Recent judgment by Supreme Court to allow same sex marriages all over the country is one of the major landmarks in light of public health. There are numerous examples when policy changes have resulted in improved health such as tobacco policy, anti soda law to curb obesity, affordable care act, and civil right movements. This judgment is also not exceptional, and it has potential to reduce health disparities among LGB groups. In 1973, American Psychiatrist Association removed homosexuality from DSM. Being LGBT has nothing to do with mental health illness; it is our (heterosexuals) conservative nature makes them feel/experience mental health problems. To appreciate Supreme Court decision, this is my brief literature review on mental health aspect of LGBT groups. And I hope this revolutionary step would also motivate other part of the world to follow the same step.
According to various different rsources, we can estimate that United States is home to three to four percent LGBT population. Because of social, cultural, religious and political fabrics and taboos, real and clear number is not available globally. Health disparities among LGBT groups in United States are well known. Building on it, my paper focus on mental health disparities in LGBT population. Compared to heterosexuals, sexual minorities that comprise lesbians, gay men, bisexual individuals and trans genders are at an increased risk for mental health illness and psychiatric morbidities. According to Meyer’s conceptual framework in from of stress theory, stressors can elucidate disproportionate prevalance of mental health illness in sexual minority groups. When coupled with other minority statuses, additive effect increases probability of experiencing homophobia, discrimination and rejection (Meyer, 2003) . People living in a state with policies that did not provide safeguards to lesbian, gay, and bisexual individuals were four times likely to suffer a comorbid psychiatric condition compared to individuals living in a state with positive policies (Hatzenbuehler, Keyes, & Hasin, 2009). They are more prone to experience depression, anxiety, high distress, substance abuse, suicidal tendency, hopelessness, and disability.
Support from family is very crucial for LGB group; even support from sexual minority group can make a big difference in light of mental health. Ryan et al study proposed that family acceptance could help in reducing the stressors in this group. (Ryan, Russell, Huebner, Diaz, & Sanchez, 2010). Even few studies have reported that friends and family support helps in cessation of substance abuse. A longitudinal cohort study established inverse relationship between family support and smoking rated among sexual minority groups. (Newcomb, Heinz, Birkett, & Mustanski, 2014). Another longitudinal study concluded negative association between alcohols uses and perceived family support (Newcomb, Heinz, & Mustanski, 2012). While distinguishing between family support and non-kin support, Almeida et al study found family support is more useful for mental health compared to non-kin support (Almeida, Subramanian, Kawachi, & Molnar, 2011).
Discrimination stemming from racism also adds up already high anxiety level. According to Myer minority theory, many minority statuses augment experience of feeling homophobia and stress, which further aggravate outcome. Social stress is contributing factor for anxiety. A recent study reported two times anxiety and mood disorders among LGBT groups compared to heterosexuals. Previous studies have found differences in distress level of LGB and heterosexuals. Research implies relationship between emotional distress and perceived discrimination in sexual minority groups (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009).
Several studies found higher chances of depression in LGB groups. Patel et al study determines that clinical depression is more widespread in sexual minority because of social rejection and stigma. (Patel, Mayer, & Makadon, 2012). According to research at UCLA Center for Health Policy Research, despite no differences in access to health care, older gays are reportedly to have higher rates of depression than heterosexual counterparts (Wallace, Cochran, Durazo, & Ford, 2011). Long time distress stemming from social environment can force patients to clinical depression (Safren & Heimberg, 1999). Stigma in union with stress put MSM to higher risk of Psychiatric morbidity in form of depression (Sandfort, Bos, Knox, & Reddy, 2015). Research conducted in Estonia, Northern European country, also reported high prevalance of anxiety and depression in sexual minority groups (Parker, Lohmus, Valk, Mangine, & Ruutel, 2015). A cross sectional study, using respondent driving sampling, conducted in Sub-Saharan Africa also reported high prevalance of depression among MSM attributed to social stigma (Stahlman et al., 2015). A longitudinal study exclusively conducted in sexual minority women found this sample had higher unadjusted odds of depressive symptoms compared to heterosexual women (Pyra et al., 2014). Lytle et al found this result consistent in across all racial groups in the United States (Lytle, De Luca, & Blosnich, 2014). Emails were sent to invite students from 30 osteopathic medical schools for cross-sectional questionnaire-based study , of which, only 6 schools responded. Results are in accordance with established association of sexual orientation and depression (Lapinski & Sexton, 2014). While evaluating distress among 9th-12th LGBT grad students, researchers found higher rates of depression among students who percieved discrimination (Almeida et al., 2009).
A number of population based studies revealed higher rates of suicidal ideations in sexual minority groups. Prevalance of suicidal tendencies among trans-genders is more than general population. According to randomized trial study, people who experienced forced anal intercourse debut are more likely to have suicidal ideation (Defechereux et al., 2015). Adolescent group is the most vulnerable group for suicide attempts in MSM population. This is because gender awareness is developed in this period (Russell & Toomey, 2012). Another study established association between parental rejection because of sexual orientation and suicidal tendency of gays (D’Augelli et al., 2005). A study designed in Denmark to investigate the suicide risk by sex and relationship status found that MSM have eight times more risk of suicide attempts compared to histories of heterosexual marriages (Mathy, Cochran, Olsen, & Mays, 2011).
Discrimination and stigma act as barrier to access to health services. Professional can also compound the problem for not having enough knowledge about community. Because of barrier and stigma, gay men in Spain are more likely to diagnose for HIV at advanced stage compared to heterosexuals (Hoyos et al., 2013). According to Hyoes et al, main barrier to HIV testing among MSMs includes: fear of HIV, legal implications of positive test and stigma/discrimination. In India, largely due to stigmatization by Indian medical community, MSM avoid routine health care (Patel et al., 2012). Sexual prejudice against MSM and transgender women is recognized as one of the impediments for access to anti retroviral therapy (Chakrapani, Newman, Shunmugam, & Dubrow, 2011). Chakrapani et al study implies barrier at three levels: family/social, health care system and at individual level. One Canadian study recommends that psychiatrists need to understand LGBT issue better.
Ryan et al study reported higher rates of smoking among sexual minorities. Bisexuals are more like to get indulged in Bing drinking and smoking. Stress resulting from stigma and discrimination contribute to higher risk of indulging in substance abuse. American College of Physicians documents the higher rates of smoking among MSMs than general population (Makadon). Alcohol misuse, a major health concern in lesbian and bisexual veterans, could be credited to higher prevalance of mental health symptoms (Lehavot, Browne, & Simpson, 2014). Revealed that gays rejected by family are more likely to indulge in alcohol and substance abuse. Gay neighborhood is not defined by more concentration of homosexuals in the neighborhood, but it is defined by higher concentration of gay bars, which highlight the magnitude and reflection of alcohol problem in sexual minorities (Midanik, Drabble, Trocki, & Sell, 2007). Lesbian bars were identified by several qualitative studies as a gathering place for lesbian women(Gruskin, Byrne, Kools, & Altschuler, 2006; Hequembourg & Brallier, 2009).
In nutshell, mental health of sexual minorities is preventable if certain policies are enacted which could help in reducing stigma and discrimination against them. Supreme court judgment is a big step in that direction and hopefully other countries in the world will follow the same suit.
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