DEPRESSION LEVELS IN LGBT COLLEGE STUDENTS
JULIANNA RUSH
abstract
Levels of depression among college students is at a peak of concern, specifically for members of minority groups including the LGBT community. A large presence of this diagnosis exists from a combination of factors including lack of acceptance and harassment. Some aspects of major depressive disorder include risk factors, symptoms, and negative life outcomes. When rates of depression regarding gay, lesbian, bisexual and transgender identifying people are com- pared to the levels of their straight and cisgender counterparts, it is concluded that members the LGBT community suffer at higher rates of major depressive disorder. All studies, besides one, showed higher percentages amongst the LGBT by about twice as much.
defining depression
Major depressive disorder is a mental illness that impacts people of all ages, races, gen- ders, and sexualities. Generally speaking, people with depression experience persistent feelings of sadness and hopelessness along with losing interest in activities they once enjoyed (5th ed.; DSM –5; American Psychiatric Association, 2013). Depression also may manifest with physical symptoms such as chronic pain or digestive issues (5th ed.; DSM –5; American Psychiatric As- sociation, 2013). In order to be diagnosed with depression, an individual must experience a min- imum of five out of the eight symptoms consistently during a two week period (5th ed.; DSM –5; American Psychiatric Association, 2013). The main symptoms of depression includes experienc- ing a depressed mood most of the day during nearly every day, feeling less interested in most ac- tivities, significant weight loss when not dieting, thought processing being slowed and a reduc- tion of physical movement, fatigue or loss of energy nearly every day, feelings of worthlessness or increased amounts of inappropriate guilt nearly every day, inability to think or concentrate, indecisiveness, recurrent thoughts of death, recurrent suicidal ideation without a plan, a suicide attempt, or a specific plan for committing suicide (5th ed.; DSM –5; American Psychiatric Asso- ciation, 2013). Symptoms are exhibited and experienced differently in people depending on their individual case. Two individuals may experience all the same symptoms while others may only share one symptom. Either way, their depression diagnosis is valid and should be taken seriously.
causes for depression
Depression can be caused by a multitude of factors including social isolation and abuse. Different types of abuse may include verbal, emotional and physical (Mehra and Braquet, 2011). Some people may only experience one form of abuse while others experience all of them. Ac- cording to one study, members of the LGBT community are more likely to experience these types of abuse due to the coming out process. For many people this is a struggle because their family members and friends do not accept them. This process may lead for the individual to en- dure rejection, stigmatization, bullying, along with abuse in forms of verbal, physical and emo- tional (Mehra and Braquet, 2011). LGBT individuals may also experience discrimination within schools and workplaces (Mehra and Braquet, 2011). The main causes of depression all stem from struggles involved with existing within our interactive and social world. Members of the LGBT community are more vulnerable to experience these struggles and therefore, experience higher rates of depression than there heterosexual and cisgender counterparts.
Prevalence of Depression Among LGBT College Students
Prevalence of Depression within Transgender Individuals
The transgender community has experienced high rates of major depressive disorder along with the daily struggles that surround this diagnosis. A study conducted by Oswalt and Lederer (2016) examined college aged students. Participants filled out a survey to see who was diagnosed with depression within the last six months. Individuals who took part in the study ranged between ages eighteen and twenty-six along with attending a variety of schools such as the University of Texas. The study compared the rates of depression between transgender individuals along with their cisgender counterparts. Out of all the cisgender female participants, 43,886 were diagnosed with depression within the last twelve months. This is equivalent to 12.3 percent of the population (Oswalt and Lederer, 2016). From the cisgender male population, 12,443 individuals were diagnosed, which equals 6.5 percent of the said population (Oswalt and Lederer, 2016). From the transgender population, 392 people were diagnosed with depression within the last twelve months. This is equivalent to 34.3 percent of the entire group of transgen- der individuals (Oswalt and Lederer, 2016). These large disparities derive from high rates of re- ported discrimination and lack of social support (Oswalt and Lederer, 2016). From the study’s findings, we it is concluded that transgender individuals are being diagnosed with depression at a substantially higher rate than their cisgender counterparts and therefore, are suffering the conse- quences from experiencing it.
