LGBTQ+ Mental Health

LGBTQ+ mental health refers to the psychological wellbeing of lesbian, gay, bisexual, transgender, queer and other sexual and gender minority people. Being LGBTQ+ is not a mental health condition. However, research consistently finds higher average rates of depression, anxiety and suicidal thoughts in these groups, and the leading explanation is minority stress: the added strain of stigma, discrimination and rejection.

This page explains how psychologists understand that gap, which groups face the highest risks, what protects mental health, and what "affirming" care means. It is an educational overview, not a guide to diagnosis or treatment.

From diagnosis to diversity: a short history

For much of the 20th century, psychiatry treated same-sex attraction as a disorder. Homosexuality appeared in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952. That changed thanks to research and activism. Psychologist Evelyn Hooker's 1957 study compared projective test results of gay and heterosexual men and found that expert judges could not tell the groups apart on psychological adjustment.

In 1973 the American Psychiatric Association removed homosexuality as a diagnosis from the DSM, and in 1990 the World Health Organization removed it from the International Classification of Diseases (ICD). In ICD-11, which took effect in 2022, "gender incongruence" was moved out of the mental disorders chapter into a chapter on conditions related to sexual health, reflecting the view that being transgender is not itself a mental illness.

What the research shows about mental health differences

Population surveys and systematic reviews point in the same direction. A widely cited 2008 meta-analysis by Michael King and colleagues found that lesbian, gay and bisexual people had roughly one and a half times the risk of depression and anxiety disorders, and about twice the risk of suicide attempts, compared with heterosexual people. Later national surveys in the US, UK and elsewhere have reported similar patterns.

A few points help interpret these findings accurately:

• They are averages. Most LGBTQ+ people do not have a mental disorder, and many report high life satisfaction and strong communities.
• Risk is not spread evenly. Bisexual people, transgender and nonbinary people, and LGBTQ+ youth tend to report higher distress than gay and lesbian adults on average.
• Context matters. Rates are generally lower where there is more legal protection and social acceptance, which supports the idea that stigma is a key driver.
• Measurement is improving. Many older surveys did not ask about sexual orientation or gender identity, so estimates for some groups are still uncertain.

Substance use and disordered eating are also reported at higher average rates in some LGBTQ+ groups. Researchers generally interpret these as partly a response to stress, and partly a reflection of social settings, such as historically bar-centered community spaces.

The minority stress model

The minority stress model, set out by social epidemiologist Ilan Meyer in 2003, is the main framework for understanding these differences. It argues that people in stigmatized groups face ongoing stress that is unique (it comes on top of ordinary life stress), chronic (it is built into social structures) and socially based (it comes from attitudes and institutions, not from the person).

Meyer described stressors on a spectrum from distal (external) to proximal (internal):

Psychologist Mark Hatzenbuehler later added a "psychological mediation" framework (2009). It proposes that stigma affects mental health partly through general processes everyone experiences, such as rumination, difficulty with emotion regulation, social isolation and hopelessness. This explains why minority stress can increase the risk of many different conditions rather than one specific disorder.

A parallel gender minority stress model, developed by Rylan Testa and colleagues in 2015, adapts these ideas for transgender and nonbinary people. It adds stressors such as non-affirmation of gender identity, for example being repeatedly called by the wrong name or pronouns.

Groups facing higher risk

LGBTQ+ young people

Adolescence is already a period of rapid identity development. LGBTQ+ teens may also face bullying, family conflict and fear of coming out. Reviews such as Russell and Fish (2016) find higher rates of depression, suicidal thoughts and self-harm among LGBTQ+ youth than among their peers, along with higher rates of homelessness, often linked to family rejection. The Trevor Project's annual US surveys have repeatedly found that a large share of LGBTQ+ young people report seriously considering suicide in the past year, and that those with accepting adults and affirming spaces report lower rates. For broader context, see teen mental health.

Bisexual people

Bisexual people make up a large share of the LGBTQ+ population, yet studies often find they report more depression and anxiety than gay and lesbian people. Explanations include stigma from both heterosexual and gay communities, stereotypes that bisexuality is a phase, lower rates of being out (and so less access to support), and fewer bisexual-specific community spaces.

