The Healthy People 2010 Companion Document for LGBT Health highlighted several areas of concern that affect all subpopulations within this community, including mental health, tobacco, and substance use. In 1973, the American Psychiatric Association removed homosexuality from its official diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II).
With this act, the association no longer characterized homosexuality as a mental illness. In the years that followed this major change, several studies set out to evaluate the prevalence of mental health disorders in the community.
Despite homosexuality being depathologized, there have been concerns that social stressors could lead to a higher prevalence of mental health disorders among sexual orientation and gender identity minorities. LGBT people face multiple stressors in their daily lives, such as rejection by peers or family, social stigma, sexual orientation discrimination, transphobia, and violence.
For many adolescents, there also is the added burden of acknowledging one’s lesbian or gay identity, often without family or social support, while also struggling to develop an adult identity. The population-based studies that have included questions on sexual orientation have revealed that rates of depression, anxiety, and suicide attempts are higher among men and women with same-sex partners.[21, 22, 23, 24, 25] The National Survey of Midlife Development in the United States (MIDUS) found that 2.5 percent of participants reported being homosexual.
Both major depression and panic disorders were higher in homosexual men, while generalized anxiety disorders were higher in lesbians. Both groups had higher rates than heterosexuals of two or more mental health disorders, and they used mental health services more than their heterosexual counterparts.
Lesbian, Gay, Bisexual, and Transgender Health
A recent study designed to evaluate the prevalence of psychiatric disorders among lesbian, gay, and bisexual black, Latino, and white individuals revealed that white lesbian, gay, and bisexual individuals had a higher prevalence of anxiety, mood, and substance use disorders compared with black and Latino participants; however, black and Latino lesbians, bisexuals, and gays had higher rates of serious suicide attempts (statistically significant for Latino participants) that mainly occurred in adolescence and young adulthood.
Why do lesbian, gay, bisexual and transgendered people have different health concerns?
A 1994 Gay & Lesbian Medical Association Membership Survey found that 50% of respondents witnessed substandard care based on patient’s perceived sexual orientation. 64% of respondents believe revealing sexual orientation places patients at risk for substandard care. This and other factors unique to the lifestyles of LGBT patients can place them at greater risk for certain health issues.
Supporting the theory that social stressors are the main cause for mood and anxiety disorders, rather than sexual orientation minority identity, a recent study showed that rates of depression and present suicidal ideation among lesbian, gay, and bisexual youth was no higher than among heterosexual youth when adjustment was made for markers of stress, such as the number of positive events and negative events, satisfaction with social support, and acceptance coping.
Anita Radix, MD, MPhil, MPH, and Gal Mayer, MD, MS
Anita Radix, MD, MPhil, MPH, Director of Research and Education, Callen-Lorde Community Health Center
Dr. Gal Mayer MD practices internal medicine in New York, New York. Callen Lorde Community Health Center
- The Gay and Lesbian Medical Association. Healthy People 2010 companion document for LGBT Health.
- Solarz AL, Institute of Medicine, eds. Lesbian Health: Current Assessment and Directions for the Future. 1st ed. Washington, DC: National Academies Press; 1999.
- Dean L, Meyer I, Robinson K, Sell R, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101-151.
- Laumann E, Gagnon J, Michael R, Michaels S. The Social Organization of Sex: Sexual Practices in the United States. Chicago, IL: University of Chicago Press; 1994.
- Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City. Men Ann Intern Med. 2006;145:416-425.
- Mosher W, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15-44 years of age, United States, 2002. Vital Health Stat. 2005;362:21-26.
- Goodenow C, Szalacha L, Rubin L, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Pub Health. 2008;98(6):1051-1058.