Mental Health Disparities Among LGBTQ+ Youth and The Strategies to Promote Their Well-Being

A Systematic Literature Review (SLR) was conducted to explore the research subject on the mental health disparities of the LGBTQ+ youth. SLRs are recognized for their standardized, transparent, replicable, unbiased, and rigorous approach, making them a preferred method over traditional literature review methods ¹¹. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

Six databases like PsychINFO, PubMed/Medline, Scopus, EMABSE, CINAHL and Web of Science were used based on their accessibility as well as frequency of using databases by other researchers in previous similar studies. Various search terms were incorporated like "LGBTQ+ or “gender minority”, “Sexual minority”, “well-being”, “mental health intervention”, and discrimination” to access relevant studies.

The studies emphasize on mental health disparities among LGBTQ+ youth or sexual minority. The studies focus interventions or strategies targeted at enhancing the well-being of LGBTQ+ youth or gender minority. The paper should be published after 2010 and to be in English. Both qualitative and quantitative research methods are used. Studies which are not available in full text and those were systematic review are excluded. The studies which are not directly associated with mental health disparities or well-being of the LGBTQ+ youth or sexual minority are discarded.

The Population, Exposure/Intervention, and Outcome (PEO) framework was incorporated for structuring the study selection process: The Population is LGBTQ+ youth or mental health disparities and the exposure/intervention are based on the Interventions and strategies the Outcome of the study is mental health disparities and well-being.

A meticulous and systematic approach was employed in the study selection process for this. After removing duplicated titles, the remained titles were scanned, and irrelevant ones were removed. The final selection underwent rigorous evaluation for quality and relevance to the study's topic. Abstracts and titles were initially screened based on specific inclusion and exclusion criteria, followed by a thorough full-text assessment to ensure alignment with the research question and methodological rigor. Additionally, the bibliography and reference lists of selected studies were scrutinized to include any other relevant studies meeting the criteria. This comprehensive method ensures that only the most pertinent studies are included in the review, contributing to the validity and reliability of the findings. A total of 15 studies was found as shown in Figure 1.

Figure 1.Prisma chart and selection process

The Critical Appraisal Skills Programme (CASP) tool was utilized to gauge the quality of the studies included. It presents a systematic approach that evaluates the methodological integrity of qualitative as well as quantitative studies ¹². The CASP instrument has been used to categorize research studies corresponding to their methodological reliability. The categorization made it easier to recognize the methodological advantages and drawbacks of the studies.

One of the most important things in the table is the studies' names, their study designs, their scores, and whether they can help to prove their arguments or not. Things with high figures usually indicate the use of complex or advanced research methods. The scores are the judges of the research or the skills that the research presented. The intensity of the evidence is categorized into different levels: "High" designates research with a strong methodology that finds similar overall outcomes, whereas "Moderate" is for studies that have the process of the research done in a respectable but not strong manner (Table 1).

A data extraction sheet was developed to extract information that is needed for analyzing data. The data extraction sheet included information such as Sample characteristics (Gender identity, sexual orientation and age), Study design (Cohort Study and randomized controlled trial), Contextual influences (Minority stress, bullying and family rejection), Healthcare access (Provider bias and LGBTQ+-affirming services), Social Support:  LGBTQ+ peers and parental support), and Mental health outcomes (suicide attempts, anxiety and depression). Table 2 shows the information extracted for this study.

For this study, the narrative thematic analysis is used to analyze the data for this study. These themes were generated by extracting and categorizing data associated with the identified themes. This process involved summarizing key findings and grouping them based on the focus areas.

A number of six studies were included in this theme which was derived from the analysis of the objectives. Themes have been generated by systematically reviewing literature associated with LGBTQ+ youth’s mental health disparities, assessing articles elaborating discussing policy changes, anti-discrimination measures and legal reforms.

