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Care of Sexual & Gender Minority Individuals: Info & Resources

Overview

The sexual and gender minority (SGM) population in the United States includes individuals who identify as lesbian, gay, bisexual, transgender, intersex, two spirit, or queer/questioning. It also includes individuals who do not self-identify with one of these terms but whose sexual orientation, gender identity or expression, or reproductive development is characterized by non-binary concepts of sexual orientation, gender, and/or sex.

Population

According to the US Census Bureau, approximately 8%* of respondents self-selected lesbian, gay, bisexual, or transgender when asked about their identity. A further 2% of participants “identify with a sexual orientation other than lesbian, gay, bisexual, or straight” (Human Rights Campaign, 2021). This could include a number of other orientations such as pansexual, asexual, and others. Census data suggests that more than 1% (more than 2 million) of people identify as transgender – an increase from prior estimates of approximately 1.4 million.

  • SGM individuals are diverse and represent various racial, ethnic, and socioeconomic backgrounds.
  • Research suggests that SGM individuals are found across all age groups, geographic regions, and educational levels (Gates, 2011, Gates, 2013 Gates, 2018; Flores, et al. 2022)

*The exact size of the SGM population is difficult to determine due to disparities in self-reporting and limited data collection methods.

U.S. Trans Survey: Reports from the 2015 survey, the largest survey ever devoted to the lives and experiences of transgender people across the United States. Results from the expanded 2022 survey coming soon.

Disparities

Sexual & Gender Minority Health Disparities Research Framework

Sexual & Gender Minority Health Disparities Research Framework from National Institutes of Health

SGM populations experience health disparities compared to the general population, including higher rates of mental health issues, substance use, and physical health conditions (Institute of Medicine, 2011). These disparities are influenced by elements such as minority stress, internalized stigma, discrimination, and limited access to inclusive healthcare (Fredriksen-Goldsen et al., 2014).

Mental Health Disparities

Studies have found higher rates of mental health disorders among SGM individuals compared to the general population.

  • LGBTQIA+ individuals are twice as likely to experience a mental health disorder in their lives (Plöderl et al., 2020).
  • Transgender individuals experience higher rates of depression, anxiety, and suicidality compared to cisgender individuals (James et al., 2016; Reisner et al., 2016).
  • SGM individuals have a higher risk of suicidal ideation, attempts, and completed suicides compared to the general population (Haas et al., 2010; Marshal et al., 2011).

Minority Stress in the SGM population refers to chronic stress resulting from stigma, discrimination, and prejudice based on sexual orientation or gender identity (Meyer, 2003). This stress can contribute to higher rates of mental health issues including depression, anxiety, substance use, and suicidal ideation (Meyer, 2003; Hatzenbuehler, 2009; Marshal et al., 2011).

Internalized Stigma is the acceptance and internalization of negative societal beliefs, leading to self-esteem issues and psychological distress (Herek et al., 2010). This includes internalized homophobia and biphobia (Meyer & Frost, 2013). These internalized beliefs contribute to self-esteem issues and psychological distress (Herek et al., 2010).

Resources

Sexual & Gender Minority Mental Health

Lesbian, Gay, and Bisexual Behavioral Health

Substance Abuse and Mental Health Services Administration (SAMHSA) data based on results from the 2021 and 2022 National Surveys on Drug Use and Health
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Child & Adolescent Mental HealthLGBTQ Children & Adolescents

CDC’s Lesbian, Gay, Bisexual, and Transgender Health Resources

A collection of resources for supporting LGBTQ youth build a foundation of mental wellness.
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Sexual & Gender Minority Mental Health

The Health of Lesbian, Gay, Bisexual, and Transgender People

2011 book from the Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. (Free PDF available)
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Care Considerations

Addressing the psychiatric-mental health needs of SGM populations requires a complex approach, including accessible and culturally competent care, tailored interventions, addressing minority stress, promoting family support, and acknowledging intersectional identities. When providing care to SGM populations, psychiatric-mental health nurses should have an understanding of the current evidence base on the following, as falls within their scope of practice and state regulations:

