Risk factors for mental health

While current knowledge of mental health problems and illness in 2SLGBTQ+ immigrants and refugees is limited due to a lack of dedicated studies, some conclusions and considerations can be drawn from general studies of immigrant 2SLGBTQ+ populations and studies of mental health in non-immigrant 2SLGBTQ+ populations.

In general, 2SLGBTQ+ individuals are at a higher risk for mental health problems and illnesses such as depression, anxiety, suicide or thoughts about suicide, and substance use problems in some pre-migration contexts or during the refugee journey.

For 2SLGBTQ+ newcomers, uncertainty about the future can interact with post-migration difficulties including poverty, unemployment and social exclusion in Canadian society. The homophobia, persecution, abuse and forms of violence 2SLGBTQ+ individuals faced in their countries of origin on the basis of gender or sexual identity can worsen mental health problems.

2SLGBTQ+ refugees have reported past emotional and physical abuse, shunning, assault, forced heterosexual marriage, blackmail and “corrective” rape (Shidlo & Ahola, 2013). Such abuse can begin as early as childhood at the hands of family members, peers or school officials (Alessi et al., 2016). Given the prolonged experiences of violence, 2SLGBTQ+ refugees may suffer from depression, anxiety, complex trauma and/or PTSD (Alessi et al., 2016; Messih, 2016).

In addition to dealing with past trauma, 2SLGBTQ+ refugees or other 2SLGBTQ+ newcomers who migrated from countries where 2SLGBTQ+ status is highly-stigmatized or criminalized must also deal with settlement stressors without necessarily benefiting from the support of their ethnocultural diaspora communities. Those individuals could be fearful to engage with their communities due to past experiences and bias toward stigmatization of 2SLGBTQ+ individuals. 2SLGBTQ+ refugees may also fear homophobia or transphobia from members of their ethnocultural communities and may therefore lack access to the support these groups can offer (Alessi, 2016; Kahn, 2015; Lee & Brotman, 2011).

2SLGBTQ+ refugees and immigrants may also feel uncomfortable about associating with 2SLGBTQ+-oriented organizations, which could prevent them from accessing support for both their trauma and their adaptation to Canada (Kahn, 2015). Social isolation may be even more of a problem for 2SLGBTQ+ immigrants and refugees who also experience marginalization due to race or ethnicity, which can negatively affect mental health (Logie, 2012). Furthermore, the 2SLGBTQ+ community, as with any community, may exhibit inequalities along with racism, classism, biphobia, transphobia or other exclusions, which can prevent members from benefiting from community resilience (Meyer, 2015).

During the refugee determination process, claimants may feel pressured to come out publicly or to express their 2SLGBTQ+ identity in a way that would be expected in Western society. How can providers support them when dealing with having to share their identity in a Western way?

2SLGBTQ+ refugee claimants arriving in Canada must navigate a complex claims process, which can be highly intrusive and traumatizing. Refugee claimants must prove they have a true fear of persecution based on their “membership” in a sexual and/or gender minority group (LaViolette, 2009) (Immigration and Refugee Board of Canada, 2020). As a result, claimants may feel pressured to come out publicly or to express their 2SLGBTQ+ identities in a way that would be expected in Western society (Kahn et al., 2017; Fernando, 2019). Ultimately, 2SLGBTQ+ refugee claimants are at higher risk of mental health problems and illnesses as a result of exposure to multiple sources of stress (Reading & Rubin, 2011) (Messih, 2017). Nevertheless, many 2SLGBTQ+ newcomers exhibit exceptional strength and resilience, dealing with the daily challenges of victimization along with symptoms of mental health problems and illnesses (Alessi, 2016).

More information about mental health among 2SLGBTQ+ people:

Canadian Mental Health Association: LGBTQ identified People and Mental Health Rainbow Health Ontario Mental Health Challenges for LGBT Asylum Seekers in Canada