LGBTQIA+ People’s Perspectives on LGBTQIA+-Targeted State Policies and Mental Health: A Qualitative Study

TL;DR

LGBTQIA+ people in the US report negative mental health effects from policies targeting their community, with the most vulnerable feeling the strongest impacts.

Contribution

This study centers LGBTQIA+ individuals' firsthand accounts of how anti-LGBTQIA+ policies affect their mental health.

Findings

Participants reported chronic worry, hypervigilance, and hopelessness due to anti-LGBTQIA+ policies.

Transgender and nonbinary individuals, youths, and marginalized communities experienced more severe mental health impacts.

Policies restricting gender-affirming care, school discussions, and sports participation were particularly distressing.

Abstract

What are lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority (LGBTQIA+) people’s perceptions of the mental health impacts of recent US LGBTQIA+-targeted policies?

In this qualitative study, 61 LGBTQIA+ adults living in states that recently proposed or enacted LGBTQIA+-targeted policies were interviewed. Participants described 3 perceived mental health impacts, including chronic worry and hypervigilance, social isolation, and hopelessness and powerlessness; they also described that these policies’ perceived negative mental health impacts are more pronounced for those most targeted (transgender and nonbinary people, youths) and for socially and economically marginalized and geographically isolated communities.

In this study, LGBTQIA+ people perceived LGBTQIA+-targeted policies to negatively impact their mental health.

This qualitative study examines how lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority (LGBTQIA+) adults perceive how their mental health has been affected by policies targeting LGBTQIA+ individuals, including, among others, restrictions on gender-affirming care, participation in sports for transgender and nonbinary individuals, discussion of sexual orientation or gender identity in schools.

There has been a rise in state policies targeting the rights of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority (LGBTQIA+) people in the United States. Although large-scale studies have quantified associations between these policies and LGBTQIA+ people’s mental health, less research has centered the first-hand accounts of LGBTQIA+ people.

To examine LGBTQIA+ people’s accounts of how they perceive these policies to be impacting their mental health.

From July to October 2024, 1-hour, semistructured, virtual interviews were conducted with LGBTQIA+ adults living in states that had recently proposed or enacted state LGBTQIA+-targeted policies. The state policies included: (1) gender-affirming care restrictions; (2) sports bans for transgender and nonbinary (TNB) people; (3) public bathroom bans for TNB people; (4) school restrictions of sexual orientation and/or gender identity discussions; and (5) religious exemptions, which permit individuals and service organizations to withhold services from LGBTQIA+ people for religious reasons.

Transcripts were analyzed using thematic analysis, focusing on participants’ perceptions of the mental health impacts of these policies.

Interviews with the 61 adult participants in the sample (median [IQR] age, 35 [30-48] years; 13 cisgender men [21.3%], 19 cisgender women [31.1%], 16 nonbinary people [26.2%], 8 transgender men [13.1%], 2 transgender women [3.3%], and 3 people with another gender identity [4.9%]) revealed that LGBTQIA+ people perceive these policies to negatively impact their mental health. These perceived impacts were organized into 3 themes: (1) chronic worry and hypervigilance, (2) social isolation, and (3) hopelessness and powerlessness. A fourth cross-cutting theme was also identified: participants perceived these policies’ mental health impacts to be unequal and more pronounced for those most frequently targeted by these policies (eg, youths, TNB people), racially and ethnically minoritized people, those without social and financial resources, and those living in rural areas.

In this qualitative study, LGBTQIA+ adults in the United States perceived LGBTQIA+-targeted policies to have profound and unequal impacts on their mental health. As LGBTQIA+-targeted policies increase in number, multilevel resources and supports are necessary to support LGBTQIA+ people’s well-being.

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