Anxiety. Depression. Stress. These are some of the emotions LGBTQ Americans experienced during the Trump administration, according to two recent studies. The reports, conducted independently, both landed on the same conclusion: There was a significant decline in the mental well-being of lesbian, gay, bisexual and transgender people while Donald Trump was president.
“Everybody’s worst fears came into reality,” Adrienne Grzenda, an assistant clinical professor of psychiatry and biobehavioral sciences at UCLA and lead author of one of the studies, told NBC News. “We were noticing this undercurrent of despair and hopelessness among our clients,” many of whom are LGBTQ.
Even before Trump's election, LGBTQ advocates sounded the alarm about his track record and that of his running mate, Mike Pence, who publicly opposed same-sex marriage and other LGBTQ rights. Once sworn in, the Trump administration took numerous steps to roll back LGBTQ rights and protections, including banning transgender people from the military, withdrawing Title IX protections for transgender students and reversing plans to count LGBTQ people on the census.
While Trump is no longer in the White House, the ongoing introduction of anti-LGBTQ legislation in the states continues to expose LGBTQ people, especially children, to the risk of significant mental health consequences, according to some advocates and researchers.
'Extreme' and 'frequent' mental distress
A study scheduled to be published in the December issue of the journal Economics and Human Biology found that “extreme mental distress” — defined as reporting poor mental health every day for the past 30 days — increased among LGBTQ people during Trump’s rise and presidency.
The report, written by Masanori Kuroki, an associate professor of economics at Arkansas Tech University, compared the likelihood of extreme mental distress among LGBTQ and non-LGBTQ people by using data on more than 1 million people interviewed from 2014 to 2020 for the government’s Behavioral Risk Factor Surveillance System.
This study found that the “extreme mental distress gap” between LGBTQ and non-LGBTQ people “increased from 1.8 percentage points during 2014–2015 to 3.8 percentage points after Trump’s presidency became a real possibility in early 2016.” Even seemingly small increases in extreme distress are important, the study notes, because such distress is not common.
While Trump was not the first president to advocate and enforce policies widely considered anti-LGBTQ, his tenure followed the relatively pro-LGBTQ Obama presidency. The possibility of removing recently gained rights and protections “might be more damaging to LGBT people’s mental well-being than simply not having equal rights in the first place,” the study states.
While Kuroki’s report does include a cautionary note about attributing the increase in mental distress among LGBTQ people to the rise and presidency of Trump, he does note that “the findings do suggest that the Biden administration may have inherited higher rates of mental distress among LGBT people” than they would have “if Trump had not run and won the 2016 election.”
In his conclusion, Kuroki suggests that future research examine LGBTQ mental health under the Biden administration, which has already implemented measures to advance LGBTQ rights and protections.
“If presidents affect LGBT people’s mental health, then we should expect that the extreme mental distress gap between LGBT people and non-LGBT people to narrow under the Biden presidency,” he stated in his report’s conclusion.
Grzenda’s study used data from the Behavioral Risk Factor Surveillance System to measure whether the 2016 election and transition to the Trump administration led to a change in the number of sexual and gender minority (SGM) adults reporting “frequent mental distress” compared to cisgender, heterosexual respondents (frequent mental distress is defined as feeling depressed, stressed or unable to control one’s emotions during at least 14 of the last 30 days). Between 2015 and 2018, LGBTQ respondents reporting frequent mental distress increased by 6.1 percentage points, from 15.4 percent to 21.5 percent, while non-LGBTQ respondents reported a 1.1 percentage point increase, from 10.4 percent to 11.5 percent.
“A clear association exists between the 2016 election and the changeover to a decisively anti-LGBT administration and the worsening mental health of SGM adults, although a completely causal relationship cannot be fully established,” the report, published this year in the journal LGBT Health, states.
The effects, however, were not seen evenly among lesbian, gay, bisexual and transgender Americans.
“We’ve got to start looking at sub-populations more,” Grzenda said. “When we break it down, it was bisexual individuals and especially transgender individuals who were really hit the hardest.”