Another study examining depression within transgender college students was conducted by Moran, Chen, and Tryon. Participants consisted of 347 LGBT college students. Part of the study specifically observed factors effecting the transgender community. A five point scale called the Epidemiologic Studies-Depression Scale was used. For this scale, one represents something not experienced and five represents an experience that has happened often. This scale was used in order to measure frequency of verbal, relational, physical, and cyber abuse. For transgender individuals, their median scores included a 2.02 for verbal abuse, 1.72 for relational abuse, 1.14 for physical abuse and a 1.69 for cyber abuse (Moran, Chen & Tryon, 2018). The individuals conducting this study did not feel the need to include these participants, meaning there is a lack of comparison data. They did not provide this due to the fact that heterosexual and cisgendered individuals do not experience these types of abuse at high rates. However, this still limits us in terms of bringing conclusions to the general population. Even with this limitation, we are able to conclude that transgender individuals are experiencing abuse in many forms. The above research demonstrates how the transgender community is at higher risk for and activity experiencing higher rates of depression.
Prevalence of Depression Within Gay, Lesbian, and Bisexual Individuals
Similar struggles exist for Gay, Lesbian, and Bisexual members of the LGBT community. Moran et al. (2018) in their research titled also studied the four types of abuse for these popula- tions. Gay individuals scored a 2.03 on the verbal scale, 1.57 on the relational scale, 1.08 on the physical scale, and a 1.42 on the cyber scale (Moran, Chen & Tryon, 2018). Lesbians scored a 1.93 on the verbal scale, 1.63 on the relational scale, 1.12 on the physical scale and a 1.42 on the cyber scale (Moran, Chen & Tryon, 2018). The bisexual population scored a 1.78 on the verbal scale, 1.42 on the relational scale, 1.03 on the physical scale and a 1.39 on the cyber scale (Moran, Chen & Tryon, 2018). Similarly to the results within the transgender community, the results for heterosexuals was not found due to the lack of necessity. Once again, this limits us in our ability to make generalized conclusions. However, we are still able to conclude that gay, les- bian, and bisexual individuals are experiencing abuse. Results show that these individuals are suffering at similar rates as the transgender population, which is an issue for all parties.
One study measuring the levels of depression within specifically lesbians and bisexual women was conducted by Kerr, Santurri, and Peters. The study consisted of students within the American College Health Association and completed the second National College Health As- sessment. Twelve different factors were measured and are listed on the chart below. For the pur- poses of this research, the three relevant factors include feeling as though things were hopeless, feeling so depressed that it is difficult to function, and having a depression diagnosis. In terms of possessing feelings of hopelessness, 51% heterosexual women agreed, 68% bisexual women agreed and 63% bisexual women agreed (Kerr, Santurri & Peters, 2013). Within the feeling so depressed it was difficult to function measure, 32% of heterosexual women, 57% percent of bi- sexual women and 51% of lesbian women all agreed with the statement (Kerr, Santurri & Peters, 2013). The amount of women who stated they have been diagnosed with depression are as fol- lows, 17% percent of straight women, 41% percent of bisexual women and 33% percent of les- bian women (Kerr, Santurri & Peters, 2013). The above statistics allow us to conclude that les- bian and bisexual women experience higher rates of hopelessness, struggling to function, and receiving a depression diagnosis.
Note: The above table exhibits mental health issues as reported by heterosexual, lesbian, and bisexual women.
Another research article measured levels of depression between members of the LGBT community versus heterosexual individuals. Participants consisted of 784 undergraduate students who completed the Well Being Assessment at Wake Forest University. The assessment showed that 49% of heterosexual participants experienced depression while 53% LGB members have experienced depression (Wilson & Liss, 2020). The p value in which correlated between sexual orientation and depression was 0.43*** and therefore, is significant and further demonstrated below. The findings allow for us to conclude that lesbian, gay and bisexual individuals are more likely to experience depression than heterosexual individuals.
Another research study proved the enhanced struggle for members of the LGBT community within the medical field. The study consisted of 1,334 students throughout multiple medical departments completing a survey about depression. The survey showed that 25% of LGBT stu- dents stated they had depression while only 12% of heterosexual students conveyed they had de- pression (Lapinski and Sexton, 2014). From the findings we can conclude that members of the LGBT community are suffering from depression at more than double the rate of their heterosexual counterparts.
