Mood Disorders
LGBTQ people are at higher risk for mood and anxiety disorders than the general population. A 2008 systematic review of 25 studies found that LGBTQ people were 1.5 times as likely to experience depression and 2.5 times as likely to have attempted suicide as their heterosexual counterparts (King et al., 2008). There is evidence that stigmatization of minority sexual identities may contribute to the formation and propagation of mood disorders, as LGBTQ people living openly and those who are in a legally sanctioned same-sex relationship have been shown to have levels of depression and anxiety similar to their heterosexual counterparts. Concerns about disclosure and stigmatization are particularly acute in the pediatric and young adult LGBTQ population, with one study finding that that cohort is up to 4 times as likely to attempt suicide as their heterosexual counterparts (Kann et al., 2011). LGBTQ populations are also at much higher risk for trauma in the form of physical and sexual abuse, both in the form of hate crimes and intimate partner violence (Lee et al., 2016).
Underlying the importance that stigmatization plays in the development and propagation of mood and trauma disorders and resultant suicidal ideation and behavior in the LGBTQ population is a 2010 study that showed that family acceptance and support of a patient’s sexual and gender identity is one of the most important protective factors for young LGBTQ adults (Ryan et al., 2010). While disclosure and acceptance have been shown to be associated with lower levels of depression and suicidality in LGBTQ patients, the situation is complicated by the fact that some patients who disclose their sexuality still face discrimination and poor treatment in social and even medical settings (Husain-Krautter et al., 2017). Indeed, disclosure of minority sexual and/or gender identities during adolescence has been associated with positive outcomes such as lower rates of mood and anxiety disorders as well as achievement of socioemotional developmental milestones earlier, but also in some studies increased incidence of trauma inflicted as a result of the person’s sexual orientation and gender identity.
Central to the treatment of the LGBTQ patient presenting with a mood, anxiety, or traumatic stress disorder is asking about, and accepting, the patient’s sexual and gender identity. The knowledgeable clinician will be able to integrate what he or she knows about the rest of the patient’s history with considerations about what role sexual and/or gender identity might be playing in influencing the trajectory of the presentation.
CME Question:
Disclosure of LGBTQ sexual identity is associated with:
Lower rates of inflicted trauma
Lower rates of mood and anxiety disorders
Decreased rates of discrimination by the medical establishment
All of the above
Answer: 2