Beyond HB2: Mental Health and LGBTQ Youth

July 27, 2016

The fallout of discriminatory LGBTQ policies, like North Carolina's House Bill 2, is clear–numerous entertainment giants have pulled out the Old North State to stand in solidarity with the LGBTQ community, including entertainers Demi Lovato, Bruce Springsteen, and, most recently, the NBA. Due to the climate created by HB2, the NBA announced that my hometown of New Orleans could possibly host the 2017 All-Star Games instead of Charlotte. And the millions in lost revenues for North Carolina point to a larger issue facing American youth. From inadequate sexual education in U.S., curricula to targeted laws and policies that discriminate against sexual minorities, LGBTQ youth can have it pretty bad.

Research conducted by many specialists studying LGBTQ health, including our faculty at the Mailman School, has shown that LGBTQ youth are at an increased risk of developing more psychological stress, lower self-esteem, experiences of victimization, more substance abuse, and lowered academic performance and achievement as compared to their straight counterparts.

The systemic stigma

According to Mailman School faculty members Mark Hatzenbuehler, Deborah Hasin, and Katherine Keyes, state policies and environment can have a profound effect on LGBTQ health disparities, especially in terms of mental health. In a political climate where LGBTQ issues have come to the forefront more often, it is up to the education system to educate the coming generations about this minority in a nonjudgmental manner, since their government-mandated educational system is where some students begin to develop an understanding of sexuality.

Unfortunately, in the few programs that cover sexuality, the topic tends to be negatively biased, which has the potential to sway how youth perceive sexual minorities and ultimately interact with them in society. Failure to promote sexuality and sexual minorities in a neutral or even positive light can create misconceptions regarding LGBTQ behavior, which can ultimately result in laws and policies that limit sexual minorities and their freedoms, as North Carolina has done with HB2.

As a result of the state's law, The American Academy of Pediatrics (AAP) has spoken out against the HB2 anti-transgender bill because of the undue harm it will cause to transgender youth, who are already targets for bullying and more extreme violence. School environments can be hostile for LGBTQ youth, with nearly 25 percent of these students getting threatened or harmed by a weapon on campus. LGBTQ youth also have higher rates of suicide and depression, according to the CDC, which may be linked to the bullying they experience. Children around the world need stability, acceptance, trust, the support of nurturing adults, and safety in their environment and HB2 does nothing to help trans teens in these ways, the AAP also explained earlier this year.

Discrimination from doctors and peers

Sexuality-based discrimination affects LGBTQ youth not only in public restrooms but also in healthcare settings. Mailman professor Marina Catallozzi and her colleague Bret Rudy found that LGBTQ-identifying or LGBTQ-leaning patients receive sub-par or no care at all from their physicians, and they are often spoken about disparagingly. Many physicians reported feeling uncomfortable asking homosexual patients about their sexual history, with many of them not even informing patients of their code of confidentiality regarding doctor-patient conversations. Catallozzi and Rudy suggested that cultural competency education programs may help in alleviating some of the stigma and victimization-induced stresses LGBTQ patients experience when interacting with their physicians.

Outside of the subtle discriminations from their doctors, a group that is trained to remain impartial, the typical LGBTQ youth tends to deal with more stressors than the average teen. For example, they usually have to “come out” or reveal their sexuality to their social network. According to professor Schrimshaw and his colleagues professors Margaret Rosario and Joyce Hunter, disclosing one’s LGBTQ identity and receiving negative reactions may result in the person experiencing heightened sense of social isolation, loss of support, and a reinforced negative view of oneself.

Though LGBTQ teens may experience increased risk for peer victimization, coming out can also result in higher levels of overall happiness. Researchers Kosciw, Palmer, and Kull found that one’s "outness" is highly correlated with lower levels of depression and higher levels of self-esteem. They believe that out LGBTQ youth who feel positive outcomes as a result of their outness have this experience because their environments contain sources of support and positive reactions from peers.

Kosciw et al. noted that "outness" can also cause increased incidences of harassment and victimization. In other words, the environment in which the LGBTQ youth “comes out” is integral to predicting the effects of “coming out” on his or her well-being, or in this context, the laws and policies that govern an environment like HB2 can influence one’s coming out experience and the consequences of an LGBTQ youth revealing his or her true nature.

It can't all be negative, right?

While today’s LGBTQ youth may have it easier than previous generations, their experience growing up is much more stressful when compared to their heterosexual peers, as Kosciw et al.’s research confirms. LGBTQ youth who fall outside of the general heteronormative culture today are still at a higher risk for violence, discrimination, marginalization, and mental and physical abuse. In terms of school communities, those who perceive their environment as hostile tend to do worse academically and psychologically than their peers. They are also at higher risk for engaging in high-risk sexual practices and substance abuse. And just because conditions are better does not necessarily mean that LGBTQ youth and their heterosexual counterparts are treated or viewed equally in society.

In direct conflict with the logic behind HB2, Hatzenbuehler, Hasin, and Keyes’ research found that people who identified as lesbian, gay, or bisexual and lived in a state with no protections for them were more likely to suffer from mood and anxiety disorders when compared to their peers who live in states with protections. Additionally, they noted that if the state had policies in place to protect sexual minorities, the citizens, sexual minority or not, had a lower rate of having more than two mental health disorders. Hatzenbuehler, Hasin, and Keyes believe this could mean that threatening environments can lead to increased instances of mental health disorders.

Attacking the prejudices that people have against LGBTQ people may help in decreasing this prevalence of mental disorders in LGBTQ youth, according to the Mailman researchers. Interestingly, the researchers also found that mental illness was prevalent among sexual minority-identifying participants even in states with policies in favor of sexual minorities. Because of this, researchers recommended that states focus on removing stigma and providing instruction on how to cope with the stress associated with stigma. They also mentioned how there are other forms of discrimination that may be prevalent within the state and affect the mental state of LGBTQ-identifying people.

Support and understanding

When LGBTQ youth are told that heterosexuality is the only normal sexuality, they are forced to adhere to gender norms outside of their identity. Teachers and administrators might even perpetuate sexual stigma and ban discussion of homosexual-based topics unless in the context of HIV/AIDS. Gay-Straight Alliances (GSAs) empower LGBTQ youth to stand up in opposition to heteronormative culture in schools, speaking out against anti-LGBTQ behaviors that would otherwise stigmatize or isolate these youths. GSAs gave members a sense of community, but were not usually successful in enacting long-lasting change. In other words, GSAs were great for creating a sense of acceptance in the environment, but without support from school officials, family, and the community, LGBTQ Youth will have much more stress to deal with leading to worse health outcomes when compared to their heterosexual peers.

The bottom line is that stigma and environment play an integral role in health outcomes for everyone. Minorities, whether they be sexual, gendered, racial, or anything in between, tend to be negatively affected more than their majority peers. It is up to us to apply these findings to youth for the betterment of their lives. Based on this research and my previous article on the current state of US sex education, I believe that comprehensive sexuality and sexual education may be the best factor in changing these negative outcomes into more positive ones. Without this, more discriminatory policies like North Carolina’s HB2 may become the new norm, limiting the rights of sexual minorities in the US.

By Kittu Pannu, Sociomedical Sciences, MPH '17

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