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Journal of psychiatric and mental health nursing
Aug, 2021;28 (4): 578-589.

The lesbian, gay, bisexual and transgender communities' mental health care needs and experiences of mental health services: An integrative review of qualitative studies.

Samuel N Rees, Marie Crowe, Shirley Harris
Author Information
  1. Samuel N Rees: Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
  2. Marie Crowe: Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand. ORCID
  3. Shirley Harris: Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
PMID: 33295065 DOI: 10.1111/jpm.12720

Abstract

WHAT IS KNOWN ON THE SUBJECT?: There is evidence that the LGBT communities experience greater health disparities, particularly in relation to their mental health needs. The LGBT communities are often faced with stigma and discrimination within mental health services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: People within the LGBT communities have identified that their experiences of mental health services reinforce stigma and lack an understanding of their specific needs. Their needs can be addressed by mental health services that challenge heteronormative assumptions and promote self-acceptance and equity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The existing heteronormative culture in mental health nursing practice needs to be challenged. Practice needs to demonstrate self-awareness of personal and societal LGBT biases, prejudices, and stigma. Practice needs to demonstrate knowledge of important LGBT health care and psychosocial issues. Practice needs to reflect LGBT clinical skills grounded in professional ethics, guidelines, and standards of care.
ABSTRACT: INTRODUCTION: The lesbian, gay, bisexual and transgender (LGBT) communities are a minority population that experience a range of health disparities, including mental health. Because these groups have higher rates of mental disorder than the general population it is, therefore, pertinent to identify their specific mental health needs and their experiences when accessing mental health care.
AIM: To identify the mental health needs of the LGBT communities and their experiences of accessing mental health care.
METHODS: An integrative review of qualitative studies was conducted.
RESULTS: A total of fourteen studies were selected for this review. The studies identified that participants' experiences of accessing mental health care were related to (a) experiencing stigma and (b) staff's lack of knowledge and understanding of LGBT people's needs. They identified a need for mental health care that promotes the principles of equity, inclusion and respect for diversity.
DISCUSSION: The LGBT communities while not a homogenous group, face unique challenges when dealing with their mental health needs. Services that promote health equity and self-acceptance are important for this group.
IMPLICATIONS FOR PRACTICE: It is vital that mental health nursing education incorporate models that promote equity, inclusion and respect for diversity regarding this group of people.

