Mental health care needs differ within LGBT community, UCLA study finds

Transgender and bisexual adults in California are more likely than other LGBT adults to report serious thoughts of suicide and moderate or serious psychological distress, according to a new study from the UCLA Center for Health Policy Research (CHPR).

LGBT adults were nearly three times as likely as non-LGBT adults (48% vs. 17%) to have seriously thought about suicide in their lifetimes, according to the study, which used data from the 2023 California Health Interview Survey. Having serious thoughts about suicide in their lifetimes was higher among transgender adults (64%) than cisgender men (those who identify with their gender assigned at birth), who identify as gay or bisexual (36%). It was higher for bisexual adults (55%) than for gay or lesbian adults (35%).

The study also found that nearly half (49%) of LGBT adults had experienced moderate or serious psychological distress in the past 12 months, compared to 66% of transgender adults, 55% of cisgender lesbian or bisexual female adults, and 61% of bisexual adults overall.

"While many people are aware that LGBT adults report serious thoughts of suicide and psychological distress more than non-LGBT adults, our report shows the range of mental health experiences among different groups within the LGBT population," said study author Imelda Padilla-Frausto, a research scientist at the UCLA CHPR.

California is the state with the largest LGBT population in the United States. In 2023, CHIS estimated that there were 2.2 million adults in California who identified as LGBT, representing about 10% of the state's adult population. Cisgender women who identify as lesbian or bisexual and cisgender men who identify as gay or bisexual were the two largest groups (44% and 41%, respectively), followed by transgender adults (15%).

Even in a politically and culturally progressive state like California, LGBT individuals experience the stressors of pervasive stigma, rejection, discrimination, mistreatment and exposure to violence and homicides targeting the LGBT community.

LGBT individuals have faced significant difficulties, including experiencing stigma or discrimination in mental health care settings, when trying to access mental health services, Padilla-Frausto said.

The study found that nearly two-thirds (65%) of LGBT adults had any need for mental health care in the past 12 months. This was more than double (30%) the percentage of non-LGBT adults. For this study, "any need for mental health care" was defined as having experienced moderate or serious psychological distress (even if someone did not say that they had a need for care) or having self-reported a perceived need for mental health care.

"By using a definition of 'any need for mental health care' that includes people with distress, but who didn't explicitly perceive they needed mental health care, we can see more clearly how many individuals might be struggling and not getting the care that would benefit them," Padilla-Frausto said.

The study found that 81% of LGBT adults with serious or moderate psychological distress and who do not have a perceived need for care had not seen a mental health practitioner or a primary care physician for their mental health in the last year.

Lifetime serious thoughts of suicide varied by age. A majority of younger LGBT adults (59% for ages 18-24 and 55% for ages 25-34) have ever seriously thought about suicide.

Nearly 1 in 3 LGBT adults ages 50-64 (32%) and almost 1 in 4 LGBT adults ages 65 and over (24%) have ever seriously thought about suicide, according to the study's findings. LGBT adults 50 and older were nearly 2.5 times as likely to have ever seriously thought about suicide as their non-LGBT adult counterparts.

Among the report's recommendations:

• Support data collection and research that will lead to a better understanding of the higher rates of poor mental health and serious suicidal ideation among transgender and bisexual adults within the LGBT community.
• Implement routine screenings for both suicidal ideation and poor mental health to provide more responsive and comprehensive care.

"This study can serve as a catalyst for better policies informed by the rigorously collected data of the California Health Interview Survey," Padilla-Frausto said. "These data can help lawmakers and service providers address the distinct mental health challenges faced by the diverse members of the LGBT community, in particular transgender and bisexual individuals."