It’s widely recognised that LGBT people are more likely to experience mental health problems such as depression, anxiety, and self-harm, but why is this?1
This is a really important question to ask. It's not just an abstract question – something that might be interesting to know – it’s a question about real-life experiences, real-life suffering. And it’s important because understanding the potential roots of that suffering may allow us to play a role in reducing it. Christians and churches should be concerned about the reality of LGBT mental health and we should be asking what we can do to try and make things better for LGBT people.
So, what is the link between LGBT and mental health? And how should we respond to that link?2
The link between LGBT and mental health
It’s not easy to conclusively say what lies behind the elevated rates of mental health problems among LGBT people. The reality is probably complex, with many different factors at play, and there is limited reliable research available to help us answer the question.3
The social stress model
The most commonly suggested explanation is the social stress model. This understanding suggests that various experiences of stress and shame experienced by LGBT people in society are the main contributor to mental health problems. This stress is caused by experiences such as discrimination, bullying, and stigma.
Discrimination and prejudice can be sadly common experiences for LGBT people. Recent evidence of this in the UK can be found in the National LGBT Survey conducted in 2017.4 It is important to note that we cannot know to what extent the results of this survey are representative of the UK population as a whole because of the way it was conducted. This is a helpful reminder that we must always consider the strengths and weaknesses of the methodologies used in research.5 But the survey results do give us an insight into the experience of the more than 100,000 people who responded. Among those who completed the survey, 40% reported experiencing a negative incident, such as verbal harassment or insults, in the previous 12 months due to being LGBT.6 Research suggests that such discrimination and prejudice can contribute to mental health problems, even after other variables (such as social class, substance misuse, etc.) are taken into consideration.7
Research among young people has shown that bullying on the basis of being LGBT has a negative impact on mental health.8 Bullying of LGBT pupils remains a problem in UK schools, despite growing acceptance of LGBT people in wider society. A survey of 1000 UK teachers found that bullying in relation to sexuality is slightly more common than bullying in relation to race, and significantly more than for sex or religion, with 71% of the teachers having witnessed homophobic bullying at school and 35% saying they observe it at least once a month.9 Perhaps unsurprisingly then, peer support, including, for example, retaining friends after coming out as lesbian, gay or bisexual, contributes to good mental health.10
Stigma is also believed to contribute to poor mental health among LGBT people. Stigma is a negative attitude towards people who share something in common which in turn implies that these people are of lower value. It is broader than discrimination, prejudice, or bullying as it is not necessarily linked to a certain event but is more about general societal or community attitudes. Stigma often feeds into an experience of shame for those who are victims of it.
The broad nature of stigma makes it much harder to study. There is some research suggesting that stigma contributes to LGBT mental health problems, although it is hard to be certain what the relationship between the two is. (Poor mental health could cause people to report greater stigma, or there may be something else lying behind both poor mental health and a perception of stigma.)11
The social stress model has been tested by exploring the impact of increased social acceptance of same-sex relationships on LGB mental health. The results have been unclear. A study investigating changes in the Netherlands over a 10-year period found that increasing social acceptance did not lead to a decrease in mental health problems among LGB people.12 However, a similar study covering 10 years of change in Sweden found a decrease in mental health problems to the extent that the disparity between LBG people and straight people was removed.13
The research currently available does not conclusively prove that social stress is the only factor at play.
Interestingly, the Swedish study found that a reduction in experiences of and threats of violence played a part in this change, although perceived discrimination and expectation of victimization remained an issue. Some note that the distinction between actual discrimination and perception or expectation of discrimination is important when considering this topic.14
Overall, while it does seem that social stress contributes to the increased rate of mental health problems among LGBT people, the research currently available does not conclusively prove that social stress is the only factor at play.
