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LGBTQIA+ people of all ages experience trauma at higher rates than their straight or cisgender peers.

Major and minor everyday traumas come in the form of discrimination, bullying, harassment, loss, intimate partner violence, physical and sexual abuse, and painful forms of stigma and bias.

Historically, many medical and mental health professionals have failed to recognize and adequately meet the needs of traumatized LGBTQIA+ people. This has led to poor engagement with the LGBTQIA+ community and other negative effects that, in some cases, intensify prior traumatic experiences.

The Trevor Project reports that more than 1.8 million LGBTQIA+ youth ages 13 to 24 seriously consider suicide each year in the U.S. — and at least one attempts suicide every 45 seconds.

Here are some ways trauma affects the mental health of LGBTQIA+ youth and young adults, and how to help.

Everyday Contributors to Trauma

LGBTQIA+ people may face discrimination and harassment in many areas of life. Here are some types of everyday situations that are harmful to LGBTQIA+ mental health:

Educational discrimination

According to the American Psychiatry Association, LGBTQIA+ students in grades K through 12 experience harassment at high rates, citing statistics such as:

• 75% of LGBTQIA+ students report having been bullied or harassed at school.
• 35% have experienced physical assault.
• 12% have suffered sexual violence at school.

Harassment and assault that occurs in school – a setting where students should feel safe and supported — can prove particularly damaging to a young person’s mental health. This bullying can cause fear, anxiety, depression, and post-traumatic stress disorder (PTSD).

A 2021 National School Climate Survey reported that 82% of LGBTQ+ students felt unsafe in school because of at least one of their actual or perceived personal characteristics. They also reported experiencing an increase in acts of intimidation, bias, and violence against LGBTQIA+ students at their schools.

The survey also showed that LGBTQIA+ students reported:

• Hearing biased remarks, including homophobic name-calling, in school.
• Missing classes or days of school because of fear or safety reasons.
• Experiencing harassment and assault in school and online.
• Experiencing discriminatory policies and practices at school.

Nearly half of LGBTQIA+ youth had seriously considered attempting suicide in the past year, according to the Trevor Project. For college students, the picture is not much better: 33% of LGBTQIA+ college students had seriously considered suicide in the past year, while 7% reported making a suicide attempt in the past year.

Institutional discrimination

LGBTQIA+ people experience institutional discrimination in a variety of situations and places. For example, workplace discrimination could take the form of getting passed over for promotions or not getting equal pay compared with gender-conforming peers. In fact, the LGBTQIA+ unemployment rate is double that of the general population.

LGBTQIA+ people also experience the full range of responses from religious organizations — from unconditional support to outright hostility. Growing up in a religious setting that rejects or condemns their nonconforming sexual- or gender- identities can cause trauma. Experiences of discrimination can lead to negative mental health outcomes, such as hopelessness, anxiety, emotional dysregulation, social isolation, and even drug misuse and incarceration.

Health disparities

Discrimination in health care settings may cause trauma and endanger lives through delays or denials of medically necessary care. This particularly affects transgender patients who may need medical interventions, such as hormone therapy and/or surgery.

Despite advanced transgender medicine treatment programs and a world standard of care, patients report a lack of providers with expertise in transgender medicine in their local areas. Lack of access is the single largest factor preventing trans people from getting care.

Other common barriers to care include:

• Lack of health insurance.
• Lack of cultural sensitivity from health care providers.
• Socioeconomic barriers, such as low income, lack of transportation, and inadequate housing.

Because they lack access to health care, transgender patients are at a much higher risk of negative health outcomes such as HIV infection, smoking, drug and alcohol use, and suicide attempts than the general population.

Family rejection

A significant source of mental and physical stress for LGBTQIA+ people is family rejection. It can set off a series of negative issues because family rejection may lead to homelessness, which makes it hard to stay in school or hold down a job. The Trevor Project found that only 37% of LGBTQIA+ youth identified their home as an LGBTQ-affirming space.

Family rejection also can lead to lifelong psychiatric problems. People who experience family rejection are more likely to get depressed, misuse alcohol, use illegal drugs, and attempt suicide than peers who did not.

