As this blog was being written, parents and children with placards were protesting outside a primary school in Birmingham. Pupils were being withdrawn from the school. The head teacher of the school was receiving malicious communications, the local MP stepped in and the police called for an end to the protest. There was counter action. But what was it all about? It was about the school teaching equality and difference – and they included LGBT people. Find out about the #NoOutsiders programme, developed by Andrew Moffat for teaching the equality act in primary schools.

The damage to young individuals this protest may have caused could be considerable, and this study on the factors associated with mental health and suicide risk among LGBTQ students (in this case the ‘Q’ stands for ‘questioning’) provides some valuable evidence on the potential harm.

Conducted in partnership with an LGBTQ young people’s support provider organisation – Metro Charity – the study provides important findings on some of the key risk factors associated with mental health problems, self-harm and suicide risk for young LGBTQ people who are at university.

The study tests some hypotheses based in the existing literature and relating to the ‘minority stress’ theory. The theory was developed by the psychologist Ilan Meyer in 2003 and posits that LGB people experience distinct forms of social stress and ameliorative coping processes that significantly contribute to distress and poorer mental health, including suicidality.

The aim of the study was to investigate:

a wide range of LGBTQ-specific and general factors hypothesized to be associated with mental health problems and suicide risk in LGBTQ youth, including university-specific factors that have not been previously investigated.

Absolutely thrilled to be asked to lead Birmingham Pride this year. What a fantastic response to the protests! #nooutsiders #visibility No Outsiders teacher to lead Birmingham Pride Parade https://t.co/q4R89rEojy

— Andrew Moffat (@moffat_andrew) May 3, 2019

Methods

This qualitative study yielded statistical data from a secondary analysis of a survey dataset.

Outcomes

The research tested a number of  LGBTQ-specific, university-specific and general risk factor hypotheses for four outcomes:

1. Use of current mental health services
2. Current mental health problem
3. Suicide risk
4. Self-harm.

The risk factors investigated were:

LGBTQ specific risk factors

• Bisexual orientation
• Transgender identity
• Negative reactions to coming out from the first friend
• Identifying as LGBTQ at a younger age
• Coming out at a younger age
• Not feeling they were accepted where they live
• Most friends being LGBTQ

University specific risk factors

• University staff not being out
• Staff and students not speaking up against homophobia
• Lectures referring negatively to LGBTQ issues

General risk factors

• Abuse and violence from someone close
• Sexual abuse
• Lower social support
• Being female

These hypotheses were tested in a secondary analysis of the 2012-2013 Youth Chances survey of 1,948 young people aged 16-25 who were recruited through LGBTQ organisations, social media, adverts in the LGBTQ press, at Gay Pride events and through snowball sampling. All respondents were in Higher Education, with a mean age of 20.3 years.

The data was subject to statistical analysis using univariate models ‘to test the association of one predictor with a dependent variable’ and multi-logistic regression to test ‘which risk factors continued to show independent associations with the outcomes when all factors were adjusted simultaneously’.

Results

Of the overall sample, 49.6% were female, 46.3% were male and 6.8% identified in another way. 10.9% identified as transgender. In terms of sexual orientation, 61.7% identified as gay or lesbian, 22.9% as bisexual, 5.3% ‘not sure’ or questioning and 9.1% as ‘something else’ (1.1% identified as heterosexual, but were excluded for the purposes of the study).

The univariate statistical analysis identified significant associations on all four outcomes with all the hypothesised general, individual and interpersonal LGBTQ risk factors and discrimination. The risk factors of sexual abuse, other abuse or violence and being transgender had the largest odds-ratio. University risk factors were found to be LGBTQ issues not being included and respected during lessons and having no out members of staff. These were associated with suicide risk and current mental health problems.

The multivariate statistical analysis showed that female gender, sexual abuse, other abuse or violence and being transgender were significantly associated with all four outcomes. In addition, the following outcomes had significant associations with particular hypothesised risk factors:

• Bisexuality for current mental health problem, suicide risk and self-harm
• Being below the age of 10 when they first thought they might be LGBTQ for current mental health service use
• Coming out below the age of 16 for use of mental health services, having a current mental health problem and self-harm
• Having half or more friends who were LGBTQ for mental health service use and self-harm
• Not feeling accepted where they live for suicide risk
• The first friend they came out to having a bad reaction with self-harm and suicide risk
• Having no members of staff at university for suicide risk
• Experiencing criminal victimisation for self-harm.

Conclusion

The authors concluded that:

…in addition to known general risk factors for mental health and suicide risk, various LGBTQ-specific factors are associated with these outcomes in LGBTQ university students. Preventive interventions should take into account that LGBTQ students have specific experiences that may contribute to their elevated risk of mental health problems, self-harm and suicide risk…The educational context provides a valuable but underused opportunity for prevention and treatment of mental health problems and self-harming behaviours in young LGBTQ people.

Strengths and limitations

This study provides some important statistical data on the factors associated with certain very serious mental health outcomes for LGBTQ students in Higher Education. The authors note a number of limitations including limits on determination of causality and on the original survey recruitment strategy.

In addition to what the authors note, the recruitment strategy will probably not have reached LGBTQ university students who were not engaged with LGBTQ communities’ activities, groups or organisations, who may well experience mental distress. So the main flaws perhaps lie in the original survey itself, rather than the study secondary data analysis.

There was highly limited demographic information, so the research couldn’t ascertain the compounding, intersectional risk factors for LGBTQ students with additional protected characteristics such as race, disability and/or religion and belief.

Summing up

Using statistical analysis of an existing dataset, the research established a number of factors associated with current mental health service use, current mental health problems, suicide risk and self-harm. While highly valuable in itself, the findings leave us with questions about the ‘why’ and ‘how’, and perhaps the need to generate more evidence to improve matters for LGBTQ students.

For example:

• Why is having most friends who are LGBTQ a risk factor, given what we know about the importance of communities of identity for belonging and support for LGBTQ people?
• Why is it that staff and students not speaking up consistently against LGBTQ stigma and LBGTQ students not being out to everyone at university were not factors associated with risk of any of the outcomes?

This perhaps leaves us with the only option is to repeat the old worn out phrase ‘further research is needed’.

But let’s apply this research to a real life situation. If we think back to the protest outside the primary school in Birmingham and the public display of intolerance towards LGBTQ people, we must consider the potential harm in the light of the study findings. Thinking they were LGBQ or T under the age of 10, victimisation, and not being accepted where they live were significantly associated with mental health and suicide risk among LGBTQ students. Sadly, equality policies won’t save us yet.

Links

Primary paper

Gnan GH, Rahman Q, Ussher G, Baker D, West E, Rimes KA. (2019) General and LGBTQ-specific factors associated with mental health and suicide risk among LGBTQ students. Journal of Youth Studies. DOI: 10.1080/13676261.2019.1581361

Photo credits

• Photo by Elyssa Fahndrich on Unsplash
• Photo by Mario Azzi on Unsplash
• Photo by Loïc Fürhoff on Unsplash
• Photo by Nadine Shaabana on Unsplash
• Photo by Jordan McDonald on Unsplash