Ana Warner and Callie Hilgendorf COVID-19 and LGBTQ+ Mental Health

come to believe that this may be a result of LGBTQ+ identifying individuals experiencing microaggressions, overt aggressions, identity confusion, and internalized homophobia (Meyer, 2013; Ross et al., 2018).

College campuses also have the potential to improve mental health outcomes for LGBTQ+ students. When LGBTQ+ individuals have safe community-oriented queer spaces to process impactful events in their lives, they perceive less social isolation and are met with more wholly advantageous coping strategies (Jackson, 2017). Community building and consistent access to these different support networks are crucial for LGBTQ+ students to manage anxieties surrounding their identities and life experiences, so that they can fully commit themselves to flourishing during their time in school and beyond (Leider, 2012; Ottenritter, 2012). Given the nature of collegiate institutions, LGBTQ+ populations, compared to their heterosexual peers, are more likely to experience mental health disparities which may have been exacerbated since the COVID-19 pandemic (Salerno et al., 2020).

Current Study

There is currently very little research available that seeks to understand the connection between anxiety in LGBTQ+ college students and the COVID-19 pandemic (Meyer, 2013; Ross et al., 2018; Seelman et al., 2017). While it is understandable that this research is not widely available yet due to the recency of the pandemic and the number of subpopulations affected by it, it is especially important to look at LGBTQ+ college students, because they are already at a higher risk of anxiety than their peers (Meyer, 2013; Salerno et al., 2020). Additionally, by focusing on this community, research can strive to discover trends in LGBTQ+ college students’ experiences with anxiety and prevent them from becoming more prevalent in the future. Experience with anxiety, in this case, will focus on symptoms (e.g., panic attacks, increased heart rate, feelings of being out of control, etc.), access to support systems, and environmental factors. This qualitative study, thus, explored the following research question: How has the COVID-19 pandemic affected the experience of anxiety in LGBTQ+ college students?

Method

Participants

Fourteen LGBTQ+ identifying students from New York University (NYU), recruited via social media, class forums, and word of mouth, participated in the study. Participants were told they must identify as part of the LGBTQ+ community and be currently enrolled at NYU to be eligible for the study. Students were also given the opportunity to request a specific interviewer to reduce response biases and encourage more open responses. All respondents (N=14) identified as one or more of the following racial/ethnic identities: White (47.1%), Black (17.6%), Latine (23.5%), and Asian (11.8%), and one or more of the following LGBTQ+ identities: lesbian (24%), gay (16%), bisexual (12%), transgender (8%), pansexual (4%), queer (36%). The following gender identities were also represented: cisgender female (62.5%), transgender (12.5%), and nonbinary (25%) with differing combinations of she/her (62.5%), they/them (31.3%), and he/him pronouns (6.3%).

Procedure

This study was conducted via 20-minute semi-structured Zoom interviews where participants were asked to report demographic information such as pronouns, gender identity, LGBTQ+ identity, ethnicity, age, and year in college. For questions such as gender identity, LGBTQ+ identity, and ethnicity, participants were not given options to choose and were encouraged to list any and all terms that they identify with. Participants were also asked questions about their experiences since the beginning of the COVID-19 pandemic and anxiety. The questions about the participants’ experiences with anxiety and COVID-19 can be found in Appendix A.

Results

All interviews were recorded and then transcribed by the interviewers. Researchers used the principles of grounded theory to code the semi-structured interviews, by coding 21% of the transcripts and discussing and defining common themes related to the research question (Chun Tie et al., 2019). The codes that were generated based on the emergent themes are: anxiety surrounding routine (anxiety linked to changes in everyday life and uncertainties as a result of COVID-19), anxiety surrounding uncertainty (anxiety linked to unforeseen changes in previously secure long-term environments such as employment, housing, and community), social isolation (a decrease in daily interpersonal interactions and ultimate feelings of detachment from their communities), lack of normality (reported feelings of continued distress and inability to adjust comfortability into the world as affected by COVID-19), and less mental capacity (a lack of self-reported cognitive capabilities to perform everyday responsibilities such as homework, attending class or work, and personal maintenance).

