People who identify as sexual (i.e., lesbian, gay, bisexual, queer) or gender (i.e., transgender, genderqueer, non-binary) minorities have similar symptoms of anxiety and depression as heterosexual and cisgender (non-transgender) individuals. Although the symptom presentation may be similar, sexual and gender minority individuals generally experience additional identity-based stressors that can contribute to the development of anxiety and depression that are relevant to their treatment. Here we use the label sexual or gender minority (SGM) as an umbrella term to describe individuals with diverse sexual and gender identities.
Individuals who identify as a sexual minority are people whose sexual orientation does not include only heterosexuals. This includes lesbian, gay, and bisexual (LGB) individuals with many other directions, such as queer, pansexual, or asexual. Gender minority people are those whose gender identity is not directly aligned with their sex at birth. A transgender man, for example, was born with a female sex but has affirmed his gender identity as a male. Transgender people can be included in the category of gender minority, as can those who identify as non-binary or genderqueer. These two examples are of gender identities that are becoming more common for people who don’t see themselves fitting into the traditional gender binary in our society.
Remember that anyone can be of any sexual orientation or gender identity. These are two different aspects of an individual’s identity. SGM individuals may have their most essential identities but also other intersectional identities such as race, ethnicity, and age cohort. These identities could be more central to who you are.
It is unsurprising that the rates of depression and anxiety in homosexual minority individuals are more than twice those of their heterosexual counterparts. Although less research has been done on gender minorities’ mental health, published studies show that high rates of depression, suicidality, and generalized anxiety are all standard. The research supports the notion that anxiety and depression are severe problems in SGM individuals and provides some clues as to why.
Although there is growing societal acceptance, SGM individuals continue to experience discrimination in many settings, which serves as an additional stressor that complicates the lives of SGM people. SGM people are still vulnerable to the same everyday stressors as heterosexual and transgender people. Still, they also have discrimination to deal with! SGM people have higher rates of anxiety and depression than other groups. This minor stress is likely due to the combination of bias and internalization of social stigma. SGM people may attempt to hide their identities to avoid being victimized by various discrimination, internalized stigma, and other factors. The concealment can be complete (not telling anyone about your SGM identity), situational (such as avoiding disclosing an SGM ID to parents in their child’s playgroup), and/or downplaying one’s identity (such as not discussing a partner’s gender when speaking casually with strangers). Even though concealment can be adaptive for short-term safety increases, it could increase stress, anxiety, and depression in the long term.
If someone close to someone (such as a parent, a friend, or a relative) rejects them, or if they’ve been bullied or have faced other forms of discrimination, the individual might experience persistent anxiety due to an expectation of rejection from others. Individuals with SGM may feel isolated and lonely, leading to depression, suicidality, or fear. This stigma can have a powerful effect on SGM individuals who identify as people of color or other marginalized identities.
Rates of anxiety and depression are incredibly high for individuals who have not disclosed their SGM identity–potentially because of the fears of negative evaluations of what others will think of them, the uncertainty of what will happen when others find out, or the stress that comes from monitoring one’s behavior. Anxiety and depression can also be increased by the internal pressure to constantly monitor one’s behavior and fears of what might happen if their identity is discovered. The same goes for not sharing your identity with others. This can lead to isolation, loneliness, and even “otherness.”
You can see that SGM people have to make difficult decisions. Being more “out” could lead to discrimination, and being more “in the closet” could result in stress. SGM people are not more likely to experience anxiety or depression simply because they have a sexual orientation or gender identity that is problematic. It is because SGM individuals live in hostile or unsupportive environments. SGM patients and clinicians should keep these essential points in mind.
These are some suggestions for SGM persons experiencing anxiety or depression…
- You can increase your social support by reaching others who share your identity. You should limit your contact to people and places that aren’t supportive. Many communities have SGM-focused support, sports, and social groups that allow people to share similar experiences.
- Locate an SGM-affirmative therapist. Many therapists claim to have worked with SGM clients. You should ensure that your therapist views SGM identity as a standard and positive variant of human behavior.
- SGM-specific helplines are available. Fenway Health, an SGM-focused health center, has one helpline (http://fenwayhealth.org/care/wellness-resources/help-lines/). The Trevor Project provides phone, chat, and texting support for SGM individuals in crisisÂ
