How Patterns of Victimization Among LGBTQ Individuals Impact Mental and Physical Health
Francesca Kassing, Ph.D., Tracy Casanova, Ph.D., James A. Griffin, Ph.D. and Lara M. Stepleman, Ph.D.
August 22, 2020
It is well-known that LGBTQ individuals are at elevated risk for violent victimization (Friedman et al., 2011; McKay et al., 2017) and often experience greater health disparities (McKay, 2011) compared to their non-LGBTQ counterparts. It is also important to consider that LGBTQ individuals historically report high rates of discriminatory violence based on their gender identity and/or sexual orientation (e.g., Pew Research Center for the People and Press, 2013) and that rates of discriminatory violence may be higher among less accepting and inclusive communities. Therefore, in our study, we wanted to 1) explore whether different patterns of victimization emerged among LGBTQ individuals, and 2) determine whether these patterns were related to mental and physical health outcomes.
To answer these questions, we analyzed a sample of 385 LGBTQ individuals participating in a health needs assessment in the Southeastern United States. The mean age of the sample was 34.82 years (SD = 13.45) and ranged from 18 to 76 years old. Participants mostly identified as gay/lesbian (63.4%) and cisgender (85.1%) and the majority were White (73.4%), with smaller contingencies of Black (19.2%) and Hispanic (7.4%) individuals. Participants reported on their previous victimization experiences, specific mental and physical health conditions (e.g., depression, anxiety, hypertension, heart disease), and number of poor mental and physical health days experienced over the past 30 days (items drawn from the HRQOL; Centers for Disease Control and Prevention, 2016).
To address our study’s research questions, we performed a latent class analysis (LCA) to identify patterns of victimization and subsequently compared identified groups on mental and physical health outcomes. The LCA identified a 3-class model with classes characterized by low trauma (71.4%), nondiscriminatory violence (15.1%), and high trauma (13.5%).
The following main findings emerged:
- The majority of the victimization items were experienced by at least 20% of our sample, with some items being reported by closer to a third of the sample (i.e., physical assault by a partner, sexual assault by a non-partner, and stalking)
- There were more cisgender women and transgender individuals in the high trauma group and more cisgender women in the nondiscriminatory violence group, suggesting that these individuals are particularly at risk for violent victimization perpetrated by partners, non-partners, and based on their gender and sexual identities
- Individuals in the high trauma class reported more poor physical and mental health days over the past month compared to both the nondiscriminatory violence and low trauma classes, demonstrating a link between experiences of varied trauma exposure and perceived health
- There were higher rates of anxiety, depression, drug abuse, suicidal ideation, and suicide attempts among the high trauma and nondiscriminatory violence groups compared to the low trauma group
- Although participants in the high trauma class reported more poor physical health days than the other two classes, they did not report higher rates of any specific physical health conditions. This finding may be a reflection of the younger mean age of our sample (i.e., 34.82 years)
Findings from this study suggest that polyvictimization is an important risk factor for poor mental and physical health among LGBTQ individuals. These findings indicate that there is diversity among LGBTQ individuals with regard to victimization classes and across different gender identities. Therefore, while it is important to understand relationships between victimization and health outcomes among the LGBTQ population as a whole, it is also necessary to understand how adverse life events impact particular subgroups to provide the best and most effective care.
Our results have particularly important implications for LGBTQ individuals living in smaller, metropolitan areas of the Southeastern United States. Given the significant association between violent victimization (particularly when based on gender or sexual identity) on health found in our study, community-level policies may be warranted in these communities to help protect these at-risk populations (e.g., policies increasing outreach and visibility of LGBTQ groups, statewide protections against employment discrimination). Furthermore, these findings have both clinical and policy-level implications for addressing victimization among LGBTQ populations. For example, health care organizations and providers should seek to take a trauma-informed care (TIC) approach to service delivery with LGBTQ individuals, which emphasizes the provision of culturally sensitive and strengths-based care to traumatized populations (Elliot et al., 2005). At a broader policy level, it is also important to acknowledge and address the health disparities present for LGBTQ populations that can exacerbate these issues and incur additional costs at the individual, institutional, and societal levels.
Centers for Disease Control and Prevention. (2016). Health-related quality of life (HRQOL): Methods and measures. Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/hrqol/methods.htm
Elliott, D. E., Bjelajac, P., Fallot, R. D., Markoff, L. S., & Reed, B. G. (2005). Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33, 461-477. https://doi.org/10.1002/jcop.20063
Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E., & Stall, R. (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101, 1481–1494. https://doi.org/10.2105/AJPH.2009.190009
McKay, B. (2011). Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources. Medical Reference Services Quarterly, 30, 393–401. https://doi.org/10.1080/02763869.2011.608971
McKay, T., Lindquist, C. H., & Misra, S. (2017). Understanding (and acting on) 20 years of research on violence and LGBTQ+ communities. Trauma, Violence, & Abuse, 20, 665–678. https://doi.org/10.1177/1524838017728708
Pew Research Center for the People and the Press. (2013). A survey of LGBT Americans: Attitudes, experiences and values in changing times. http://www.pewsocialtrends.org/2013/06/13/a-survey-of-lgbt-americans/
Kassing, F., Casanova, T., Griffin, J.A., Wood, E. and Stepleman, L.M. (2020), The Effects of Polyvictimization on Mental and Physical Health Outcomes in an LGBTQ Sample. Journal of Traumatic Stress. doi:10.1002/jts.22579
Questions for Discussion
- What are some potential explanations for why the high trauma group reported more poor physical health days, but not higher rates of specific health conditions (e.g., hypertension, heart disease)? Is one of these outcomes more relevant for clinical practice?
- How could these findings be applied to improve our current screening and intervention practices for trauma exposure and mental health among LGBTQ individuals? Should these practices be different in medical vs. non-medical settings?
- What specific policy changes would be appropriate at the local, state, and federal levels to reduce victimization and health disparities for LGBTQ individuals based on our findings?
About the Authors
Francesca Kassing, Ph.D., is a Postdoctoral Fellow at the Trauma and Grief Center at Baylor College of Medicine/Texas Children’s Hospital. Her research interests include risk and protective factors for externalizing behavior, effects of traumatic experiences, and predictors of intervention outcomes. Her research seeks to examine the effects of environmental stressors on longitudinal outcomes to inform effective interventions for at-risk individuals.
Tracy Casanova, Ph.D., is an Assistant Professor in the Department of Psychiatry and Health Behavior at Augusta University. Her research interests include health disparities and identity development in the LGBTQ community, the impact of trauma on physical and mental health, and the cultural factors of mental illness. Her research seeks to examine how systemic factors disproportionality affect minority communities and how to mitigate these issues.
James A. Griffin, Ph.D., is a Behavioral Health Psychologist in the LGBT Health Resource Center at Chase Brexton Health Care. His research interests include biopsychosocial and cultural determinants of health within LGBTQ+ communities.
Lara Stepleman, Ph.D. is a Professor of Psychiatry & Health Behavior in the Medical College of Georgia at Augusta University and the Patient-and Family-Centered Care LGBTQ Information Officer for Augusta University Medical Center. Her research and training interests are related to sexual health and functioning, LGBT health disparities, gender-affirming care, and the intersection of chronic physical and mental illness.