Summarising the evidence available up until 2016, one overview of the evidence concludes: ‘There is evidence linking some forms of mistreatment, stigmatization, and discrimination to some of the poor mental health outcomes experienced by non-heterosexuals, but it is far from clear that these factors account for all of the disparities between the heterosexual and non-heterosexual populations.’15 They note that this is important to recognise if we want to see improvement in mental health outcomes for LGBT people.
Family acceptance and rejection
A related factor is family acceptance and rejection. Research suggests that the response of those closest to LGBT people, especially family members, can have a significant effect on mental health.16
One study found that discrimination from family and friends contributed to greater psychological distress but discrimination from others didn’t.17 Research from Caitlin Ryan and others at the Family Acceptance Project has found that high rates of rejection by family members can contribute to mental health problems,18 but family acceptance is protective against mental health problems and can contribute to greater self-esteem and general health.19
Many of the behaviours the researchers classed as accepting behaviours should be instinctive to Christian family members.
It is important to specify what constitutes rejection and acceptance. Many have assumed that holding to a historic, Christian view of sexuality is tantamount to rejection of LGBT family members, but this is not so. The Family Acceptance Project offers examples of rejecting behaviours, including verbal harassment or physical abuse, exclusion from family and family activities, and expressing that you are ashamed of your child or that they will bring shame on the family. Any such responses to an LGBT family member would be completely out of line with biblical teaching. By contrast, many of the behaviours the researchers classed as accepting behaviours should be instinctive to Christian family members. These include expressing affection when a young person comes out and requiring that other family members respect them.20
Concealment and disclosure
Many of us would instinctively assume that not being able to be open about one’s experience of sexuality would negatively impact mental health. However, studies of the impact of concealment and disclosure about sexuality have produced greatly varying results.
A recent meta-analytic review explores the diversity of findings across 193 existing studies.21 The authors outline both limitations and diversity in the methodologies used in the studies, suggesting that these may offer some explanation for the varying results. Their review concludes that those who are not open about their sexual orientation may be slightly more likely to experience mental health problems such as depression, anxiety, distress, and problematic eating.
Some researchers have also suggested that concealment and disclosure themselves are less significant than access to social support. Openness about one’s sexuality will not necessarily be protective against mental health problems if it isn’t accompanied by helpful social support.22
A few other potential factors have been suggested by researchers.
Some note that experiences of sexual abuse have been found to be more common among LGB people than among the wider population and that survivors of sexual abuse have been shown to be at greater risk of mental health problems. It is therefore possible that the greater experience of sexual abuse among LGB people could be a factor in the greater experience of mental health problems.23
Another suggestion is that genetic factors common to sexual orientation and mental health problems may play a part. One study of sexual orientation and depression found that genetic factors accounted for 60% of the correlation between sexual orientation and depression among the study subjects, although they also note that a definite position on the cause of the correlation can’t be reached.24 Another study observed that a genetic influence was evident in a correlation between sexual orientation and psychiatric vulnerability, with no evidence that environmental factors might be relevant. This suggests that the correlation between orientation and psychiatric vulnerability was likely to be genetically rooted.25 The idea that genetics may be relevant to LGBT mental health has, however, proved controversial.26
What’s the link?
It seems likely that multiple factors are in play and that any simple answer would be inaccurate and unhelpful.
The current state of the research doesn’t allow us to give a simple answer to the question of why rates of mental health problems are higher among LGBT people. It seems likely that multiple factors are in play and that any simple answer would be inaccurate and unhelpful. This reality should caution us against accepting simplistic perspectives on the problem and should encourage us to consider a broad range of responses as we seek to work for the wellbeing of LGBT people. It also calls into question the claim made by some that a change in the Church’s teaching on sexuality and gender would improve the mental health of LGBT people.
How should we respond?
Knowing a little about the potential reasons behind the high rates of mental health problems among the LGBT population helps us to think about how we should respond. When we do, we find that Christians and churches are well-placed to make a significant difference to the mental health of LGBT people in their communities.
