Although lesbian, gay, bisexual, trans and queer identified (LGBTQ) people are as diverse as the general Canadian population in their experiences of mental health and well-being, they face higher risks for some mental health issues due to the effects of discrimination and the social determinants of health.

This information was compiled by Rainbow Health Ontario and CMHA Ontario.

What factors impact on mental health?

Socio-economic factors (or determinants) play a key role in mental health and wellbeing for all of us, and are particularly important for marginalized populations. Three significant determinants of positive mental health and wellbeing are: social inclusion; freedom from discrimination and violence; and access to economic resourcesⁱ.

All three factors impact LGBTQ individuals and communities in Ontario:

• Bisexual and trans people are over-represented among low-income Canadians
  • An Ontario-based study found that half of trans people were living on less than $15,000 a yearⁱⁱ

LGBTQ people experience stigma and discrimination across their life spans, and are targets of sexual and physical assault, harassment and hate crimesⁱⁱⁱ

• Hates crimes motivated by sexual orientation more than doubled in Canada from 2007 to 2008, and were the most violent of all hate crimes^iv
• An Ontario-based study of trans people found that 20 per cent had experienced physical or sexual assault due to their identity, and that 34 per cent were subjected to verbal threats or harassment^v
• Trans people in both Canada and the US report high levels of violence, harassment, and discrimination when seeking stable housing, employment, health or social services^v

Additional factors that may impact on mental health and well-being for LGBTQ people include the process of “coming out” (sharing one’s LGBTQ identity with others), gender transition, internalized oppression, isolation and alienation, loss of family or social support, and the impact of HIV and AIDS.^vii

Intersectionality

LGBTQ individuals may experience multiple forms of marginalization or disadvantage at the same time. For example, an individual’s experience may be shaped at the same time by their sexual orientation, racialization, gender, disability and income (e.g. a bisexual South Asian woman may have an anxiety disorder and be living in poverty).

Intersectionality refers to an approach by which intersecting experiences of marginalization and the needs of the whole person are considered.

There are multiple ways that intersectionality impacts the mental health of LGBTQ people. For example, LGBTQ people may experience other forms of marginalization – such as racism, sexism, poverty or other factors – alongside homophobia or transphobia that negatively impact on mental health. Additionally, an individual with a mental health condition who is also an LGBTQ person may face added challenges in accessing mental health services that are appropriate and inclusive and may face discrimination on the basis of both disability and sexual orientation.

LGBT people and the DSM

Due to homophobia and transphobia, LGBTQ identities have been included in the Diagnostic and Statistical Manual of Mental Disorders (the DSM). The DSM is a classification of mental health conditions (termed mental disorders) published by the American Psychiatric Association (APA) . The first edition of the DSM was published in 1952, and multiple revised editions have been released since.

In 1973 and 1974, due to growing evidence and protest, a majority of APA membership agreed to remove homosexuality from the manual. Although homosexuality was delisted in the 1980 edition (the DSM-III), variations of the listing remained until 1986. Since 1980, Gender Identity Disorder, or trans identity, has been listed as a disorder. The fifth edition of the DSM, released in 2013, introduces the term ”Gender Dysphoria” to replace previous terms.

Facts and figures

LGBTQ people face:

• Higher rates of depression, anxiety, obsessive-compulsive and phobic disorders, suicidality, self-harm, and substance use among LGBT people^x
• Double the risk for post-traumatic stress disorder (PTSD) than heterosexual people^xi

LGBTQyouth and trans people face increased risk. For example:

• LGBTQ youth face approximately 14 times the risk of suicide and substance abuse than heterosexual peers^xii
• 77% of trans respondents in an Ontario-based survey had seriously considered suicide and 45% had attempted suicide
  • Trans youth and those who had experienced physical or sexual assault were found to be at greatest risk^xiii

There is also evidence that LGBTQ people are at higher risk for substance use issues than the general population^xiv:

• Some research suggests that use of alcohol, tobacco and other substances may be 2 to 4 times higher among LGBT people than heterosexual people^xv
• A Toronto-based study found significantly higher rates of smoking among LGBT adults (36%) than other adults (17%) ^xvi
• American studies report higher rates of alcohol-related problems among lesbian and bisexual women than other women ^xvii

Promoting positive mental health and wellbeing

Key factors for positive mental health and wellbeing for LGBTQ individuals include:

• Support from family and friends, particularly for youth^xvii
• Supportive workplaces and neighbourhoods^xix
• Low levels of internalized homophobia (homophobia adopted by the LGBT person themself)^xx, which can be fostered and supported through identification or community building with other LGBT individuals^xxi
• Experiencing positive responses to coming out^xxii
• Addressing the social determinants of health