Even as societal attitudes and laws have shifted, many queer people from minority communities still stay in the closet. Understanding the reasons why can help health professionals better serve this group, and everyone to better understand the challenges this community faces.

One overarching area of concern is the experience of "minority stress," which is defined in the research literature as the extra mental stress that comes from being in a marginalized group (Meyer 2003). This applies to people of color, LGBTQ+ people, and those identifying with multiple marginalized groups. For example, psychiatric symptoms have been linked to both heterosexism and racism for black gay men (Zamboni and Crawford 2007) and for Latino gay and bisexual men (Diaz et. al. 2001).

Coming out of the closet can be a stressful time for anyone. And in terms of staying in the closet, the research has shown some differences when comparing LGBTQ+ people of color to their white counterparts. People of color are less likely to come out to their parents (Grov et. al. 2006) and both Black and Latinx LGBTQ+ youth disclose their identity to fewer people than white LGBTQ+ youth. Studies also show that black LGBTQ+ youth are less comfortable with their sexual and gender identity and less likely to engage in LGBTQ+ groups or activities (Rosario, et al 2004).

The Role of Discrimination in Minority LGBTQ+ Mental Health

There is much evidence of discrimination from the larger racial minority communities that would lead someone to be reluctant to disclose an LGBTQ+ identity. In the Black community, studies show that there is strong religious affiliation and strong adherence to rigid gender roles which can make being LGBTQ+ people less accepted (Martinez and Sullivan 2012). Many out LGBTQ+ Black people therefore conceal their sexual and gender identities in church and family functions, adhere to strict gender guidelines so as to "pass" in their community, and report harboring a significant amount of internalized homophobia (Bowleg 2013, Walsh 2016, Bowleg et. al. 2003).

For all LGBTQ+ people of color, racial microaggressions, homophobia and transphobia in the form of internalized discriminatory beliefs and family rejection all impact mental health (Salerno et al. 2023). Some studies show that Latino men experience more anti-gay prejudice in their communities than European Americans. Asian Americans sometimes associate LGBTQ+ identities with being "Western" and therefore deny their existence within the Asian-American community, seeing it as shameful (Balsam et. al. 2011).

Another issue affecting this population is racism within the LGBTQ+ community. Racial minority LGBTQ+ individuals sometimes report exclusion from LGBTQ+ events and spaces. They also report being either explicitly rejected or objectified based on their race in LGBTQ+ dating spaces (Balsam et. al. 2011). This is sometimes termed "sexual racism" and feeds off stereotypes. It can lead to worse mental health outcomes for LGBTQ+ people of color, as well as higher rates of substance use and internalized prejudice, resulting in lower self-esteem (Wade and Haper 2020, Plummer 2007). This is not just confined to the United States, as LGBTQ+ people of color in the UK and Australia also report similar racism in LGBTQ+ dating (Greaves 2022, Callendar, et al 2015).

Impacts of Discrimination

Multiple studies have shown that LGBTQ+ people of color suffer disproportionately in multiple domains. The Williams Institute of UCLA found that LGBTQ+ people of color are less insured, less likely to attend college, less likely to be married, and less likely to be financially stable than their white counterparts. One silver lining is that LGBTQ+ people of color were less likely to be depressed than their white counterparts, though the research did not offer an explanation as to why (Williams Institute 2022). However, one possibility is that strong family and social bonds within many minority communities may be protective for depression, even for LGBTQ+ people.

A 2020 survey from the Center for American Progress found that LGBTQ+ people of color were more likely to be discriminated against by their healthcare provider or have a provider refuse to see them versus their white counterparts. Especially alarming was the finding that transgender people of color were two to four times more likely to face discrimination, abuse, or outright rejection in a healthcare setting compared to white transgender people.

Similarly, LGBTQ+ people of color were twice as likely to be discriminated against in housing and were slightly more likely to avoid public spaces or seek healthcare due to fears of discrimination as compared to white LGBTQ+ people. Finally, like the Williams Institute study, the Center for American Progress found that LGBTQ+ people of color were more likely to be impoverished and financially struggling compared to their white counterparts (Center for American Progress 2021).

Taking Action

The main takeaways from the research and action steps for health professionals and LGBTQ+ people of color:

1. Clinicians should be aware that the multiple minority status of this population causes increased mental stress and worse health and social outcomes. Therefore, particular attention and assistance must be given to LGBTQ+ people of color.
2. LGBTQ+ people of color can take steps to heal the mental stress by finding spaces with people like them in order to feel less alone or isolated, seeking out mentors in order to better navigate the world as a multiple minority, and going to therapy. One example of this is "Mi Centro, " the Latinx-focused program of the Los Angeles LGBT Center, where I work. It has Spanish-language programming and groups and treatment designed specifically for the Latinx LGBTQ+ community.
3. More research is needed into the specific outcomes and interventions for LGBTQ+ people of color.
4. More education of providers is needed in order for Psychiatrists to be culturally competent in treating these specialized populations