The social stress model reminds us of the importance of working for the end of discrimination, bullying, and stigma against LGBT people. Christians should be at the forefront of the battle to end all such treatment of any people because we know that all people are created in the image of God, and so all deserve respect and freedom from abuse.
Sadly, Christians have often been part of the problem behind the social stress model. We have been guilty of discrimination against LGBT people and of bullying and stigmatisation. All Christians must acknowledge the part that we, as the Church, have played, and we must now be the first to stand up for and to work for the good of LGBT people.
The risks posed by family rejection of LGBT people remind us of the need to make sure that Christians understand the biblical call to love and welcome all people. Churches should work to help parents, and all people, to know how to respond if a family member comes out to them. Parents should prepare by thinking in advance how they would seek to respond well if their child came out as gay or trans.
The Church can also be family for those who lose biological family. As a family open to all, we, the Church, have the ability to be safe, loving, accepting family to those who experience the horror of family rejection because of being LGBT. Churches should be known as the places where everyone can experience family.
Churches should be the safest places for all of us to be completely honest and open about our experience of life, and also to be loved, welcomed, and cared for.
Churches should also be the safest places for all of us to be completely honest and open about our experience of life, and also to be loved, welcomed, and cared for. The potential benefits of openness about one’s sexuality or gender when accompanied with social support – benefits highlighted in the research on concealment and disclosure – suggest that church communities have the opportunity to be contexts that are protective of LGBT mental health. Christians can also be good friends to LGBT people, offering the social support that helps mental health.
The sobering reality of the higher rates of sexual abuse experienced by LGBT people should remind us of the vital importance of rigorous safeguarding practices in society, including in the Church. And churches should be places where survivors of abuse can find hope and healing.
It’s clear that Christians and churches are well-placed – perhaps uniquely so – to work for the improvement of LGBT mental health. However, we have to openly acknowledge that we have historically failed to help in many of the ways that we could have done. This is despite the fact that each of the above suggestions should be standard practice for Christians.
Going forward, we have an opportunity. We have the opportunity to be those who work for the thriving and flourishing of LGBT people, just as we are called to do for all people. We can be part of the answer to the problem of LGBT mental health issues.
More on mental health
- For more on LGBT mental health and a Christian response, see ‘A Christian Perspective on LGBT Mental Health’.
- The broad category of LGBT is used here, although much of the research available focuses specifically on sexuality. In what follows I have sought to be accurate about the subgroups considered in the relevant research.
- Sociologist Mark Regnerus warns that many of the studies often cited to answer the question suffer from ‘weak data, small samples, and politicized conclusions’. Mark Regnerus, ‘Weak data, small samples, and politicized conclusions on LGBT discrimination’, MercatorNet. Accessed 25 March 2021.
In what follows I have made particular use of two studies that offer a summary of existing research and in which the authors take into consideration important issues related to the methodology of the research they are collating:
Nathan Hudson-Sharp and Hilary Metcalf, 'Inequality Among Lesbian, Gay, Bisexual and Transgender Groups in the UK: A Review of Evidence', Government Equalities Office.
Lawrence S. Mayer and Paul R. McHugh, ‘Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences', The New Atlantis.
- ‘National LGBT Survey: Research Report’, Government Equalities Office.
- The National LGBT Survey used a voluntary non-probability sample, meaning that people volunteered to complete the survey after seeing it advertised, and so there is no guarantee that the sample is representative of the population as a whole. In fact, it is known that voluntary surveys tend to attract people with strong views on the survey subject. A large-scale, randomised sample would need to be used to gain data that is more likely to be representative of the population as a whole.
- ‘National LGBT Survey: Research Report’, Government Equalities Office, p.33. Accessed 22 March 2021.
- Hudson-Sharp and Metcalf, ‘Inequality’, pp.39, 46. Accessed 25 February 2021. Mayer and McHugh, ‘Sexuality and Gender’, p.77-79. Accessed 22 March 2021.
