Health concerns across the LGBTQIA+ spectrum

Abstract

LGBTQ+ individuals represent a large, heterogenous group. Individuals in this group often experience prejudice, discrimination, and inequities in the healthcare system, making them less likely to seek care and more likely to experience adverse outcomes. In addition to stigma and denial of primary or specialized care, they may also experience inappropriate pathologizing of their sexual orientation or gender identity both within and outside of healthcare settings that drives them away from accessing life-saving services linked to their health and well-being. This collection invites original research on LGBTQ+ health – both broad and intersectionally construed. We welcome quantitative, qualitative, and mixed method studies on LGBTQ+ health. We also welcome manuscripts that apply evidence synthesis including systematic reviews, as well as meta-analyses which focus on health-related outcomes (e.g., disparities, predictors of mental or physical health outcomes, group comparisons, experience in/access to/utilisation of healthcare provisions), focusing on clear health-related outcome(s) among LGBTQ+ communities.

The arc of scientific inquiry bends slowly but inexorably towards greater inclusiveness and accurate understanding of human diversity. For generations, individuals who identified as lesbian, gay, bisexual, transgender, queer, intersex, asexual, or other minority sexual and gender identities (LGBTQ+) were either rendered invisible in research or pathologised by it. For example, McHenry¹ traced the scientific and clinical Western understanding of same-sex attraction starting from the first mental disorders’ diagnostic tool, the Diagnostic and Statistical Manual of Mental Disorders (DSM²:), which identified homosexuality as a “sociopathic personality disturbance.” This reference to homosexuality as a mental health disorder was only removed in the 2013 edition of DSM³. Similarly, the DSM has gradually shifted away from pathologizing people whose gender identity differs from their sex assigned at birth. However, it should be noted that the DSM continues to use the classification of ‘gender dysphoria’, which some organisations have used as a basis for policies that continue to pathologise and police trans bodies and act as a gatekeeper to stop provision of healthcare⁴.

In the last few decades, the proliferation of rigorous, data-driven research has begun to replace prejudice with evidence, illuminating the profound health disparities faced by these communities, as well as their predictors and protective elements. The goal of an upcoming Collection at Scientific Reports is to contribute to this effort, bringing together compelling evidence-based scholarship ranging from documenting relevant health disparities and their predictors to identifying potential personal, societal, and institutional manners to reduce them. So far, a number of papers submitted to the Collection have been published, including two from contrasting fields - work by Cheng and Roy⁵ on the impact of young and women directors on advancing LGBTQ+-inclusive health benefits in U.S. firms and by Conabere et al⁶. on using twin data to examine heritable and intrauterine hormonal influences on transgender and gender diverse identities. This special Collection comes at an important time for LGBTQ+ health globally, where political forces have led to a shift away from evidence-based care and curtailment of equality, diversity and inclusion and gender studies programmes (e.g⁷.,).

The empirical evidence is stark, overwhelming, and demands action both inside and outside of the research arena. LGBTQ+ individuals experience significantly higher rates of mental health conditions: a recent U.S. national survey of LGBTQ+ youth⁸ provides indications of some of the current hardship reported by these individuals, such as high rates of suicidality (~ 40%), great barriers in accessing mental health support (50% reported wanting, but being unable to access such services), and the negative impact of recent politics on their wellbeing (experienced by 90% of the respondents). Globally, the challenge is even more severe: in many countries around the world, systemic and legal policies blend with ideological and/or religious perspectives to not only invalidate LGBTQ+ identities, but to put their freedom, basic rights, and physical safety in jeopardy (e.g^9–11). These are not mere statistics; they are echoes of lived distress, amplified by a social context that too often questions their very existence or acceptability.

LGBTQ+ individuals do not only face mental health disparity, but also a disproportionate burden of physical health issues. For example, substance use disorders, and the substantial physiological costs that come with them, are significantly more prevalent among LGBTQ+ individuals¹². The HIV epidemic continues to disproportionately impact communities of men who have sex with men (e.g¹³.,) and transgender women (e.g¹⁴.,) fuelled by a complex interplay of stigma, economic disenfranchisement, and barriers to prevention services like PrEP. Furthermore, emerging evidence suggests higher risks for cardiovascular disease among sexual minorities¹⁵, potentially driven by the physiological toll of minority stressors (e.g¹⁶.,).

The 2015 U.S. Transgender Survey reported that 23% of respondents avoided seeking necessary healthcare in 2014-15 due to fear of mistreatment¹⁷. This avoidance has cascading consequences, contributing to poorer management of chronic conditions and lower rates of preventive screenings for conditions such as cancer. The sociological challenge before us is to develop robust, longitudinal models that can provide health cost/benefit analyses for specific regulatory guidelines and policies in the healthcare space.

The LGBTQ+ population is heterogenous and diverse, individuals vary on important demographic dimensions, such as sex, gender identity, race, ethnicity and sexual orientation, which contribute to differences in lived experiences and crucial intersection. These differences in experience contribute to global unmet needs. Such variations show a need to move beyond WEIRD (Western, Educated, Industrialized, Rich, and Democratic) countries in data collection and actively incorporate perspectives from Aboriginal, Indigenous, and First Nations Peoples, and from Asian, African, South American, and other societies outside of Western knowledge systems¹⁸. Such perspectives should be incorporated in analytical approaches, for example disaggregated analyses to examine meaningful subgroup differences rather than treating sexual and/or gender minority individuals as a monolithic category. Intersectionality¹⁹ is a valuable framework that allows us to address LGBTQ+ health contexts. This framework provides insight into systems that produce stigma and other inequities.

Thus, the goal for this Collection is to provide a designated outlet for original research on LGBTQ+ health – both broad and intersectionally construed. Analyses linking LGBTQ+ health with social determinants (e.g., immigration, transportation, employment, housing, law/policy) are invited. Specifically, we welcome quantitative, qualitative, and mixed method studies on LGBTQ+ health. We also welcome manuscripts that apply evidence synthesis, including meta-analyses which focus on health-related outcomes (e.g., disparities, predictors of mental or physical health outcomes, group comparisons, experience in/access to/utilisation of healthcare provisions) among LGBTQ+ communities. We strongly encourage research developed through participatory and culturally informed methodologies that highlight empathy and respect of the lived experiences of affected communities.

Author contributions

ID-N drafted the editorial; MB provided edits.

Declarations

Competing interests

The authors declare no competing interests.