Abstract
Purpose:
The abrupt closure of universities across the U.S. in March 2020 may have sent some lesbian, gay, bisexual, and transgender (LGBT) college students home to unsafe or unaccepting families and environments. The objective of this study was to examine the mental health needs of LGBT college students in the U.S. during the COVID-19 pandemic.
Methods:
We fielded a rapid-response online survey in the spring of 2020. We recruited 477 LGBT-identifying college students aged 18–25 years by contacting LGBT-serving organizations on 254 college campuses and through targeted social media advertising.
Results:
Nearly half (45.7%) of LGBT college students have immediate families that do not support or know their LGBT identity. Approximately 60% of sampled LGBT college students were experiencing psychological distress, anxiety, and depression during the pandemic.
Conclusions:
Health-care providers, college and university administrators, and campus counseling centers should take swift action to ensure that LGBT students receive mental health support during the pandemic.
Keywords: COVID-19, LGBTQ health, College health
The COVID-19 pandemic has created additional stressors in everyday life, including social isolation and insecurities in housing, finances, and food [1,2]. Recent studies have also raised concerns about the health and well-being of college-aged students. According to a previous study of 725 students, 35% reported COVID-19 symptoms but few (<5%) received tests and most (95%) were sheltered in place at home [3]. Other research has documented elevated levels of depression and anxiety among college students during the COVID-19 pandemic [4–6]. These stressors may be greater risk factors for vulnerable populations, including lesbian, gay, bisexual, and transgender (LGBT) individuals, who already report worse mental health outcomes as a result of discrimination, stigma, and experiences of rejection because of their sexual orientation or gender identity [7–9]. One study has provided qualitative evidence from chat-based support groups that LGBT youth feel “stuck at home with unsupportive parents” during the COVID-19 pandemic [10]. Less attention has been given to the subset of LGBT college students who may be experiencing unique challenges due to their sexual orientation and/or gender identity. In particular, the abrupt closure of U.S. colleges and universities in March 2020 may have sent many LGBT students home to unsafe or unaccepting environments [11]. The closure of colleges and universities may have also resulted in other unfavorable factors for self-quarantine, including limited access to LGBT-specific campus resources and distance from their affirming social networks.
Methods
From April 24 to June 5, 2020, we recruited 477 LGBT college students aged 18–25 years to participate in a rapid-response online survey on their health and well-being during the COVID-19 pandemic. Participants were recruited through email listservs, outreach to LGBT student organizations, LGBT office directors and/or diversity officers at 254 colleges and universities, and targeted social media advertisements via Facebook and Instagram. Participants resided in 47 states and Puerto Rico. We calculated descriptive statistics and estimated the prevalence of three mental health outcomes: (1) frequent mental distress (i.e., ≥14 days of “not good” mental health in the past 30 days) [12]; (2) generalized anxiety disorder using the GAD-2 criteria [13]; and (3) major depression based on the Patient Health Questionnaire 2-item (PHQ-2) screening instrument [14]. Then, we estimated multivariable logistic regression models to identify the risk factors for frequent mental distress, anxiety, and depression among LGBT college students. Fully adjusted models simultaneously controlled for sexual orientation, gender identity, age, race/ethnicity, ability to receive mental health if needed during the pandemic, the degree to which participants’ lives were disrupted by COVID-19, concerns about COVID-19, whether the participant, family or a friend had previously tested positive for COVID-19, and the immediate family’s (defined as parents and siblings) awareness and support of the participant’s LGBT identity. Logistic regression results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). This study was deemed exempt by the Vanderbilt University Institutional Review Board and is part of a larger forthcoming study that includes focus groups and qualitative analyses.
Results
Table 1presents the descriptive statistics of our study sample aged 18–25 years. Most LGBT college students in our sample described their sexual orientation as gay, lesbian, bisexual, or queer. The mean age was 20.7 years, and approximately 30% of the sample was nonwhite. Most LGBT college students reported that their lives were disrupted by the COVID-19 pandemic by a fair amount or a great deal. More than half of the LGBT college students were very or extremely concerned about the COVID-19 pandemic. Approximately 17% of LGBT students had previously tested positive or knew a family member or friend who tested positive for COVID-19. Almost half (45.7%) of LGBT college students have immediate families that do not support or know their LGBT identity.
