Lesbian, gay and bisexual (LGB) people are significantly more likely to have mental health conditions and report alcohol and drug misuse than heterosexual people. This is according to a study led by UCL researchers in collaboration with the University of East Anglia and City, University of London, with the findings published in Psychological Medicine.

Given this continued disparity, the report’s authors are calling for government action to ensure equity in health and social care services. They highlight the need for improved awareness among health professionals to the mental health needs of sexual minority groups and are calling for policies that improve societal understanding, starting with encouraging schools to intervene earlier to encourage tolerant attitudes towards sexual minorities across the whole school community.

The research analyzed data from the 2007 and 2014 Adult Psychiatric Morbidity Surveys (APMS), which had a combined sample of 10,433 people in England aged 16-64. The surveys are completed via face-to-face interviews and/or computer self-completion and contain data relating to sexual orientation, common mental disorders (CMD), hazardous alcohol use, and illicit drug use. Further information is collected on experiences of bullying and discrimination, religious identification and childhood sexual abuse.

In this analysis of 2007 and 2014 data, the researchers found there had been no change (i.e. no improvement) between 2007 and 2014, with LGB people remaining at higher risk of poorer mental health when compared to heterosexuals.

The prevalence of depression and anxiety disorders among bisexual people was 40%, and for lesbian and gay people it was 28%, which was significantly higher than that for heterosexuals at 16%. Similarly, illicit drug use was highest among bisexual people, at 37%, while for lesbian and gay people it was 25% and heterosexuals, at 10.5%. Alcohol misuse was highest in lesbian and gay people, at 37%, compared with bisexual people at 31%, and heterosexuals, at 24%.

Researchers found evidence to suggest that exposure to bullying and discrimination may help explain the observed poorer mental health in lesbian women and gay men but not in bisexual people.

No evidence was found to support any apparent contribution of differences in religious affiliation or experiences of adversity such as childhood sexual abuse in the association between sexuality and mental health problems.

Lead author, Dr. Alexandra Pitman (UCL Psychiatry), said: “What this study highlights is the significant and ongoing disparity in mental health between LGB people and heterosexual people, as evidenced by higher levels of mental health problems and alcohol and drug misuse.”

For Pitman, “in order to reduce this persistent inequality in society, we must ensure that health and social care professionals are better trained to identify and care for the wellbeing and mental health needs of sexual minority groups, who are often made to feel invisible within national health systems.”

Pitman said that secondary schools must implement policies and practices that create supportive environments for sexual minority students, including providing (and actively promoting) access to a member of staff who is a designated minorities contact person, who students can talk to in confidence about experiences of discrimination, bullying, or mental health difficulties.

“More can also be also be done to implement anti-discrimination strategies and policies in health care institutions. This might include: the use of positive images of LGB people in health service marketing material; ensuring that equal opportunities statements include grounds of sexual orientation; taking a LGB-affirmative stance in psychotherapy (with implications for training of therapists); and training all professionals not to assume heterosexuality,” Pitman said.

Senior author, Professor Michael King (UCL Psychiatry), said: “Our research shows that stigma and social exclusion on the basis of sexual orientation may be more subtle and enduring than we imagine. Despite greater public acceptance and legal changes to ensure equality, the lived experience of a proportion of LGB people remains negative. We would emphasise however that these data also show that the majority of LGB people have robust mental health and lead happy lives.”

Co-author, Dr Joanna Semlyen (The University of East Anglia), said: “We know that sexual minorities are at increased risk of poor mental health than the heterosexual population. What this paper shows is that those inequalities did not change between the two study collection points of 2007 and 2014. This is really important because it shows that, despite some changes in societal attitudes, people who are lesbian, gay and bisexual continue to experience poor mental health.”

For Semlyen, “what we need to do now is not only continue to monitor health in sexual minority populations as standard but also to design studies to understand what causes these inequalities and develop interventions to reduce them.”

COVID-19 exacerbated the ongoing mental health disparities for transgender and gender nonbinary people.

This is according to a study – “Understanding the Impact of the COVID-19 Pandemic on the Mental Health of Transgender and Gender Nonbinary Individuals Engaged in a Longitudinal Cohort Study” by Jeremy D. Kidd, MD, MPHORCID; Kasey B. Jackman, PhD, RN; Renato Barucco, MS; Jordan D. Dworkin, PhD; Curtis Dolezal, PhD; Theresa V. Navalta, BS; Joseph Belloir, MS; and Walter O. Bockting, PhD – that appeared in the Journal of Homosexuality.

