Mental Health Risks Among LGBTQ Youth With Diabetes
Editor’s Note: If you identify as a member of the LGBTQ community and are experiencing a change in your mental state, text or call the Trevor Project hotline at 1-866-488-7386. The hotline is available 24/7.
2021 surpassed 2015 for having the most anti-LGBTQ legislation, according to the Human Rights Campaign. One of the laws passed earlier this year occurred in Arkansas, banning access to gender-affirming care for transgender youth. Not only do LGBTQ youth experience mental health issues due to stigma, discrimination and denial of human rights, but the policies and communities in which they live have a direct impact on their health. So what happens when taking care of an intense disease like diabetes is added to the mix?
For Jessie*, a ninth grader with type 1 diabetes based in Connecticut, navigating their LGBTQ identity and type 1 diabetes was challenging, especially in school. “I definitely had some anxiety at school before all my other friends came out,” Jessie tells Beyond Type 1.
When Jessie disclosed their LGBTQ identity to their mother Amanda*, who is also a volunteer for several diabetes non-profits, she thought it was a phase. “I didn’t think anything of it,” Amanda tells Beyond Type 1. But after that talk, their relationship evolved. “I’ve tried to be super supportive. I’ve told Jessie, no matter what name it’s been, you don’t need to decide right now. Be fluid,” Amanda says.
It also took a while for Jessie to find their friend group. “That friend group has evolved over the years. There’s definitely been some friends that were lost along the way because they’ll just never understand or they won’t support, but there’s a good group of friends that support both type 1 and LGBTQ now, which is great,” Amanda says.
“You should try and find supportive friends,” Jessie says.
The Mental Health Impact: It’s About Support
The intersection of having diabetes and an LGBTQ identity can add layers of stress, says Nicole M. Bereolos, PhD, MPH, MSCP, CDCES, clinical psychologist and certified diabetes care and education specialist.
One thing that can make navigating diabetes as an LGBTQ individual difficult is the lack of acceptance from loved ones, including family and friends. When family acceptance is in question, “their immediate concern is not diabetes self-management. Instead, it is more fundamental things, such as housing and food,” Bereolos tells Beyond Type 1.
According to the Human Rights Campaign, LGBTQ youth are at higher risk of experiencing homelessness due to family rejection and inadequate support from social services. Particularly in these cases, managing diabetes may be put on the back burner in order to helm concerns of being kicked out of their home by family, or getting cut off from family and financial support.
This lack of acceptance coupled with diabetes management contributes to mental health issues, says Bereolos. In a 2018 report, 77 percent of LGBTQ teenagers reported feeling depressed or down and 95 percent reported trouble sleeping. Other mental health issues can include anxiety, body dysmorphia, gender dysphoria and suicidal ideation.
Barriers To Health Care
According to Sean Cahill, PhD, director of health policy research at Fenway Health, there are a myriad of barriers that prevent LGBTQ people from seeking and accessing care. A major barrier is the lack of access to health insurance.
“Most insurance in this country is still provided by employers. And so having a job correlates with having insurance,” Cahill tells Beyond Type 1. While many youths are covered under their parent’s insurance, LGBTQ youth who are at higher risk of experiencing homelessness are also more likely to not have health insurance coverage. As they grow older, issues of workplace and systemic discrimination continue to make an impact.
In 2017, 15 percent of LGBT (acronym used in the study) Americans across all income ranges were uninsured, based on a study conducted by the Center for American Progress. According to research, when anti-discrimination laws are not put in place, LGBT individuals may lose their jobs and health insurance as a result of being identified as a sexual or gender minority.
Although Jessie has health insurance, Amanda struggled to find mental health care providers with experience treating patients with diabetes who would accept their insurance plan. “I wanted to see this provider because I knew that she was familiar with type 1 diabetes and the specific challenges that a child might have because of it,” Amanda says. The provider was out of network, but Amanda filed for approval with her insurance company. “I got approval, but it took forever,” Amanda says. “In the meantime, we waited to access care.”
Another barrier is the stigmatization of mental health care. 3,500 LGBTQ youth provided detailed written descriptions to the Trevor Project and used words like “embarrassed,” “ashamed,” and “weakness” as reasons for not seeking mental health care, albeit stating that they wanted it. Additionally, LGBTQ youth reported concerns about trusting their therapists as it relates to conversion efforts and privacy of information.
Culturally Competent Care And Acceptance
Coupled with the lack of health insurance, the scarcity of culturally competent providers creates an additional barrier. “A lot of transgender people have had negative experiences in healthcare settings—[they’ve been] treated badly by staff, they’ve been misgendered,” Cahill of Fenway Health explains.
For LGBTQ people of color, their experience with the healthcare system can be even more dire. In one research study, all LGBTQ participants of color reported negative healthcare experiences. A majority of participants reported that they believe they would have been treated better if they were cisgender or white. “And that can cause somebody to just walk out of a healthcare practice,” Cahill says. This underscores the importance of culturally competent providers who are trained in providing LGBTQ health care.
Rob Todaro, communications manager for The Trevor Project, tells Beyond Type 1 that LGBTQ youth are at even higher risk for suicide because of how they are treated. “We know that increased experiences of victimization can compound and produce negative mental health outcomes,” Todaro says.
Misgendering a person can have a profound impact on suicide rates. The Trevor Project’s National Survey on LGBTQ Youth Mental Health 2021 found that 24 percent of LGBTQ youth attempted suicide when no one in their household respected their pronouns compared to 13 percent of LGBTQ youth who lived in a household where all members respected their pronouns.
“Something as simple as respecting a transgender or nonbinary young person’s pronouns can be life-saving,” Tadaro says. “Our research has found that just one accepting adult can reduce the risk of a suicide atttempt among LGBTQ young people by 40 percent. It’s on all of us to foster acceptance of LGBTQ youth and to create safe, affirming spaces in all aspects of life where they can thrive.”
The Bottom Line
“No matter what, your child is still your child, whether they are a boy or girl, or they choose to not identify with a gender, you should still love them no matter what,” Amanda says. In addition to culturally competent care and the backing of family, Amanda stresses that community is needed to better support LGBTQ youth with diabetes.
On September 30, 2021, Jessie joined GLASS (Gay, Lesbian, And Straight Students) Alliance in hopes of forming a more inclusive community for all students, especially LGBTQ students with type 1 diabetes at their school.
“You need the power of community. Whether you’re LGBTQ, type 1, or both, you need to have people around you that support you as a person,” Amanda says.
Health Insurance Access and Resources
Under the Affordable Care Act, LGBTQ youth under the age of 19 with an income less than 138 percent of the federal poverty line may be eligible for Medicaid coverage, depending on a state’s Medicaid expansion. People can stay informed of their state’s healthcare laws and policies using the Movement Advancement Project’s Equality Maps. Other resources include the LGBTQ Education Center, Human Rights Campaign, PFLAG and The Trevor Project
*Names have been changed to protect the youth included.