‘They literally have to hide again.’ LGBTQ youth suffer growing despair as COVID-19 drags on

The back-to-back calls from anguished parents of two different patients stunned Dr. John Steever. As a pediatrician at Mount Sinai Adolescent Health Center in New York City, Steever cares for young patients who identify as LGBTQ. It’s not uncommon to hear about a few who cut themselves to release the psychological pain that they are enduring.

But when two patients in a row became hospitalized because of self-harm, it was a sign of the growing despair among LGBTQ youth.

“Levels of depression have gone up,” Steever said.

Americans of all ages are reporting increased depression, anxiety and even thoughts of suicide as the pandemic presses on, but the problems are most pronounced among the young, and especially LGBTQ youth. In a recent survey of nearly 5,500 adults by the federal Centers for Disease Control and Prevention, 75% of those ages 18 to 24 said they have suffered at least one adverse mental or behavioral health symptom related to the pandemic. Almost 26% reported thinking about suicide.

The pandemic is also raising the risk of depression, anxiety, and other mental health disorders among children and adolescents, research has shown.

Adolescent health experts and social workers say the disruptions that make the pandemic so emotionally vexing for many people — physical distancing, social isolation, loneliness, and anxiety about the future —are especially tough for LGBTQ youth and young adults. They may be trapped in a home where no one accepts their sexual orientation or identity. In New York City, where many of Steever’s patients are low-income and live with family in small apartments, there is little privacy for Zoom chats and phone calls with companions.

“They’d come out (as LGBTQ) before the pandemic, and after they had done something big like that, they literally have to hide again,” Steever said. “Suddenly, when you take away the friend structure, that makes (coming out) a bit more of a challenge. Everybody’s suffering, but I think for the sexual minority kids, not only are the bad things still there, but there are no friends.”

Even before the upheaval of COVID-19, LGBTQ were particularly vulnerable to mental health struggles and faced significant barriers to getting care. The Trevor Project, an organization focused on suicide prevention efforts among lesbian, gay, bisexual, transgender, queer and questioning youth, surveyed 40,000 LGBTQ youth ages 13 to 24 and found that 40% had seriously considered suicide and 68% had recently experienced symptoms of anxiety disorder.

More than half said they wanted mental health care but could not get it, most often because they couldn’t afford it or had concerns about asking for the permission of a parent or caregiver. Black, Latinx, and Asian American youth were less likely to receive services than White youth, and youth in the South more often reported unmet mental health needs than youth in other regions, according to a breakdown of the data.

“Suddenly, when you take away the friend structure, that makes (coming out) a bit more of a challenge. Everybody’s suffering, but I think for the sexual minority kids, not only are the bad things still there, but there are no friends.” —  Dr. John Steever, Mount Sinai Adolescent Health Center

 

Black, Latinx, and Asian American/Pacific Islander youth who identify as LGBTQ also expressed concerns about the stigma of seeking mental health services and worried about a mental health system they believe isn’t equipped to understand their racial and ethnic identities.

The researchers found some promising results too: youth who had a relationship with an accepting adult such as a teacher, coach or school counselor were 40% less likely to report a suicide attempt in the past year. But the pandemic may erode that sort of progress. An updated study by The Trevor Project found that many LGBTQ youth no longer have access to their usual support systems because of the pandemic disruptions.

“Given the disproportionately higher rates of mental health challenges and suicide attempts reported by LGBTQ youth, any barriers to mental health care can have enormous consequences," said Amy E. Green, director of research for The Trevor Project.

“From the top down, we must all work together to actively confront mental health stigma and reduce fears around asking for help," Green said via email. “It will require major investment in public-funded programs and a wide variety of policy changes aimed at expanding access, improving the cultural competency of providers, and eliminating structural barriers.”

Those barriers are a concern for Erica Rodriguez, a mental health clinician within the Children, Youth and Family Services at the Los Angeles LGBT Center. “Taking away a support system that they knew, the structure that LGBTQ youth had set up for themselves, was greatly impacted by this pandemic,” she said.

In the past few weeks, more parents and even a youth’s uncle have called her to say their child is being bullied during virtual class time, because of the child’s sexual orientation.

And what about the LGBTQ youth who can’t call? Rodriguez worries about young people from low-income families who may not accept their identity or even know about it, or youth who may lack the privacy to make a phone call because they share cell phones with family members.

Even with more positive representations of LGBTQ people on television and social media, young people can still feel their sexual orientation or gender identity carries a stigma for parents, Rodriquez said. Youth who feel this way are more likely to become withdrawn and may recede back into the shadows.

“As humans we are resilient,” she said. “But our resilience comes from connecting to others. What we are going to see is that resilience starts to taper off.”

Abi Raderman, 17, a hotline volunteer for Teen Line, often hears the fear, loneliness, and anxiety in the voices of youth who call in. Based out of Cedars-Sinai Medical Center in Los Angeles, Teen Line is open from 6 to 10 p.m. Pacific Time, but calls come from youth nationwide.

Before the pandemic, teens typically called, sent texts, and emailed to share issues with parents, school, and friends. Now more teens are calling about feeling trapped and having no outlets to talk to others their age.

Calls to the hotline have increased by 44%, according to Teen Line Executive Director Michelle Carlson. Fewer kids are calling about school-related stressors, and more are talking about anxiety, family tensions, suicide and loneliness. Calls reporting self-harm have increased by 24%.

For those who identify as LGBTQ, there is an added layer of anxiety, Raderman said.

"You have parents who are not supportive, who are not accepting of them or who are not using the pronouns of choice.”

Having had her own issues with mental health, Raderman said she understands the need to feel reassured. She tries to help teens feel valued and connects LGBTQ callers with resources such as The Trevor Project.

"We let them know there's nothing wrong with them, that they are loved, and accepted,' she said. "We keep letting them know that they are not alone."

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