Grzenda said the differential impact on gender minority adults may be because of the Trump administration’s targeting of transgender rights and protections in military service, health care and access to public facilities. At the same time, the focus on lesbian, gay and transgender rights may have “exacerbated feelings of bisexual invisibilty/erasure,” and compounded existing stress for bisexual respondents.
The study, which had a sample size of nearly 270,000 adults, approximately 5 percent of them LGBTQ, states in its conclusion that its findings provide “data-driven support for advocacy efforts toward the implementation of unequivocal antidiscrimination protects on the basis of [sexual orientation and gender identity] across all domains of daily living, immutable to sudden political realignment.”
Grzenda, like Kuroki, notes that a definitive causal link cannot be drawn between the Trump administration and the decline in LGBTQ mental health with existing data, though both studies controlled for likely competing factors.
'Bullying by legislation'
The effect of politics on LGBTQ mental health is not just relegated to the federal government and national policies. The spate of anti-LGBTQ legislation in statehouses raises concerns about other sources of mental health strain, particularly for young people.
From 2015 to 2019, 42 states introduced more than 200 pieces of anti-LGBTQ legislation, according to a recent study by Child Trends, a nonpartisan research institute, and the introduction of these measures were found to have negative mental health consequences on LGBTQ minors.
The report notes that Crisis Text Line, a global nonprofit that provides free mental health texting services, saw an uptick in messages from LGBTQ youths in the four weeks after their respective states proposed anti-LGBTQ legislation.
“This suggests the bills are harmful whether or not they are passed,” Dominique Parris, director of diversity, equity and inclusion at Child Trends and lead author on the study, told NBC News. “We need to understand the full scope of what these laws do to young people.”
Among the most common types of anti-LGBTQ bills introduced during the 2015-19 timeframe were restrictions on single-sex facilities, the report states.
This year alone, there have already been over 200 anti-LGBTQ bills introduced at the state level, Parris said.
“Oftentimes the argument in support of [these bills] is to protect children, but what this research suggests is that that may not in fact be the outcome, and simply proposing this legislation may cause children distress,” Parris said.
Researchers at the Trevor Project, an LGBTQ youth crisis intervention and suicide prevention organization, found a staggering 94 percent of LGBTQ young people said recent politics negatively affected their mental health.
“When there have been public policy decisions, we hear about that on our crisis line,” Amit Paley, the project’s CEO, told NBC News.
When Trump banned transgender people from the military, the Trevor Project saw an increase in trans and nonbinary people reaching out for crisis services, he said. This was not due to trans people necessarily wanting to serve in the military, Paley added, but because a powerful public figure was making judgments about their worth.
“Young people are listening,” he said. “When their message is discriminatory and hateful, that does have an impact.”
Trans and nonbinary youth are at particular risk for the most devastating consequences of mental distress, including suicide, according to Trevor Project research.
“That’s not because LGBTQ trans nonbinary people are born more likely to consider suicide," Paley said. "It’s because of the discrimination, isolation and rejection they face.”
Paley said that Texas legislators this year have introduced dozens of anti-LGBTQ bills, many of which target trans and nonbinary people.
On Wednesday, a bill that would that would require student athletes to compete on sports teams corresponding to their “biological sex” advanced out of committee and heads toward a full vote on the state House floor where it is likely to pass. The bill advanced despite emotional testimony from parents and students regarding the toll such a law would take on trans children, something LGBTQ children’s advocates have been sounding the alarm about for some time.
“Trevor Project has received almost 4,000 calls, chats and texts from trans and nonbinary people in Texas this year,” Paley said. “This is effectively bullying by legislation. It is dangerous and it is wrong.”
‘Some steps forward and several steps backward’
Advocates hope LGBTQ mental health might improve under the Biden administration, which has made public statements and enacted policies in support of LGBTQ rights.
However, some, like Paley and Parris, worry about the message that certain signals — like the ongoing support for Trump among many Republicans, the onslaught of anti-LGBTQ state legislation and the failure to pass the Equality Act in Congress — will send to LGBTQ youth and adults.
“I think we are seeing some steps forward and several steps backward,” Paley said.