Keywords

bisexual gay integrative review lesbian mental health qualitative transgender

References

  1. Adams, J., Braun, V., & McCreanor, T. (2012). Gay men talking about health: Are sexuality and health interlinked? American Journal of Men���s Health, 6(3), 182-193. https://doi.org/10.1177/1557988311421980
  2. Adams, J., Dickinson, P., & Asiasiga, L. (2013). Mental health promotion for gay, lesbian, bisexual, transgender and intersex New Zealanders. Journal of Primary Health Care, 5(2), 105-113. https://doi.org/10.1071/HC13105
  3. Aggarwal, S., & Gerrrets, R. (2014). Exploring a Dutch paradox: An ethnographic examination of gay men���s mental health. Culture, Health and Sexuality, 16(2), 105-119.
  4. American Psychiatric Association (2013). Diagnostic and Statistical Manual for Mental Disorders (DSM-5). American Psychiatric Association.
  5. Austin, A., Craig, S. L., & D���Souza, S. A. (2018). An AFFIRMative cognitive behavioural intervention for Transgender youth: Preliminary effectiveness. Professional Psychology: Research and Practice, 49(1), 1-8.
  6. Bailey, J. M. (1999). Homosexuality and mental illness. Archives of General Psychiatry, 56, 883-884. https://doi.org/10.1001/archpsyc.56.10.883
  7. Benson, K. E. (2013). Seeking support: Transgender client experiences of mental health services. Journal of Feminist Family Therapy, 25(1), 17-40.
  8. Bess, J. A., & Stabb, S. D. (2009). The experiences of transgendered person in psychotherapy: Voices and recommendations. Journal of Mental Health Counseling, 31(3), 264-282.
  9. Bidell, M. P., & Stepleman, L. M. (2017). An Interdisciplinary approach to Lesbian, Gay, Bisexual, and Transgender clinical competence, professional training, and ethical care: Introduction to the special issue. Journal of Homosexuality, 64(10), 1305-1329. https://doi.org/10.1080/00918369.2017.1321360
  10. Bockting, W., Barucco, R., LeBlanc, A., Singh, A., Mellman, W., Dolezal, C., & Ehrhardt, A. (2020). Socio-political change and Transgender people's perceptions of vulnerability and resilience. Sexuality Research and Social Policy, 17, 162-174. https://doi.org/10.1007/s13178-019-00381-5
  11. Carastathis, G. S., Cohen, L., Kaczmarek, E., & Chang, P. (2017). Rejected by family for being gay or lesbian: Portrayals, perceptions, and resilience. Journal of Homosexuality, 64(3), 289-320.
  12. Cicero, E. C., Reisner, S. L., Merwin, E. L., Humphreys, J. C., & Silva, S. G. (2020). The health status of transgender and gender nonbinary adults in the United States. PLoS One, 15(2), e0228765.
  13. Cochran, S. M., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health service use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53-61.
  14. Colpitts, E., & Gahagan, J. (2016). ���I feel like I am surviving the health care system���: Understanding LGBTQ health in Nova Scotia. Canada. BMC Public Health, 16(1005), 1-12.
  15. Corrigan, P. W., Larson, J. E., Hautamaki, J., Matthews, A., Kuwabara, S., Rafacz, J., & O���Shaughnessy, J. (2009). What lessons do coming out as gay men or lesbians have for people stigmatized by mental illness? Community Mental Health Journal, 45(5), 366-374.
  16. Daley, A. E., & MacDonnell, J. A. (2011). Gender, sexuality and the discursive representation of access and equity in health services literature: Implications for LGBT communities. International Journal for Equity in Health, 10(40), 1-10.
  17. DiNapoli, J. M., Garcia-Dia, M. J., Garcia-Ona, L., O���Flaherty, D., & Siller, J. (2014). A theory-based computer mediated communication intervention to promote mental health and reduce high-risk behaviors in the LGBT population. Applied Nursing Research, 27, 91-93.
  18. Dominguez, M. L. (2017). LGBTQIA people of color:Utilizing the cultural psychology model as a guide for the mental health assessment and treatment of patients with diverse identities. Journal of Gay & Lesbian Mental Health, 21(3), 203-220.
  19. Dorson, C., & Van Devanter, N. (2016). Open arms, conflicted hearts: Nurse-practitioner���s attitudes towards working with lesbian, gay and bisexual patients. Journal of Clinical Nursing, 25, 3716-3727.
