Why Mental Illness is More Prevalent in The LGBT Community than in The General Population

Despite the increase in public support for LGBT issues members of the community are still at higher risk of a compromised mental health. During the last two decades the large emergenceof scientific and public awareness LGBT lives and issues has made an impact. This awareness includes, socio Cultural shiftsin understandings of sexual and gender identities. It can be traced back to the ‘Gay Rights’ movement in the 1970’s and the advent of HIV/AIDS in the 1980’s. The first research attention to LGBT youth focuses explicitly on mental health. A small number of studies in the 1980s began to identify concerning rates of reported suicidal behavior among “gay” youth, and a US federal report on “gay youth suicide” (Gibson 1989) became controversial in both politics and research (Russell 2003).

During the past two decades there have been not only major shifts in public attitudes toward LGBT people and issues (Gallup 2015), but also the arrival of research from multiple and diverse fields that has created a solid foundation of knowledge regarding mental health in LGBT youth. In recent years the changes in societal acceptance has made coming out possible for many people however there are still problems regarding social regulation of gender and sexuality, for example homophobia. Due to the social and historical problems mental health is a pressing concern for the LGBT youth regardless of increasing social acceptance. Mental health in LGBT youthBefore the 1970’s homosexuality was listed as a ‘sociopathic personality disturbance’ in the

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Studies on the prevalence of same-sex sexuality (Ford and Beach 1951)(Kinsey et al 1948,1953) and psychological comparisons between gay and heterosexual men stimulated a change in attitudes from the psychological community and prompted the removal of homosexuality as a mental disorder in 1973, although all of the conditions concerning same sex attraction were not removed until 1987. The topic of same-sex sexuality shifted from the idea that there is essentially a link between poor mental health and homosexuality, towards understanding the social determinants of LGBT mental health. There have also been recent debates regarding the diagnoses related to gender identity that currently remain in the DSM. Adolescence is a critical period for mental health and this is because many mental illnesses show onset during or directly after this developmental stage ( Kessler et al 2005,2007). In addition to this suicide is the third leading cause of death for youth ages 10 to 14 and the second leading cause of death for those aged 15 to 24 (CDC 2012). Knowledge of the the prevalence of LGB mental health has greatly improved due to the inclusion of sexual attraction, behaviour and identity measures in population based studies.

There is a great need for the growth and inclusion of measures to identify transgender people in order to gain a greater understanding of mental health among transgender youth. International studies consistently conclude that LGBT youth report higher rates of emotional distress, symptoms related to mood and anxiety disorders, suicidal behaviour and self harm, when compared to heterosexual youth (Eskin et al 2005, Marshal et al 2011)In a recent meta analysis, (Marshall et al, 2011), reported that sexual minority youth were almost three times as likely to report suicidality, a statistically moderate difference in depressive symptoms compared to heterosexual youth was noted. Although there is a plethora of literature highlighting differences in symptoms and distress, there is a lack of studies to explore the presence of mental health disorders or diagnoses among LGBT youth. Fergusson et al (1999) used a birth cohort of australian youth from 14 to 21 years old and they found that LGB youth were more likely to report suicidal thoughts or attempts and experienced more major depression substance abuse or generalised anxiety disorders. at a later date Fergusson et al (2005) conducted another study to show differences among LGB youth which was quite interesting. Studies found that in regards to LGB youth suicide there is a stronger association between sexual orientation and suicide attempts for secual minority males compared to sexual minority females. LGBT young people face fear, hatred and prejudice in school, with friends, in the community and at home, which can lead to higher risks of self-harm and thoughts of suicide. LGBT teens are six times more likely to experience symptoms of depression than the general population. Additionally, LGBTQ youth struggle in coming out to family members, friends, classmates and teachers, especially those that are not accepting of the LGBTQ community. GLSEN, the Gay, Lesbian and Straight Education Network has developed an annual report called the National School Climate Survey, which reports on the experiences of lesbian, gay, bisexual and transgender youth in U. S. schools. Early intervention, comprehensive treatment and family support are the key to helping LGBT youth on the road to recovery from a mental health condition. Triggers Minority stress theory by Meyer (1995,2003)has provided a framework to understand sexual minority mental health discrepancies.

