Lesbian, Gay, Bisexual, and Transgender Pride Month (LGBT Pride Month) is celebrated every year in June to honor the 1969 Stonewall riots. It aims to achieve equal justice and equal opportunity for lesbian, gay, bisexual, transgender, and questioning (LGBTQIA+) Americans.

While there is much to celebrate, there is still a long way to go in terms of mental health within this group. Of particular concern, is the increased risk of youth suicide within the LGBTQIA+ community.   

Suicide a leading cause of death

Suicide continues to be the second-leading cause of death for all youths aged 15-24 (CDC WONDER: Underlying Cause of Death, 1999–2019, 2020), and this does not include the thousands of unsuccessful suicide attempts that are not reported. Moreover, lesbian, gay, bisexual, transgender, and questioning (LGBTQIA+) youth are more than three times as likely to have suicidal thoughts or behaviors (STB) when compared to their heterosexual peers.

According to current research, LGBTQIA+ people are most likely to die by suicide in their teens and early 20s. In 2015 LGB-identified high school students attempted suicide more than 4.5 times more than non-LGB students (29.4% vs. 6.4%); 42.8% seriously thought about suicide.

Bisexual youth and youth questioning their sexual orientation or gender identity suffer from depression and suicidality at higher rates than their non-LGBT peers (Laura Kann et al., 2016). These trends continue to increase, and a survey published by the LGBTQIA+ mental health nonprofit, the Trevor Project showed that “forty-five percent of young LGBTQIA+ people seriously considered attempting suicide in 2021”.

It is the third consecutive year that rates of suicidal ideation have increased among LGBTQIA+ youth, the organization said (The Trevor Project: 2022 National Survey on LGBTQ Youth Mental Health, 2022). More focused research has shown that transgender youth are at an even higher risk for STB (Hatchel et al., 2021).

The needs of transgender and nonbinary youth must be understood. Compared to cisgender lesbian, gay, bisexual, queer, and questioning youth, transgender and nonbinary youth had more than double the risk of depressed mood and suicidality. Male transgender youth were most likely to experience depression and suicidality (Price-Feeney et al., 2020).

Risk Factors for Suicide

According to the CDC, those who identify as sexual or gender minorities may be more likely to experience factors associated with suicide, which include social isolation, impulsive or aggressive tendencies, and adverse childhood experiences, such as child abuse and neglect, and bullying (Center for Disease Control (CDC), n.d.-a).

Other health disparities (Disparities in health outcomes and their causes between different groups) may also affect these groups. CDC tracks and monitors suicide rates in groups disproportionately affected by suicide based on age, gender, race, ethnicity, geography (such as a state or county), and, most importantly for this discussion, sexual orientation (Center for Disease Control (CDC), n.d.-b).

However, as the Trevor Project states, it is essential to note that LGBTQIA+ youth are not “inherently prone to suicide risk because of their sexual orientation or gender identity but rather placed at higher risk because they are mistreated and stigmatized in society.”

Why is it Important to Understand Gender Fluidity? 

We tend to understand reality according to specific categories and schemas. Most schemas clash and contain two opposing variables. The same goes for sexuality, as it is still common for people to understand sexual identity (a component of identity that reflects different aspects of sexuality and sexual orientation) in terms of sexual attraction that a person feels towards others (as divided into two categories: heterosexuality and homosexuality).

However, with the accumulation of research on the subject, the understanding of sexual orientation has changed. We now understand that sexual orientation is a fluid trait that can vary throughout adulthood. The range is based on pluralistic and flexible thinking and is influenced by culture, environment, personality, and relationships.

Sexual orientation is no longer seen as a tendency to be homosexual or heterosexual but rather as a sequence of movements between them. In this group, the total sexual attraction to men and women (or pan-sexuality) is characterized by aesthetic appeal, romantic love, or sexual desire towards people, without association to their gender identity or biological species.

Sexual attraction and sexual orientation are becoming more flexible than in the past, both in their definition and the perception of the LGBTQIA+ community.

During adolescence, the developmental stage of self-perception and the formation of personal identity is prominent. This is often a turbulent period when adolescents’ perception of themselves and the world takes shape, and a process of gender and sexual identity formation takes place.

In parallel, these young people also deal with the physiological changes of adolescence. For LGBTQIA+ youths, accepting these changes alongside coping with gender roles dictated by society and the culture in which they find themselves is a complex, ongoing and delicate process. When a youth experiences shame and concealment of their desires and needs or feels a mismatch between the biological sex and their gender experience, forming a personal identity becomes complex.

For example, a girl who feels from a young age that she is a boy, dresses as a boy, and acts like a boy, experiences a gap between the gender identity she wants to adopt and her biological identity. In such cases, there is a chance they may develop anger and/or self-hatred that impair their functioning and well-being in the various areas of life.

When individuals are exposed to external stigma, it can lead to the emergence and maintenance of issues such as internalized homophobia (i.e., negatively conceived self-perception). The psychological well-being of LGBTQIA+ people is affected by various other factors, such as identity, personality, and community. On the other hand, the optimal success of this process will positively impact their mental state and the self-perception of the youth in the present and later life (Wang et al., 2021). 

