Mental Health

  • Sheri R. NotaroEmail author
Part of the Neighborhoods, Communities, and Urban Marginality book series (NCUM)


This chapter investigates the relationships among discrimination, stigma, and bias and mental health within the LGBTQ community. The chapter discusses symptoms and correlates of poor mental health including psychological distress, suicide, and homelessness while also considering resiliency and protective factors. The chapter examines within group differences among the LGBT population, including the relationship of sexual identity to internalized homophobia and HIV/AIDS stigma and the ensuing impact of these stressors on the psychological distress of gay Black men. Another focus of chapter six is suicide given the data indicating that racial minority LGBT youth (African American and Latino) attempt suicide at twice the rate of non-minority LGBT youth (Centers for Disease Control and Prevention [CDC], Youth Risk Behavior Surveillance, 2011). Homelessness is also discussed given that within the population of runaway and homeless youth (RHY), LGBTQ individuals are overrepresented at 20–40%, a much higher percentage than either heterosexual or cisgender (individuals whose gender identity matches the sex that they were assigned at birth) peers (e.g., Durso & Gates, Serving Our Youth: Findings from a National Survey of Service Providers Working with Lesbian, Gay, Bisexual, and Transgender Youth Who Are Homeless or at Risk of Becoming Homeless, 2012).


