Ms Karen Field1
Associate Professor Andrew Lewis2
Professor John Toumbourou2
1 Drummond Street Services
2 Deakin University
beyondblue Victorian Centre of Excellence
Project completion year
The current project explored risk and protective factors present in files of 299 gay, lesbian bisexual and questioning/queer (GLBQ) clients attending for counselling at Drummond street services within a three year timeframe. A comprehensive list of risk and protective factors were identified, and their frequencies and their relationship to presence of depression or anxiety were explored.
Key findings were as follows:
- Risk and protective factors found in high frequency were those common to the mainstream community (for example, level of education, employment and income, experience of childhood sexual abuse and trauma in adulthood) (and possibly at higher rates to the general population), as well as those unique to the GLBQ community (for example experience of homophobia and ‘questioning’ transition)
- There is the need to attend to both common and GLBQ unique risk and protective factors within mental health interventions, recognising that the majority of GLBQ community members seek help in relation to concerns common to the mainstream community
- The ‘coming out’/questioning period in relation to sexual identity is a time of increased vulnerability in relation to mental ill-health, and further understanding of the needs, and increased access to informal and formal supports for this period, are required
- Being bisexual likewise places individuals at greater risk of mental ill-health than being gay or lesbian, for example, and was also associated with increased feelings of isolation from the broader, as well as the queer communities
- The importance of negative family of origin experiences including lack of support for sexual identity, for mental health risk was highlighted, and the need for more specialist GLBQ family support services
- The importance of positive friendships and connection to the queer community as protective factors for mental health was highlighted, and further opportunities for social connection and support are important
- The importance of the experience of homophobia, as per the literature, as well as other trauma experiences, were highlighted in terms of their association with increased mental health risk and the need for interventions to take these into account
- The possible protective role of mediating variables to reduce the impacts of risk factors (including experience of Homophobia for example), such as ‘identity cohesion’ and sense of connection to the queer or broader community require further investigation and provide clues as to protective preventive, early intervention and clinical interventions
A ‘GLBQ Screening and Outcome Tool’ has been developed which incorporates identified risk and protective factors and a measure of mental health to be used for both research purpose (validation of current identified factors) and clinical purpose of informing assessment and intervention, and evaluating interventions. It is hoped that this tool may be incorporated into a larger trial to further validate risk and protective factors and explore pathways to mental health and illness, as well as to trial and evaluate developed GLBQ mental health interventions arising out of the current study.
The current research project aimed to increase knowledge-base in relation to risk and protective factors important in the development of higher rates of mental ill-health within the GLBQ community (as compared to the broader community), via the following aims:
- undertake qualitative research to identify risk and protective factors present within client files of the GLBQ clients attending for counselling in a mainstream but well known queer-friendly family service agency in inner Melbourne, within a three year period; and
- explore the relationship of these risk and protective factors to the presence or absence of depression and anxiety diagnosis.
In addition to making a contribution to the existing knowledge base in this area, the project also intended to inform policy, practice, and future research directions, towards informing the development of future community public health initiatives targeted at reducing the rates of anxiety and depression for sex, gender and sexuality diverse people.
The current study involved in-depth qualitative file audit of 299 non-heterosexual counselling clients who attended Drummond street (within a 3 year period from 2008-2011), with 220 risk and protective factors identified relating to the individual (cognitive and coping styles, physical health and health risk behaviours), family of origin, couple relationship and parenting, stressful life events, school and work factors, social connection to mainstream and queer communities, and queer-specific factors (such as exposure to homophobia and being currently in a ‘questioning’ stage regarding sexual identity formation). Data analyses indicated risk and protective factors significantly correlated with diagnosis of depression or anxiety, or both, or neither.
The present study did not identify intersex clients within the sample, and while 20 sex and/or gender diverse clients were identified, specific qualitative and quantitative analysis in relation to this group are yet to be undertaken. The project does however provide some illuminating findings in relation to risk and protective factors specific to GLBQ clients, and the nature of factors’ mediating roles in mental health and illness.
Key findings were provided in the main messages above.
Implications for policy makers and funders are as follows:
In recognition of the high prevalence rates and impacts on vulnerable groups and the specialist needs of specific sub-populations, funders including governments at all levels in policy and service funding would be well placed to set key targets and outcomes to “close these gaps”. It is common practice for tender responses and contract requirements with community providers to enshrine requirements to ensure the appropriate knowledge, competency, engagement and servicing of vulnerable groups. Two examples include Indigenous Australians and our culturally and linguistically diverse communities. This could very easily be expanded within policy to include the GLBQ community in, for example:
- the collection and reporting of service data as a measure of ability to engage with and provide services to this community
- tender and service agreements which ensure all staff have Queer Affirmative training and all aspects of provider operations are Queer sensitive.
While we have seen some efforts to support mainstream organisations through training and the use of QA type processes, they may well be too cumbersome for organisations – it needs to be incremental and achievable or organisations will give up.
This research calls for a recognition and commitment to fund specialist evidence-based or informed public health responses for this community beyond the many important initiatives to reduce homophobia. It needs to be understood that it will take substantial time for these efforts to achieve population level outcomes, however, that there are a number of urgent efforts which, if funded, could make considerable ground to reduce prevalence rates, and assist in early identification and intervention, therefore lessening the disabling effects of depression and anxiety. These efforts could include:
- additional funding of research to expand our knowledge of the relationship between these risk and protective factors such as a trial of the ‘GLBQ Screening and Outcome Tool’
- trial of clinical interventions which are able to address both common and unique risk and protective factors for mental health within this community
- funding for specialist parenting and family support services
- expansion of existing fledgling peer support models within clinical interventions to address increased social isolation and support network, and connection to other queer identified or questioning individuals.
Implications for practice and services are as follows:
- The importance of family of origin connection and support for ‘coming out’/questioning transition and sexual identity more generally, and the need for further specialist Family Support Services (e.g. for families who have a child/young person or other loved one who is questioning their gender/sexual identity, and families coming to terms with their family members’ difference, as well as upstream parenting education in relation to supporting children’s resilience capacity prior to ‘coming out’).
- Current evidence-based treatments which address cognitive factors regarding depression and social connection appear important, with appreciation for added complexities, along with the inclusion of interventions which address GLBQ unique factors
- The importance of Queer Cultural Competency (for queer-identified and queer-friendly practitioners and queer-affirmative services) to ensure GLBQ unique factors are attended to, while recognising GLBQ clients may present with concerns similar to the general population and common risk factors, therefore the need for mental health and other practitioners to attend to both common/mainstream and ‘GLBQ unique’ risk and protective factors
- The need for further social campaigns to address stigma and discrimination, particularly within young people, as well as ignorance and discrimination within health, mental health and family services and professionals working in these fields
- The need for greater social support as vital protective factor during the ‘coming out’ transition, via families and services
- The need for data collection processes regarding sex, gender and sexual identity diversity requiring expanding and clarification for recording and assessment purposes
- The importance of specialist trauma-informed assessment and interventions which take into account the effects of trauma on development of gender and sexual identities.