The theory proposed that sexual minorities experience clear chronic stressors regarding their stigmatised identities. This includes discrimination, victimisation or prejudice. These negative experiences alongside everyday stressors compromise the mental health of LGBT people. Overall the minority stress model is based around the idea that the relationship between members of minority and dominant communities results in social conflict with the social environment. With relation to to sexual minorities this concerns people in the LGBT community dealing with homophobic culture which can be hostile to them. Minority stress does not manifest itself in the same way for every minority group and it depends on their personal experiences, Sexual minorities can experience stress due to perceived discrimination or from situations where they may be bullied harassed or become victims of violence. Issues like perceived discrimination can lead to problem behaviours such as cigarette smoking improper nutrition or substance abuse. Being verbally bullied or physically harmed due to having a minority status can cause a great amount of distress and can result in mental health issues that may not even be immediately diagnosed. For example some members of the LGBT community may experience stress from being rejected because of who they are or fromhiding their sexual orientation,or internalised homophobia. Stress can have a tremendous effect on the physical and mental well being of an individual. When an individual is stressed certain hormones are released which are often referred to as stress hormones. If the stress response system is triggered frequently over a long period time it can disrupt several of the body's processes which ultimately increases the risk for numerous health problems. Stress can prematurely age the immune systems stem and enhance the risk of various age related illnesses. There is evidence for the benefits of constant positive stress that shows how stress may actually be correlated with longevity—if a person doesn’t view it as a negative. Researchers at the University of Wisconsin-Madison asked almost 29,000 people to rate their level of stress over the past year as well as how much they believed this stress influenced their health — a little, a moderate amount or a lot. Over the next eight years, public death records were used to record the passing of any subjects. They found that people who reported having high levels of stress and who believed stress had a large impact on their health had a whopping 43% increased risk of death.

On the other hand, those that experienced a lot of stress but did not perceive its effects as negative were amongst the least likely to die as compared to all other participants in the study. When referencing the stress experienced by the LGBT community, it is solely the negative impact. Within the LGBT community stress varies between lesbians, gays, bisexuals and Transgenders. This is heavily due to the level of acceptancein society. Lesbians are more accepted in society but have been more widely fetishlised, Gays are less accepted due to toxic masculinity however they are more likely to be represented in the media. Bisexuals are viewed as having an identity crisis and are often subject to harassment in and out of the LGBT group. Transgenders are the least accepted in society and are most at risk. Harassment is a major contributor to poor mental health in the LGBT community. LGBT people are victims of harassment and violence particularly at school. This form harassment is known as hate crimes. In 1992 the US congress defined hate crimes ‘As the defendant conduct motivated by hatred, bias or prejudice based on the actual or perceived race colour religion national origin ethnicity gender, sexual orientation or gender identity of another individual or group individuals. The punishment for hate crimes has become more severe over the years. Gregory M. Herek (1993,1996) conducted a study to investigate the effect of hate crimes on mental health. The study used a range of people the sample included gay men,bisexuals and lesbians. The median age was 34 years old and there was an equal amount of males and females. Participants were asked to complete a questionnaire about their experiences with crime, their community involvement and they were asked for their beliefs on various topics. Results from the study showed that hate crimes had a bigger impact psychologically than other crimes. Lesbian and gay survivors ofhate crimes-stress, depression and anger showedsignificantly higher levels of distress than those who had survived crimes that were not related to sexual orientation.

The heightened distress was thought to be caused by the association of personal vulnerability concerning their identity. In addition to causing more stress, the duration of distress due to hate crimes was also longer lasting in comparison to non bias crimes. Harassment references a broad spectrum of offensive behaviours. The journal of adolescent health published a study to explore the link between discrimination at school and mental health risks. Data comparing lesbian gay and bisexual youths and heterosexual youths was taken from the 1995 youth risk behaviour survey. The study's conclusion said ‘’ the findingsprovide evidence that differences in health risks among LGB youth are mediated by discrimination at school. ’’ There are many different types of harassment including bullying, psychological harassment, racial harassment, religious harassment, sexual harassment, street harassment stalking and gang stalking. Verbal harassment is defined as the act of directing negative statements toward someone causing emotional harm. Verbal harassment is the most frequently reported type of harassment as there are no limitations. The gay lesbian and straight society education network measured the anti gay harassment found in school. They found that61. 1% of gay lesbian transgender Students reported being verbally harassed. The journal of consulting and clinical psychology published an article which reviewed rh verbal and physical abuse of lgbt youths. The article states ‘this response to gay male, lesbian and bisexual adolescents by significant others in their environment is often associated with several problematic outcomes including runaways,conflict with the law, school related issues, substance abuse, prostitution and suicide. Although the causal link between these stressors has not been scientifically established there is suggestive evidence that these outcomes are consequences of verbal and physical harassment. Bullying is a form of harassment that can occur not only in the playground but the classroom or in the workplace. This type of psychological harassment can be mortifying and can definitely lower an individual's self esteem Bullying is generally seen in the form of actions, gestures or verbal comments’’ (savin-williams,1994). Bullying can also occur in writing e. g. bathroom walls in school’. Homophobia is one of the reasons that youth are often harassed.