According to ¹⁵ the struggle for the protection and recognition of LGBTQ (Lesbian, Gay, Bisexual, and Transgender) rights has been an arduous as well as long journey, characterized by the tribulations and triumphs. In recent decades, there has been a growing global awareness of the necessity for securing equal protections and rights for LGBT individuals.

¹⁴ conducted a scoping review on gender and sexual diversity in Thailand for researching on LGBTQ+ exclusion, discrimination and policy responses which are found fragmented and limited. Policy proposals shifted from tighter LGBTQ+ antidiscrimination regulations to boosting the quality and scope of LGBTQ+ healthcare. Legalizing same-sex marriage, enabling people to adjust gender codes on identity papers, specifically mentioning LGBT Q+ individuals within laws protecting sexual assault/rape, and enhancing data collecting on LGBTQ + populations were some the specific concepts. ⁸ found specific prevention interventions and strategies that emphasize on developing spaces for LGBTQ+ youth, expanding a sense of acceptance and support within families, schools and healthcare settings while lowering experiences of stigmatization and victimization based on sexual orientation and gender identity.⁸ wrote about some recommendations for school counsellors in order to prepare the school for aiding LGBTQ+ students.

Total three studies deemed appropriate for this theme which has been generated from identifying cultural and contextual factors that lead to mental health disparities among the LGBTQ+ youths in the existing pool of literature. According to ¹⁵ LGBTQ+ young adults confront gender policing, structural stigma, and anti-LGBTQ+ religious messages related to their mental health. This paper has demonstrated the significance of an intersectional minority stress model in order to document various processes that can influence mental health inequalities. The requirement of integrating intersectionality in clinical treatments for sexual minority groups in order to enhance their psychological health is pointed out in the review by. It states that a substantial proportion of the research studies examined did not correctly represent intersecting identities, instead taking respondents into account as a single unit. A large number of interventions targeted on the connection between sexual minority verification and HIV-positive diagnosis. Only some programs entirely incorporate intersectionality into the preparation, implementation, and assessment, enabling respondents to draw on the several drawbacks in their life and respond to their specific requirements. ¹⁶ found that community engagement mechanisms that prioritize marginalized groups' viewpoints comply with the empowering notions of intersectionality.

This theme has also found three relevant studies from literature which was generated from the literature search on the role of social and family support in eliminating mental health disparities among LGBTQ+ youth. ¹⁷ in their study observed that social support, especially from families, has been detected as an integral promotive factor. The findings reveal the significance of family support for LGBTQ+ youth. Youth who are likely to lack family support, but have other types of support, showcase a decline in psychological distress along with a spike in family support throughout the stage of adolescence. On the other hand, youth who lack all forms of support are likely to showcase high distress. ¹⁷ similarly noted that youth from higher socioeconomic status are more prone to receive support from family, friends and from others. For most of the mental health outcomes, family support seems to be a specifically important and relevant source of support for targeting LGBTQ+ youth.

Found that social support is critical for psychosocial well-being of LGBTQ+ youth. Support from diverse sources like teachers, parents, friends and classmates can have a substantial influence on the mental health and adjustment of LGBTQ+ youth ¹⁸. The authors constructed a structural equation model where three primary parcels were developed for each source of social support including classmate, parent, close friend and teacher in addition to self-esteem and depression.

A multiplicity of factors, like social stigma, discrimination, and lack of understanding and acceptance could lead to the existence of mental health issues among young LGBTQ people. The youth from sexual minorities face increased internal discrimination, times when their friends and family do not support them, and LGBTQ+ bullying. They will end up being more responsible for mental health problems like depression, anxiety, and thoughts of committing suicide. On the other hand, ²⁸ add that minority stress increases inequalities due to difficulties that are unique to LGBTQ+ people in a heteronormative society. Discrimination and prejudice in society, coupled with a lack of appropriate healthcare services, all disregard the needs of LGBTQ+ youth and decrease the quality of their lives. The patients can feel supported, welcomed, and seen as individuals when the care is affirming, culturally competent, and cares about their identities. One aspect of the availability of mental wellness specialists who have exclusive knowledge of the special needs of LGBTQ+ people is embodied in this. However, comfortable interaction can be developed through the provision of the info, support groups, and safe spaces dedicated to the youth belonging to the LGBTQ+ community. On the other hand, ²⁹, stated that sex education that is all-encompassing including support for different orientations and identities with regard to gender, and implementation of anti-bullying policies by schools and communities are two factors that help to raise the emotional health of LGBTQ+ kids in school. Mental health crises can be a result of stress, burnout, and increasing instances of depression. Campaigns that normalize asking for help and advocate for open discussions on mental health issues are equally vital. The extent to which LGBTQ+ youth can enjoy a much-tolerating and promoting group can be achieved through legislation that protects LGBTQ+ rights and treats structural inequalities.