  1. American Psychological Association (APA). (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67, 10–42.CrossRefGoogle Scholar
  2. Association of American Medical Colleges (AAMC). (2014). Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender non-conforming, or born with DSD (difference of sex development). Retrieved from
  3. Balsam, K., Beadnell, B., & Molina, Y. (2012). The daily heterosexist experiences questionnaire: Measuring minority stress among lesbian, gay, bisexual, and transgender adults. Measurement and Evaluation in Counseling and Development, 46(1), 3–25.CrossRefGoogle Scholar
  4. Boone, M., Cook, S., & Wilson, P. (2016). Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual men. AIDS Care, 28(6), 764–770.CrossRefGoogle Scholar
  5. Bostwick, W., Boyd, C., & Hughes, T. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100(3), 468–475.CrossRefGoogle Scholar
  6. Bruce, D., Stall, R., Fata, A., & Campbell, R. (2014). Modeling minority stress effects on homelessness and health disparities among young men who have sex with men. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 91(3), 568–580.CrossRefGoogle Scholar
  7. Calzo, J., Antonucci, T., Mays, V., & Cochran, S. (2011). Retrospective recall of sexual orientation identity development among gay, lesbian, and bisexual adults. Developmental Psychology, 47(6), 1658–1673.CrossRefGoogle Scholar
  8. Centers for Disease Control and Prevention (CDC). (2011). Youth risk behavior surveillance. Atlanta: Centers for Disease Control and Prevention. Retrieved from
  9. Child Welfare League of America. (2012). Recommended practices to promote the safety and well-being of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth and youth at risk of living with HIV in child welfare settings. Retrieved from
  10. Choi, K., Han, C., Paul, J., & Ayala, G. (2011). Strategies for managing racism and homophobia among U.S. ethnic and racial minority men who have sex with men. AIDS Education and Prevention, 23(2), 145–158.Google Scholar
  11. Coker, T., Austin, S., & Schuster, M. (2010). The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health, 31, 457–477.CrossRefGoogle Scholar
  12. Corliss, H., Goodenow, C., Nichols, L., & Austin, B. (2011). High burden of homelessness among sexual-minority adolescents: Findings from a representative Massachusetts high school sample. American Journal of Public Health, 101(9), 1683–1689.CrossRefGoogle Scholar
  13. Corporation for Supportive Housing. (2011, November 11). True colors provides safe haven for LGBT youth. Retrieved from
  14. Courtney, M., Dworsky, A., Ruth, G., Keller, T., Havilicek, J., & Bost, N. (2005). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 19. Retrieved from
  15. Cray, A., Miller, K., & Durso, L. (2013). Seeking shelter: The experiences and unmet needs of LGBT homeless youth. Retrieved from
  16. De Graaf, R., Sandfort, T., & Ten, H. (2006). Suicidality and sexual orientation: Differences between men and women in a general population-based sample from the Netherlands. Archives of Sexual Behavior, 35(3), 253–262.CrossRefGoogle Scholar
  17. Derogatis, L., & Spencer, P. (1993). Brief Symptom Inventory: BSI. Upper Saddle River, NJ: Pearson.Google Scholar
  18. Diaz, R. (2006). In our own backyard: HIV/AIDS stigmatization in the Latino gay community. In N. Teunis & G. Herdt (Eds.), Sexual inequalities and social justice (pp. 50–67). Los Angeles: University of California Press.CrossRefGoogle Scholar
  19. Dohrenwend, B. (2000). The role of adversity and stress in psychopathology: Some evidence and its implications for theory and research. Journal of Health and Social Behavior, 41(1), 1–19.CrossRefGoogle Scholar
  20. Durso, L., & Gates, G. (2012). Serving our youth: Findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of becoming homeless. Los Angeles: The Williams Institute with True Colors Fund and the Palette Fund. Retrieved from
  21. Fergusson, D., Horwood, J., & Ridder, E. (2005). Sexual orientation and mental health in a birth cohort of young adults. Psychological Medicine, 35, 971–981.CrossRefGoogle Scholar
  22. Frisell, T., Lichtenstein, P., Rahman, Q., & Langstrom, N. (2009). Psychiatric morbidity associated with same-sex sexual behavior: Influence of minority stress and familial factors. Psychological Medicine, 40(2), 315–324.CrossRefGoogle Scholar
  23. Frost, D., & Meyer, I. (2012). Measuring community connectedness among diverse sexual minority populations. Journal of Sex Research, 49(1), 36–49.CrossRefGoogle Scholar
  24. Gattis, M. (2013). An ecological systems comparison between homeless sexual minority youths and homeless heterosexual youths. Journal of Social Service Research, 39(1), 38–49.CrossRefGoogle Scholar
  25. Gay and Lesbian Medical Association. (2013). Recommendations for enhancing the climate for LGBT students and employees in health professional schools. Retrieved from
  26. Hatzenbuehler, M. (2009). How does sexual minority stigma “get under the skin?” A psychological mediation framework. Psychological Bulletin, 135(5), 707–730.CrossRefGoogle Scholar
  27. Herek, G. (2009). Hate crimes and stigma-related experiences among sexual minority adults in the Unites States: Prevalence estimates from a national probability sample. Journal of Interpersonal Violence, 24(1), 54–74.CrossRefGoogle Scholar
  28. Kessler, R., Andrews, G., Colpe, L., Hiripi, E., Mroczek, D., Normand, S., … Zaslavsky, A. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.CrossRefGoogle Scholar
  29. Keuroghlian, A., Shtasel, D., & Bassuk, E. (2014). Out on the street: A public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. American Journal of Orthopsychiatry, 84(1), 66–72.CrossRefGoogle Scholar
  30. King, M., Semlyen, J., Tai, S., Killespy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay, and bisexual people. BMC Psychiatry, 8(70), 1–17.Google Scholar
  31. King, N. (1998). Template analysis. In G. Symon & C. Cassell (Eds.), Qualitative methods and analysis in organizational research: A practical guide (pp. 118–134). Thousand Oaks, CA: Sage.Google Scholar
  32. Legate, N., Ryan, R., & Weinstein, N. (2012). Is coming out always a “good thing”? Exploring the relations of autonomy support, outness, and wellness for lesbian, gay, and bisexual individuals. Social Psychological and Personality Science, 3(2), 145–152.CrossRefGoogle Scholar
