mental and physical health dimensions in transgender parents and non-parents. Using the U.S. Transgender Population Health Survey (TransPop), the authors did not find any significant differences between trans or cisgender parents and their non-parent counterparts in terms of mental and physical health, despite the social stigma and negative expectations about transgender parenthood.
In addition to all sorts of existing social distress, changes in the political climate could become a further source of distress for sexual minority groups. Krueger et al. (2021) used Generations data to examine the state of mental health of Black and Latinx sexual minority adults over 17 months post the 2016 US presidential election and found a significant worsening. During that time, the sociopolitical environment changed, and sexual minority populations faced discriminatory policies such as revoking regulations that provided protections to LGBT people or attempts to exclude them from public health surveys. Such changes, the authors said, “coincided with worsening mental health for Black and Latinx SM people.” The authors noted their analysis assessed the general impact of the election on this population’s mental health, and it was not designed to assess the impact of specific policy changes or any specific racist/anti-sexual/gender minority rhetoric.
Adolescents, youth, and young adults
The process of disclosing sexual orientation or ‘coming out’ can be difficult and stressful for many LGBT youths especially those who confront homophobia or peer rejection. Consequently, sexual-minority youths can become isolated from their families or communities, according to Daniels and Leaper (2011). The increased rates of depression, self-harm, and suicidal ideation among LGBT youths have been a concern among psychologists. Using the NICHD Study of Early Child Care and Youth Development: Phase IV, 2005-2007, Martin-Storey and Crosnoe (2012) found a meaningful correlation between sexual minority status and depressive outcomes. According to this study, 15-year-old LGBT youths who experienced harassment because of their sexual orientation reported a lower level of self-concept, more negative perception of the school environment, and decreased self-regulation that led to depressive outcomes.
The National Longitudinal Study of Adolescent to Adult Health (Add Health), 1994-2018 is another good source to study mental health in sexual minority youths. This multi-wave longitudinal study of US adolescents was begun in 1994 to study teens in grades seven through 12, and has had multiple follow-up interviews. The latest wave of this study was conducted from 2016 to 2018, when the original Wave I respondents were 33 to 43 years old. The study collected demographic, social, familial, socioeconomic, behavioral, psychosocial, cognitive, and health survey data from participants and their parents. Also, it provides information on the physical and psychological well-being of sexual minority adolescents and young adults.
Lourie and Needham (2016) utilized Add Health data to demonstrate that sexual orientation discordance increases the risk of unfavorable mental health including stress and depressive symptoms. The study found that in general, both females and males who identified as heterosexual at Wave IV—respondents aged 24 to 32— who showed sexual orientation discordance at any of the four waves, had increased depressive symptoms and experienced higher levels of psychological distress. In contrast, males and females who identified as bisexual or homosexual at Wave IV and exhibited sexual orientation discordance did not have an increased level of depressive symptoms. Using the four waves available to them at the time allowed the authors to make a unique comparison between heterosexual-identified and sexual minority respondents and their sexual orientation discordance.
Ueno et al. (2014) assessed the association between sexual orientation, migration patterns, and mental health. Using Add Health data, they demonstrated that sexual minority women benefit from migrating, especially migrating to countries with higher proportions of urban residents. Also, sexual minority men benefit from migrating to counties with higher proportions of college-educated and urban residents. The authors argued that migration to more urban and progressive areas improves sexual minorities’ mental health, especially men’s. However, the analysis showed that migration promotes mental health in those who reported same-sex orientation during their young adulthood in contrast to those who reported it during their adolescence. But sexual minorities do not necessarily migrate more than heterosexual people, perhaps due to insufficient resources or restrictions
Suicide ideation and attempts among sexual minority groups
According to WHO (2021), suicide rates among vulnerable groups including racial and sexual minorities are high. Although we do not know the exact rate of suicide for sexual minority people in the US, some studies show that one in five LGB adults have attempted suicide in their lifetime Hottes (2016). Also, according to Herman et al. (2019), data from the 2015 U.S. Transgender Survey (USTS), another ICPSR study containing data about sexual minorities, indicate that 40.4 percent of sexual minority people reported suicide attempts during their lifetime, and 7.3 percent reported attempting suicide during the past year of data collection for the survey.
