Covid-19 Is Wreaking Havoc on LGBTQ+ Mental Health
LGBTQ+ people are especially vulnerable to the pandemic’s mental health impacts. Here’s why.
The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community is disproportionately affected by mental health disorders. According to the American Psychiatric Association (APA), LGBTQ+ individuals are more than twice as likely to experience anxiety and depression compared with the general population.
Now, a recent study from the University of California, San Francisco (UCSF) published in the Journal of General Internal Medicine suggests that since the onset of the coronavirus crisis, the level of anxiety and depression among LGBTQ+ individuals has increased even more, especially in those who haven’t struggled with these conditions before.
Vulnerability to economic fallout and negative health outcomes
Like other minority populations, LGBTQ+ people are more likely to experience poor mental health outcomes due to a variety of factors, including discrimination, limited access to mental health care, and stigma around seeking treatment, according to the APA.
The acute stress of the pandemic is now adding to the problem, the study authors say. “It could be that the pandemic is such a huge stressor that folks who were not prone to anxiety and depression [before] are starting to have those symptoms now,” says Mitchell R. Lunn, MD, senior co-author and assistant professor at Stanford University Medical Center.
Self-reported data from study participants showed marked increases in anxiety and depression since the pandemic began. Scores on a clinical survey used to assess symptoms of anxiety and depression increased by an average of 50% and 17% respectively compared with before the pandemic.
Economic hardship seems to play a particularly important role in the increase in anxiety and depression. LGBTQ+ people are nearly twice as likely as the general population to feel their personal finances are “much worse off” than they were a year ago, according to an April study from the Human Rights Campaign (HRC) and PSB Research. What’s more, a UCLA Williams Institute study released prior to the pandemic found the poverty rate among LGBTQ+ Americans was 22% compared with 16% for the general population.
As unemployment has skyrocketed across the board, existing economic disparities are only expected to grow starker. HRC, which warned early on during the coronavirus crisis that LGBTQ+ people in the U.S. are disproportionately vulnerable to negative health outcomes and economic fallout, estimates that five million LGTBQ+ adults work in industries that have shut down due to the pandemic or put them at increased risk of exposure to the virus in hospitals and other frontline positions.
“It could be that the pandemic is such a huge stressor that folks who were not prone to anxiety and depression [before] are starting to have those symptoms now.”
Missing health coverage and social isolation
HRC data from 2018 also found that 17% of LGBTQ+ adults have no form of health coverage, compared with 12% of non-LGBTQ+ adults. Lack of paid medical leave, loss of employer health care, and barriers to accessing care are all serious risk factors for negative health outcomes, according to HRC. These disparities are worse for non-white and transgender LGBTQ+ adults; 32% of transgender people of color lack any form of coverage despite having specialized health care needs.
For example, consider a trans person who’s lost their job and employer-sponsored health insurance, cutting off their access to gender-affirming hormones. “If you’re no longer getting the therapy that’s important for your gender affirmation, you can imagine that that might make people more depressed or anxious,” Lunn tells Elemental.
On top of that, LGBTQ+ elders and youth are at risk for social isolation and lack of physical and emotional support networks, which likely worsened during state lockdowns and stay-at-home orders. Even before the pandemic, LGBTQ+ people were twice as likely to age alone, and 60% of LGBTQ+ elders report feeling a lack of companionship, according to Service and Advocacy for GLBT Elders (SAGE). Times are especially precarious for homeless youth who may rely on social services, like regular school lunches, and for LGBTQ+ kids who may be forced to quarantine in unsupportive family environments.
Given the LGBTQ+ population’s vulnerability to poor health outcomes, economic fallout, and social isolation caused by the pandemic, “it is not surprising to see this increase in anxiety and depression among this population,” says Tari Hanneman, director of HRC’s Health and Aging Program, in a UCSF news article about the study results.
“If you’re no longer getting the therapy that’s important for your gender affirmation, you can imagine that that might make people more depressed or anxious.”
New-onset anxiety and depression as a direct response to the coronavirus crisis
One aspect of the recent findings came unexpectedly. Rather than seeing heightened anxiety in those who were already anxious, the researchers found the greatest changes in anxiety among people who weren’t anxious prior to Covid-19.
Those who reported anxiety and depression prior to the pandemic showed little to no change in those feelings since. The major spikes came from people whose feelings arose in direct response to the stress of the coronavirus crisis.
“The hypothesis, potentially, is that people who already have anxiety and depression have developed compensatory coping mechanisms or may already be getting treatment of some sort,” whether that means therapy or medication, Lunn says.
The study also raises a number of questions for further research. Most urgent, says Lunn, is to find out whether those who reported increased depression and anxiety are at greater risk for self-harm or suicide or perhaps even contracting Covid-19 if their anxiety stems from an actual risk of exposure.
And then there’s the lasting impact of the coronavirus pandemic on mental health across various populations. “Once we’re able to resume some semblance of our lives, how do we identify the people who are most at risk for having difficulty recovering? And how do we provide appropriate therapies for them?” Lunn asks.
The answer may be to continue collecting data as the pandemic unfolds so that providers and advocates can prepare for the road ahead. “It will be important to find out what happens over time and to identify who is most at risk,” says Annesa Flentje, PhD, another co-author of the UCSF study. “So we can be sure to roll out public health interventions to support the mental health of our communities in the best and most effective ways.”