RESEARCH WEEKLY: Serious Mental Illness in Sexual and Gender Minorities By Tasha Paul, August Warshauer, Preethika Ratnam, Meara Kane, Katie Beard, Kendal Win and Linden James Editor's note: In honor of May being Mental Health Awareness Month, we are featuring guest Research Weekly blogs written by members of Active Minds, a non-profit organization focused on young adult mental health with more than 550 chapters at high schools and colleges/universities throughout the United States. Sexual and gender minority (SGMs) individuals are at a higher risk for developing psychiatric disorders and also tend to have poorer access to healthcare resources, according to research in The Oxford Handbook of Sexual and Gender Minority Mental Health. The increased risk for psychiatric disorders is associated with minority stressors, such as childhood trauma and discrimination, but many studies fail to acknowledge the role sexuality and gender may play in this risk. A new study by Amelia M. Stanton et al. from Massachusetts General Hospital published in Plos One this year supports this hypothesis, finding that mental illness symptom severity and substance use is greatly increased for transgender and gender diverse individuals. The researchers postulate that the increased risk for psychiatric disorders in SGM individuals is in line with minority stress theory, which states that minorities experience greater health risks due to the unique stress they face in addition to the everyday stresses experienced by the average person. Study details The study used data from health records of a community health center specializing in sexual and gender minority health to compare the severity of self-reported depression, anxiety and substance use symptoms, the likelihood of meeting clinical standards for these disorders, and the number of behavioral health appointments among patients. The study included 29,988 patients across six gender groups: cisgender women, cisgender men, transgender women, transgender men, non-binary individuals assigned male at birth (AMAB) and non-binary individuals assigned female at birth (AFAB). Results AFAB non-binary individuals had significantly higher anxiety and depression symptom severity compared to any of the other gender groups. Non-binary AMAB individuals had the greatest levels of use for all substances except alcohol and were most likely to have a substance use disorder. Transgender women and non-binary patients were the most likely to meet clinical levels for a depressive disorder and non-binary AFAB patients were the most likely to meet clinical levels for an anxiety disorder. Non-binary patients also had the highest prevalence of dually diagnosed mental illness and substance use disorders. Implications The results of this study have specific implications for SGMs with a serious mental illness. As this new study shows, sexual and gender minorities have a higher prevalence of mental illness and substance use disorders compared to the general population. This higher prevalence is also in line with SGMs higher risk of developing a psychiatric disorder, as described in past research. The increased risks and prevalence for mental illness, including serious mental illness such as major depression, is in part due to the additional stressors that this group faces in daily life as a result of their sexual and gender identities, according to these results. According to The Oxford Handbook of Sexual and Gender Minority Mental Health, transgender and non-binary identities have historically been labeled as psychotic symptoms, which makes some clinicians reluctant to support gender-affirmative medical interventions or affirm SGM identities. This can result in negative experiences with the healthcare system and make it more difficult for individuals to seek treatment. SGM persons with psychotic disorders often face a “dual stigma.” They face rejection from the LGBTQ community due to their illness and there are widespread accounts of anti-SGM violence and microaggressions in the mental health system. Evidence-based psychosis treatments rarely include SGM-specific treatment, SGM-affirming therapists rarely specialize in serious mental illnesses, and publications regarding SGM-specific treatment rarely include psychotic disorders. Little is currently known about the treatment experiences of SGM persons with serious mental illnesses. While new research on the general mental health of sexual and gender minorities, like the new article in Plos One, are a step in the right direction, more research is needed on SGM individuals with serious mental illness, and affirmative treatment models need to be incorporated to eliminate barriers to healthcare. References Stanton, A. M., Batchelder, A. W., Kirakosian, N., et al. (January 2021). Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center. Plos One. Peta, J. L. (2020). Schizophrenia spectrum and other psychotic disorders among sexual and gender minority populations. In E.D Rothblum (Ed.), The Oxford handbook of sexual and gender minority mental health (pp. 125-134). Oxford University Press. Tasha Paul, August Warshauer, Preethika Ratnam, Meara Kane, Katie Beard, Kendal Win and Linden James are members of the Active Minds chapter of North Carolina School of Science and Mathematics. View as Webpage To receive Research Weekly directly in your email inbox on a weekly basis, click here. Questions? Contact us at [email protected] Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. 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