Using Project STRIDE data, Meyer et al. (2008) examined the prevalence of psychiatric disorders among lesbian, gay, and bisexual Black, Latino, and White individuals. Their study showed that Black lesbians, gay men, and bisexual people had a lower prevalence of all disorders compared to Latino and White LGBs. However, more Black, and especially Latino LGBs reported a suicide attempt compared to their White counterparts. Since suicide attempts were seen mostly among younger people, which is a coming-out period for many of them, the authors speculated that it could be related to “social disapprobation” experienced in communities of color. Finally, the authors noted that a higher risk of suicide among LGBs was not associated with a higher risk of mental disorders.
Using the same dataset, Meyer et al. (2015) later assessed the association between different forms of treatment and odds of a suicide attempt among LGB adults aged 19-59. According to this study, 23 percent of those who reported suicide attempts sought mental health or medical treatment, and 14 percent sought religious or spiritual treatment before the attempt. The study revealed that receiving mental health or medical treatment did not prevent suicide attempts. Also, those who received religious or spiritual treatment had higher odds of suicide attempts compared to those who did not seek treatment at all. The study showed that Black LGBs relied on religious and spiritual treatment more than White LGBs.
The USTS is one of the first and most comprehensive large-scale samples of transgender populations in the US, and it covers a broad range of topics including suicidal thoughts and behaviors. Using this dataset, Yockey et al. (2020a) studied suicide ideation among transgender adults in the United States. Their analysis showed almost 5 out of 10 individuals reported thinking about suicide, which is an increase, when comparing results of previous research. This analysis showed that many demographic factors such as current gender and gender identity were associated with higher odds of suicidal thoughts. Also, suicidal ideation existed more among low-income individuals (who made less than $25,000), those who had a lack of family support, and those who experienced physical or sexual assault. Similarly, Cramer et al. (2021) used the USTS to analyze suicidal thoughts and behaviors among transgender and gender-diverse adults. Their analysis supported the previous findings: Almost all forms of discrimination and victimization were found as risk factors for suicidal thoughts and behaviors.
With a focus on African American transgender individuals, Yockey et al. (2020b) examined USTS data and found that 33.5 percent had experienced suicidal thoughts at least once. Also, 20 percent had planned to attempt suicide, and 38 percent had attempted suicide. Individuals who reported drinking alcohol, smoking, or using e-cigarettes/vaping were more likely to report attempting suicide. Moreover, the study found that individuals who reported ever being victimized or who had experienced intimate partner violence were at higher risk of suicide.
In an article by Liu and Wilkinson (2021), marital status is introduced as one of the other risk factors in suicide attempts/ideation among transgender populations. Using the 2015 USTS, the analysis showed that marital status is one of the key social factors in satisfying the life experience of transgender people. According to the study, compared to married transmen and transwomen, never married and previously married transgenders had a higher risk of suicide attempts and ideation, with an exception in never married transwomen, who showed a lower risk of suicide ideation (not attempt).
Conclusion
This Research Spotlight does not reflect all of the existing research regarding the mental health of the LGBTQ population. To see how each of the ICPSR studies mentioned in this Spotlight has been examined in other scholarly literature, to gain ideas for extending prior research, or to conduct a larger literature review, you can search the ICPSR Bibliography of Data-related Literature. The term, “LGBT,” typically encompasses identities of “gay,” “lesbian,” “bisexual,” and “transgender,” but may also include other communities identifying under terminology such as “pansexual,” “nonbinary,” or “genderqueer.” Using search terms like mental health AND sexual minorities or mental health AND (“lesbian” OR “gay” OR “transgender”) will lead you to search results containing publications linked to the study data analyzed in them. Discovering data via the literature in this way can begin your investigation of the existing and potential uses of the data distributed by ICPSR.
When authoring publications that include your secondary analysis of study data downloaded from ICPSR, be sure to cite the study in the publication’s references section, using the provided data citation and unique identifier (in the form of a URL containing a DOI). Once your paper is published, submit its citation to the ICPSR Bibliography via this form, so it can be added to ICPSR’s collection of linked data-related literature, enabling others to find, learn from, and cite your work.
*LGBTQ people are represented in some or all of the study samples and publications used in this Research Spotlight; other members of the LGBTQ2+ community are not.
