LGBTQ health
Within the healthcare sphere, lesbian, gay, bisexual, transgender, and queer people face specific challenges and hardships that make access to healthcare less equitable. According to the US Gay and Lesbian Medical Association, some of the most common issues related to LGBTQ health are HIV/AIDS, breast and cervical cancer, hepatitis, mental health, substance use disorders, alcohol use, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove." These negative social stereotypes and pressure presented by the media are correlated with an increase of negative body image and declining self-worth, which can coincide with developing eating disorders and impact obesity rates.
LGBTQ people may face barriers to accessing healthcare on the basis of their sexual orientation and/or gender identity or expression. Many avoid or receive inferior care due to perceived or real homophobia, transphobia, or discrimination by healthcare providers and institutions. In other words, negative personal experiences, or fear of experiencing discrimination may deter these individuals from accessing care.
General health issues affecting LGBTQ individuals
According to the Committee on Lesbian, Gay, Bisexual and Transgender Health Issues and Research Gaps and Opportunities, there are several difficulties in conducting health research on LGBTQ populations. These challenges include the complexity of defining sexual orientation and gender nonconformity, and the hesitancy among individuals to answer questions concerning these topics. Other posed challenges include logistical and financial challenges of recruiting a sufficient sample size for meaningful analysis, considering the difficulty of an already smaller proportion of LGBTQ individuals among the general population.Lesbian, gay, bisexual, and transgender people are often grouped together in research and discussions. This can become problematic because they are each distinct groups that are non-inclusive of all non-heterosexual or gender non-conforming. In some studies, lesbian, gay, bisexual, and queer individuals are all combined under the label "non-heterosexual", while in HIV research, participants may be grouped together in categories that include various identities. Most research focuses on lesbian women and gay men, with significantly less attention given to bisexual, transgender, intersex, asexual, and other queer individuals, resulting in higher levels of discrimination. These disparities in research and perspectives of LGBTQ identities as a monolith erases the individuality of each identity.
A review of studies in North America found that LGBTQ individuals generally reported poorer self-rated health, more physical health symptoms, and higher rates of certain health conditions, including diabetes, asthma and high blood pressure, compared to heterosexuals. These disparities were most pronounced among adolescents and young adults, with smaller differences among older age groups. Factors such as health behaviors and experiences of discrimination, victimization, and violence among sexual minorities were found to contribute to these disparities in physical health.
Mental health appears worse among LGBTQ people than among the general population, with depression, anxiety, self-harm, and suicide ideation being higher than the general population. This arises partly from the societal discrimination, bias, and marginalization they face. About 30 percent of all completed suicides have been related to sexual identity crisis. Students who also fall into the gay, bisexual, lesbian or trans gendered identity groups report being five times as more likely to miss school because they feel unsafe after being bullied due to their sexual orientation. These mental health disparities are also evident in LGBTQ+ youth, with self-harm being reported by 65% of LGBQ youth and 46% of youth.
Research indicates noticeable barriers separating LGBTQ patients and health professionals, likely due to homophobia, assumptions of heterosexuality, and a lack of knowledge about LGBTQ people and their needs. Institutional barriers were also identified as a detriment to LGBTQ healthcare, including issues such as inappropriate referrals, lack of patient confidentiality, discontinuity of care, absence of LGBTQ specific healthcare, and lack of relevant psycho-sexual training.
Research points to issues encountered from an early age, such as sexual and gender minorities being targeted for bullying, assault, and discrimination, as contributing significantly to depression, suicide and other mental health issues in adulthood. Social research suggests that LGBTQ individuals experience discriminatory practices in accessing healthcare. One way that LGBTQ individuals have attempted to deal with discriminatory health care is by seeking "queer-friendly" health care providers.
Causes of LGBTQ health disparities
Research explains healthcare disparities in LGBTQ people is likely due to minority stress. Minority refers to the weight of facing negative societal attitudes and reactions towards one's sexual and gender identity. It includes stressors resulting from social exclusion and stigma, leading to adverse mental health effects. The theory of minority stress explains how experiences of victimization related to gender and sexual non-conformity contribute to psychological and mental health issues among LGBT individuals. This stress is rooted in negative social interactions and, when prolonged, can significantly impact mental health, leading to behaviors like substance abuse, suicidal thoughts, poor communication, and unintentional actions. Research has shown various negative mental health outcomes linked to chronic experiences of minority stress. The 'What We Know Project' reviewed thousands of peer-reviewed studies and found a strong link between discrimination and harm to the health of LGBT people. The findings showed that the presence of discrimination, stigma, and prejudice creates a hostile social climate which increase the risk of poor mental and physical health, even for those not directly exposed to the discrimination.A systematic review of healthcare access for LGBTQ individuals found that they often struggle to communicate with healthcare providers due to fear of assumptions and embarrassment about their sexual orientation. This, coupled with homophobia in healthcare, leads to exclusion and marginalization, reducing their attendance and engagement in body care and preventive health programs.
