LGBTQ+ College Students and Mental Health Stigma

Gianna Rose Boccieri

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at an increased risk for mental health problems as compared to heterosexual and cisgender people (Gmelin et al., 2022; Price-Feeney et al., 2020; Semlyen et al., 2016; Wanta et al., 2019). For instance, lesbian, gay, and bisexual individuals are twice as likely to have depression, anxiety, and substance use issues than their heterosexual counterparts (Gmelin et al., 2022; Semlyen et al., 2016; Substance Abuse and Mental Health Services Association, 2016), and transgender individuals are four times as likely to be diagnosed with anxiety, personality disorders, schizophrenia, and post-traumatic stress disorder (PTSD) than their cisgender counterparts (Price-Feeney et al., 2020; Wanta et al., 2019). The minority stress theory posits that the disproportionate mental health issues LGBTQ+ people face are due to stressors from hostile social environments, such as homophobia, prejudice, discrimination, and stigma (Meyer, 2003). In particular, LGBTQ+ young adults in college are an at-risk population and are more likely to be depressed or to have attempted suicide than their heterosexual counterparts (Alessi et al., 2017; Greathouse et al., 2018; Lipson et al., 2022). Despite the mental health challenges they face, LGBTQ+ college students avoid seeking treatment, which can be explained by the mental health stigma, but little research has been done on how the stigma impacts them (Martin, 2010; O’Connor et al., 2018).

LGBTQ+ College Students

College students face many stressors that can negatively impact their mental health, including academic stress, transition to college related stress, financial stress, and relationship stressors that make them at-risk for mental health issues (Hurst et al., 2012). Considering that 75% of lifetime mental disorders will onset between ages 18-25, which increases lifetime prevalence and comorbidity with additional mental disorders, these stressors compound college students’ risk of mental health issues (Kessler et al., 2005; Kessler et al., 2007; Suvisaari et al., 2008; Wittchen et al., 1998). Recently, in the United States, college students’ mental health issues have been increasing (LeViness et al., 2020; Lipson et al., 2022), and this has been further exacerbated by the COVID-19 pandemic, with college students reporting increased symptoms of anxiety, difficulty concentrating, increased concerns about academic performance, and increased depressive thoughts (Son et al., 2020; Wang et al., 2020).

LGBTQ+ college students are disproportionately impacted by the stressors that college students face, and, therefore, report using their college counseling services for more frequent and prolonged periods than heterosexual college students (Reeves et al., 2018). For example, LGBTQ+ college students are nearly four times more likely to be depressed, experience feelings of hopelessness, or have attempted suicide than their heterosexual college counterparts (Centers for Disease Control and Prevention [CDC], 2021; Greathouse et al., 2018; Hurst et al., 2012; Price-Feeney et al., 2020; The Trevor Project, 2022). One reason for the disproportionate issues that LGBTQ+ college students face is that they experience dual stressors, as they have to deal with stressors exclusive to their queer identity (e.g., microaggressions, discrimination, and sexual stigma) and also the stressors of being a college student (e.g., academic, financial, and relationship stress; Alessi et al., 2017; Hurst et al., 2012). Furthermore, negative campus climates that are not accepting of queer students and perpetuate homophobia and transphobia increase the negative well-being of LGBTQ+ college students (Thacker Darrow et al., 2022).

Despite the disproportionate mental health struggles that they face, factors such as positive social support (e.g., family and friends that support their queer identity, being friends with LGBTQ+ individuals; Doty et al., 2010; McDonald, 2018) and identity self-awareness (i.e. a belief that one’s sexual identity increases one’s awareness of one’s own feelings and strengths; Amador et al., 1991; Knight et al., 2018; Meyer, 2015, p. 210; Pistella et al., 2023) have been shown to protect against this increased risk (Poteat et al., 2015; Wilkerson et al., 2016; Williams et al., 2005). Additionally, recent literature highlights how LGBTQ+ college students are resilient and able to thrive in the face of homophobia and transphobia (Hill et al., 2020; Nicolazzo, 2016; Riggle & Rotosky, 2011; Singh et al., 2014). Although these protective factors exist, LGBTQ+ college students note a number of barriers to treatment, such as long waitlists, not feeling comfortable going, and their university not having LGBTQ+ counseling centers (The Trevor Project, 2022).