  33. Leon, A. (2017, May 12). LGBT people are prone to mental illness. It’s a truth we shouldn’t shy away from [Web log post]. Retrieved from
  34. Lingardi, V., Nardelli, N., & Tripodi, E. (2015). Reparative attitudes of Italian psychologists toward lesbian and gay clients: Theoretical, clinical, and social implications. Professional Psychology: Research and Practice, 46(2), 132–139.CrossRefGoogle Scholar
  35. Lolai, D. (2015). “You’re going to be straight or you’re not going to live here”: Child support for LGBT homeless youth. Law & Sexuality: A Review of Lesbian, Gay, Bisexual, & Transgender Legal Issues, 24, 35–98.Google Scholar
  36. Maccio, E., & Ferguson, K. (2016). Services to LGBTQ runaway and homeless youth: Gaps and recommendations. Children and Youth Services Review, 63, 47–57.CrossRefGoogle Scholar
  37. Malebranche, D. (2008). Bisexually active black men in the United States and HIV: Acknowledging more than the “down low”. Archives of Sexual Behavior, 37(5), 810–816.CrossRefGoogle Scholar
  38. Masten, A. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56(3), 227–238.CrossRefGoogle Scholar
  39. Meyer, I. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.CrossRefGoogle Scholar
  40. Meyer, I. (2007). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.CrossRefGoogle Scholar
  41. Millet, G., Malebranche, D., Mason, B., & Spikes, P. (2005). Focusing “down low”: Bisexual black men, HIV risk and heterosexual transmission. Journal of the National Medical Association, 97(Suppl. 7), S52–S59.Google Scholar
  42. Mohr, J., & Fassinger, R. (2000). Measuring dimensions of lesbian and gay male experience. Measurement and Evaluation in Counseling and Development, 33, 66–90.CrossRefGoogle Scholar
  43. National Conference of State Legislatures. (2014). Fostering Connections Act: State action. Retrieved from
  44. National Institute of Statistics. (2012). The homosexual population into the Italian community: Year 2011. Retrieved from
  45. Neblett, E., Rivas-Drake, D., & Umana-Taylor, A. (2012). The promise of racial and ethnic protective factors in promoting ethnic minority youth development. Child Development Perspectives, 6(3), 295–303.CrossRefGoogle Scholar
  46. Nolan, T. (2006). Outcomes for a transitional living program serving LGBTQ youth in New York City. Child Welfare, 85(2), 385–406.Google Scholar
  47. Paul, J., Cantania, J., Pollack, L., Moskowitz, J., Canchola, J., Mills, T., … Stall, R. (2002). Suicide attempts among gay and bisexual men: Lifetime prevalence and antecedents. American Journal of Public Health, 92(8), 1338–1345.CrossRefGoogle Scholar
  48. Pizer, J., Sears, B., Mallory, C., & Hunter, N. (2012). Evidence of persistent and pervasive workplace discrimination against LGBT people: The need for federal legislation prohibiting discrimination and providing for equal employment benefits. Loyola of Los Angeles Law Review, 45(3), 715–779.Google Scholar
  49. Reynolds, W. (1982). Development of reliable and valid short forms of the Marlowe-Crowne social desirability scale. Journal of Clinical Psychology, 38, 119–125.CrossRefGoogle Scholar
  50. Rosario, M., Schrimshaw, E., & Hunter, J. (2011). Different patterns of sexual identity development over time: Implications for the psychological adjustment of lesbian, gay, and bisexual youths. Journal of Sex Research, 48(1), 3–15.CrossRefGoogle Scholar
  51. Ryan, C. (2010). Engaging families to support lesbian, gay, bisexual, and transgender youth: The family acceptance project. Prevention Researcher, 17(4), 11–13.Google Scholar
  52. Ryan, C., Huebner, D., Diaz, R., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352.CrossRefGoogle Scholar
  53. Savin-Williams, R., & Ream, G. (2003). Sex variations in the disclosure to parents of same-sex attractions. Journal of Family Psychology, 17(3), 429–438.CrossRefGoogle Scholar
  54. Shelton, J. (2015). Transgender youth homelessness: Understanding programmatic barriers through the lens of cisgenderism. Children and Youth Services Review, 59, 10–18.CrossRefGoogle Scholar
  55. Shelton, J., & Winkelstein, J. (2014). Librarians and social workers: Working together for homeless LGBTQ youth. Young Adult Library Services, 13(1), 2024.Google Scholar
  56. Shepard, B. (2013). From community organization to direct services: The Street Trans Action Revolutionaries to Sylvia Law Project. Journal of Social Service Research, 39(1), 95–114.CrossRefGoogle Scholar
  57. Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumers’ report. Professional Psychology: Research and Practice, 33, 249–259.CrossRefGoogle Scholar
  58. Sidaros, R. (2017). Current challenges in the management of LGBT suicide. Psychiatry Online, 12(1), 8–10.Google Scholar
  59. Snapp, S., Hoenig, J., Fields, A., & Russell, S. (2015). Messy, butch, and queer: LGBTQ youth and the school-to-prison pipeline. Journal of Adolescent Research, 30(1), 57–82.CrossRefGoogle Scholar
  60. Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). A practioner’s resource guide: Helping families to support their LGBT children. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  61. United States Department of Housing and Urban Development (USDHUD). (2014). The 2014 annual homeless assessment report (AHAR) to Congress. Retrieved from
  62. Wilson, P. (2008). A dynamic-ecological model of identity formation and conflict among bisexually-behaving African-American men. Archives of Sexual Behavior, 37(5), 794–809.CrossRefGoogle Scholar
  63. Yu, V. (2010). Shelter and transitional housing for transgender youth. Journal of Gay & Lesbian Mental Health, 14(14), 340–345.CrossRefGoogle Scholar
  64. Zhao, Y., Montoro, R., Igartua, K., & Thombs, B. (2010). Suicidal ideation and attempt among adolescents reporting “unsure” sexual identity or heterosexual identity plus same-sex attraction or behavior: Forgotten groups? Journal of the American Academy of Child and Adolescent Psychiatry, 49(2), 104–113.Google Scholar
  65. Zimmerman, L., Darnell, D., Rhew, I., Lee, C., & Kaysen, D. (2015). Resilience in community: A social ecological developmental model for young adult sexual minority women. American Journal of Community Psychology, 55, 179–190.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2020

Authors and Affiliations

  1. 1.Washington University in St. Louis St. LouisUSA

Personalised recommendations