During the past decade, the LGBTQ social movement in United States and worldwide contributed to the increasing trend of public recognition and acceptance toward the community. Reports from the Institute of Medicine, US National Institutes of Health and other nonprofit organizations have called to address the gap in LGBT training and education for healthcare professionals. Current research indicate that LGBT individuals face disparity compared to their heterosexual and cisgender counterparts regarding access to health facilities, qualities, and treatment outcomes.
It is often pointed out that the reason for this is heterosexism in medical care and research.
LGBTQ health and social support networks
LGBTQ+ health outcomes are strongly influenced by social support networks, peers, and family. One example of a support network now available to some LGBTQ+ youth include Gay-Straight Alliances, which are clubs that work to improve the climate for LGBTQ+ youth at schools and educate students and staff about issues faced by the LGBTQ+ community. Studies show that students who attend schools with GSAs have better overall health outcomes, especially mental health, for LGBTQ+ youth. The study also shows LGBTQ+ students who have access to a GSA feeling a greater sense of belonging.The mental health trajectories of LGBTQ+ youth correlate heavily to the family and social support networks they have access to. Family rejection as a result of a young LGBTQ+ individual 'coming out' has the potential to cause adverse health outcomes. In fact, LGBTQ+ youth who experienced family rejection were 8.4 times more likely to attempt suicide, 5.9 times more likely to experience elevated levels of depression, and 3.4 times more likely to use illegal drugs than those LGBTQ+ youth who were accepted by family members. Family rejection sometimes leads youth to either run away from home or be kicked out of their home, which relates to the high rate of homelessness experienced by LGBTQ+ youth. In turn, homelessness relates to an array of adverse health outcomes that sometimes stem from homeless LGBTQ+ youths' elevated rates of involvement in prostitution and .
One longitudinal study of 248 youth across 5.5 years found that LGBTQ+ youth that have strong family and peer support experience less distress across all-time points relative to those who have uniformly low family and peer support. Over time, the psychological distress experienced by LGBTQ+ youth decreased, regardless of the amount of family and peer support that they received during adolescence. Nonetheless, the decrease in distress was greater for youth with low peer and family support than for those participants with high support. At age 17, those who lacked family support but had high peer support exhibited the highest levels of distress, but this distress level lowered to nearly the same level as those reporting high levels of support within a few years. Those LGBTQ+ youth without family support but with strong support from their peers reported an increase in family support over the years in spite of having reported the lowest family support at the age of 17.
Similarly, another study of 232 LGBTQ+ youth between the ages of 16–20 found that those with low family and social support reported higher rates of hopelessness, loneliness, depression, anxiety, somatization, suicide, global severity, and symptoms of major depressive disorder than those who received strong family and non-family support. In contrast, those who solely received non-family support reported worse outcomes for all measured health outcomes except for anxiety and hopelessness, for which there was no difference.
Some studies have found poorer mental health outcomes for bisexual people than gay men and lesbians, which to some degree can be attributed to this community's lack of acceptance and validation both within and outside of the LGBTQ community. Those who identify as bisexual often report feeling as though their mental health issues can be traced back to discrimination and biphobia directly related to their bisexual identity. Many report feeling as though in order to be seen as valid within their LGBTQ communities or have their identity recognized by heterosexual individuals, they must practice monosexism, or the desire for only one single gender. This concept can be attributed to bisexual erasure, or labeling bisexual individuals as having invalid LGBT experiences, making them feel invisible. This erasure can manifest in the form of microaggressions, or seemingly irrelevant comments or remarks that actually cause significant harm to the community or marginalized group being targeted. These societal perspectives can be repetitive experiences or ideas that eventually manifest internally, negatively impacting a bisexual individual's confidence and self-esteem. In order to address issues of self acceptance, participants recommended embracing spirituality, exercise, the arts, and other activities that promote emotional health.