Mental Health Stigma

One of the most notable barriers to treatment is the mental health stigma (i.e., the negative views toward a person or group of people who have been diagnosed with or perceived to have mental health issues, mental disorders, and/or mental illnesses; American Psychiatric Association, 2020; Dudley, 2000; Goffman, 1964). Research has shown that the stigma surrounding mental health leads to decreased likelihood to seek treatment or stay with treatment (Yanos et al., 2020), and is a potential reason for the under-reporting of mental disorders (Bharadwaj et al., 2017). For example, mental disorders are reported less than physical health conditions, such as diabetes or cardiovascular disease (Bharadwaj et al., 2017). College students report that they avoid seeking treatment due to a fear of being judged, discriminated against, or being treated differently by classmates and university faculty/staff (Eisenberg et al., 2009; Martin, 2010).

It is important to distinguish the two types of mental health stigma – public stigma and self-stigma – since they have different impacts on individuals (Corrigan, 2004; Corrigan & Penn, 1999). Public stigma refers to the negative stereotypes about mental illness held by people in society (e.g., people with mental illnesses are crazy and dangerous), which creates feelings of shame and a lack of seeking treatment for people with mental health issues (Corrigan, 2004; Corrigan & Penn, 1999; Corrigan & Shapiro, 2010; New Freedom Commission on Mental Health, 2003; Parcesepe & Cabassa, 2012; Walker et al., 2008). On the other hand, self-stigma refers to when an individual who identifies with the stigmatized group internalizes and believes the negative stereotypes (Corrigan, 2004; Corrigan & Penn, 1999). Research has shown that self-stigma is more strongly associated with lower help-seeking behaviors than public stigma and significantly prolongs recovery for individuals with mental illnesses (Oexle et al., 2018; Ritsher et al., 2003; Yu et al., 2022). Although there is limited research focusing on LGBTQ+ college students, existing literature does show that internalized self-stigma in LGBTQ+ individuals is associated with negative attitudes towards the self and lower feelings of safety and contentment (O’Connor et al., 2018; Pistella et al., 2023). Additionally, it has been demonstrated that low self-awareness about their sexual/gender identity is associated with less coping and resiliency to minority stressors due to a decrease in social adjustment and well-being (Meyer, 2015; Pistella et al., 2023). Despite LGBTQ+ college students’ greater risks for mental health issues (Alessi et al., 2017; Greathouse et al., 2018), few studies have looked at how the mental health stigma influences their psychological well-being and help-seeking behaviors (O’Connor et al., 2018).

Current Study

Few studies have focused on the personal experiences of LGBTQ+ college students and how mental health stigma influences their psychological well-being and help-seeking behaviors. The research that has been done has focused on the dual stigma experienced by LGBTQ+ adults with severe mental health issues, highlighting how they feel out of place in both queer communities and mental health settings based on the intersection of their identities (O’Connor et al., 2018). Although these findings are substantial and begin to explore the influences of the mental health stigma, they do not take into account the experiences of LGBTQ+ college students, who are unique atrisk population due to the intersection of being a queer college student (Alessi et al., 2017; Greathouse et al., 2018; Reeves et al., 2018). Therefore, this qualitative study explored the following research question: How does the stigma surrounding mental health issues relate to the well-being and help-seeking behaviors of LGBTQ+ college students?

