LGBTQ Youth in the South Face Greater Mental Health Challenges

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New research from The Trevor Project found that nearly half of LGBTQ youth in the South live in unaccepting communities, which can negatively affect their mental health and increase their risk of suicide. Getty Images
  • New research from The Trevor Project found that 46 percent of LGBTQ youth in the South said their “community was somewhat or very unaccepting.”
  • This stands in stark contrast to 32 percent in other parts of the country.
  • The research also showed that young LGBTQ people living in southern states had greater odds of a suicide attempt in the past year compared with other parts of the country.
  • Mental health experts say these findings highlight how impactful supportive, affirming, and inclusive environments can be on a young person’s mental health.

A new report from The Trevor Project examined the current state of mental health for LGBTQ youth living in the American South.

The survey shows that young LGBTQ people living in southern states had greater odds of a suicide attempt in the past year compared with other parts of the country. It also sheds a light on how impactful supportive, affirming, and inclusive environments can be on a young person’s mental health.

Experts say surveys like this are helpful in assessing young people’s needs and spreading awareness about suicide prevention and education.

Knowing that they live in a community, attend a school, or are part of a family that respects and affirms their gender identity and sexuality could significantly affect a young person’s overall mental health for the better.

The data for this report came from an online survey conducted from October to December 2020 among 34,759 LGBTQ youth who were recruited for the research through social media ads.

The participants were asked what state they live in, with researchers then breaking down four major United States Census regions.

The researchers also turned to the Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey on items that dealt with thoughts or attempts of suicide in the past 12 months, according to The Trevor Project’s research brief.

It’s important to look at the backgrounds and identities of those who participated.

The new report found that more than 1 in 3 surveyed youth lived in the South. Within this number, young LGBTQ People of Color were more represented in the southern states (48 percent) compared with other parts of the United States at large (43 percent).

Young LGBTQ Black individuals in the South stood at 8 percent, compared with other parts of the United States at 4 percent.

The respondent’s self-identified sexual orientations and gender identities matched those of other parts of the country.

For example, The Trevor Project found 43 percent of respondents in the South reported using pronouns outside the gender binary — like they/them, as well as combinations of pronouns — which is similar to the 42 percent of LGBTQ youth in other areas.

They found that about 25 percent of southern LGBTQ youth said religion was very important to them, compared with 23 percent in other areas.

Looking more closely at the data, the brief shows southern LGBTQ youth had 9 percent greater odds of a suicide attempt in the past year, compared with peers in other parts of the country.

They found that 44 percent of LGBTQ youth in the South had higher rates of suicidal thoughts versus 41 percent of peers in other regions. Additionally, 16 percent of these young people in the South attempted suicide, compared with 14 percent in other areas.

A lack of access to affirming or accepting safe spaces was a common theme for many of these young respondents.

The survey found 46 percent of LGBTQ youth in the South said their “community was somewhat or very unaccepting,” which stands in stark contrast to 32 percent in other parts of the country.

The report shows that 32 percent reported lower rates of access to LGBTQ-affirming homes, 47 percent cited lack of access to affirming schools, and 14 percent said they did not have access to safe and affirming community events.

About 15 percent of these young people in the South said they are subjected to conversion therapy programs, compared to 12 percent in other parts of the United States.

Southern transgender and nonbinary youth said they experienced lower rates of people respecting their pronouns, at just 27 percent, compared with 34 percent elsewhere in the United States.

The report shows that 66 percent of transgender and nonbinary young people in the South said they want, but aren’t able to, change their official documents to match their gender identity, compared with 54 percent in other parts of the country.

“One of the things we know is that the rates we see of LGBTQ cases of suicide, a big impact on that is how youth are treated,” Myeshia Price, PhD, senior research scientist at The Trevor Project, told Healthline.

Price said this research suggests LGBTQ youth in the South are generally living “in somewhat less accepting” and open environments than their peers in other parts of the country.

This can have a significant cascade of negative effects on a young person’s mental health, increasing risk of suicide, she added.

Heading into collecting this research, Price said she would have actually expected that statistic of “9 percent greater odds of suicide attempt in the past year” to be higher.

She said the current wave of anti-LGBTQ legislation in southern states and some problematic, damaging media and political messaging that swirl around it, can create an environment that can be very hard for these young people.

“It’s important for future researchers to examine: what are the conditions in the South, where they are able to sort of protect themselves from some of this anti-LGBTQ rhetoric that is happening around them,” she said.

On the flip side of the worrying statistics presented in the report, the survey offers a roadmap for just how helpful a supportive environment can be for the mental well-being of LGBTQ young people, especially those who might be at elevated risk for suicide or suicidal ideation.

The researchers show that southern LGBTQ young people living in “somewhat or very accepting communities” had 40 percent lower odds of reporting a suicide attempt in the past year.