The results from the above four research articles allow us to conclude that lesbian, gay, and bisexual individuals suffer from depression, in terms of a diagnosis and symptoms, at higher rates than their heterosexual counterparts. These rates in all studies, besides for the one conduct- ed at Wake Forest, were significantly higher than their heterosexual and cisgender counterparts. From these results, we can conclude that depression is highly prevalent amongst college members of the LGBT community, which is a large issue.
Trends of Depression Among LGBT College Students
Members of the LGBT community have suffered from lower levels of depression since the start of the early 2000s. According to Mehra and Braquet, LGBT individuals go through the coming out process approximately ten years earlier than people did thirty years ago, which im- plies that LGBT individuals are experiencing less emotional hardships than ever before (Mehra and Braquet, 2011). Coming out is directly associated with the reduction of stress and anxiety, higher self esteem and an improved quality of life (Mehra and Braquet, 2011). Depression tends to decrease as all these three factors increase and therefore, people are experiencing depression at lower rates due to positive change.
The change in levels of suffering has a lot to do with technology and the connections people build through using it. Social media, in all forms, allows for individuals to connect with those they might not have otherwise. It also for people to reach out for assistance without expos- ing their identity, which means people can openly and honestly find answers about their internal conflict without feeling a sense of vulnerability. Technology also solves the problem of distance. People are now exposed to individuals from all over the world, which means more information can be shared with one another. Due to these connections and spread of knowledge, even more knowledge has come from it. Stages of coming out have now been identified in order to help others understand their own emotions and experiences. The five stages include self recognition, sharing one’s identity with other LGBT members and other people in the individual’s life, positive self identification and integration of LGBT identity within one’s own life (Mehra and Braquet, 2011). These forms of communication and levels of knowledge have changed the lives of the LGBT community drastically within the last twenty years because they now have the re- sources necessary in order to process and accept their identity.
Educational institutions have taken notice to this change and started the process of im- plementing these resources within their libraries, which only furthers the LGBT community’s access to the information they need (Mehra and Braquet, 2011). Institutions increase their re- source levels with the intent to support LGBT causes in ways such as implementing practice-based and action-oriented efforts of support, documenting the stories of coming out events and their outcomes, collecting both quantitative and qualitative sets of data that can be used to sup- port and validate various LGBTQ causes at the local, regional, and national levels of use (Mehra and Braquet, 2011). School systems and their increased resources positively impact the decrease in depression amongst LGBT college students.
The combination of technology, educational institutions, and communication has allowed for depression in the LGBT community to decrease. College students use technology as their main resource for information, indicting that they have more access to research and knowledge than the members of the LGBT community that came before them and therefore, suffer from de- pression at lower rates (Mehra and Braquet, 2011).
Negative Effects of Depression
Experiencing depression is troubling experience and impacts different aspects of life neg- atively. Some effects from having depression include struggling with sleep, having an irregular appetite, high levels of self-blame, and struggles with concentration. One study conducted by Fried measured these aspects of life before and after a diagnosis with major depressive disorder. Participants consisted of 3,021 interns within connecting institutions to the researchers (Fried et al., 2015). In order to acquire their calculations, participants filled out the Patient Health Ques- tionnaire, also known as the PHQ-9, which measures and accounts for categories within the DSM-5 (Fried et al., 2015). The study recorded mean values for each category at the baseline and under stress. For sleep, the baseline mean was 0.54 and the under stress mean was 0.82. Under the appetite measure, the baseline mean was 0.35 and the under stress mean was 0.93. For self- blame, the baseline mean was 0.21 and the under stress mean was 0.58. Under the concentration measure, the baseline mean was 0.17 and the under stress mean was 0.52. Each of these had a p value of <0.001, which makes these results significant. From these findings, we can conclude that depression has large effects on sleep, appetite, self-blame and concentration.
Along with more typical unfortunate effects, it also impacts other areas of life and can cause dangerous actions. One study measured the amount of attempted suicides amongst college members of the LGBT community. Participants consisted of 776 LGBT college students. Some participants had overlapping identities, which implies they identified with one or more of the categories being analyzed. 552 of the participants identified as cisgender and a sexual minority, which is referred to as cisgender LGBQ. 214 participants identified as transgender and also expe- rienced an overlap in certain categories (Woodford et al., 2018). Amongst the cisgender community, 36% of gay men, 21% of lesbian women, and 39% of bisexual individuals have all attempt- ed suicide at some point during their lifetime (Woodford et al., 2018). Within the transgender community, 9% general members of the trans community, 9% of gay individuals, 12% of lesbian individuals, and 68% of bisexuals have attempted suicide during their lifetime (Woodford et al., 2018). These numbers are startlingly high, especially for all transgender and bisexual people. From this research, we can conclude that suicide awareness needs to be heightened for members within the LGBT community and more assistance should be provided to those struggling.