Participants

Method

Participants included seven college students (N = 7) from New York University (NYU) that self-identify as LGBTQ+ individuals and were recruited through social media and by word of mouth. Requirements for participation included: being currently enrolled in a college/university and identifying as a member of the LGBTQ+ community. Six participants disclosed their race/ethnicity (see Fig. 1 for full breakdown) and the majority identified as White. All participants identified as one or more of the LGBTQ+ identities: queer (4), lesbian (4), gay (2), bisexual (1), and asexual (1). The following gender identities were represented: cisgender woman (4), genderqueer (2), and transgender (1) with pronouns of she/her (4), she/they (2), and he/him (1). All participants reported their degree tracks with a majority completing their Bachelor’s degree (see Fig. 2 for full breakdown). The mean age of the participants was 21 years old.

Procedure

This study was conducted using an open-ended survey through Google Forms (see Appendix A) where participants were first asked demographic questions such as age, race/ethnicity, gender identity, and sexual identity. For questions asking about gender, sexual, and race/ethnicity identity, participants were asked to write all identities they associated with in their own words. Participants were then asked about their experience as an LGBTQ+ college student and if the mental health stigma has had an influence on their psychological well-being and help-seeking behaviors (e.g., “How do you believe the stigma surrounding mental health influences your well-being as an LGBTQ+ college student?”). An open-ended survey was used since discussions of stigma and one’s gender and sexual identity can be very sensitive topics and this method allowed for more participant comfort. Participants were also made aware that participation in the survey is voluntary and that responses to every question were not required.

Coding

Results were coded using a thematic grounded theory approach by analyzing one participant’s response (14.3%) at the sentence level and creating themes that emerged within the data related to the research question. These themes were then examined on the next participant’s response to check for alignment and were re-evaluated if new themes emerged. All data was then coded by one researcher.

Results & Discussion

This study aimed to address the gaps in the literature surrounding how the mental health stigma impacts LGBTQ+ college students’ well-being and help-seeking behaviors. Thematic analysis led to the emergence of four major themes: campus environment, social support, self-awareness, and exposure to prejudice. While results did indicate that the mental health stigma has impacts on the well-being and help-seeking behaviors of LGBTQ+ college students, it also indicated that each theme was able to have a dual impact on stigma: the themes that emerged either had a positive or negative influence on the mental health stigma depending on the participant’s experience. The findings of this study build upon previous research on college students and LGBTQ+ people individually by providing a unique understanding of how the mental health stigma impacts individuals when these identities intersect.

Theme 1: Campus Environment

Analysis of the data indicated that the campus views and attitudes toward queer students and mental health issues have an impact on the well-being, help-seeking behaviors, and mental health stigma of LGBTQ+ college students. Four participants noted that they do not believe that mental health stigma has much of an impact on them as LGBTQ+ students due to their supportive campus environment. Participants stated that the campus’s openness to LGBTQ+ students and discussions about mental health helps to encourage a sense of community and promotes seeking treatment. For example, one participant stated that the faculty’s attitudes toward seeking treatment largely influenced them to utilize their campus counseling resources.

On the other hand, five participants indicated that they perceive a lack of support or inadequate resources from their college campus. Four of these participants noted feeling that the campus does not view mental health issues as one of their top concerns and instead advances a “just grit your teeth and get through it” mentality, with one participant directly stating this as a barrier to treatment. Two participants noted that some faculty members are unsupportive and do “not accept mental health concerns as a legitimate reason to ask for an extension or take time off.” In relation to LGBTQ+ college students, one participant said:

I think that in order to fight the very common feeling of not being able to seek help that is shared among LGBTQ student[s] is for the university to show more of an effort to give services for students. I really haven’t seen much.

Although the participants had differing experiences with campus environment, these findings are in line with previous research that highlights how campuses can provide either a positive or negative environment for their LGBTQ+ students (Ellis, 2009; Evans et al., 2017; Horn & Szalacha, 2009; Longerbeam et al., 2007; Thacker Darrow et al., 2022). Previous research has shown that classroom climate, residence hall environment, and faculty attitudes can promote either positive or negative experiences depending on the campus’ support of LGBTQ+ college students (Evans et al., 2017; Stevens, 2004; Tetreault et al., 2013). The findings of this study expand upon previous research (e.g., Evans et al., 2017), but also indicate that campus environment can act as a protective or risk factor for mental health stigma and overall well-being and help-seeking behaviors of LGBTQ+ college students.