  20. Duggan, S. J., & McCreary, D. R. (2004). Body Image, Eating Disorders, and the drive for muscularity in gay and heterosexual men. Journal of Homosexuality, 47(3-4), 45-58.
  21. Eady, A., Dobinson, C., & Ross, L. (2011). Bisexual people���s experiences of mental health services: A qualitative investigation. Community Mental Health, 47, 378-389.
  22. Ellis, S., Bailey, L., & McNeil, J. (2015). Trans people���s experiences of mental health and gender identity services. Journal of Gay and Lesbian Mental Health, 19, 4-20.
  23. Flanders, C. E., Robinson, M., Legge, M. M., & Tarasoff, L. A. (2016). Negative identity experiences of bisexual and other non-monosexual people: A qualitative report. Journal of Gay & Lesbian Mental Health, 20(2), 152-172. https://doi.org/10.1080/19359705.2015.1108257
  24. Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H., Lehavot, K., Walters, K. L., Yang, J., & Hoy-Ellis, C. P. (2015). The health equity promotion model: Reconceptualization of Lesbian, Gay, Bisexual and Transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 635-663.
  25. Graham, K., Treharne, G. J., Ruzibiza, C., & Nicolson, M. (2017). The importance of health(ism): A focus group study of lesbian, gay, bisexual, pansexual, queer and transgender individuals��� understandings of health. Journal of Health Psychology, 22(2), 237-247. https://doi.org/10.1177/1359105315600236
  26. Hughto, J. M. W., Pachankis, J. E., & Reisner, S. L. (2018). Healthcare mistreatment and avoidance in Trans Masculine Adults: The mediating role of rejection sensitivity. Psychology of Sexual Orientation and Gender Diversity, 5(4), 471-481. https://doi.org/10.1037/sgd0000296
  27. Jackson, J. (2000). Understanding the experience of no inclusive occupational therapy clinics: Lesbians' perspectives. American Journal of Occupational Therapy, 54(1), 26-35.
  28. Kecojevic, A., Wong, C. F., Corliss, H. L., & Lankenau, S. E. (2015). Risk factors for high levels of prescription drug misuse and illicit drug use among substance-using young men who have sex with me (YMSM). Drug and Alcohol Dependence, 150, 156-163.
  29. Keuroghlain, A. S., Ard, K. L., & Makadon, H. J. (2017). Advancing health equality for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. Sexual Health, 14, 119-122.
  30. King, M., McKeown, E., Warner, J., Ramsay, A., Johnson, K., Cort, C., & Davidson, O. (2003). Mental health and quality of life of gay men and lesbians in England and Wales. British Journal of Psychiatry, 183, 522-558.
  31. King, M., Semlyen, J., See Tai, S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70.
  32. Lockwood, C., Munn, Z., & Porritt, K. (2015). Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation. International Journal of Evidence-Based Health Care, 13(3), 179-187. https://doi.org/10.1097/XEB.0000000000000062
  33. Lucassen, M. F. G., Merry, S. N., Hatcher, S., & Frampton, C. M. A. (2015). Rainbow SPARX: A novel approach to addressing depression in sexual minority youth. Cognitive and Behavioral Practice, 22, 203-216. https://doi.org/10.1016/j.cbpra.2013.12.008
  34. Mason, T. B., Lewis, R. J., & Heron, K. E. (2018). Disordered eating and body image concerns among sexual minority woman: A systematic review and testable model. Psychology of Sexual Orientation and Gender Diversity, 5(4), 397-422.
  35. Matthews, C., Lorah, P., & Fenton, J. (2005). Towards a grounded theory of lesbians' recovery from addiction. Journal of Lesbian Studies, 9(3), 57-68.
  36. Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United states. American Journal of Public Health, 91(11), 1869-1876. https://doi.org/10.2105/AJPH.91.11.1869
  37. McAndrew, S., & Warne, T. (2010). Coming out to talk about suicide: Gay men and suicidality. International Journal of Mental Health Nursing, 19, 92-101. https://doi.org/10.1111/j.1447-0349.2009.00644.x
