Abstract
In the USA, the LGBT community has grown significantly and continues to grow. Lesbian, gay, bisexual, and transgender (LGBT) individuals encounter a range of stressors throughout their lifetime. Compared to heterosexuals the LGBT community reports higher prevalence rates of anxiety, depression, trauma, substance abuse, and suicide. Minority stress has been linked to increased psychological distress among sexual minorities, specifically prejudice and discrimination. Several evidence-based treatments have been adapted to address the specific needs of the LGBT community, including addressing minority stress, specifically cognitive behavioral therapy. In this chapter we discuss prevalence’s rates of psychological distress among the LGBT community, adapted treatments for working with LGBT, and describe several guidelines and principles to assist in working with the LGBT community.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67, 10–42.
Balsam, K. F., Martell, C. R., & Safren, S. A. (2006). Affirmative cognitive-behavioral therapy with lesbian, gay, and bisexual people. In P. A. Hays & G. Y. Iwamasa (Eds.), Culturally responsive cognitive-behavioral therapy: Assessment, practice, and supervision (pp. 223–243). Washington, DC: American Psychological Association. https://doi.org/10.1037/11433-010
Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology, 73(3), 477–487. https://doi.org/10.1037/0022-006X.73.3.477
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.
Barefoot, K. N., Warren, J. C., & Smalley, K. B. (2017). Women’s health care: The experiences and behaviors of rural and urban lesbians in the USA. Rural and Remote Health, 17(1), 3875.
Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Murray Latin, H., Ellard, K. K., Bullis, J. R., … Cassiello-Robbins, C. (2017). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide (2nd ed.). New York, NY: Oxford University Press.
Brown, G. R., & Jones, K. T. (2016). Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the Veterans Health Administration: A case–control study. LGBT Health, 3(2), 122–131. https://doi.org/10.1089/lgbt.2015.0058
Cochran, B. N., Balsam, K., Flentje, A., Malte, C. A., & Simpson, T. (2013). Mental health characteristics of sexual minority veterans. Journal of Homosexuality, 60(2–3), 419–435. https://doi.org/10.1080/00918369.2013.744932
Coull, G. D., & Morris, P. G. (2011). The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review. Psychological Medicine, 41(11), 2239–2252.
Center for Disease Control and Prevention. (2010). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved from https://www.cdc.gov/injury/wisqars/index.html
Flores, A. R., Herman, J. L., Gates, G. J., & Brown, T. N. T. (2016). How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute.
Hottes, T. S., Bogaert, L., Rhodes, A. E., Brennan, D. J., & Gesink, D. (2016). Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: A systematic review and meta-analysis. American Journal of Public Health, 106(5), e1–e12. https://doi.org/10.2105/AJPH.2016.303088
Kuerbis, A., Mereish, E. H., Hayes, M., Davis, C. M., Shao, S., & Morgenstern, J. (2017). Testing cross-sectional and prospective mediators of internalized heterosexism on heavy drinking, alcohol problems, and psychological distress among heavy drinking men who have sex with men. Journal of Studies on Alcohol and Drugs, 78, 113–123.
Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian, gay, and bisexual young adults in Australia: Associations with psychological distress, suicidality, and substance use. Archives of Sexual Behavior, 43, 1571–1578.
Marsack, J., & Stephenson, R. (2017). Sexuality-based stigma and depression among sexual minority individuals in rural United States. Journal of Gay and Lesbian Mental Health, 21, 51–63.
Medley, G., Lipari, R., Bose, J., Cribb, D., Kroutil, L., & McHenry, G. (2016). Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 National survey on drug use and health. NSDUH Data Review. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Meyer, I. H., & Frost, D. M. (2013). Minority stress and the health of sexual minorities. In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 252–266). New York, NY: Oxford University Press.
Mongelli, F., Perrone, D., Balducci, J., Sacchetti, A., Ferrari, S., Mattei, G., & Galeazzi, G. M. (2019). Minority stress and mental health among LGBT populations: An update on the evidence. Minerva Psichiatrica, 60(1). https://doi.org/10.23736/S0391-1772.18.01995-7
National Center for Transgender Equality. (2017). 2015 U.S. transgender survey report. Retrieved from https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
Newport, F. (2018). In U.S., Estimate of LGBT population rises to 4.5%. Retrieved from https://news.gallup.com/poll/234863/estimate-lgbt-population-rises.aspx
Pachankis, J. E. (2014). Uncovering clinical principles and techniques to address minority stress, mental health, and related health risks among gay and bisexual men. Clinical Psychology: Science and Practice, 21(4), 313–330.
