Dr Briony Dow1
Dr Catherine Barrett2
Dr Jean Tinney1
Associate Professor Phillip Maude3
1 National Ageing Research Institute
2 The Australian Research Centre in Sex, Health and Society, La Trobe University
3 RMIT University
Beyond Blue National Priority Driven Research Program
Project completion year
Higher rates of depression and/or anxiety have been observed in older lesbian, gay, bisexual and transgender (LGBT) people, compared to the broader community. This project looks at factors contributing to depression and/or anxiety; and strategies that older LGBT people have enlisted to cope with depression and/or anxiety. Having been subjected to discrimination throughout their lives, many older LGBT people fear discrimination from service providers, and worry that providers of aged care services will not understand or meet their needs. This can lead to older LGBT people delaying or avoiding accessing aged care (including residential care, assisted living services and adult day care), or mental health services. This project explored older LGBT people’s experience of depression and anxiety, their strategies for coping and their suggestions of LGBTI inclusive aged care services. It makes recommendations as to how service providers could be more LGBTI inclusive. It includes an education resource for service providers that can be used to raise awareness of issues affecting older LGBTI people, including anxiety and depression.
In order to gather appropriate research to inform the education resource, this project had various stages, including:
- a review of the relevant literature
- interviews with 30 older LGBTI people (aged over 65) about their experiences of depression and anxiety; contributing factors; strategies for coping; and advice to service providers about making their organisation LGBTI inclusive
- development of an education resource through presentation of study findings to health professionals, undergraduate students and feedback from an advisory group comprising representatives from consumer and LGBTI groups.
Factors that contribute to experience of anxiety and depression
Many factors contribute to anxiety and depression experienced by LGBTI older people.
- Discrimination on the basis of sexual orientation, gender identity or intersex status can include physical violence, emotional abuse, loss of work or promotion opportunities and ostracism from families and religious organisations.
- Fear of such discrimination caused many people to hide their sexual orientation, gender identity or intersex status. For many, the emotional stress of this ‘closeting’ in an effort to ensure their safety and conform to expected norms was an important contributor to depression and anxiety.
- The rejection by family sometimes triggered or exacerbated anxiety and depression and could also mean the loss of valuable sources of psychosocial support for LGBT participants in their formative years.
- Many participants married, some as often as three times, in an effort to meet familial and societal expectations. These attempts to ‘straighten up’ were not generally successful, but the sense of confusion and loss of self-belief that accompanied a sense of not fitting in or living a lie, was another frequently cited contributor to a lack of mental wellbeing.
- Other contributing factors were commonly shared by the broader community. These included the loss of someone close; a childhood that involved family tension, bullying or sexual abuse; a family history of depression or mental illness; the experience of illness, pain or disability; and life pressures including relationship problems or family and economic tensions.
A key project outcome is the development of an awareness-raising education resource for providers of mental health services and aged care services including residential care, home care, hospital staff and individual health practitioners in the community. Sources for the resource include findings from the literature review; the responses from thirty individual interviews with LGBT people over 65 with experience of depression and anxiety; and research regarding intersex people.
Interview participants made suggestions and expressed their priorities for the sort of knowledge which would lead to inclusive practices in all aged care contexts.
The education resource consists of:
- facilitator notes
- a Powerpoint presentation and accompanying facilitator notes
- four narrative life stories with discussion questions
- a References and Resources handout.
It is intended that a trainer from a service provider or aged care organisation could give the presentation to staff to raise awareness of issues of anxiety and depression for older LGBTI people/clients, and indicate ways services could become more LGBTI inclusive. It also directs service providers to resources and audit tools for making their organisation LGBTI inclusive.