Why the risk is higher
Being lesbian, gay, bisexual, transgender, queer or questioning is not a mental health problem. What raises the risk is how the world can respond. NAMI notes that LGBTQ+ adults are more than twice as likely as heterosexual adults to experience a mental health condition, especially depression and anxiety disorders, and that discrimination, prejudice, harassment and family rejection can lead to new or worsening symptoms. The NHS similarly links higher rates of depression among LGBTQ+ people to discrimination, homophobia or transphobia, bullying, isolation and rejection.
These pressures are often ongoing rather than one-time events. Some examples adults describe:
- Deciding again and again whether it is safe to come out at a new job, a doctor's office or a neighborhood gathering
- Distance or conflict with parents, siblings or a faith community after coming out
- Being misgendered, or having to correct records and explain yourself to systems that were not built with you in mind
- Worry about legal or political changes that affect your family, health care or safety
- Coming out later in life, after a marriage or career built around a different public identity
- Feeling not fully at home in either LGBTQ+ or straight spaces, which bisexual people often describe
NAMI also emphasizes the other side: LGBTQ+ identity and community can be a strong source of pride and resilience. Many people find that connection with others who share their experience is one of the most protective things in their lives.
Isolation and older LGBTQ+ adults
Loneliness is a quiet risk for depression at any age. The National Institute on Aging lists discrimination based on sexual orientation among the factors that can raise the risk of social isolation and loneliness in older adults. Many LGBTQ+ people in their sixties and beyond lived much of their lives when being out carried serious costs, may not have children, and may have lost friends and partners. Building and protecting a circle of chosen family, staying connected through community groups, and telling a doctor when loneliness is constant are all worth doing. Loneliness, Isolation and Depression covers this in more depth.
Family relationships can also change over time. Some parents and siblings who reacted badly at first move toward acceptance years later; others do not. Therapy can be a place to grieve the family you hoped for, decide what contact is healthy for you, and invest in the relationships that do support you.
Signs it is time to reach out
The NHS suggests getting help if you are tired or sleeping poorly, feel anxious, irritable, low or depressed, no longer want to do things you used to enjoy, or are using alcohol or drugs to cope with your feelings. It also stresses that it is never too late to get help, whatever the size of the problem. NAMI notes that substance use as a way of coping is a particular concern in the community, so it is worth being honest with yourself about drinking or other use.
What affirming care means
Affirming care means your identity is treated as a normal, healthy part of who you are, not as the cause of your distress or something to be changed. A therapist does not need to share your identity to be affirming, but they do need to understand the pressures above and not make you educate them about the basics.
NAMI offers a practical point: if your anxiety or depression is not mainly about orientation or gender identity, a provider with solid baseline competency in LGBTQ+ issues may be enough, and you may not need a specialist. The NHS notes that a therapist trained to work with LGBTQ+ people may help with issues such as accepting your orientation, coping with others' reactions, gender dysphoria, and rejection from family or community. The American Psychological Association publishes practice guidelines for psychologists working with sexual minority clients and with transgender and gender nonconforming clients, which shows how seriously the profession treats this competence.
Questions to ask any therapist
- How much experience do you have working with LGBTQ+ clients, and with people of my particular identity?
- How do you approach someone whose family has not accepted them?
- Will you use my name and pronouns in sessions and in your records?
- If I come with a partner, do you work with couples like us?
- What happens to my information, and who might see it? Is Therapy Confidential in Michigan? explains the general rules.
NAMI adds that many therapist directories, including insurance company directories, let you filter for providers who list LGBTQ+ competency. A good therapist will welcome these questions. A defensive or vague answer is useful information too. Questions to Ask a Therapist About Anxiety or Depression has a broader list.
Community support in Southeast Michigan
Therapy works best alongside other connections. Affirmations, which describes itself as Michigan's largest LGBTQ+ community center, has served Southeast Michigan since 1989. Its site lists support groups, social events and a queer-friendly therapy program. Community groups, faith communities that welcome LGBTQ+ members, and friends who are chosen family can all ease the isolation that feeds depression.
Working with Dr. Lehmann
Dr. Lehmann is a licensed clinical psychologist who sees adults in Franklin or by telehealth for clients physically in Michigan. Her approach is insight-oriented and integrative, looking at family history and current relationships alongside practical coping skills. Her anxiety therapy page describes how she works with worry and stress. As with any therapist, it is reasonable to ask her about her experience with LGBTQ+ clients and with your particular concerns before you start.