Analysis of the data highlighted that 34% percent of participants indicated they were experiencing “anxiety surrounding uncertainty” over the past month. This included anxiety about relocating, changes in employment, and financial instability. Additionally, 13 out of the 14 participants indicated they were struggling with changes in everyday life, as well as “anxiety surrounding changes in routine” as a result of COVID-19. These changes included a shift to online learning due to COVID-19, adjusting to different workloads in employment or unemployment, moving locations during the pandemic, and shifting daily activities to a more indoor environment. Eightysix percent of the participants reported that they were lacking a sense of normality in their daily interpersonal interactions. This included participants feeling equipped to adjust to a reorganized change in normality, and professors failing to recognize student accommodations due to COVID-19 related issues.

Throughout the pandemic, community engagement (e.g.,

through roommates, family, family-friends, or colleagues) has been a source of both reduced anxiety (21.4%) and increased anxiety (57.1%) for participants. Some specific examples of reduced anxiety that participants noted included a decrease in social anxiety given that social interactions decreased, and connecting with friends and family has switched to virtual communication. Out of the total responses, 13% of participants expressed that they had been experiencing “social isolation” through separation from their respective communities due to COVID-19. Potential causes for increases in anxiety levels that stem from “social isolation” include: living alone in an apartment, abrupt separation, limited social interactions, partner separation, contraction anxiety between partners, and NYU community seperation. Of the 14 interviews conducted, nine participants indicated that they were experiencing feelings of social isolation.

All 14 participants indicated at least once that they were struggling with less mental capacity to perform everyday responsibilities including homework, attending class or work, and personal hygiene or self-care. These experiences of anxiety focus specifically on the symptoms our population of study encounters. There was a noticeable trend in the participants’ quantity and quality of sleep; out of the 11 participants who chose to disclose their symptoms, six identified insomnia, or restlessness, as a significant source of their anxiety. These sleep disruptions totaled to 55% of the symptoms reported by the participants.

Another heavily represented symptom included trouble eating and nausea; five out of fourteen, or 35.7%, of participants expressed this manifestation of anxiety. Among the three participants who disclosed a medical diagnosis of Obsessive Compulsive Disorder (OCD,) two indicated that their obsessive thoughts or repetitive compulsions have increased because of an increase in anxiety related to COVID-19. Other common symptoms of anxiety that were expressed by our participants include: headaches, fidgeting, anxiety attacks (i.e., tightness in the chest, feeling an inability to breathe, and trouble thinking clearly), and dissociation from the present moment. Participants commonly reported struggling with one or more combinations of dissociation, lack of motivation, trouble focusing, and fatigue as symptoms of their anxiety. These symptoms combined with feelings of uncertainty, dramatic changes in routine, and intrusive thoughts and behaviors make it difficult to perform everyday tasks such as attending work and school and maintaining physical and mental hygiene. Some participants specifically said that they must be more strategic with planning their days around their available mental capacities. They also stated that they have had to significantly adjust their daily routines by increasing alone time, minimizing time on the computer, and scheduling daily outings.

Another aspect that was highlighted during the semistructured interviews is that having access to mental health services is important for LGBTQ+ college students during the pandemic. Although it was not part of the formal interview questions, access to medication and counseling services came up organically in many conversations with the participants. Only five participants mentioned that they were taking medication to help manage their feelings and symptoms of anxiety and/ or regularly seeing a mental health professional during the pandemic. In each of those cases, students reported a decrease in symptoms of anxiety and general improvement in their dayto-day lives.

Discussion

This study aimed to address the gaps in the literature surrounding the experiences of anxiety that LGBTQ+ college students face throughout the COVID-19 pandemic. The findings support past research by highlighting the anxiety experienced by LGBTQ+ college students (Goodman & Epstein, 2020; Meyer, 2013). One of the most common shared experiences from the participants was related to new or heightened stressors that have been increasingly difficult to manage since the pandemic. Specifically, individuals are forced to resume their lives with academics and work, but with less perceived mental capacity. Participants commonly reported struggling with one or more combinations of dissociation, lack of motivation, trouble focusing, and fatigue as symptoms of their anxiety. These symptoms combined with feelings of uncertainty, dramatic changes in routine, and intrusive thoughts and behaviors make it difficult to perform everyday tasks such as attending work and school and maintaining physical and mental hygiene.