Found a global perspective on the challenges confronted by LGBTQ+ individuals in terms of their rights, stressing the journey characterized by triumphs and tribulations ³⁰. While acknowledging advancements, the authors underscore ongoing disparities, demanding a comprehensive analysis of the rights of LGBTQ+ people all over the world. This is aligned with the wider literature, which underlines the global scope of LGBTQ+ rights advocating and the demand for complete legal protections and recognition. ¹⁴ carry out a scoping examination of diversity in sexuality and gender in the multifaceted setting of Thailand. Their results reveal different policy responses, with a shift away from major antidiscrimination guidelines and towards a focus to enhance the quality and scope of LGBTQ+ healthcare. Specific policy suggestions comprise legalizing same-sex marriage, revising gender codes for identifying documents, and integrating LGBTQ+ people specifically in laws defending against rape/ sexual assault.

Contribute by offering prevention strategies and methods aimed at developing inclusive environments for LGBTQ+ youth ⁸. Their emphasis on developing acceptance as well as assistance within social circles, educational institutions, and health care institutions coincides with larger studies asking for extensive support systems that minimize stigma as well as victimization ³¹. The value of legal frameworks for LGBTQ+ rights is well-known in the wider literature, with studies often focusing on the beneficial effect of legal recognition on mental health outcomes ². The constantly changing nature of policy suggestions, as shown by ¹⁴ assessment, indicates a constant debate and adaptation to adapt to the LGBTQ+ community's growing demands.

Schmitz ¹⁵ shed the spotlight on cultural and contextual aspects impacting LGBTQ+ young adults' mental health. The study of gender policing, institutional stigma, as well as anti-LGBTQ+ religious messages reveals the complexities of minority stressors. The implementation of an intersectional minority stress model, is vital in comprehending the interactions of several variables that lead to mental health disparities. The wider literature supports the belief that cultural and environmental factors are important in LGBTQ+ mental health. The impacts of discrimination and stigma extends beyond individual experiences to encompass institutional frameworks and cultural norms—intersectionality into therapeutic procedures, which addresses a flaw in many studies. ¹⁶ demonstrates the significance of community involvement that elevates marginalized groups' opinions, which resonates with the empowering values of intersectionality. This underscores the value of procedures that take into consideration the different challenges encountered by diverse LGBTQ+ individuals in their individual situations.

The findings of ¹⁷ underscore the essential function of social assistance, especially among families, in enhancing the well-being of LGBTQ+ youth. The reported reduction in psychological distress associated with higher family support throughout adolescence indicates the dynamic characteristics of support systems. Their understanding of the impact of their socioeconomic standing on support obtained parallels wider debates regarding the interrelated aspects influencing LGBTQ+ lives. ¹⁸ offer a valuable contribution by emphasizing the necessity of social support from a number of sources, including parents, teachers, friends, and classmates. Positive parental support and acceptance are linked with greater self-confidence and superior mental health, whereas peer and teacher support contributes to school safety as well as overall well-being.

In the wider literature, the significance of family support for LGBTQ+ people is constantly demonstrated ³². The findings correspond with the wider comprehension that diverse types of support like peer, family and community extensively contribute to the mental health outcomes of LGBTQ+ people ²⁷.