Theme 2: Social Support

In participants’ responses, six mentioned the theme of social support in some capacity. For this study, social support was defined as one’s social network, such as family, friends, and support groups, that helps them to cope with stressors (APA, n.d. -b). Of these participants, three noted that having family members who are supportive of both their queer identity and mental health issues increased their help-seeking behaviors and reduced the impacts of stigma, with two participants noting the same influences from their friends with similar identities. Two participants indicated that they had unsupportive family members who did not take mental health seriously, which was noted as a big barrier to accessing and seeking treatment. Interestingly, one participant highlighted that when they are with less accepting social groups (i.e., family), they feel the influence of the mental health stigma more than when they are with more accepting social support (i.e., queer community).

These findings further expand upon previous research that highlights how social support can reduce mental health issues and suicidality while increasing self-esteem and wellbeing (Doty et al., 2010; McDonald, 2018; Poteat et al., 2015; Wilkerson et al., 2016; Williams et al., 2005). The results of this study are able to demonstrate the dual impact social support can have on LGBTQ+ students’ well-being and help-seeking, but also how it can help to mitigate the influences from the mental health stigma.

Theme 3: Self-Awareness

For the purposes of this paper, self-awareness was defined as one’s awareness of their mental health issues (e.g., need for treatment) and queer identity (e.g., comfortability with sexuality; Amador et al., 1991; Meyer, 2015). Four participants highlighted that their psychology classes have frequent discussions about mental health and this has made them “hyper-aware” of their struggles, the mental health stigma, and when it is necessary to seek treatment. For example, one participant stated that they do not feel like the mental health stigma has much of an influence on their well-being due to their psychology major. Additionally, one participant stated that they do not feel their mental health and LGBTQ+ identity “intertwined” in any way due to their comfortability with their sexuality and, therefore, they felt not impacted by the mental health stigma. This was a unique finding that highlights how one’s self-awareness about their own sexual and/or gender identity can reduce the impacts of the mental health stigma. Additionally, another participant communicated that they “sometimes feel invalidated” about their identity but their comfortability with their sexual orientation has been a protective factor for their well-being.

In line with previous research, these findings support that self-awareness about one’s mental health issues and/ or mental disorders is a protective factor against the mental health stigma (Amador et al., 1991; Knight et al., 2018; Meyer, 2015). Furthermore, these findings also indicate how selfawareness about one’s sexual and/or gender identity and their comfortability with that identity can decrease internalized selfstigma and increase positive attitudes toward themselves and their safety, which also protects against the mental health stigma (Pistella et al., 2023). The finding of education being a protective factor does support previous findings of knowledge mitigating the mental health stigma (Martin, 2010), but these results highlight the protective role higher education and/or studying psychology has for LGBTQ+ students.

Theme 4: Exposure to Prejudice

Four participants stated incidences of exposure to prejudice, which includes stereotypes, discrimination, and judgment about being queer and/or having mental health issues that perpetuate feelings of shame and guilt (APA, n.d. -a). These participants expressed that these exposures made them feel invalidated and socially isolated, which had negative impacts on their wellbeing. Three participants highlighted moments of being forced to be resilient due to their family, community, and/or university not supporting their mental health struggles, which created barriers to help-seeking. One participant, in particular, noted they gained resiliency in the face of these situations but was also forced to self-advocate for treatment at a young age, which they noted had negative influences on their well-being.

