Understanding mental health problems in lesbian, gay, bisexual and transgender university students:
: a mixed method approach

Student thesis: Doctoral ThesisDoctor of Philosophy


Lesbian, gay, bisexual and transgender (LGBT+) students have been shown to be at a higher risk of mental health problems, including depression, anxiety and suicidality, compared to their heterosexual and cisgender peers. Minority stress theory (Meyer, 2003) and the psychological mediation framework (Hatzenbuehler 2009) attribute this increased risk of mental health problems to their experiences with discrimination, prejudice and societal stigma. This association may be caused via both direct and indirect effects, including general and LGBT+ specific cognitive, behavioural and psychological processes. 
This thesis investigates some of the factors contributing to common mental health problems and suicidality in LGBT+ students’ and their support needs. The aim was to produce evidence that would facilitate the development of evidence-based preventive and treatment interventions that seek to reduce psychological distress among this population. This thesis adopted a mixed method design, combining quantitative and qualitative research. 
The first study investigated general and LGBT+ specific factors associated with having a current mental health problem, suicide risk, self-harm and use of mental health services in 1948 LGBT+ university students (aged 16-25). This was a cross-sectional study analysing secondary data from young people who had taken part in the Youth Chances community study in the UK. In multivariate logistic regression, factors associated with all four outcomes were female gender, sexual abuse, experiences of other domestic abuse or violence, and being transgender. Further factors that were significantly associated with one or more of the outcomes included: being bisexual; thinking they were LGBT+ under the age of 10; coming out as LGBT+ under the age of 16; not feeling accepted where they live; having no out staff at university and experiencing LGBT+ related crime. 
The next study was a prospective online study of 385 LGBT+ students. This study investigated a cognitive behavioural model of distress in which the individual’s beliefs and behavioural responses were tested as contributors to subsequent distress. Measures of beliefs (e.g. hopelessness, internalised heteronormativity), mediating factors (e.g. rumination, avoidance), as well as three main distress outcomes (depression, anxiety and suicidality) were tested at baseline, one month and two month follow-up. Structural equation modelling supported the hypothesis that general negative beliefs about the self are prospectively associated with depression/anxiety and suicidality, and that LGBT+ related negative beliefs are independently associated with these outcomes. Both general and LGBT+ related cognitive and behavioural responses mediated the relationship between beliefs and these outcomes, although in the combined final model, LGBT+ related rumination and concealment were significant mediators for only suicidality and not depression / anxiety. 
The qualitative research involved semi-structured interviews and thematic analysis with 20 LGBT+ students with current or previous common mental health problems. Their views on the effects of stigma on their mental health, their coping strategies, and methods of best supporting and treating LGBT+ students experiencing distress were sought. Analyses of their experiences of these issues are presented in three separate chapters. Overt discrimination, microaggressions, societal stigma and family reaction to coming out were perceived as affecting LGBT+ students’ mental health. Participants reported negative effects such as internalised stigma, low self-esteem, hopelessness and anxiety relating to fear of prejudice or discrimination due to their minority identity. The interviews also revealed the use of some unhelpful coping strategies such as rumination and avoidance. The findings suggest that some LGBT+ students may be in a negative cycle of stigma contributing to low and anxious mood, which in turn makes them both more vulnerable to the impact of stigma and the use of unhelpful coping strategies, further adversely impacting their mental health. However, the students also reported a number of helpful strategies including social support; active coping methods such as physical exercise; directly addressing LGBT+ stress and changing the way they think about LGBT+ stigma experiences. Interventions could aim to help cultivate such strategies in LGBT+ students experiencing stigma and/or distress. This study also suggests that students with experience of a common mental health problem had not been able to access LGBT+ targeted interventions and that within generic services their specific needs were not adequately addressed. 
This is the first research of its kind to adopt a mixed method approach, target LGBT+ university students specifically, and include both LGBT+ specific factors and general factors while investigating multiple mental health outcomes. The current thesis underlines the importance of university counselling services, personal tutors and others supporting LGBT+ students being aware of the potential negative effects of external stigma and discrimination, as well as self-stigma, on these young people’s mental health and risk of suicidality. This thesis highlighted a number of potential targets for interventions with LGBT+ students. Psychological interventions may be required to address severe and chronic effects of childhood or subsequent victimisation, reduced self-esteem, hopelessness, negative attitudes towards the self and others, avoidance, rumination and confusion or lack of self-acceptance about one’s minority identity. The findings support the provision of CBT for LGBT+ students and suggest targeting both general and LGBT+ related negative beliefs and responses. Qualitative findings highlight the need for interventions to address the individual, interpersonal and societal factors that may influence mental health in LGBT+ students.
Date of Award1 Dec 2019
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorKatharine Rimes (Supervisor) & Qazi Rahman (Supervisor)

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