Homophobic bullying andharassmenthas been estimated to be the cause of one in five homosexuals attempt to kill themselves. Bullying is a type of trauma so can therefore cause injury to the health of an individual. Research has shown that LGB youth are more likely than adults to be victimised by antigay prejudice events, and the psychological consequences of their victimisation may be more severe. Surveys of schools in several regions of the United States showed that LGB youth are exposed to more discrimination and violence events than their heterosexual peers. Several such studies, conducted on population samples of high school students,cross in their findings and show that the social environment of sexual minority youth in U. S. high schools is characterised by discrimination, rejection, and violence (Faulkner & Cranston, 1998; Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998). Compared with heterosexual youth, LGB youth are at increased risk for being threatened and assaulted, are more fearful for their safety at school, and miss school days because of this fear (Safe Schools Coalition of Washington, 1999). in a random sample of Massachusetts high schools students, LGB students more often than heterosexual students had property stolen or deliberately damaged, were threatened or injured with a weapon and were in physical fight requiring medical treatment Safe Schools Coalition of Washington, 1999). A national survey of LGBT youth conducted by the advocacy organization Gay, Lesbian, and Straight Education Network (GLSEN; 1999) reported that those surveyed experienced verbal harassment sexual harassment physical harassment, and physical assault. The majority of LGBT youth sometimes or frequently heard homophobic remarks at their schools, with many reporting hearing these remarks from faculty or school staff (GLSEN, 1999). Risk factorsThere are two ways used to explore risk for mental health in LGBT youth.

The first approach is to look at the the likelihood of universal risk factors that have already been identified for all youth for examplefamily conflict or child maltreatment. LGBT youth score higher on severalof the critical universal risk factors for compromised mental health, such as substance use and abuse conflict with parents(Russell 2003). The second method explores LGBT-specific factors such as stigma and discrimination and how these add onto everyday stressors to aggravate poor outcomes. Here we concentrate the latter and discuss prominent risk factors identified in the field—the absence of institutionalised protections, family rejection and biased-based bullying—as well as developing research on intrapersonal characteristics associated with mental health vulnerability. At the interpersonal level, an area that has gathered new attention is the distinct negative effect of biased-based oppression compared to general harassment (Poteat & Russell 2013). Researchers have demonstrated that biased-based bullying (i. e. , bullying due to one’s perceived or actual identities including race, ethnicity, religion, sexual orientation, gender identity or expression, and disability status) increases the effects of victimisation on negative outcomes. When compared to non-biased-based victimisation, youth who experience LGB-based victimisation report increasedlevels of depression, suicidal ideation, suicide attempts, substance use, and truancy (Poteat et al. 2011, Russell et al. 2012a), regardless of whether these experiences are in person or via the Internet (Sinclair et al. 2012).

Disparities In Care

The history of mental health treatment of lesbian, gay, bisexual andtransgender (LGBT) populations is a very uneasy one. In the 1950s and 60s, many psychiatrists believed that homosexuality, as well as bisexuality, was a mental illness. Gay men and lesbians were often subjected to treatment against their will, including forced hospitalisa­tions, aversion therapy and electroshock therapy. Fortunately, there have been great developments made in the nearly 35 years since the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders(DSM).

Despite this, there are still disparities and unequal treatment among LGBTQ groups seeking care. Though more therapists and psychiatrists today have positive attitudes toward the LGBTQ community, people still face unequal care due to a lack of training and/or understanding. Health care providers still do not always have up-to-date knowledge of the unique needs of the LGBTQ community or training on LGBT mental health issues. Providers who lack knowledge and experience working with members of the LGBTQ community may focus more on a person’s sexual orientation and/or gender identity than a person’s mental health condition.

Conclusion

In conclusion mental health is more prevalent in the LGBT community than in the general population. Lesbian, gay, bisexual and/or transgender people are at significantly greater risk of mental health problems than heterosexual people. Evidence suggests people identifying as LGBT are at higher risk of experiencing poor mental health. LGBT people are more likely to experience a range of mental health problem. The higher prevalence of mental ill health in LGBT people can be attributed to a range of factors such as discrimination, isolation and homophobia. clear and consistent evidence. Without mental health we cannot be healthy. We all experience emotional ups and downs from time to time caused by events that occur in our lives. Mental health conditions go beyond these emotional reactions to specific situations. They are medical conditions that cause changes in how we think and feel and in our mood.