Similarly, those who had access to at least one in-person LGBTQ-affirming space had 40 percent lower odds of reporting a suicide attempt in the past year.

The report also shows that transgender and nonbinary youth who said their pronouns were respected by some people in their lives were shown to have 42 percent lower odds of a suicide attempt in the past year.

Those young people whose pronouns were respected by “everyone in their lives” had 58 percent lower odds of attempting suicide.

The transgender and nonbinary young people in the South who were able to change their official documentation to accurately reflect their gender identity but had yet to do so, reported 38 percent lower odds of attempting suicide than those who would like to make that change but were not able to.

Price said that, when talking about the lived experience of transgender and nonbinary youth, having pronouns respected is a big part of feeling welcomed, appreciated, and seen by the people in their lives and their surrounding communities.

“This relationship of feeling affirmed for who you are, it’s a consistent thing we see in our data. When this is not happening, you see higher rates of suicide,” Price added.

Dr. Matthew Hirschtritt, MPH, a physician researcher with The Permanente Medical Group Delivery Science & Applied Research Physician Researcher Program, is not affiliated with The Trevor Project research.

When asked how harmful misgendering a transgender or gender nonbinary young person can be, Hirschtritt said it’s “essential” for the mental health of transgender and gender nonbinary youth to feel their identities are affirmed in a supportive environment.

Hirschtritt, who is also an assistant program director for research in the Kaiser Permanente Oakland Psychiatry Residency Training Program, said this includes what may seem like small steps, such as “using preferred pronouns, asking proactively what pronouns a youth prefers to use, and having gender-neutral bathrooms.”

“These… ways of communicating and operating can make a world of difference for youth who don’t fit into the gender binary,” he said.

Hirschtritt further explained that there’s a growing amount of literature out there about transgender adults and youth and their trust of medical professionals and the medical system as a whole.

“Many gender nonbinary patients ask their provider to ask them what pronouns they prefer and to use those pronouns… and not make assumptions,” he said.

“So I think there’s a lot of sensitivity and cultural competence that any provider can learn and enact to help make any patient who’s transgender [or] gender nonbinary feel more comfortable,” Hirschtritt added.

When asked why research like this new report seems to indicate seemingly more challenging environments for LGBTQ youth in southern states, Hirschtritt said it’s a complicated dilemma.

“It’s hard to know exactly why youth in the South would have higher rates of suicide. But the later results in that same study that show lower rates of supportive environments might be at the root of this disparity,” he explained.

“Youth who do not have a supportive environment may turn to self-harm, or thoughts of self-harm, more readily than youth who feel supported and have other ways of addressing difficult emotions associated with their sexuality or gender identity, or discrimination that they’re facing due to their sexuality or gender expression.”

Hirschtritt and Price both echoed how key it is for young people to feel supported and safe in their environments. A supportive school or household that respects your identity can make a difference.

“Youth who feel more supported are less likely to turn to self-harm in order to address those feelings and stressors. So [this means] having supportive schools [and] counseling parents on ways to think about and to talk about sexuality and gender,” Hirschtritt said.

“The study showed that LGBTQ youth in the South were more likely to identify religion as having a central part in their life than other regions of the United States,” he said.

Hirschtritt said it might be helpful if youth are “able to reach out to clergy and to other religious leaders, finding ways that the church can support youth who are LGBTQ.”

“That could hold a lot of weight for many southern families, and trickle down to schools and hopefully to youth… I think that might be a cultural aspect of the South that is a little bit different from other parts of the United States,” he added.

Price said that it’s important that future research on and awareness of LGBTQ youth mental health and suicide risk look at what supportive environments look like.

Price also said a big piece of the puzzle is educating communities themselves to better serve their young people.

“Everyone has a role to play in breaking down these barriers, educating our communities, being supportive of LGBTQ youth — that is something that needs to happen across the country,” she said. “If we know what that support looks like… then that is something we can be a part of.”

Outside support groups and resources can also play a role. Price pointed to the numerous resources made available by The Trevor Project itself, including its online resources and its advocacy team that’s currently pushing back on anti-LGBTQ legislation.

Hirschtritt also pointed to the National Suicide Prevention Lifeline, among other useful resources.

“It’s only a Google search away to find the closest LGBT resource center. There is also PFLAG and that’s oriented towards parents, but reaching out to your local chapter could be a way to open up all the local resources that are available to a young person,” he added.

Additionally, he pointed to Kaiser Permanente’s own Find Your Words program, and mental health trainings.

When it comes to looking at this research, Hirschtritt stressed that it’s important to take into account intersectionality in how support is offered to especially vulnerable LGBTQ youth in the country.

“LGBTQ youth in the South may encounter — even more so than other parts of the United States — multiple sources of stigma and discrimination based on race, sexual orientation, gender identity, and perhaps socio-economic status, though that’s not measured here,” he added.

“So it’s important to think about ways to support these youth, knowing the multiple stressors they may have.”



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