These findings expand upon the minority stress theory on how exposure to prejudice negatively impacts LGBTQ+ people and individuals with mental disorders (Eisenberg et al., 2009; Feinstein et al., 2012; Herek, 2004; Meyer, 2003; Walch et al., 2016; Yang & Mak, 2017) and highlights the unique ways it influences LGBTQ+ college students in terms of their well-being and help-seeking behaviors. An interesting concept of “forced resiliency” emerged surrounding mental health prejudices, which is different than the previous research that demonstrated how LGBTQ+ individuals are resilient in the face of sexual/ gender identity prejudices, such as homophobia and transphobia (Hill et al., 2020; Nicolazzo, 2016; Riggle & Rotosky, 2011; Singh et al., 2014). This topic of “forced resiliency” may be important for future research to consider when working with LGBTQ+ people and people with mental health struggles considering the differing stigmas they face surrounding their identities (Feinstein et al., 2012; Herek, 2004; Meyer, 2003; Yang & Mak, 2017).

Conclusion

The current study sheds light on the impacts of the mental health stigma on an at-risk, marginalized community which has previously been under-researched. The results of this study indicate that the mental health stigma does have an impact on LGBTQ+ college students’ well-being and help-seeking behaviors, but protective factors, such as self-awareness and social support, help to negate the impact and vice versa. These findings highlight the experiences of queer students, a population of increasing research concern, and can help college campuses better understand the needs of their queer students. Most notably, the importance of a supportive campus environment and adequate resources provided to queer college students, such as LGBTQ+ centers, clubs, and counseling centers, were demonstrated as protective factors against the mental health stigma. Furthermore, the protective and risk factors against mental health stigma presented in this study can help to inform mental health professionals more about LGBTQ+ college students and create targeted treatments to address the unique stressors they face as a marginalized community and college students. Moreover, findings regarding the implications of the mental health stigma on individuals allow researchers, mental health professionals, and policymakers to better develop ways to mitigate these influences. Lastly, these findings can help to oppose the anti-LGBTQ+ laws and policies currently circulating since they focus on the experiences of LGBTQ+ individuals and the impacts of their mental health.

Due to the limited research on this specific population, the researcher chose to focus on the experiences of LGBTQ+ college students at New York University to gain an initial understanding of the impacts of the mental health stigma. To further advance the findings on this topic, future research may explore how the experiences of queer students at other colleges are similar or different from these preliminary results. Additionally, the majority of participants in this sample were in a psychology-related field and further research should be conducted with a wider range of areas of study to examine how different educational pathways play a role on the impact of the mental health stigma. Although the sample size of the current study did not permit this, future research could examine how different mental disorder diagnoses potentially relate to the mental health stigma. Additionally, considering how gender minorities are at a greater risk for mental health issues than sexual minorities (Wanta et al., 2019), future research should examine how the mental health stigma impacts the separate LGBTQ+ identities individually to discern differences in experiences, if any. Moreover, various cultures hold more traditional views on mental health and LGBTQ+ people, which can have an impact on well-being and helpseeking behaviors (Department of Health and Human Services, 2001), and, therefore, future research should examine how race/ ethnicity and culture have an influence on the mental health stigma. Lastly, to explore this finding of “forced resiliency” more, future research should examine if LGBTQ+ individuals also feel like their resiliency in the face of sexual/gender prejudices is “forced” since previous research does not mention it. This will be most successfully conducted using qualitative measures since it is based on the participants’ experiences that will be difficult to capture using quantitative measures.

Critical Reflexivity

I am a self-identifying bisexual, cisgender woman that has struggled with mental health issues in my life and am in a unique position to understand this community’s struggle with stigma regarding our sexual identity and mental health. Additionally, my identity as a White, cisgender woman may put me in a position where I could misinterpret the responses of my BIPOC and transgender participants since I cannot fully understand their experiences of oppression and discrimination. To help with this issue, open-ended surveys were used to allow participants to explain their own experiences. While analyzing the data, I focused only on the participant’s responses and experiences while putting my own aside. I did this by acknowledging that my own experiences will not be the same for everyone and that the participant’s experiences are the most important. This helped to code the data objectively and not misconstrue any of the participant’s experiences.

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Figure 1

Participant Demographics: Race/Ethnicity

Figure 2

Participant Demographics: Degree Tracks