Along with suicide being a high risk from depression, so is substance abuse. Another re- search study showed the high alcohol abuse levels amongst college members of the LGBT community. The study consisted of 12,493 participants ranging from ages 18 through 25 during 2003, 2005, 2007, or 2010 surveys and were combined to accumulate the following results (Coulter et al., 2018). In terms of having an alcohol use disorder, 14% of straight women, 30% of bisexual women and 29% of lesbian women have all suffered from one (Coulter et al., 2018). Also in terms of suffering from an alcohol use disorder, 27% of straight men, 39% of bisexual men and 41% of gay men have suffered from one (Coulter et al., 2018). These results imply that more than a fourth of people within each population suffer from an alcohol use disorder, which is an issue. More specifically, members of the LGBT community within each category suffered at higher rates than people who identify as straight.
The above research demonstrates how LGBT college students are at risk for much more than depression. Their depression diagnosis makes them more vulnerable for everyday life im- pacts, suicide and alcohol abuse. From this we can conclude that access to treatment is a very urgent need for these individuals.
Treatment and its Positive Effects
There are multiple forms of treatment that could be accessed for depression such as ther- apy. Campuses often times offer access to counseling centers to their student body. One study looked at the effects of on campus treatment amongst LGBT college students. The study consist- ed of 6,093 college students who used their counseling centers as a form of treatment for their depression. The following statistics show the median levels of pre treatment and post treatment levels of depression. Lesbian individuals had 1.18 median levels of depression pretreatment and 1.19 post treatment. Gay individuals had 1.76 median levels of depression pretreatment and 1.27 post treatment. Bisexuals had 1.80 median levels of depression pretreatment and 1.34 post treat- ment. Lastly, straight individuals had median depression levels of 1.69 pretreatment and 1.17 post treatment (Effrig et at., 2014). The research also noted that lower levels of family support during the pretreatment stage lessened the chance of the counseling services having an effective and positive outcomes for the individual (Effrig et at., 2014). Although none of the p values were <.001, which would have made them significant, we are still able to conclude that counseling centers provided mental health improvements for all participants. These findings imply that counseling is a good treatment option for members of the LGBT community along with their straight counterparts and that acceptance from others is highly important in terms treatment being effective.
One type of therapy those with depression might use for treatment includes CT, which stands for cognitive therapy. Cognitive therapy is based on premise of inaccurate beliefs and maladaptive information processing, which forms the basis of negative thinking patterns (DeRubeis et al., 2008). Along with therapy, people can also be treated with medications. These medications are often referred to as ADM, also known as antidepressant medications. Some of these medications include Monoamine Oxides Inhibitors, or MAOIs for short, and tricycle anti- depressants, which is also referred to as TCAs (DeRubeis et al., 2008). One study measured the impacts both forms of treatment had on a multitude of participants ranging from various treat- ment centers. Effectiveness results were recorded after eight and sixteen weeks of treatment. As for ADMs, 50% of participants experienced positive change within eight weeks and 58% experi- enced positive change after sixteen weeks (DeRubeis et al., 2008). For CT, 43% experienced positive change after eight weeks and 58% experienced positive change after sixteen weeks (DeRubeis et al., 2008). Although we do not have specifics on population, we are able to conclude that ADMs and CT are effective forms of treatment for those with major depressive disorder.