Another aspect which has appeared to contribute to how LGBTQ+ students are re-prioritizing their available time and energy is their individual engagement in their classes. The rise of COVID-19 has created or heightened anxiety surrounding uncertainty with employment, finances, and housing amongst students and thus impacts individuals’ motivation and ability to be engaged in their coursework which is consistent with previous literature (Aucejo et al., 2020; Chen et al., 2020; Perz et al., 2020;). One student specifically mentioned that, “online school is not fun or easy, especially with professors who are not trained to teach online and when everything else in the world is a mess.” When participants were asked about how they were able to adjust their priorities and maintain engagement in school and work, every response mentioned the impact of their professors’ attitudes and/or policies in some way. Based on the findings, it appears that the attitudes of professors are impactful to LGBTQ+ students’ experiences with anxiety during COVID-19, which could be beneficial to take into account when planning lessons, deadlines, and general class structure in the future to better support students during this time.

Identity also seemed to play a role in the reported experiences of anxiety in this study. One person went as far as to mention that “some of [their] anxiety is specifically because [they] are LGBTQ+ and exist during the COVID-19 pandemic.” This feeling seemed to resonate in a few respondents who mentioned having to move out of their own spaces on or around campus and moving in with family or friends for extended periods of time in

early 2020. Experiences ranged from not being able to engage in meaningful discussions with like-minded individuals about their lives or identities to entirely having to act as though they were not part of the LGBTQ+ community, which correspond to increased feelings of anxiety surrounding routine, anxiety surrounding uncertainty, social isolation, lack of normality, and less mental capacity based on the study’s coding measures. When LGBTQ+ college students are living through these experiences, it impacts their ability to perform at work and school as well as their ability to adequately take care of themselves. In order to address the ramifications of these experiences, it is especially important for institutions such as businesses, universities, and community organizations to prioritize the accessibility of a variety of mental health services (e.g., counseling, medication, etc.), as well as creating community support to re-engage young people in dialogue and action that empowers them in their identities. Organizations should also seek to utilize avenues that allow the individual to maintain their security within their living environment such as having e-book clubs, pen pals, and virtual affinity groups. It is important that research is able to center LGBTQ+ people to address existing disparities in mental health outcomes and prevent these from becoming exacerbated as a result of COVID-19.

Limitations and Future Directions

The researchers chose to identify patterns in experiences with anxiety amongst LGBTQ+ students at New York University in order to get the most representative sample for this context. With the resources available, if the study had included other universities there may not have been enough representation from any one place to get an accurate depiction of students’ experiences. Future research might explore how the experiences of LGBTQ+ identifying students at other universities are the same or different so that administrators and other stakeholders can adequately support their students.

Aside from universities, one aspect that was often touched on in this study was respondent’s experiences with finances and employment. No participants discussed the level of support and communication that they received from their employers during the pandemic. Given that many of the participants mentioned being employed at some point before or during the pandemic, it may also be beneficial for future research to explore how LGBTQ+ individuals’ employment has been affected by the pandemic to better address potential financial discrepancies and discern how employers can best support their employees during this time. Additionally, it is common for people with anxiety to experience other mental health complications at the same time, such as depression and phobias (Kaufman & Charney 2020; Last et al., 1987). This study did not examine comorbidities of anxiety, but in order to get a more holistic understanding of the needs and experiences of LGBTQ+ individuals during COVID-19 future qualitative research should investigate intersectional mental health concerns as well.

Shedding-light on the experience of anxiety that college students are currently facing has a positive impact on the amount of attention this topic receives in psychology research. Future studies can address some of the limitations of this study in order to develope a more well-rounded understanding of how to support different LGBTQ+ communities. By highlighting the need for more anxiety-related mental health support for the LGBTQ+ community, further research can also expand to other mental health conditions that are prevalent in adolescents’ lives. As the pandemic progressively becomes under control, it is important to continue to support vulnerable communities.