- Hudson-Sharp and Metcalf, ‘Inequality’, pp.24-25. Mayer and McHugh, ‘Sexuality and Gender’, p.78.
- ‘LGBT bullying more common than racist bullying in schools – poll’, Sky News. Accessed 22 March 2021.
- Stephen T. Russel and Jessica N. Fish, ‘Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth’, Annual Review of Clinical Psychology.
- Mayer and McHugh, ‘Sexuality and Gender’, pp.79-81.
- Theo G.M. Sandfort et al, ‘Same-sex sexuality and psychiatric disorders in the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2)’, LGBT Health.
- M.L. Hatzenbuehler et al ‘Societal-Level Explanations for Reductions in Sexual Orientation Mental Health Disparities: Results From a Ten-Year, Population-Based Study in Sweden’, Stigma and Health. The author suggests different ways of measuring sexual orientation may explain the difference in results between this study at that of Sandfort et al. Mayer and McHugh, ‘Sexuality and Gender’, consider a few similar studies but find them inconclusive (pp.82-85).
- Regnerus, ‘Weak data’. Accessed 29 March 2021.
- Mayer and McHugh, ‘Sexuality and Gender’, p.85. Other scholars also note that alternative explanations for LGBT mental health have yet to be sufficiently examined. See J. Michael Bailey, ‘It is Time to Stress Test the Minority Stress Model’, Archives of Sexual Behaviour.
- Helpful reviews of the research are offered in Russell and Fish, ‘Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth’, and Alida Bouris et al, ‘A Systematic Review of Parental Influences on the Health and Well-Being of Lesbian, Gay, and Bisexual Youth: Time for a New Public Health Research and Practice Agenda’, The Journal of Primary Prevention. Bouris also helpfully highlights some of the methodological limitations of the studies.
- Wilson S. Figueroa and Peggy M. Zoccola, ‘Sources of Discrimination and Their Associations With Health in Sexual Minority Adults’, Journal of Homosexuality.
- Caitlin Ryan et al, ‘Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults’, Pediatrics.
- Caitlin Ryan et al, ‘Family Acceptance in Adolescence and the Health of LGBT Young Adults’, Journal of Child and Adolescent Psychiatric Nursing.
- Caitlin Ryan, ‘Supportive Families, Healthy Children: Helping Families with Lesbian, Gay, Bisexual & Transgender Children’, Family Acceptance Project, pp.8-9. Accessed 11 March 2021. See also, Heather Sells, ‘Southern Baptists Push Back Against LGBT Activists’, CBN News. Accessed 11 March 2021: ‘[Caitlin] Ryan says what's most important is not a family's religious beliefs but the behaviors that families exhibit towards members that are LGBT.’
- John E. Pachankis et al, ‘Sexual Orientation Concealment and Mental Health: A Conceptual and Meta-Analytic Review’, Psychological Bulletin.
- See, for example, A. van der Star et al, ‘Sexual orientation openness and depressive symptoms: A population-based study’, Psychology of Sexual Orientation and Gender Diversity. Also, Hudson-Sharp and Metcalf, ‘Inequality’, pp.46-47.
- Mayer and McHugh, ‘Sexuality and Gender’, p.85. Brendan P. Zietsch et al, ‘Do shared etiological factors contribute to the relationship between sexual orientation and depression?’, Psychological Medicine.
- Zietsch et al, ‘Shared etiological factors’.
- Brendan P. Zietsch et al, ‘Sexual Orientation and Psychiatric Vulnerability: A Twin Study of Neuroticism and Psychoticism’, Archives of Sexual Behaviour.
- See, for example, Ilan H. Meyer and John Pachankis, ‘Do Genes Explain Sexual Minority Mental Health Disparities?’, Archives of Sexual Behaviour. And this subsequent response: Bailey, ‘It is Time to Stress Test the Minority Stress Model’.