The Population Cohort: LGBTQ The lesbian, gay, bisexual, transgender, and questioning (LGBTQ) comprise a minority population. Although a diverse group in terms of socioeconomic class background, age, ethnicity, and gender identity, shared experiences of discrimination will impact mental health outcomes. In fact, self-hatred and internalized stigma due to continued exposure to prejudicial attitudes leads to problems like hiding or identity concealment—remaining in the closet—will compound mental health issues by preventing the person from seeking help when needed (Edwards, 2012). Stress due to stigma and discrimination will be compounded by additional factors like race/ethnicity and gender. The composition of the LGBTQ population is incredibly diverse, with the possibility for double or triple minority status such as with Asian American, African American, and other minority groups within the LGBTQ community (Chong-suk Han, Ayala, Paul, et al., 2015; Syzmanski & Sung, 2010). Research has shown that members of the LGBTQ community experience stressors that are “unique to their sexual orientation,” necessitating research into how the LGBTQ community can develop effective coping mechanisms and build resilience (Lewis, Derlega, Griffin, et al., 2003, p. 716). Several public health organizations and public health initiatives like the Healthy People 2020 program and the National Institute of Medicine have recently drawn attention to the stress-related risks and needs of the LGBTQ community (Mink, Lindley & Weinstein, 2014).

Specificity of Minority Stress

Sources of minority stress experienced by the LGBTQ community in particular include intimate partner violence, identity distress, bullying and hate crime, lack of social support, intersectionality, and persistent stigma and hostility.

Intimate Partner Violence

While intimate partner violence is not unique among the LGBTQ community, it may be untreated for longer in this population because of barriers to accessing social and human servies. Researchers have shown that...

As both a cause and an effect of stress in the LGBTQ community, intimate partner violence is an issue that may also be poorly addressed in existing mental health settings. Lack of access to mental health services, relationship counseling, and other remedial services that could otherwise build resilience and reduce the prevalence and severity of the violence can also exacerbate the stress related to discrimination, and the stress related to abusive relationships.
Identity Distress

In a society that does not yet actively support the expression of non-normative sexual identities, orientations, and gender identities, individuals may experience serious identity stress, which can then lead to adverse health outcomes (Kelleher, 2009). In fact, Kelleher’s (2009) study found that identity conflict, including the perceived need to hide one’s true self or express oneself differently in different social situations, was one of the major sources of stress among LGBTQ populations. Some members of the LGBTQ population even report not being able to divulge their sexual orientation to therapists, as “clients do not believe that anyone will respond positively to their LGBTQ identity,” (Budge, 2014, p. 351). On the other hand, being among a supportive community mitigated the stressors that might have been associated with identity distress (Kelleher, 2009). Reducing identity-related stress among the LGBTQ population requires an abundance of positivity and support.

Bullying and Hate Crime

Bullying is a complex social phenomenon that can include verbal as well as physical abuse. As Kelleher (2009) points out, hearing an anti-gay joke is a type of bullying that can lead to significant stress, as can being physically assaulted. Hate crimes constitute…