  • Culturally Competent Care
  • Gender Dysphoria and Transgender Health
  • Mental Health Disparities and Minority Stress
  • The Process of Coming Out and Family Support
  • Intersectionality and Multiple Identities

Therapeutic Intervention

Therapeutic treatment for the sexual and gender minority (SGM) population includes a variety of interventions that have been tailored to address the unique challenges of the SGM population. At the current moment, comprehensive studies on SGM-specific treatments are limited. However, various approaches have shown greater potential in supporting the mental health and resilience of SGM individuals. These include:

  • Affirmative Therapy
  • Cognitive-Behavioral Therapy (CBT)
  • Acceptance and Commitment Therapy (ACT)
  • Supportive Therapy
  • Group Therapy
  • Family Therapy

Access

Access to care for SGM populations varies across states due to differences in healthcare policies, laws, and availability of SGM knowledgeable providers and resources. As laws are changing more rapidly, it’s recommended that providers utilize up-to-date sources (see resources below) for the most accurate information on SGM access to care by state.

Resources

Sexual & Gender Minority Mental Health

National Alliance on Mental Illness (NAMI) LGBTQ+ Resources

Resources, support, and educational materials for both individuals and mental health providers on mental health concerns within the LGBTQIA+ community.
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Sexual & Gender Minority Mental Health

National LGBT Health Education Center

Educational resources, webinars, and training opportunities to enhance the cultural competence of healthcare providers working with LGBTQ+ patients. They also provide resources specific to transgender health.
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Sexual & Gender Minority Mental Health

Center of Excellence on LGBTQ+ Behavioral Health Equity

Provides behavioral health practitioners with information, training, coaching, and technical assistance on supporting the SGM population.
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Sexual & Gender Minority Mental Health

Healthcare Equality Index

A Human Rights campaign interactive map to identify SGM-friendly facilities.
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Sexual & Gender Minority Mental Health

ACLU Tracker

Provides an understanding of current SGM-related bills by state.
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Sexual & Gender Minority Mental Health

The Fenway Institute

Organization devoted to addressing the specific health needs of sexual and gender minorities (SGM) and people affected by HIV.
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Sexual & Gender Minority Mental Health

GLAAD

Resources and advocacy for LGBTQ+ individuals, including mental health resources and information on finding LGBTQ+-friendly therapists.
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Sexual & Gender Minority Mental Health

The Trevor Project

Organization providing crisis intervention and suicide prevention services to LGBTQ+ youth and offering a range of resources and support, including a 24/7 helpline and online chat.
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References

Flores, A. R., Herman, J. L., Gates, G. J., & Brown, T. N. T. (2020). How Many Adults Identify as Transgender in the United States? The Williams Institute.

Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H. J., Lehavot, K., Walters, K. L., Yang, J., … & Muraco, A. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 653-663.

Gates, G. J. (2011). How many people are lesbian, gay, bisexual, and transgender? The Williams Institute.

Gates, G. J. (2013). LGBT adult percentages highest in D.C., lowest in North Dakota. Gallup.

Gates, G. J. (2018). In U.S., more adults identifying as LGBT. Gallup

Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., … & Clayton, P. J. (2010). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. Journal of Homosexuality, 58(1), 10-51.

Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707-730.

Herek, G. M., Gillis, J. R., & Cogan, J. C. (2010). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 57(3), 328–342.

Human Rights Campaign (2021, December 9). We Are Here: At Least 20 Million LGBTQ+ Adults in U.S. Retrieved from https://www.hrc.org/press-releases/we-are-here-lgbtq-adult-population-in-united-states-reaches-at-least-20-million-according-to-human-rights-campaign-foundation-report Institute of Medicine. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. National Academies Press.

James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality.

Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., … & Brent, D. A. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49(2), 115-123.

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

Meyer, I. H., & Frost, D. M. (2013). Minority stress and the health of sexual minorities. The Williams Institute

Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, E., … & Baral, S. D. (2016). Global health burden and needs of transgender populations: a review. The Lancet, 388(10042), 412-436.

Last updated December 2023.

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