Table 1.
Descriptive statistics of lesbian, gay, bisexual, and transgender (LGBT) college students, 18–25 years old
| Sample size (n) | Percent (%) | |
|---|---|---|
| Sexual orientation | ||
| Gay/lesbian | 99 | 20.8 |
| Bisexual | 91 | 19.1 |
| Queer | 104 | 21.8 |
| Pansexual | 66 | 13.8 |
| Asexual | 51 | 10.7 |
| Questioning | 33 | 6.9 |
| Other | 33 | 6.9 |
| Gender identity | ||
| Cisgender man | 74 | 15.5 |
| Cisgender woman | 202 | 42.4 |
| Transgender | 43 | 9.0 |
| Gender nonconforming | 120 | 25.2 |
| Other | 38 | 8.0 |
| Age | ||
| Mean, in years | 477 | 20.7 |
| Race/ethnicity | ||
| White | 292 | 61.2 |
| Black or African American | 44 | 9.2 |
| Hispanic/Latinx | 63 | 13.2 |
| Asian or Pacific Islander | 66 | 13.8 |
| Other | 12 | 2.5 |
| Able to receive mental health care if needed | ||
| Yes | 279 | 58.5 |
| No, because of cost | 84 | 17.6 |
| No, because of stay-at-home orders | 61 | 12.8 |
| No, because of other reasons | 53 | 11.1 |
| Life disrupted by COVID-19 | ||
| Not at all or not much | 61 | 12.8 |
| A fair amount | 237 | 49.7 |
| A great deal | 179 | 37.5 |
| Concerned about COVID-19 | ||
| Not concerned or moderately concerned | 227 | 47.6 |
| Very or extremely concerned | 250 | 52.4 |
| Participant, family, or friend tested positive for COVID-19 | ||
| No | 394 | 82.6 |
| Yes | 83 | 17.4 |
| Immediate family supportive of participant’s LGBT identity | ||
| Supportive | 177 | 37.1 |
| Neither supportive or unsupportive | 82 | 17.2 |
| Unsupportive or family does not know | 218 | 45.7 |
Source: Online sample of LGBT identified young adults from April 24 to June 5, 2020.
Table 2 presents the prevalence and aORs of mental health conditions among LGBT college students aged 18–25 years during the COVID-19 pandemic. More than 60% of the sampled LGBT college students were experiencing frequent mental distress, anxiety, or depression. Compared to cisgender men, transgender students were much more likely to report frequent mental distress (aOR = 3.41; 95% CI = 1.31–8.86). LGBT college students unable to receive mental health care because of stay-at-home orders were more likely to report frequent mental distress (aOR = 2.30; 95% CI = 1.17–4.56) and depression (aOR = 2.43; 95% CI = 1.24–4.74). LGBT students whose lives were disrupted “a great deal” were more likely to have frequent mental distress (aOR = 2.37; 95% CI = 1.20–4.66) and anxiety (aOR = 2.13; 95% CI = 1.09–4.14). Similarly, those who were extremely concerned about COVID-19 were more likely to have frequent mental distress (aOR = 1.84; 95% CI = 1.21–2.79), anxiety (aOR = 1.77; 95% CI = 1.17–2.69), and depression (aOR = 1.71; 95% CI = 1.15–2.56) compared to those who were not concerned about COVID-19. Finally, LGBT students with unsupportive families were more likely to exhibit frequent mental distress (aOR = 1.83; 95% CI = 1.13–2.95) compared to students with families supporting their LGBT status.
Table 2.