Transgender and nonbinary people

Transgender and nonbinary people report some of the highest levels of distress in surveys, alongside high rates of discrimination in employment, housing and healthcare. Research consistently links social support, being able to live in one's identified gender, and respectful treatment by others with better mental health. Decisions about medical aspects of gender care are made between individuals and their healthcare providers and are outside the scope of this page.

Overlapping identities

People who belong to more than one marginalized group, for example LGBTQ+ people of color, disabled LGBTQ+ people or LGBTQ+ immigrants, can face several sources of stigma at once. Researchers use the term intersectionality for this. It can mean, for example, experiencing racism within LGBTQ+ spaces and homophobia within one's cultural community. Related pages cover racial trauma and immigration and mental health.

Coming out and identity

"Coming out" is the process of recognizing and sharing one's sexual orientation or gender identity. It is rarely a single event; people make choices about disclosure in each new setting, from a new job to a medical appointment. Early stage models, such as Vivienne Cass's 1979 model of homosexual identity formation, described a sequence from confusion to synthesis. Modern researchers see identity development as more fluid and less linear than those models suggested.

Research on outness is nuanced. Being out is linked with less concealment stress and more access to community support, but disclosure in a hostile setting can bring rejection or danger. That is why decisions about coming out are personal and depend on safety. There is no "right" timeline.

Protective factors and resilience

Focusing only on risk gives an incomplete picture. Many LGBTQ+ people show considerable resilience, and research has identified several factors linked with better outcomes:

At the individual level, factors such as self-acceptance, coping skills, meaningful relationships and self-compassion are associated with wellbeing. These are general wellbeing resources, not a substitute for professional help when difficulties are persistent or severe.

What affirming mental health care means

Many LGBTQ+ people report past experiences of feeling judged, misunderstood or having to educate their own clinicians. This can make it harder to seek help. Affirming care means a professional:

• treats sexual orientation and gender identity as normal variations of human experience;
• does not assume that a client's identity is the cause of every problem, or that it is irrelevant;
• understands minority stress and the realities of discrimination;
• uses the client's name and pronouns and is comfortable discussing relationships and identity;
• never tries to change a person's orientation or gender identity.

Established therapies such as cognitive behavioral therapy have been adapted for LGBTQ+ clients. One example is ESTEEM, developed by John Pachankis and colleagues, which targets minority stress processes in gay and bisexual men; early trials found reductions in depression and anxiety, though more research is needed. The therapeutic alliance, the working relationship between client and therapist, matters for everyone and may matter especially when trust has been damaged before.

Practical guidance on choosing a professional is in how to find a therapist and types of mental health professionals.

Conversion practices

"Conversion therapy" (also called reparative therapy or sexual orientation and gender identity change efforts) refers to attempts to change a person's sexual orientation or gender identity. In 2009 an American Psychological Association task force reviewed the evidence and concluded that there was no adequate scientific support for these efforts working, and that there were reports of harm such as depression, anxiety and suicidal thoughts. Major medical, psychiatric and psychological organizations oppose these practices, and a growing number of countries and states restrict them.

How allies, families and friends can help

Support from the people around someone is one of the strongest protective factors in the research. Helpful approaches include:

• Listening first. If someone comes out to you, thank them for trusting you and let them lead the conversation.
• Respecting privacy. Let them decide who else is told and when.
• Using affirming language. Use the name and pronouns they ask for, and correct yourself simply if you slip.
• Speaking up. Challenge jokes or mistreatment when it is safe to do so.
• Learning on your own. Read and seek support elsewhere instead of expecting the person to educate you about everything.

More general guidance is available in how to support someone with mental health issues.

When and where to get help

Ongoing low mood, anxiety that interferes with daily life, withdrawal from others, or thoughts of self-harm are all reasons to talk to a primary care doctor or licensed mental health professional. Many countries have LGBTQ+-specific helplines and community centers, such as the Trevor Project in the US and Switchboard in the UK, alongside general services.

If you or someone you know is in immediate danger or thinking about suicide, contact local emergency services or a crisis line straight away. Our crisis resources page lists options by country.