References

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Appendix A LGBTQ+ College Student Semi-Structured Interview Protocol (2020)

Demographic Questions

What is your name? What is your age? What is your gender identity? What pronouns do you use? What is your ethnicity? Please list any and all terms that apply. What term or terms best describe your LGBTQ+ identity? Please list any and all that apply. What year in college are you?

Anxiety and Experience Questions

After NYU announced that it was going to be online for the remainder of the spring semester, did you experience any other major changes in your life (e.g.: housing, employment, community, etc.)? If yes, what kind of changes and to what extent did it impact your life? Have you ever been diagnosed with anxiety? Have you been experiencing anxiety throughout the last month? If yes, what kind of symptoms have you been noticing? Do you feel that this is representative of what you have experienced throughout the pandemic? How is it the same/different? Why do you think that is? Do you feel that your anxiety has more to do with potentially contracting COVID-19 or more to do with changes in your life and environment due to COVID-19? Both? Neither?

BIOGRAPHIES

Editor-in-Chief op496@nyu.edu

Olivia is a senior in the Applied Psychology program, double majoring in Gender & Sexuality Studies. She is passionate about bridging psychology and gender & sexuality, evident by her research interests and experience. She is currently a research assistant on Dr. Yoshikawa’s Gender and Sexuality Alliance Research Consortium (GSARC), where she is involved on two smaller projects: the Principal Interview Study, exploring school principals’ experiences with the LGBTQIA+ community, and the Dissemination Efforts team, creating resources for high-school GSAs based on previous GSARC research. Upon graduation, Olivia is pursuing a Master of Arts at NYU Steinhardt in Counseling for Mental Health and Wellness, with an advanced certificate in LGBTQ Eduation, Health, and Social Services.

Maya Metser (she/her)

maya.metser@nyu.edu Editor-in-Chief

Maya is a senior in the Applied Psychology program. She is currently pursuing an Honors thesis under the mentorship of Dr. Natalie H. Brito at the ISLAND Lab, where she is exploring the effects of mother-infant heart rate synchrony on infant attention outcomes. In the past, she was an advocate for the ROSES research team and a research assistant at the SCAN Lab, a fetal neuroimaging lab. Moving forward, she hopes to bridge her passion for neuroscience, education, and juvenile justice reform to make early environments better support positive development. Lastly, Maya hosts a podcast called Psych Mic that explores the lives and career paths of industry leaders who use psychology to make an impact in the world. Psych Mic highlights psychology’s versatile applications and provides practical advice about opportunities in the field.

Katie Mundt (she/her)

kvm256@nyu.edu Editor-in-Chief

Katie is a fall graduate of the Global Public Health/Applied Psychology program. She is interested in improving community health through a psychological lens, applying the skills and theories from psychology to health research and policy reform. She worked at NYU Langone on the Smoke-Free Housing Project, which evaluated the effectiveness of a smoke-free policy in NYC public housing developments. Currently, she works as a research assistant for the RISE lab and has helped develop a grant-awarded research proposal for the Social Perception Action & Motivation (SPAM) lab, which examined how the media’s portrayal of the COVID-19 pandemic impacts perception and subsequent behavior. She recently accepted a Service Coordinator position with ComPsych, an employee assistance program headquartered in Chicago, IL. Biographies | 50

Layout and Design Director cec747@nyu.edu

Chloe is a sophomore in Applied Psychology with a strong interest in the effects of media on the mind. While pursuing a minor in Media, Culture, and Communication, she hopes to assist in the creation of more psychology related media in order to raise mental health awareness and educate others.

Sydney Liang (she/her)

Layout and Design Director syl569@nyu.edu

Sydney is a junior in the Applied Psychology program with a minor in Media, Culture, and Communication. She is currently a research assistant at Play and Language Lab, which examines how children interact with their environment as well as how social and cultural factors influence children’s development. Previously, she has interned at various organizations ranging from nonprofits to multinational companies. She plans on continuing to explore various career paths which highlight the intersection between psychology, research, and communication before pursuing higher education.