There are multiple different treatments options for LGBT college students. They can refer to their own campuses for counseling center assistance. They could also seek out different styles of therapy such as cognitive therapy. Aside from therapy, medication is also a treatment option with a variety of choices including MAOIs and TCAs (DeRubeis et al., 2008).
limitations
Although this compilation of research allows for us to come to conclusions and ways in which to assist LGBT college students, each article still comes with it’s limitations in terms of claim making. Many of the studies used self report data collection, which allows for possible misinformation to be recorded (Woodford et al., 2018: Oswalt and Lederer, 2016: Kerr, Santurri, & Peters, 2013: Moran, Chen,& Tryon, 2018, Fried et al., 2015). Some research is also catego- rized as cross-sectional, which means we are unable to claim causation (Woodford et al., 2018). One study only accounted for those who worked in the medical field, which means these results cannot be said for outside of this department (Lapinski and Sexton, 2014). Another study used the ACHA-NCHA-II, which is a reference group and therefore, could have not included certain participants in the research (Kerr, Santurri, & Peters, 2013). In another study measuring the level of family support as an assistant factor, they only measured the level of this type of support during pretreatment and not during or after due to the fact that they did not believe this would likely change over time (Effrig et at., 2014). Certain studies had an outweighing amount of one population over another (Chen,& Tryon, 2018). One study used a unit of measure created by Wake For- est University, which needs more evidence of it’s construct validity (Wilson and Liss, 2020). Some studies did not have a wide range in populations types and only observed students within their own institutions (Moran, Chen,& Tryon, 2018: Wilson and Liss, 2020: Coulter et al., 2018). One study spoke very generally about their findings and did not give specific statistics (Mehra and Braquet, 2011). Another study did not list which institutions their participants were found from (DeRubeis et al., 2008).
references
American Psychological Assiciation, DSM-5, (2013)
Coulter, R. W. S., Jun, H., Calzo, J. P., Truong, N. L., Mair, C., Markovic, N., Charlton, B. M.,
Silvestre, A. J., Stall, R., & Corliss, H. L. (2018). Sexual‐orientation differences in alcohol use
trajectories and disorders in emerging adulthood: results from a longitudinal cohort study in the
United States. Addiction, 113(9), 1619–1632. https://doi.org/10.1111/add.14251
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for
depression: treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9(10),
788–796. https://doi.org/10.1038/nrn2345
Effrig, J. C., Maloch, J. K., McAleavey, A., Locke, B. D., & Bieschke, K. J. (2014). Change in
Depressive Symptoms Among Treatment-Seeking College Students Who Are Sexual Minorities.
Journal of College Counseling, 17(3), 271–285. https://doi.org/10.1002/j.
2161-1882.2014.00063.x
Fried, E. I., Nesse, R. M., Guille, C., & Sen, S. (2015). The differential influence of life stress on
individual symptoms of depression. Acta Psychiatrica Scandinavica, 131(6), 465–471. https://
doi.org/10.1111/acps.12395
Kerr, D., Santurri, L., & Peters, P. (2013). A Comparison of Lesbian, Bisexual, and Heterosexual
College Undergraduate Women on Selected Mental Health Issues. Journal of American College
Health, 61(4), 185–194.
Lapinski, J., & Sexton, P. (2014). Still in the closet: The invisible minority in medical education. BMC Medical Education, 14, 171. doi:http://dx.doi.org/10.1186/1472-6920-14-171
Mehra, B., & Braquet, D. (2011). Progressive LGBTQ reference: Coming out in the 21st century. Reference Services Review, 39(3), 401-422. doi:http://dx.doi.org/ 10.1108/00907321111161403
Oswalt, S. B., & Lederer, A. M. (2017). Beyond depression and suicide: The mental health of transgender college students. Social Sciences, 6(1), 20. doi:http://dx.doi.org/10.3390/soc- sci6010020
Moran, T. E., Chen, C. Y., & Tryon, G. S. (2018). Bully victimization, depression, and the role of
protective factors among college LGBTQ students. Journal of Community Psychology, 46(7),
871–884. https://doi.org/10.1002/jcop.21978
Wilson, L. C., & Liss, M. (2020). Safety and belonging as explanations for mental health dispari- ties among sexual minority college students. Psychology of Sexual Orientation and Gender Di- versity. Advance online publication. https://doi.org/10.1037/sgd0000421
Woodford, M.R., Weber, G., Nicolazzo, Z., Hunt, R., Kulick, A., Coleman, T., ... Renn, K.A. (2018).Depression and Attempted Suicide among LGBTQ College Students: Fostering Resilience to the Effects of Heterosexism and Cisgenderism on Campus. Journal of College Student Devel- opment 59(4), 421-438. doi:10.1353/csd.2018.0040.
.png)
Julianna Rush '21
Julianna Rush is a psychology major graduating in May 2021. She was driven to complete this research project by her dedication to improving the lives of members of the LGBT community and discovering solutions to mental health issues.