History of trauma

Many people who identify as LGBTQIA+ have experienced past physical or sexual assault and harassment. Past trauma compounds current trauma, which may worsen anxiety about future safety.

Laws and legislation

Several states have passed or are trying to pass legislation that may harm and even promote hostility toward transgender and gender-nonconforming people. These potential laws are stressful for LGBTQIA+ persons in these states, especially in a political climate that feels hostile. The Trevor Project survey found that 86% of LGBTQIA+ youth reported recent politics as having a negative impact on their well-being.

Microtraumas/microaggressions

LGBTQIA+ people often experience small, subtle expressions of hostility or discrimination on a daily basis. Those who experience microtraumas may not meet diagnosable criteria for PTSD but may suffer greatly from minor stressors, such as internalized phobias, rejection sensitivity, and marginalization both in their personal life and other settings.

Though microaggressions are often associated with racial or ethnic minorities, they may also affect LGBTQIA+ and other marginalized populations. And for LGBTQIA+ persons of color, microtraumas and microaggressions can compound.

More than half of all LGBTQIA+ students of color report experiencing in-person victimization based on race/ethnicity. Over time, these microtraumas and microaggressions can take a toll on both mental and physical health.

How to Help

When it comes to helping LGBTQIA+ people achieve and maintain good mental health, connecting them with inclusive mental health resources is a critical factor.

For teens, encouraging them to connect with a school psychologist, guidance counselor, or teacher could be the best first step. In the school climate survey, almost all LGBTQIA+ students (96%) could identify at least one staff member who is supportive of LGBTQIA+ students at their school. More than half (52%) had seen at least one “safe space” sticker or poster at their school to identify supportive educators.

For college students, experts say that making on-campus LGBTQIA-affirming mental health services available, accessible, and inclusive is crucial for colleges and universities to reduce the risk of suicide among their LGBTQIA+ students.

For those living in the community, there are a number of places to find inclusive mental and emotional support:

• Pennsylvania’s Support & Referral Helpline links PA residents with local resources (855-284-2494).
• LGBTQ+ Healthcare Directory lists medical professionals who have registered themselves as LGBTQIA+ friendly.
• The Trevor Project provides a direct link to a counselor right from its website.

How to Be an Ally or Advocate

An ally is a person who supports LGBTQIA+ people. Some people now prefer to use the term advocate instead because it implies that the person has put effort into their stance. Whichever term you use, being an ally or advocate means that being around you is safe.

Here are some tangible ways you can show your support for an LGBTQIA+ person and their community:

• Respect the identity they are expressing by using their preferred name and pronouns.
• Don’t disclose sensitive information with which someone has entrusted you. Let the person tell their own story in their own time.
• Listen, be open-minded, and be willing to talk.
• Create a safe space by being inclusive and treating everyone with dignity and respect.
• Shut down anti-LGBTQIA+ comments and jokes and let people know you find them offensive.
• Defend your LGBTQIA+ friends against discrimination.
• Support inclusive policies in your schools and communities.
• Confront your own prejudices and biases, even if it is uncomfortable to do so.

Understanding and identifying the many ways trauma can affect the mental and physical health of an LGBTQIA+ person is the first step toward supporting them and their peers.

For more information on how to best support the LGBTQIA+ child or teen in your life, contact UPMC Western Psychiatric Hospital or call 412-624-1000. The Division of Adolescent and Young Adult Medicine at UPMC Children’s Hospital of Pittsburgh is also a center for gender-affirming care in Pittsburgh and the region.

LGBTQ+ Crisis/Suicide Prevention Hotlines

*Not LGBTQIA+ specific but LGBTQIA+ inclusive

LGBTQIA+ Youth

• LGBT National Youth Talkline: 1-800-246-7743
• TrevorLifeline: 1-866-488-7386
• TrevorText: Text START to 678-678
• The Steve Fund Crisis Textline*: Text STEVE to 741741

LGBTQ+ Adults

• Lifeline*: 1-800-273-8255
• Crisis Text Line*: Text HOME to 741741

All Ages

• LGBT National Hotline: 1-888-843-4564

Transgender Community

• Trans Lifeline: 877-565-8860