Cover Story

The results of several breakthrough studies are offering new insights on gay men, lesbians and bisexuals. Among the key findings:

  • Several studies suggest that gay men, lesbians and bisexuals appear to have higher rates of some mental disorders compared with heterosexuals, although not to the level of a serious pathology. Discrimination may help fuel these higher rates.

  • A study found lesbians reported equally strong levels of mental health as their heterosexual sisters and higher self-esteem.

  • A new study of gay and lesbian youth finds that they are only slightly more likely than heterosexual youth to attempt suicide, refuting previous research that suggested much higher rates.

Researchers say these studies demonstrate the need for better, more tailored psychological treatment for lesbian, gay and bisexual (LGB) people.

Population-based studies

Several large population-based public health studies are discussed in the November American Psychologist (Vol. 56, No. 11) by Susan Cochran, PhD, an epidemiologist in the University of California, Los Angeles School of Public Health, who authored or co-authored many of the studies. Specifically, the studies find:

  • Higher rates of major depression, generalized anxiety disorder and substance use or dependence in lesbian and gay youth.

  • Higher rates of recurrent major depression among gay men.

  • Higher rates of anxiety, mood and substance use disorders, and suicidal thoughts among people ages 15 to 54 with same-sex partners.

  • Higher use of mental health services in men and women reporting same-sex partners.

Gleaning this type of information on LGB people has never been possible in general surveys before, Cochran notes. However, because the surveys on which these studies are based examine HIV-risk factors, including psychiatric problems and sexual behavior, they include questions on sexual orientation and sexual partners, she says.

"It's a breakthrough because it has traditionally been difficult to gather large samples of gays, lesbians and bisexuals due to their small numbers in the population," Cochran explains.

The data contradict previous findings that there are no significant differences in the mental health of heterosexuals and LGB people, adds Cochran, who notes she is concerned that these findings may give ammunition to people who want to falsely promulgate the argument that gay people are by nature mentally ill.

For one thing, she says, "these are certainly not levels of morbidity consistent with models that say homosexuality is inherently pathological." For another, the data simply don't prove either pro- or anti-gay arguments on the subject, whether it's that the inherent biology of homosexuality causes mental illness or that social stigma provokes mental illness in LGB people, she says.

Cochran believes the studies demonstrate the need for better psychological treatment for LGB people--an observation consistent with the U.S. Surgeon General's recommendations in his report on sexuality and health, she observes.

Discrimination and mental health

In a study that examines possible root causes of mental disorders in LGB people, Cochran and psychologist Vickie M. Mays, PhD, of the University of California, Los Angeles, explored whether ongoing discrimination fuels anxiety, depression and other stress-related mental health problems among LGB people. The authors found strong evidence of a relationship between the two.

Again using data from one of the large public health surveys, the team compared how 74 LGB and 2,844 heterosexual respondents rated lifetime and daily experiences with discrimination.

They looked at particular instances of discrimination, such as not being hired for a job or being denied a bank loan, as well as feelings of perceived discrimination, such as the sense that people treated them with less respect. The team also assessed rates of mental health disorders in both groups.

LGB respondents reported higher rates of perceived discrimination than heterosexuals in every category related to discrimination, the team found.

While the findings do not prove that discrimination causes mental health problems, they take a step toward demonstrating that the social stigma felt by LGB people has important mental health consequences. That again points to the need for tailored mental health treatment, in particular therapy that includes ongoing discussion of how discriminatory experiences may affect stress levels, they note.

The findings are reported in the November issue of the American Journal of Public Health (Vol. 91, No. 11).

Gay and lesbian youth and suicide

An article in the December issue of APA's Journal of Consulting and Clinical Psychology points to a possible cause of seemingly higher rates of suicide among LGB and transgendered (LGBT) youth: discrepancies between what gay youth report about suicide attempts and what they're actually doing.

The article, by Cornell University's Ritch C. Savin-Williams, PhD, reports on two studies that conclude that even though sexual-minority teens are more likely than heterosexual youth to report suicide attempts, half of those reports are false--that is, the young people had thought about suicide but hadn't acted on it. In addition, Savin-Williams found, many of the true attempts the young people reported weren't life-threatening.