Prevalence and adjusted odds ratios of mental health conditions among lesbian, gay, bisexual, and transgender (LGBT) college students, 18–25 years old
| Frequent mental distress |
Anxiety |
Depression |
||||
|---|---|---|---|---|---|---|
| Prevalence (%) | aOR (95% CI) | Prevalence (%) | aOR (95% CI) | Prevalence (%) | aOR (95% CI) | |
| All sampled LGBT college students | 61.0 | NA | 65.0 | NA | 60.4 | NA |
| Sexual orientation | ||||||
| Gay/lesbian | 38.4 | 1.00 [Reference] | 51.5 | 1.00 [Reference] | 51.5 | 1.00 [Reference] |
| Bisexual | 64.8 | 2.72 (1.38–5.36)* | 62.6 | 1.31 (.68–2.54) | 55.0 | 1.07 (.56–2.06) |
| Queer | 66.4 | 2.76 (1.42–5.35)* | 71.2 | 1.87 (.96–3.61) | 64.4 | 1.62 (.85–3.10) |
| Pansexual | 71.2 | 3.05 (1.43–6.49)* | 68.2 | 1.30 (.62–2.74) | 68.2 | 1.63 (.78–3.41) |
| Asexual | 68.6 | 2.55 (1.12–5.81)* | 66.7 | 1.17 (.52–2.62) | 66.7 | 1.61 (.72–3.59) |
| Questioning | 69.7 | 2.77 (1.09–7.04)* | 78.8 | 2.73 (1.004–7.42)* | 63.6 | 1.34 (.55–3.26) |
| Other | 60.6 | 1.68 (.66–4.31) | 69.7 | 1.48 (.58–3.80) | 60.6 | 1.01 (.41–2.48) |
| Gender identity | ||||||
| Cisgender man | 36.5 | 1.00 [Reference] | 48.7 | 1.00 [Reference] | 47.3 | 1.00 [Reference] |
| Cisgender woman | 58.4 | 1.21 (.63–2.33) | 62.9 | 1.30 (.68–2.48) | 56.9 | 1.10 (.58–2.07) |
| Transgender | 79.1 | 3.41 (1.31–8.86)* | 76.7 | 2.30 (.92–5.76) | 74.4 | 2.31 (.94–5.65) |
| Gender nonconforming | 69.2 | 1.63 (.79–3.37) | 70.0 | 1.56 (.75–3.21) | 65.0 | 1.25 (.62–2.55) |
| Other | 76.3 | 2.62 (.96–7.14) | 79.0 | 2.93 (1.05–8.13)* | 73.7 | 2.35 (.89–6.16) |
| Age | ||||||
| In years | NA | .92 (.82–1.03) | NA | 1.01 (.90–1.13) | NA | .91 (.82–1.01) |
| Race/ethnicity | ||||||
| White | 64.0 | 1.00 [Reference] | 67.8 | 1.00 [Reference] | 59.9 | 1.00 [Reference] |
| Black or African American | 61.4 | .79 (.37–1.65) | 68.2 | .87 (.41–1.85) | 63.6 | 1.12 (.55–2.29) |
| Hispanic/Latinx | 57.1 | .68 (.36–1.28) | 68.3 | .91 (.48–1.73) | 66.7 | 1.22 (.65–2.27) |
| Asian or Pacific Islander | 48.5 | .44 (.23–.82)* | 51.5 | .40 (.22–.74)* | 51.5 | .67 (.37–1.21) |
| Other | 75.0 | 2.18 (.47–10.18) | 41.7 | .21 (.06–.81)* | 75.0 | 2.11 (.51–8.72) |
| Able to receive mental health care if needed | ||||||
| Yes | 55.9 | 1.00 [Reference] | 60.2 | 1.00 [Reference] | 54.8 | 1.00 [Reference] |
| No, because of cost | 65.5 | 1.46 (.82–2.58) | 70.2 | 1.54 (.87–2.73) | 65.5 | 1.49 (.86–2.57) |
| No, because of stay-at-home orders | 72.1 | 2.30 (1.17–4.56)* | 73.8 | 1.78 (.91–3.50) | 75.4 | 2.43 (1.24–4.74)* |
| No, because of other reasons | 67.9 | 1.38 (.69–2.78) | 71.7 | 1.61 (.79–3.30) | 64.2 | 1.24 (.64–2.41) |
| Life disrupted by COVID-19 | ||||||
| Not at all or not much | 45.9 | 1.00 [Reference] | 52.5 | 1.00 [Reference] | 52.5 | 1.00 [Reference] |
| A fair amount | 56.5 | 1.46 (.77–2.76) | 62.0 | 1.51 (.81–2.81) | 57.4 | 1.21 (.67–2.23) |
| A great deal | 72.1 | 2.37 (1.20–4.66)* | 73.2 | 2.13 (1.09–4.14)* | 67.0 | 1.58 (.83–3.02) |
| Concerned about COVID-19 | ||||||
| Not concerned or moderately concerned | 53.7 | 1.00 [Reference] | 58.2 | 1.00 [Reference] | 53.7 | 1.00 [Reference] |
| Very or extremely concerned | 67.6 | 1.84 (1.21–2.79)* | 71.2 | 1.77 (1.17–2.69)* | 66.4 | 1.71 (1.15–2.56)* |
| Participant, family, or friend tested positive for COVID-19 | ||||||
| No | 60.9 | 1.00 [Reference] | 63.5 | 1.00 [Reference] | 58.1 | 1.00 [Reference] |
| Yes | 61.5 | 1.13 (.64–1.99) | 72.3 | 1.71 (.96– 3.06) | 71.1 | 1.81 (1.03–3.17)* |
| Immediate family supportive of participant’s LGBT identity | ||||||
| Supportive | 53.1 | 1.00 [Reference] | 58.2 | 1.00 [Reference] | 54.8 | 1.00 [Reference] |
| Neither supportive or unsupportive | 58.5 | 1.09 (.59–2.00) | 68.3 | 1.39 (.76–2.56) | 64.6 | 1.18 (.65–2.13) |
| Unsupportive or family does not know | 68.4 | 1.83 (1.13–2.95)* | 69.3 | 1.58 (.98–2.54) | 63.3 | 1.29 (.82–2.03) |
