People who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ+) are at least twice as likely to have mental health challenges compared to the general population. It raises the question, why does the LGBTQ+ community experience more mental health concerns?

Much of it comes down to life experiences. Chances are you’ve been in situations that have made you uncomfortable. Maybe someone said or did something. Or perhaps it was just a look that made you feel unwelcomed. But the worst thing was feeling like no one had your back.

How did you feel? Were you stressed, anxious or lonely? Did you just want out of the situation? Now, imagine you were constantly surrounded by the negative attitudes and behaviors of others. Consider how that would affect your mental health.

People who identify as LGBTQ+ experience stressors that are unique and widespread. Those in the LGBTQ+ community are more likely to be the victim of discrimination, sexism and violence. On top of that, people who identify as LGBTQ+ don’t always have access to the support and resources to improve their mental health.

Here at HealthPartners, we’re hoping to be a resource to those who identify as LGBTQ+ and also for those want to support the LGBTQ+ community. Read on to learn about minority stress, how it affects mental health in people who identify as LGBTQ+ and what you can do to help.

How minority stress affects the LGBTQ+ community

People who are minorities have different life experiences than those in the majority population. But how does this apply to people who identify as LGBTQ+?

What does it mean to be a sexual minority?

When people hear the word “minority,” they often think about ethnic and racial minorities. But there are other ways to be a minority in the United States. People who identify as LGBTQ+ belong to the sexual minority – about 7% of U.S. adults identify as LGBTQ+, according to a 2022 Gallup poll.

What is the minority stress model?

In the early 2000s, researchers developed the minority stress model to help explain the challenging emotions and experiences of marginalized populations. What they discovered is that minority populations experience stress that’s different than the stress experienced by the majority population. They found that minority stress has three key characteristics:

1. Minority stress is socially based

Minority stress goes beyond stress factors that every individual may experience. Instead, minority stress is triggered by the processes, institutions, structures and thought processes that currently shape the world we live in.

For example, any child could be nervous about starting high school. But a teen who is transgender could have additional stress if their school’s electronic systems don’t allow them to change their name or pronouns. Even if the teachers know to call them by their chosen name and pronouns, the youth may fear that the teacher might slip up in class – and the emotional or physical bullying that could happen if their peers know the name and sex they were assigned at birth.

2. Minority stress is unique

People in the sexual minority have unique stressors that are not part of the heterosexual experience. For example, a gay man may worry that others will treat him poorly or that he’ll get fired if he talks about his spouse at work.

A person who is heterosexual may worry that others may not like their spouse, but they don’t need to worry about discrimination or bias if they reveal their partner’s gender.

3. Minority stress is chronic

People who are part of the sexual minority usually have a constant undercurrent of stress because they can’t escape the subtle – and not so subtle – attitudes and behaviors of others.

Like other minority groups, the LGBTQ+ community experiences ongoing discrimination and bias that affects nearly all aspects of their lives. They can also experience widespread homophobia, sexism and violence.

In an example that’s close to home, 64% of Minnesotan adults who identify as LGBTQ+ said they experienced some form of anti-LGBTQ+ behaviors within the last year, according to the Rainbow Health Survey.

Minority stress among people of color who identify as LGBTQ+

People of color who identify as LGBTQ+ experience higher levels of minority stress – likely because they can experience discrimination for their race, ethnicity, gender identity and/or sexual orientation.

In Minnesota, 79% of Black, Indigenous and people of color (BIPOC) who identify as LGBTQ+ experienced anti-LGBTQ+ behavior. And in the 12 months leading up to the Rainbow Health survey, over half were physically attacked or threatened because they were LGBTQ+.

Why minority stress creates mental health challenges in the LGBTQ+ community

When stress isn’t appropriately managed, it can lead to health problems and unhealthy behaviors – this is true for anyone regardless of sexual orientation, gender identity, race or ethnicity. But the characteristics of minority stress and the life experiences of marginalized populations increases the likelihood of mental health concerns in people who identify as LGBTQ+.

People who identify as LGBTQ+ may not have the support systems needed to help manage their stress and emotions. Plus, behaviors they use to protect themselves often have the opposite effect.

When you’re constantly under threat, a natural defense is to build up walls and be on the lookout for danger. If you’re afraid someone won’t like you, it’s easiest to not give anyone the chance to reject you. If every situation seems scary, it can feel safer to just stay home alone.

The problem is that always being on the defensive can increase feelings of stress, depression, anxiety and fatigue. It also robs you of the chance to make connections that could help you live a happy, healthy life.

