LGBTQ youth have a lot of hurdles to overcome, with the pressures of coming out, dealing with harassment and bullying, and trying to find acceptance in the world surrounding them. In part because of these stressors, they may be at higher risk for a variety of mental health concerns. So when working with an LGBTQ teen in the primary care setting, it is important to be aware of this risk and be diligent about screening for psychiatric concerns, while also recognizing the strengths and potential of these young persons.
The 2015 National Youth Risk Behavior Study, notes that LGBTQ youth are at increased risk for violence against them, including teasing, bullying, harassment, and physical and sexual assault.
The National Alliance on Mental Illness, notes that LGBTQ youth are three times more likely than other youth to experience a mental health condition like depression or an anxiety disorder. Related to that, they are at higher risk have suicidal ideation and to consider suicide. According to one 2014 study, 29% of LGBTQ youth had attempted suicide at least once in the prior year compared to 6% of heterosexual youth.
LGBTQ are also at higher risk for substance misuse and truancy from school. They are at risk for engaging in sexual behavior that can increase their risk for sexually transmitted diseases like HIV.
The Trevor Project, an LGBTQ advocacy group, teamed with two other national agencies to conduct a survey of over one thousand LGBTQ teens and over 50% report they have been diagnosed with an eating disorder. An additional 25% suspected they might have an eating disorder even though they had not been formally diagnosed.
On the flip side, there are supports that can be implemented in schools, in clinics, and the community at large to help reduce these risks. A positive school climate and social group has been associated with lower rates of depression, suicidal ideation, substance use and truancy among LGBTQ students. Research has shown that students were less likely to experience threats of violence, miss school because they felt unsafe, or attempt suicide if they attended schools that have LGBTQ support groups (such as gay-straight alliances) and explicit policies against harassment, compared to schools that didn’t have these in place.
It is also important for parents to be supportive and open with their children. Parental rejection is also a risk factor for co-morbid mental health concerns, suicidal ideation, substance abuse and truancy.
There is a national shortage of health care providers with comprehensive training on the LGBTQ community, their unique needs, and their mental health concerns. As providers, it is important to be comfortable in discussing sexual identity, orientation and behaviors. Awareness of the increased risks of this population and comfort in screening for potential mental health concerns should be part of the primary care provider’s toolkit.
Some local resources include:
https://www.rchsd.org/programs-services/endocrinology-diabetes/services/gender-management-clinic/
https://www.thetrevorproject.org/#sm.00000agvl8xnyafkerg27xi52mljf
http://www.thecentersd.org/programs/youth-services/