  38. McCann, E. (2015). People who are transgender: Mental health concerns. Journal of Psychiatric and Mental Health Nursing, 22, 76-81. https://doi.org/10.1111/jpm.12190
  39. McCann, E., & Sharek, D. (2014). Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual, and transgender people in Ireland: A narrative account. International Journal of Mental Health Nursing, 23(6), 525-533. https://doi.org/10.1111/inm.12081
  40. McCann, E., & Sharek, D. (2016). Mental health needs of people who identify as transgender: A review of the literature. Archives of Psychiatric Nursing, 30, 280-285. https://doi.org/10.1016/j.apnu.2015.07.003
  41. McCann, E., Sharek, D., Higgins, A., Sheerin, F., & Glacken, M. (2013). Lesbian, gay, bisexual and transgender older people in Ireland: Mental health issues. Aging and Mental Health, 17(3), 358-365.
  42. McDowell, M. J., Hugho, J. M. W., & Reisner, S. L. (2019). Risk and protective factors for mental health morbidity in a community sample of female-to-male trans-masculine adults. BMC Psychiatry, 19(16), 1-12.
  43. McGarrity, L. A., Huebner, D. M., & McKinnon, R. K. (2013). Putting stigma in context: Do perceptions of group stigma interact with personally experienced discrimination to predict mental health? Group Processes & Intergroup Relations, 16(6), 684-698.
  44. McParland, J., & Camic, P. M. (2016). Psychosocial factors and ageing in older lesbian, gay and bisexual people: A systematic review of the literature. Journal of Clinical Nursing, 25, 3415-3437.
  45. Morales, M. J., King, M. D., Hiler, H., Coopwood, M. S., & Wayland, S. (2014). The Greater St. Louis LGBT health and human services needs assessment: An examination of the silence and baby boom generations. Journal of Homosexuality, 61(1), 103-128.
  46. Neville, S., & Henrickson, M. (2006). Perceptions of lesbian, gay and bisexual people of primary healthcare services. Journal of Advanced Nursing, 55(4), 407-415.
  47. Neville, S., & Henrickson, M. (2008). The constitution of ���lavender families���: An LGB perspective. Journal of Clinical Nursing, 18, 849-856.
  48. Newman, C. E., Holt, M., Bryant, J., Kippax, S. C., Paquette, D. M., Canavan, P. G., & Saltman, D. C. (2012). Comparing ���doctor��� and ���patient��� belief about the role of illicit drug use in gay men���s depression. Health and Social Care in the Community, 20(4), 412-419.
  49. Ngamake, S. T., Walch, S. E., & Raveepatarakul, J. (2016). Discrimination and sexual minority mental health: Mediation and moderation effects of coping. Psychology of Sexual Orientation and Gender Diversity, 3(2), 213-226.
  50. Nuttbrock, L., Bockting, W., Rosenblum, A., Hwahng, S., Mason, M., Macri, M., & Becker, J. (2015). Transgender community involvement and the psychological impact of abuse among Transgender woman. Psychology of Sexual Orientation and Gender Diversity, 2(4), 386-390.
  51. Paris, J., Zweig-Frank, H., & Guzder, J. (1995). Psychological factors associated with homosexuality in males with Borderline Personality Disorder. Journal of Personality Disorders, 9(1), 56-61. https://doi.org/10.1521/pedi.1995.9.1.56
  52. Persson, T. J., & Pfaus, J. G. (2015). Bisexuality and mental health: Future research directions. Journal of Bisexuality, 15(1), 82-98. https://doi.org/10.1080/15299716.2014.994694
  53. Pettinato, M. (2008). Nobody was out back then: A grounded theory study of midlife and older lesbians with alcohol problems. Issues in Mental Health Nursing, 29(6), 618-638. https://doi.org/10.1080/01612840802048865
  54. Riggs, D. W., & Bartholomaeus, C. (2016). Australian mental health nurses and transgender clients: Attitudes and knowledge. Journal of Research in Nursing, 21(3), 212-222. https://doi.org/10.1177/1744987115624483
  55. Robertson, A. (1998). The mental health experiences of gay men: A research study exploring gay men���s health needs. Journal of Psychiatric and Mental Health Nursing., 5, 33-40. https://doi.org/10.1046/j.1365-2850.1998.00097.x
  56. Ross, L., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100(3), 496-502. https://doi.org/10.2105/AJPH.2008.156307