Grace Park (she/her)

Layout and Design Director hjp332@nyu.edu

Grace is a junior in Applied Psychology minoring in Nutrition and Dietetics. She is interested in raising awareness of mental health in minority communities and hopes to help such populations by providing culturally competent care. Grace will be working as a research assistant for The Listening Project which aims to train middle school students and teachers in a semi-structured method of interviewing with the goal of enhancing listening skills, empathy, trust, academic engagement and achievement. The Listening Project works to disrupt stereotypes and build relationships across differences. Grace ultimately hopes to complete her masters at NYU in Counseling for Mental Health and Wellness.

Janean Cuffee (she/her)

Contributing Writer

Janean is a senior in the Applied Psychology program double minoring in Sociology and History. She is also a member of the varsity women’s basketball team at NYU. She is interested in equal educational opportunities across socioeconomic backgrounds and the mental health impacts of childhood trauma. In the past, she has worked with under-resourced youth in her internship at Harlem Children’s Zone and fellowship at Uncommon Schools. Currently, she is an Assistant Lab Manager for the RISE Lab that works to advance and improve the lives of marginalized populations. Additionally, she is the founder of BLAC (Black Latinx Athlete Coalition), a space meant to provide comfort to minority athletes that may not always feel at home in a PWI. After graduation, Janean will be a middle school teacher at a charter school in Brooklyn in the Uncommon Schools Organization.

Anjali Mehta (she/her)

Contributing Writer

Anjali Mehta is a junior at NYU, getting a B.S. in Applied Psychology with a minor in Philosophy, and an M.A. in Mental Health Counseling. Anjali works at the Mindful Education Lab, where she is currently investigating the overlap between cognitive neuropsychology and meditation, specifically by researching attention and technology. Her research interests also include selfknowledge, violence, and PTSD, specifically from military trauma and sexual abuse. Outside of NYU, Anjali is a certified advanced yoga instructor, yoga therapist, and MBSR coach and has also delivered a TEDx talk on the “Power of Breath.” Though she has more than five years of experience as a yoga instructor, Anjali intends to earn a Ph.D. in Clinical Psychology and ultimately to become a practicing psychotherapist, in order to investigate the inner workings of the mind. Her career plans may include serving in the Singapore Military as a Clinical Psychologist.

Gizem Kurtbolat (she/her)

Contributing Writer

Gizem is a senior in the Applied Psychology program. She is interested in working with children and adolescents and raising mental health awareness among this population. In the past she has volunteered at school for children with Autism as a classroom volunteer. Currently she is an intern at Ramapo for Children, working on creating content on school climate and researching for reports and articles that can be useful resources for schools. In addition she volunteers as a tutor at Econnected, a non-profit organization that supports English Language Learners with their English and Math skills. After graduation, she would like to gain more experience working with children and adolescents in clinical settings to work towards becoming a child and adolescent psychologist.

Samantha Ruggiero (she/her)

Contributing Writer

Samantha is a senior in the Applied Psychology program with a minor in Public Policy and Management. Her research interests include the ways in which social inequality impacts individuals in the workplace. In the past, Samantha has interned in a variety of professional settings, including in schools, research labs, non-profits, and start-ups. Currently, Samantha is working as a Research Assistant in Dr. Rezarta Bilali’s Social Inequality and Intergroup Conflict Lab. Specifically, she is working on projects that are centered on evaluating the ways in which social movement organizations and mainstream media outlets portray historical narratives and their various components. She is also working on a code-writing project to analyze data from a study that measured participant perceptions of the Women’s March. Upon graduation, Samantha will be continuing her post-baccalaureate education at New York University in the Master of IndustrialOrganizational Psychology program.