For the researchers, “TGNB individuals have unique health needs, including gender-affirming hormonal and surgical interventions that many TGNB people need to align their bodies with their gender identity.”

These same interventions may also help other people perceive a TGNB person’s gender as they experience it, thus facilitating gender-affirming social interactions.

For this study, 208 TNGB individuals were surveyed between March-June 2020. The researchers then used multivariable linear regression to examine reduced LGBTQ/TGNB community support and disruptions in gender-affirming health care as predictors of psychological distress during the pandemic.

The researchers found that “the pandemic exacerbated ongoing mental health disparities for TGNB individuals. Furthermore, reduced LGBTQ/TGNB support was associated with increased psychological distress during the pandemic.”

Among the 208 participants, access to LGBTQ-specific and TGNB-specific support services was reduced for 113 individuals (54.3%) and 91 individuals (43.8%), respectively. Out of 208 TGNB individuals, 23 participants (11.1%) reported having a previously scheduled gender-affirming surgery canceled or postponed; 68 participants (32.7%) experienced an interruption in receiving (n = 55) or a delay in starting (n = 13) gender-affirming hormones.

Regarding psychological distress, the study found that “a significantly higher percentage of respondents met criteria for ‘clinically significant psychological distress’ during the pandemic, compared to pre-pandemic ratings.”

The researchers recommended for special attention to be given “to address the unique ways in which TGNB individuals were affected by the COVID-19 pandemic. This includes increasing access to LGBTQ/TGNB community support and addressing long-standing health disparities.”

They added: “Policy-makers tasked with developing programs to assist individuals during and after the pandemic should pay special attention to meeting the unique needs of TGNB individuals while also addressing the long-standing disparities that impact the health and wellbeing of TGNB individuals.”

Homophobic language and hate speech against transgender people are on the rise in many European countries, according to the ILGA-Europe’s “Annual Review of the Human Rights Situation of Lesbian, Gay, Bisexual, Trans and Intersex People in Europe and Central Asia”, released in February.

The annual report, which includes events that occurred between January and December 2020, provides a snapshot of what happened during the year, at national, regional and international levels, and it documents progress and trends regarding the human rights situation of LGBTI people.

According to the report: “There has also been a substantial rise in hate speech, both from official sources, in the media and online.”

In reports received by ILGA-Europe from different countries, “we see a stark rise in abuse and hate speech against LGBTI people; many who became vulnerable to homelessness have been forced to move back in to hostile family and community situations; LGBTI organizations have had to skew their work towards provision of basic necessities like food and shelter while many governments leave LGBTI people out of their relief packages; and there has been a resurgence of authorities and officials using LGBT people as scapegoats while authoritarian regimes are empowered to isolate and legislate without due process.”

It also noted that the trend of politicians verbally attacking LGBTI people has grown sizeably and spread in countries including Albania, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Czechia, Estonia, Finland, Hungary, Italy, Kosovo, Latvia, Moldova, North Macedonia, Poland, Russia, Slovakia, and Turkey.

Religious leaders also propagated hate-speech in Belarus, Greece, Slovakia, Turkey and Ukraine, many of them directly blaming LGBTI people for COVID-19.

Hate speech on social media has risen in Belgium, Bulgaria, Croatia, Czechia, Malta, Montenegro,
Russia and Turkey, and in the general media in Slovenia and Ukraine, while hate speech is an ongoing issue in Georgia, Ireland, Netherlands, North Macedonia, Portugal, Romania, Slovakia, Spain and the UK.

There are also countries where LGBTQIA rights are not only stagnant, but even backslid. In Kazakhstan, for instance, legislators introduced a discriminatory norm in the healthcare law, raising the age limit for trans healthcare access from 18 to 21 and excluding those with a mental health or “behavioral disorder” diagnosis. Similarly in Kyrgyzstan, a new version of the law “On acts of civil status” came into force in autumn, making it no longer possible for trans people to change their legal gender marker.

Fortunately, according tot the report, “many courts and governmental institutions are beginning to have a larger awareness of this growing trend, and beginning to talk about regulating online hate speech, including on the EU level.”

Transgender adults experience elevated levels of substance use disorder diagnoses (SUDD) relative to their cisgender peers, which suggests that effective, culturally tailored SUDD treatment interventions are warranted.