Protective Factors:

LGBTQIA+ people can benefit from building resilience in order to improve their mental health and life adjustment. A number of factors can help prevent LGBTQIA+ youth from spiraling into depression and suicidal behavior, including: 

• The acceptance of a person by their family (e.g., parents, siblings, grandparents, children). For example, the Trevor survey respondents said they feel supported by their parents or caregivers when they welcome their LGBTQIA+ friends or partners, talk respectfully with them about their identity, correctly use their name and pronouns, support their gender expression, and educate themselves about LGBTQIA+ people and issues (Ryan et al., 2010).
• Being surrounded by LGBTQIA+ friends, allies, and family of choice (a close relationship with people who are not biologically related, but act as family nonetheless) is essential. Additionally, young LGBTQIA+ people living in communities that accept them reported significantly lower rates of suicide attempts compared to those living in communities that do not (The Trevor Project: 2022 National Survey on LGBTQ Youth Mental Health, 2022). 
• Medical and mental health services that are LGBTQIA+ inclusive are accessible and used (Bockting et al., 2016).

By participating in LGBTQIA+-affirming counseling and therapy, receiving medical care, and accessing LGBTQIA+-specific resources, resiliency factors can be enhanced. In order to minimize the impact of stigma and discrimination on LGBTQIA+ youth and adults, mental health providers can use minority stress treatment principles (Pachankis, 2014): 

• Reduce the adverse effect of minority stress by normalizing it
• Promote emotional awareness, regulation, and acceptance
• Strengthen assertive communication
• Rework minority stress cognitions
• Raise awareness of the unique strengths of LGBTQIA+ individuals
• Encourage supportive relationships and community
• Support the expression of sexuality and gender in a healthy and rewarding way 

“The fact that very simple things — like support from family and friends, seeing LGBTQIA+ representation in media, and having your gender expression and pronouns respected — can have such a positive impact on the mental health of an LGBTQIA+ young person is inspiring, and it should command more attention in conversations around suicide prevention and public debates around LGBTQIA+ inclusion.” Amit Paely, CEO Trevor Project 

New York Behavioral Health therapists can provide professional therapy for the LGBTQIA+ community. 

References

Bockting, W., Coleman, E., Deutsch, M. B., Guillamon, A., Meyer, I., Meyer, W., Reisner, S., Sevelius, J., & Ettner, R. (2016). Adult development and quality of life of transgender and gender nonconforming people. Current Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 188–197. https://doi.org/10.1097/MED.0000000000000232

CDC WONDER: Underlying cause of death, 1999–2019. (2020). https://wonder.cdc.gov/Deaths-by-Underlying-Cause.html

Center for Disease Control (CDC). (n.d.-a). LGBT Youth | Lesbian, Gay, Bisexual, and Transgender Health | CDC. Retrieved May 17, 2022, from https://www.cdc.gov/lgbthealth/youth.htm

Center for Disease Control (CDC). (n.d.-b). Risk and Protective Factors | CDC. Retrieved May 17, 2022, from https://www.cdc.gov/suicide/factors/index.html

R., & Espelage, D. L. (2021). Suicidal Thoughts and Behaviors Among LGBTQ Youth: Meta-Analyses and a Systematic Review. In Archives of Suicide Research (Vol. 25, Issue 1, pp. 1–37). Routledge. https://doi.org/10.1080/13811118.2019.1663329

Laura Kann, P., Emily O’Malley Olsen, M., Tim McManus, M., William A. Harris, M., Shari L. Shanklin, M., Katherine H. Flint, M., Barbara Queen, M., Richard Lowry, M., David Chyen, M., Lisa Whittle, M., Jemekia Thornton, M., Connie Lim, M., Yoshimi Yamakawa, M., Nancy Brener, P., & Stephanie Zaza, M. (2016). Morbidity and Mortality Weekly Report Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9-12-United States and Selected Sites, 2015 Surveillance Summaries Centers for Disease Control and Prevention MMWR Editorial and Production Staff (Serials) MMWR Editorial Board. MMWR.

Pachankis, J. E. (2014). Uncovering Clinical Principles and Techniques to Address Minority Stress, Mental Health, and Related Health Risks Among Gay and Bisexual Men. Clinical Psychology: Science and Practice, 21(4), 313–330. https://doi.org/10.1111/CPSP.12078/FULL

Price-Feeney, M., Green, A. E., & Dorison, S. (2020). Understanding the Mental Health of Transgender and Nonbinary Youth. Journal of Adolescent Health, 66(6), 684–690. https://doi.org/10.1016/j.jadohealth.2019.11.314

Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing : Official Publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 23(4), 205–213. https://doi.org/10.1111/J.1744-6171.2010.00246.X

The Trevor Project: 2022 National Survey on LGBTQ Youth Mental Health. (2022). https://www.thetrevorproject.org/survey-2022/

Wang, Y., Feng, Y., Han, M., Duan, Z., Wilson, A., Fish, J., Sun, S., & Chen, R. (2021). Methods of attempted suicide and risk factors in LGBTQ+ youth. Child Abuse and Neglect, 122. https://doi.org/10.1016/j.chiabu.2021.105352