For people who identify as LGBTQ+, it can even stop them from getting the health care they need. The Rainbow Health survey found that 40% of Minnesota adults identifying as LGBTQ+ didn’t go to the doctor when they needed to because they feared disrespect or discrimination. The fears aren’t without reason – it hasn’t always been easy for those in the LGBTQ+ community to get health care that respects and affirms their sexual orientation or gender identity.

LGBTQ+ mental health statistics

So, what is the actual impact of minority stress on mental health in the LGBTQ+ community? Some of the statistics may be eye-opening.

People in the LGBTQ+ community are about twice as likely to have a mental health disorder in their lifetime compared to the general population. Of particular concern is mental health within the transgender community, as this group tends to have the highest levels of depression, anxiety and suicidal thoughts.

Anxiety disorders in the LGBTQ+ community

Many people experience anxiety. According to the Anxiety and Depression Association of America, it’s the most common mental health concern in the United States – affecting about 1 in 5 adults.

Anxiety is even more common in the LGBTQ+ community. The Rainbow Health survey found that two-thirds of Minnesotan adults who identify as LGBTQ+ feel anxious at least weekly. For BIPOC adults who identify as LGBTQ+, this number is even higher – 90% feel anxious on a weekly basis.

Among youth who identify as LGBTQ+, 73% experience symptoms of anxiety, according to the Trevor Project survey.

Depression in the LGBTQ+ community

Depression is another common mental health concern in the United States – 1 in 20 people in the U.S. have regular feelings of depression. But as with anxiety, depression is far more common in the LGBTQ+ community.

According to the Rainbow Health survey, about 75% of Minnesotan adults who identify as LGBTQ+ feel depressed one or more times per week, and about 20% feel depressed 5-7 days each week. Fifty-eight percent of LGBTQ+ youth report experiencing symptoms of depression, according to the Trevor Project survey.

Suicidal behaviors in the LGBTQ+ community

Suicide is a serious public health problem. In 2020, it ranked among the top nine leading causes of death for people ages 10-64 and was the second leading cause of death for people aged 10-14 or 25-34, according to the Centers for Disease Control and Prevention (CDC).

Identifying as LGBTQ+ makes it much more likely that someone will consider, plan or attempt suicide. LGBTQ+ youth are about four times more likely to try suicide than their heterosexual peers. The Trevor Project survey found that 45% of LGBTQ+ youth seriously considered suicide in the last year and 14% tried.

Lesbian, gay and bisexual adults are also more likely to consider, plan or try suicide than the general population. According to a 2021 research article, suicidal behaviors among lesbian, gay and bisexual adults of all ages, races and ethnicities were 3-6 times greater than those among their heterosexual peers.

There’s a strong connection between mental health and suicide – it’s estimated that about 90% of those who commit suicide had at least one mental disorder.

Substance use disorders in the LGBTQ+ community

When alcohol or drug use affects a person’s health or life, it’s called a substance use disorder (SUD). About 15% of the general population has a SUD, according to 2020 reports from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The rate of SUD in the LGBTQ+ community is even higher. SAMHSA reports that 34% of adults who identify as lesbian, gay or bisexual have substance use disorders. Also, it’s estimated that between 20-30% of people who identify as transgender may have a SUD, but research is ongoing.

Substance misuse is strongly connected to mental health concerns – among LGB adults with a substance use disorder, 70% also have a mental health concern, according to the SAMHSA reports.

Eating disorders in the LGBTQ+ community

About 9% of the U.S. population will have an eating disorder in their lifetime, according to ANAD (National Association of Anorexia Nervosa and Associated Disorders). But those in the LGBTQ community are much more likely to have eating disorder symptoms than the general population – this is especially true for boys, men and people who identify as transgender or gender nonconforming.

• Boys who identify as gay or bisexual are more likely to engage in food restrictive behaviors, self-induced vomiting, laxative abuse and diet pill use in order to control their weight, compared to their heterosexual peers.
• Gay adult men are seven times more likely to report binging and 12 times more likely to report purging than heterosexual adult men.
• Transgender college students are about four times more likely to have an eating disorder than their peers. People who are genderqueer and/or gender nonconforming are most likely to be affected.

There is singlular reason for eating disorders within the LGBTQ+ community – they can be linked to poor body image, gender dysphoria, stress and other factors. The Melrose Heals podcast provides honest conversations about eating disorders and what you can do to help.

Support from friends, family and the community is pivotal to the mental health of people who identify as LGBTQ+ – it can literally mean the difference between life and death for some people.