Vion He (she/her)

Contributing Writer

Vion is a junior in the Applied Psychology program with a minor in BEMT (Business of Entertainment, Media and Technology). She is interested in improving mental health literacy and increasing access to psychological services for marginalized populations, particularly the LGBTQIA+ community. As a research assistant at Families and Children Experiencing Success (FACES) Lab, she focuses on examining the effectiveness of parenttargeted interventions for children with behavioral challenges (e.g., ADHD) and their families, as well as parental engagement in treatment. In addition, she volunteers at the College Prep Academy program at NYU Metro Center, where she delivers group coaching services to high school students on topics including college planning, careers, and mental health. While planning to explore career path possibilities, she hopes to dedicate herself to providing mental health care and treatment to minority populations in the future.

Julia Leschi (she/her)

Contributing Writer

Julia is a senior in the Applied Psychology program minoring in Public Health. She is interested in applying a psychological lens to public health and policy issues. In the past, she worked as a clinical assistant at a substance use clinic in Midtown Manhattan. She is currently working as the Associate Director of Research at the Empower Lab, a clinical research and advocacy lab working to further gender equity through scientific approaches to issues of gender-based violence. There, she is conducting a qualitative exploration of sugar dating practices on college campuses, and studying the health needs of human trafficking survivors and asylum seekers. In the future, she hopes to put her research skills in service of policy reform and community work before continuing her education.

Macarena Kruger (she/her)

Contributing Writer

Macarena is a senior in the Applied Psychology undergraduate program. She is also a member of the varsity women’s tennis team at NYU and a research assistant at NYU-LFELD (Latino Family Engagement and Language Development). Specifically, she works for the MEAL project, which focuses on examining Latine children’s development and math skills learning in the United States. Throughout the Spring semester, Macarena has been coding data collected on mother-child semi-naturalistic interactions. She is currently writing “Math heroes biographies” in Spanish for third graders. The main purpose of the project is for low-income Latine children to learn about the lives of people of color who have been successful and to make an explicit connection between their professions and the use of math. Macarena is also working on her Honors thesis under the mentorship of Dr. Gigliana Melzi., exploring Mexican-heritage mothers’ relative importance given to children’s academic and socio-emotional skills and their book sharing practices.

Joy Shen (she/her)

Contributing Writer

Joy is a recent graduate of the Applied Psychology undergraduate program. During her time at NYU, Joy was involved in research in Dr. Brito’s ISLAND Lab, where she worked with families and explored infant development. Currently, Joy works as a research assistant at the Cognitive and Behavioral Consultants, a mental health facility, where she works on various program and treatment evaluations to manage and track patient’s progress. Her projects focus on implementing DBT in schools, overseeing intensive DBT and CBT programs, and conducting qualitative studies on program dropout. Ultimately, she hopes to work with a diverse population to help promote equity in mental health treatment and to focus on the incarceration system. Outside of school, Joy spends her free time skateboarding, painting, and baking. In the fall, Joy will begin her PsyD program at Yeshiva University’s Ferkauf Graduate School of Psychology, where she will train to practice psychotherapy and broaden her research.

Ana Warner (she/her)

Contributing Writer

Ana is a senior double majoring in the Applied Psychology and Global Public Health programs. She is interested in expanding healthcare access and education with LGBTQ+ and BIPOC populations, especially amongst students. She is currently exploring these interests as an HRTP Intern at the NYC Department of Health and Mental Hygiene and a research assistant in the Gender and Sexuality Alliance Research Consortium (GSARC) at NYU under the direction of Dr. Yoshikawa. In the future, she hopes to combine her passions for public health policy and psychology to expand mental health access, education, and autonomy for young people.

Callie Hilgendorf (she/her)

Contributing Writer

Callie is a senior double majoring in Global Public Health and Applied Psychology. She is interested in actively engaging within communities to combat oppressive systems and how mental health trauma is experienced and pathologized by stigma. She is currently working as a research assistant in the Project for the Advancement of our Common Humanity Listening Project (PACH): The Listening Project at NYU under the direction of Dr. Yoshikawa and Dr. Way. She also holds a leadership position with the NYU chapter of Peer Health Exchange (PHE), a non-profit organization focusing on improving health equity and advocacy outreach for adolescents. Upon graduation, Callie will be pursuing a Master of Public Health at Columbia University in the Sociomedical Sciences and a certificate in Population Mental Health.