  57. Ross, L. E., Doctor, F., Dimito, A., Kuehl, D., & Armstrong, M. S. (2007). Can talking about oppression reduce depression? Modified CBT group treatment for LGBT people with depression. Journal of Gay & Lesbian Social Services, 19(1), 1-15. https://doi.org/10.1300/J041v19n01_01
  58. Ross, L. E., O���Gorman, L., McLeod, M. A., Bauer, G. R., MacKay, J., & Robinson, M. (2016). Bisexuality, poverty and mental health: A mixed method analysis. Social Science and Medicine, 156, 64-72.
  59. Rounds, K. E., McGrath, B. B., & Walsh, E. (2013). Perspectives on provider behaviours: A qualitative study of sexual and gender minorities regarding quality of care. Contemporary Nurse, 44(1), 99-110.
  60. Rowan, N. L., & Butler, S. S. (2014). Resilience in attaining and sustaining sobriety among older lesbians with alcoholism. Journal of Gerontological Social Work, 57(2-4), 176-197. https://doi.org/10.1080/01634372.2013.859645
  61. Russell, C. J., & Keel, P. K. (2002). Homosexuality as a specific risk factor for eating disorders in men. International Journal of Eating Disorders, 31(3), 300-306. https://doi.org/10.1002/eat.10036
  62. Rutherford, K., McIntyre, J., Daley, A., & Ross, L. E. (2012). Development of expertise in mental health service provision for lesbian, gay, bisexual and transgender communities. Medical Education, 46, 903-913. https://doi.org/10.1111/j.1365-2923.2012.04272.x
  63. Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205-212. https://doi.org/10.1111/j.1744-6171.2010.00246.x
  64. Silberstein, L. R., Mishkind, M. E., Striegel-Moore, R. H., Timko, C., & Rodin, J. (1989). Men and their bodies: A Comparison of homosexual and heterosexual men. Psychosomatic Medicine, 51, 337-346. https://doi.org/10.1097/00006842-198905000-00008
  65. Smith, N. G., Hart, T. A., Kidwai, A., Vernon, J. R. G., Blais, M., & Adam, B. (2017). Results of a pilot study to ameliorate psychological and behavioural outcomes of minority stress among young gay and bisexual men. Behavior Therapy, 48, 664-677.
  66. Treharne, G. J., & Adams, J. (2017). Critical perspectives on the diversity of research into sexualities and the health in Aotearoa/New Zealand: Thinking outside the boxes. Psychology of Sexualities Review, 8(1), 53-70.
  67. Turban, J. K., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry, 77(1), 68-76. https://doi.org/10.1001/jamapsychiatry.2019.2285
  68. Uldall, K. K., & Palmer, N. B. (2004). Sexual minorities and mental health: The need for a public health response. Journal of Gay & Lesbian Psychotherapy, 8(3-4), 11-24. https://doi.org/10.1080/19359705.2004.9962377
  69. Welch, S., Collings, S. C. D., & Howden-Chapman, P. (2000). Lesbians in New Zealand: Their mental health and satisfaction with mental health services. Australian and New Zealand Journal of Psychiatry, 34, 256-263. https://doi.org/10.1080/j.1440-1614.2000.00710.x
  70. Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546-553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
  71. Winter, S., Diamond, M., Green, J., Karasic, D., Reed, T., Whittle, S., & Wylie, K. (2016). Transgender people: Health at the margins of society. The Lancet, 388(10042), 390-400. https://doi.org/10.1016/S0140-6736(16)00683-8
  72. World Health Organisation [WHO] (2013). Mental health action plan. WHO.
  73. Wylie, J., Knudson, G., Khan, S. L., Bonierbale, M., Watanyusakul, S., & Baral, S. (2016). Serving transgender people: Clinical care considerations and service delivery models in transgender health. The Lancet, 388(10042), 401-411. https://doi.org/10.1016/S0140-6736(16)00682-6
  74. Yelland, C., & Tiggemann, M. (2003). Muscularity and the gay ideal: Body dissatisfaction and disordered eating in homosexual men. Eating Behaviours, 4(2), 107-116. https://doi.org/10.1016/S1471-0153(03)00014-X

MeSH Term

Female
Health Promotion
Humans
Mental Health
Mental Health Services
Sexual and Gender Minorities
Transgender Persons
Male
Journal Article Review
Article has an altmetric score of 8

Word Cloud

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