For example, LGBTQ+ youth who feel that their community is accepting are far less likely to try suicide than those whose communities are unaccepting or only moderately accepting, according to the Trevor Project survey.

But what are the best ways to offer support to people who identify as LGBTQ+? It can feel difficult or awkward. Here are some ways to be a friend.

Treat them like you would anyone else

If a person shares about their interests, joys, struggles or relationships, treat them how you would anyone else. Remember, identifying as LGBTQ+ is only one part of who they are – chances are you’ll have plenty more to talk about other than gender identity and sexual orientation.

Respect boundaries

You can be genuine and curious about someone’s life without being invasive. Ask open-ended questions, then listen. If someone identifies as transgender, don’t ask about their birth name or the medical steps they’ve taken toward gender affirmation.

Use correct language

Using the correct language is another way to show respect. Take the person’s lead on which LGBTQ+ terms to use, and always try to reflect a person’s language about partners and identity. If you are unsure, ask directly. Be willing to make mistakes and try again without being defensive.

Using chosen pronouns is an especially important way to show support for people who are transgender – it can even save lives. According to a survey from the Trevor Project, trans youth were half as likely to consider suicide when their chosen pronouns were used.

But how do you respectfully ask people about their pronouns? This can be as easy as saying, “My name is Alex, and my pronouns are she and her. What are yours?”

It’s also possible that information about a person’s pronouns is already available to you. Many people now include their pronouns in online social media profiles or in their email signature.

Keep learning

Taking steps to learn more about the LGBTQ+ community is a great way to show your support. The following is a list of resources to get you started.

• Twin Cities Pride – Focuses on improving the lives of people who identify as LGBTQ+. The Twin Cities Pride website includes community resources and a listing of upcoming festivals and events.
• The Minnesota People of Color LGBTQ+ Pride Organization – Creates connections and improves equity and equality for people of color who identify as LGBTQ+.
• Gender Spectrum – Provides resources and hosts online groups for LGBTQ+ children and their parents, caregivers and other family members.
• OutFront Minnesota – Works to create LGBTQ+ equality in Minnesota though policy and organizing, anti-violence activities and educational equality.
• Minnesota Transgender Health Coalition – Focuses on improving access to high-quality health care for people who identify as trans or gender nonconforming.

What if someone who identifies as LGBTQ+ seems to be struggling?

Give support in the way you would give it to anyone. Active listening is a good way to start. So is asking how you can help. Make it clear that you care about them, and you just want to make sure that they’re safe.

If you’re worried that someone is considering suicide, don’t shy away from asking if they’re thinking of hurting themself – it’s a question that could save their life.

They may not want to talk to you. If that’s the case, ask if they have someone they can talk to. If they don’t, let them know that there are free resources for people who identify as LGBTQ+.

LGBTQ+ mental health resources

Free resources for people identifying as LGBTQ+ include:

• 988 Suicide & Crisis Lifeline – Phone counseling any time, day or night by dialing 988.
• LGBT National Help Center – Hotlines based on age groups: 800-246-7743 for youth, 888-843-4564 for adults and 888-688-5428 for seniors. Weekly chatrooms for youth and online peer support are also available.
• Trevor Project Lifeline – 24/7 phone, text and online support for LGBTQ+ youth.
• Rainbow Health – Mental, chemical and sexual health services for LGBTQ+ people and communities that historically and currently face barriers to behavioral health support.
• Reclaim! – Affordable mental health care for youth who identify as queer or trans.
• Trans Lifeline – Trans peer support available by calling 877-565-8860.

Suggest counseling

Therapy can be valuable for most people struggling with mental health concerns. And those identifying as LGBTQ+ can benefit from working with a therapist who understands gender dysphoria and sexual identity issues.

If you have a close relationship with someone who is struggling, definitely recommend therapy. For example, one of the best ways to support your LGBTQ+ child is to get them therapy if they want it (and most children identifying as LGBTQ+ are interested).

Embracing diversity and improving LGBTQ+ mental health

People who identify as LGBTQ+ experience unique, chronic and socially based stressors that increase their chances of having a mental disorder. This isn’t fair.

At HealthPartners, we hope for a future where minority stress doesn’t play such a huge role in the mental health of marginalized communities. Getting to this better future will require that individuals and organizations work together to overcome bias and embrace diversity.

Embracing diversity is being inclusive of all people, ideas and viewpoints. It’s respecting others. It’s being open and curious. And, it’s promoting fairness and opportunity for all.

We’re looking forward to improving health care for diverse communities and ensuring that everyone feels welcome and included. How will you be part of the change?