"When you ask in-depth questions about suicide attempts, the responses you get account for the rate differences between heterosexual and sexual minority youth suicide," Savin-Williams says. "The heterosexual youth had hardly any false attempts, while those with same-sex attractions had a lot of them."

In one of the studies, 23 percent of 83 young sexual-minority women said they'd attempted suicide at least once. On further questioning, though, 29 percent of the reported attempts turned out to be false, and 80 percent of the true attempts were not life-threatening, Savin-Williams writes. The one exception was a small number of young women who were part of a support group, whose rate of actual suicide attempts was much higher than others in the sample.

In the other study, Savin-Williams compared reported suicide attempts in 126 young sexual-minority young people and 140 young heterosexual men and women. Again, while sexual-minority men and women were far more likely to report suicide attempts than heterosexual subjects, the two groups showed similar rates of true suicide attempts.

The findings suggest that gay youth are vulnerable to the media's and researchers' well-meaning but negative depictions of gay youth as highly troubled people heading on a collision course with life, Savin-Williams maintains.

"There's a script we have in our culture--a 'suffering suicidal' script--that these kids have picked up on," he says. A better approach for researchers, teachers and other youth workers, he believes, is to treat all young LGBT people as ordinary kids with great potential, unless they show research-based or visible indicators of suicide risk.

Lesbian mental health

On an even more positive note, two large-scale studies of lesbians and bisexual women report good news about lesbians' mental health, particularly if the women are "out."

In a study that used sisters as a control group in research on lesbians, University of Vermont psychologists Esther D. Rothblum, PhD, and Rhonda Factor, PhD, find that lesbians are as likely to report being mentally healthy as their heterosexual sisters and to report higher self-esteem.

The study, featured in the December issue of Psychological Science (Vol. 12, No. 1), compared mental health and lifestyle factors in 184 pairs of lesbian and heterosexual sisters, 44 pairs of bisexual and heterosexual sisters, 29 pairs of lesbian and bisexual sisters, 18 pairs of bisexual sisters and 11 pairs of heterosexual sisters. The authors recruited lesbian and bisexual female participants through ads placed in LGB periodicals, but labeled the study as one of sisters rather than of lesbian mental health.

While it's not clear why lesbians displayed higher self-esteem, the authors speculate it may be that lesbians are more educated and mobile than their heterosexual sisters. As a consequence, the lesbian sisters may be more likely to join supportive communities that allow them to bolster their self-worth, the authors hypothesize.

The study also found that bisexual women had significantly poorer mental health than lesbians and heterosexual women--findings consistent with other studies on bisexuals. Possible reasons are that bisexuals tend to face rejection in both the straight and gay communities; and that their mixed sexual orientation is more difficult to integrate psychologically than homosexuals' single-sex orientation, the authors speculate.

A second study, reported in the January 2001 American Journal of Orthopsychiatry (Vol. 71, No. 1), tested a structural equation model related to "outness" on 2,401 lesbian and bisexual women. In this work, researchers found that the more "out" lesbians and bisexual women were--as measured by self-identification as a gay or lesbian, number of years out and level of involvement in the lesbian or bisexual community--the less psychological distress they reported. These findings held true for a range of racial and ethnic subsamples including African-American, white European, Latina, Asian-American, Native American and Jewish women.

The study--conducted by Rothblum, Jessica Morris, PhD, a private practitioner in Northampton, Mass., and Craig R. Waldo, PhD, of the University of California, San Francisco Center for AIDS Prevention Studies and AIDS Research Institute--is the largest on lesbian mental health to date and is one of the only to look at the relationship of being out to lesbians' mental health, Rothblum says.

The findings support the idea that therapy that facilitates the coming-out process is good for lesbians' mental health. "Such affirmative psychotherapy, provided during the coming out process, may prevent or buffer against subsequent mental health problems," the authors write.

Tori DeAngelis is a writer in Syracuse, N.Y.