This is according to a study – “Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults” by Jaclyn M. W. Hughto, PhD, MPH; Emily K. Quinn, MA; Michael S. Dunbar, PhD; et al – that appeared in JAMA Network Open.

This cross-sectional study used the OptumLabs Data Warehouse to analyze de-identified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017.

The study involved 15,637 transgender adults (4,955 [31.7%] transmasculine/TM) and 46,911 cisgender adults (23,664 [50.4%] men). Most (8,627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years.

Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2,594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs.

Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]).

The researchers concluded that “the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers.”

So for the researchers, there is a “need to ensure access to high-quality SUD treatment for transgender individuals as well as additional research to understand facilitators and barriers to SUD treatment engagement for this population. Such research can inform the development of novel public health interventions to prevent and treat SUD among transgender people.”

The odds of contracting a severe case of COVID-19 may be greater for adults who identify as gay, lesbian or bisexual than for heterosexuals.

This is according to a report – “Sexual Orientation Disparities in Risk Factors for Adverse COVID-19–Related Outcomes, by Race/Ethnicity — Behavioral Risk Factor Surveillance System, United States, 2017–2019” by Kevin C. Heslin, PhD and Jeffrey E. Hall, PhD; and appeared in the Morbidity and Mortality Weekly Report – released by the US Centers for Disease Control and Prevention (CDC).

In the report, the researchers found that “sexual minority persons… have higher self-reported prevalences of several underlying health conditions associated with severe outcomes from COVID-19 than do heterosexual persons, both in the overall population and among racial/ethnic minority groups.”

For the report, CDC researchers combined data from three years of health-related telephone surveys (2017-2019) conducted in up to 31 US states that included a question about sexual orientation. There were 643,956 survey participants, and 4.7% identified as gay, lesbian or bisexual.

The report, however, noted that the number of respondents identifying as transgender or nonbinary was too small for reliable estimates.

The report found that there is disparity, and this existed across all the underlying conditions and behaviors for LGBT people, although not equally.

The top 11 in ranked order were:

• current asthma sufferers
• chronic obstructive pulmonary disease (COPD)
• kidney disease, current smokers
• past asthma sufferers
• stroke
• cancer
• heart disease
• diabetes
• obesity
• hypertension

The report stressed: “Because of their sexual orientation, sexual minority persons experience stigmatization and discrimination that can increase vulnerabilities to illness and limit the means to achieving optimal health and well-being through meaningful work and economic security, routine and critical health care, and relationships in which sexual orientation and gender identity can be openly expressed. Persons who are members of both sexual minority and racial/ethnic minority groups might therefore experience a convergence of distinct social, economic, and environmental disadvantages that increase chronic disease disparities and the risk for adverse COVID-19–related outcomes.”

The researchers recommended the inclusion in discussions of the intersections of sexual orientation and race/ethnicity, deemed “critical to ensuring health equity for all, including subpopulations whose circumstances often remain uncaptured despite acknowledgments of their distinct importance and needs.”

“Because of longstanding social inequities and higher prevalences of several underlying health conditions, sexual minority populations might be vulnerable to COVID-19 acquisition and associated severe outcomes, and this vulnerability might be magnified when coupled with other demographic characteristics such as race/ethnicity,” they added.

A United Nations (UN) report claims that the Islamic Republic of Iran imposed electric shock torture on LGBTQIA children, among its human rights violations.

In this UN report, the Committee on the Rights of the Child expressed concern that these practices occurring in 2016 eyed to “cure” LGBTQIA children.

According to the UN Special Rapporteur for the Islamic Republic of Iran, Javaid Rehman, he is “concerned at reports that lesbian, gay, bisexual and transgender children were subjected to electric shocks and the administration of hormones and strong psychoactive medications. These practices amount to torture and cruel, inhuman and degrading treatment, and violate the State’s obligations under the International Covenant on Civil and Political Rights and the Convention on the Rights of the Child.”

The UN report stressed that “international law is clear in affording the protection of human rights of all people, including LGB and intersex persons,” and so “the reported treatment of these individuals violates their rights to liberty, fair trial, integrity, privacy, dignity, equality before the law, non-discrimination and the absolute prohibition on torture and other cruel, inhuman and degrading treatment and punishment, as enshrined in international law.”

It is actually illegal to have same-sex relations in Iran, with sex between men meriting the death penalty and sex between women meriting 100 lashes.