Research on biological and psychosocial factors in mental health disparities offers clues to reducing the mental health burden among LGBTQ+ people.
In Pride month, one of the areas that will be much discussed is mental health among LGBTQ+ people.
My name is Qazi, and I’m a scientist and lecturer at King’s College London. I’ve been studying the origins of sexuality for about 20 years, and I am now working on understanding the factors involved in mental health problems among LGBQT+ people. This field is fascinating for its own sake because sexuality is central to human nature and our deepest passions. But this research can also help improve the lives of LGBTQ+ people. Here I describe some of the work that myself and others have been doing.
But let me start with a word about terminology.
In our community, we have a bit of an alphabet soup of different acronyms we use. In this article, I’ve used “LGB” to stand for lesbian, gay, bisexual, and in other places “non-heterosexual” where the studies use broader groups. I’ve also used “SGM” or “sexual or gender minority” which is a more recently coined broader term for people who are LGBTQ as well as LGBT+. This includes people who may not identify as such but include those who have same-sex attractions or engage in sexual relationships with people of the same sex or gender.
People who identify as lesbian, gay, and bisexual (LGB) are at almost twice the increased risk of common mental health problems, such as depression, anxiety, suicidal thinking, self-harm and substance dependence compared to heterosexuals.
Bisexual people also appear to have even poorer mental health while lesbian and bisexual women have a particular risk of substance dependence.
So LGB people have an increased need for mental health interventions, but we know very little about whether they benefit equally compared to heterosexual people from the mental health interventions currently on offer.
My colleague Professor Kate Rimes investigated this by analysing data from all the NHS Talking Therapies programmes in England (this is a programme that provides psychological therapies for common mental health problems on the NHS). What she found was that for psychological interventions offered for depression and anxiety, lesbian and bisexual women had poorer treatment outcomes than heterosexual women. Bisexual men also had poorer treatment outcomes than heterosexual and gay men. So, we need to improve treatments for these groups.
One thing that would help us to improve our treatments is if we had a better understanding of the causes of mental health problems in LGBTQ+ people.
Some researchers argue that so-called “minority stressors” cause mental health problems in LGB people. These stressors include the discrimination and stigma they experience (such as homophobic abuse) as well as psychological factors such as hiding one’s sexuality or gender identity, and their own negative beliefs about being LGBTQ+ (sometimes called internalised homophobia). These different stressors may interact with each other to cause mental health problems.
While these factors are enormously important, we also wanted to test whether genetics played a role. Are LGBTQ+ people genetically more vulnerable to experiencing mental health problems?
In one study, we did with our PhD student Liadh Timmins, we recruited identical twin pairs (who share all of their genes) where one twin was heterosexual and their co-twin non-heterosexual. We then asked them to complete surveys about their mental health and experiences of minority stressors. Since the twins already share the same genotype, genetics cannot be the explanation for any differences found.
We found that there were no differences between the twin pairs in depression, anxiety, and well-being, although the LGB twins had higher rumination than their heterosexual co-twins. Rumination is a vulnerability factor for depression and anxiety and involves overthinking or trying to think about why you are feeling low.
Our study has two main implications: yes, there is some influence of genetics in their experience of mental health problems, as both twin pairs had similar levels of depression and anxiety, but also that social experiences unique to each twin influence mental health, as only the LGB twins had increased rumination. This suggests that targeting rumination might be one avenue for researchers and clinicians to consider in improving mental health among LGB people.
At this point in our understanding of the science, we have some evidence that genetics influence some mental health problems in non-heterosexual people, but not necessarily on the specific psychological factors (such as rumination) that we might be able to change. The next step is whether we can identify additional modifiable psychological factors that could be potential targets in future psychological interventions.
We tried to do this in two studies where we followed up people over long periods of time. This method helps us to better understand whether one factor causes another over time.
In the first, Dr Kunle Oginni found that people who identified as a sexual minority at age 15 went on to report more suicidal ideation and self-harm at 20 years of age. Importantly, he also found that low self-esteem measured at 17 years was an important factor in this link. This shows that targeting self-esteem among LGB people might help us to reduce suicidal ideation and self-harm later on, as well as depression.
In a second study, our PhD student Georgina Gnan studied the mental health of LGBT university students over three time points, a month apart. She found that having lower self-esteem and more negative beliefs at earlier time points was associated with more depression, anxiety, and suicidality later on, because of more rumination and also more avoidance (such as avoiding difficult situations) and hiding one’s LGBT identity.
My colleague Professor Kate Rimes is drawing on these and other findings from our research to develop a new intervention to target low self-esteem in young LGBT+ adults, and the early results appear promising.
In concluding this piece, I think it is important to note that many factors influence mental health disparities between LGB and heterosexual people. Discrimination and stigma are important but do not entirely explain these differences. Genetics does not explain it away completely either. Thus, there are many more factors at play here.
It is also important to end on a positive note and I encourage readers to remember that based on our scientific knowledge about the rates of mental health problems in LGBTQ+ populations, most people who are LGBTQ+ will not develop mental health problems, and of those who develop them, few are attributable to being LGBTQ+. And most importantly, new psychological interventions developed specifically for this community are coming soon.
