By Iris Smith, Ph.D.

Although research has shown that LGBTQ individuals have a higher risk of mental health and substance misuse problems compared to heterosexual and cisgender individuals, research within group differences is limited. Data from the 2022 Trevor Project survey of 34,000 LBGTQ+ youth and young adults ages 13-24 found that 45% of youth seriously considered suicide in the past 12 months, with more than half of transgender and non-binary youth reporting suicidal behavior. The survey also found that 58% of LGBTQ+ youth experienced symptoms of depression and 73% reported experiencing anxiety. Also, 73% of LGBTQ youth reported that they had been discriminated against based on their sexual orientation or gender identity and 37% of transgender and nonbinary youth reported that they have been physically threatened or harmed due to their gender identity or sexual orientation. 82% of respondents wanted mental health care, but only 40% received it.¹

Despite research documenting higher prevalence of substance use and mental health disorders (including suicide) among LGBTQ+ populations, research examining within group differences is still very limited. A recent scoping review of research studies that reported outcome data on LGBTQ populations found that out of 113 published studies reviewed, only 10% (n=11) focused specifically on the LGBTQ+ population and only a small proportion of these studies examined more than one dimension of LGBTQ+ identity such as race/ ethnicity or age, or transgender issues.  Only 4 studies reported on heroin use outcomes and no studies on opioid overdose or mortality were found. Several of the studies reviewed reported elevated rates of prescription opioid use and heroin use among bisexual and other non-monosexual populations (e.g., Those attracted to more than one sex or gender). These studies found that while rates of prescription opioid misuse declined in the general population between 2015 and 2018, use rates remained high for both adult and youth populations that identified as bisexual or bisexually attracted, with greater disparities between bisexual women and heterosexual women. When social factors, mental health history, incarceration, and other drug use were controlled, transgender women and girls who identified their sexual identity as “other” had significantly higher odds of lifetime misuse compared with those who identified as heterosexual. Two of the studies reviewed suggested the risk of opioid misuse is higher among gay men compared to heterosexual men.

The results of the scoping review highlight the importance of considering the intersectionality of the LGBTQ+ experience (e.g., due to race, age, socio-economic, and cultural differences) that may exacerbate disparities both within the LGBTQ+ population and compared to heterosexuals.  Evidence based mental health interventions for LGBTQ+ individuals are emerging, including suicide prevention. A review of the efficacy of psychological interventions for transgender and non-binary youth and adults found positive outcomes for individuals who were able to access MH services.^{2 3} However, intervention research on treatment for sexual minority women and gender minority individuals is limited and these groups face considerable challenges accessing mental health and substance misuse treatment services. Disparities are greatest for sexual minority women. The review studies cited in this article highlight the need for more research specific to LGBTQ+ populations including research that examines racial/ethnic treatment outcome differences.  Research on substance use among LGBTQ+ populations has focused primarily on alcohol, tobacco, and amphetamines with limited attention to other drugs of abuse, including opioids.⁴ Given the public health crisis of opioid misuse, overdose, and mortality, there is a need to better understand disparities within the LGBTQ+ population in order to develop evidence-based prevention, intervention, and treatment approaches for this population.

Resources

Casey LS, Reisner SL, Findling MG, Blendon RJ, Benson JM, Sayde JM, Miller C (2019). Discrimination in the United States: Experiences of Lesbian, Gay, Bisexual, Transgender and Queer Americans.  Health Services Research 54; pg 1454-1466. DOI: 10.1111/1475-6773.13229

Kidd JD, Paschen-Wolff MM, Mericle AA, Caceres BA, Drabble LA, Hughes TL (2022) A Scoping Review of Alcohol, Tobacco, and Other Drug Use Treatment Interventions for Sexual and Gender Minority Populations.  Journal of Substance Abuse Treatment 133; pg.10853

Paschen-Wolff MM, Kidd JD, Paine EA (2023).  The State of the Research on Opioid Outcomes Among Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexuality- and Gender Diverse Populations:  A Scoping Review. LGBT Health 10 (1).

The Trevor Project National Survey on LGBTQ Mental Health  The Trevor Project is the world’s largest suicide prevention and mental health organization for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people.