Source: Online sample of LGBT identified adults from April 24 to June 5, 2020.
aORs were obtained from multivariable logistic regression models adjusting for all the covariates listed in the table simultaneously. Frequent mental distress is defined as reporting ≥ 14 days of “not good” mental health (which includes stress, depression, and problems with emotions) in the past 30 days. Anxiety is defined as scoring three or greater based on the two-item general anxiety disorder (GAD-2) screening instrument. Depression is defined as scoring three or greater using the two-item patient health questionnaire (PHQ-2) screening instrument.
aOR = adjusted odds ratio; CI = confidence interval.
p < .05.
Discussion
To overcome the high prevalence of frequent mental distress, anxiety, and depression among LGBT students, colleges and universities should ensure that LGBT students receive mental health support during the COVID-19 pandemic. First, campus counseling centers should provide telehealth options with flexible hours that are extended until the return of in-person classes and referral services to low- or no-cost providers in the student’s place of residency. Second, identity-based affinity groups should leverage virtual platforms to sustain a sense of community when possible. Relatedly, colleges and universities should utilize campus, community, or national LGBT resources to provide privacy-enabled asynchronous digital content, webinars, and/or podcasts for students and families from unsupportive households. Third, universities should seek to eliminate any closure-related stressors by providing housing accommodations and financial resources to those expressing need. Financial resources should not be solely based on the parental/family information attained through traditional financial aid processes, as separation from one’s parental household may be a necessary option for students to remain physically and emotionally safe. Finally, health-care providers should be mindful of the mental health needs of LGBT college students who may have returned home to unsafe or unaccepting environments. Primary care providers may be the first point of contact for LGBT college students seeking mental health care in their communities until they return to campus. To ensure welcoming environments, health-care providers who are less familiar with the needs of LGBT populations should seek avenues to educate themselves on LGBT issues, such as enrolling in online continuing medical education (CME) modules that focus on LGBT patient populations [15].
Limitations of this study include its nonprobability sampling, selection bias, small sample sizes, and limited generalizability. Our study may be missing LGBT college students who are currently homeless, lacking Internet access, or are not comfortable responding to an LGBT-focused online survey in their homes. In addition, since we leveraged the networks of LGBT college centers and organizations to facilitate data collection, our findings may best reflect the experiences of LGBT college students better affiliated with the LGBT community at their college. Nevertheless, our study is one of few investigations identifying the mental health needs of LGBT college students during the COVID-19 pandemic, which are substantial based on our results.
IMPLICATIONS AND CONTRIBUTION.
In response to the COVID-19 pandemic, colleges abruptly closed which may have confined lesbian, gay, bisexual, and transgender (LGBT) students to unaccepting environments. This study documents the mental health needs of LGBT students during the pandemic. Approximately 60% of sampled LGBT students were experiencing psychological distress, anxiety, and/or depression.
Footnotes
Conflicts of interest: The authors have no financial sources or conflicts of interest to report.
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