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83(5), 875–889. https://doi.org/10.1037/ccp0000037
Perez-Brumer, A., Hatzenbuehler, M. L., Oldenburg, C. E., & Bockting, W. (2015). Individual- and structural-level risk factors for suicide attempts among transgender adults. Behavioral Medicine, 41, 164–171.
Reisner, S. L., Biello, K. B., White Hughto, J. M., Kuhns, L., Mayer, K. H., Garofalo, R., & Mimiaga, M. J. (2016). Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: Baseline findings from project LifeSkills. JAMA Pediatrics, 170(5), 481–486. https://doi.org/10.1001/jamapediatrics.2016.0067
Rendina, H. J., Gamarel, K. E., Pachankis, J. E., Ventuneac, A., Grov, C., & Parsons, J. T. (2017). Extending the minority stress model to incorporate HIV-positive gay and bisexual men’s experiences: A longitudinal examination of mental health and sexual risk behavior. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 51(2), 147–158. https://doi.org/10.1007/s12160-016-9822-8
Roberts, A. L., Austin, S. B., Corliss, H., Vandermorris, A. K., & Koenen, K. C. (2010). Pervasive trauma exposure among US sexual orientation adults linked to posttraumatic stress disorder risk. Comprehensive Psychiatry, 51(6), e8–e9. https://doi.org/10.1016/j.comppsych.2010.06.039
Roberts, A. L., Rosario, M., Corliss, H. L., Koenen, K. C., & Austin, S. B. (2012). Childhood gender nonconformity: A risk indicator for childhood abuse and posttraumatic stress in youth. Pediatrics, 129(3), 410–417. https://doi.org/10.1542/peds.2011-1804
Sandholtz, N., Langton, L., & Planty, M.G. (2013). Hate Crime Victimization 2003–2011, National Crime Victimization Survey, Bureau of Justice Statistics. Retrieved from http://www.bjs.gov/index.cfm?ty=pbdetail&iid=4926
The William’s Institute. (2019). LGBT data and demographics. Los Angeles, CA: The Williams Institute, UCLA School of Law. Retrieved from https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#about-the-data
Timmins, L., Rimes, K. A., & Rahman, Q. (2017). Minority stressors and psychological distress in transgender individuals. Psychology of Sexual Orientation and Gender Diversity, 4(3), 328–340. https://doi.org/10.1037/sgd0000237
Virupaksha, H. G., Muralidhar, D., & Ramakrishna, J. (2016). Suicide and suicidal behavior among transgender persons. Indian Journal of Psychological Medicine, 38(6), 505–509. https://doi.org/10.4103/0253-7176.194908
Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W., … Lin, H. (2017). Prevalence of depression and depressive symptoms among outpatients: A systematic review and meta-analysis. British Medical Journal, 7(8), e017173.https://doi.org/10.1136/bmjopen-2017-017173
Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014). Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013. Retrieved from https://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf
Wawrzyniak, A. J., & Sabbag, S. (2018). PTSD in the Lesbian, Gay, Bisexual, and Transgender (LGBT) population. In B. Nemeroff & C. R. Marmar (Eds.), Post-traumatic stress disorder (pp. 229–244). New York, NY: Oxford.
Weir, C., & Piquette, N. (2018). Counselling transgender individuals: Issues and considerations. Canadian Psychology/Psychologie Canadienne, 59(3), 252–261. https://doi.org/10.1037/cap0000129
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Gonzalez, F.R. (2020). Cultural Considerations in Behavioral Health Service Delivery with LGBT Populations. In: Benuto, L.T., Gonzalez, F.R., Singer, J. (eds) Handbook of Cultural Factors in Behavioral Health. Springer, Cham. https://doi.org/10.1007/978-3-030-32229-8_13
Download citation
DOI: https://doi.org/10.1007/978-3-030-32229-8_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-32228-1
Online ISBN: 978-3-030-32229-8
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)