Mental health impacts of substance use during pandemic greater in LGBTQ community

Negative mental health effects and increased substance use caused by the COVID-19 pandemic were more common in the LGBTQ community, according to a repeated cross-sectional monitoring survey conducted in Canada.

“Literature prior to COVID-19 demonstrates disparities in mental health between [sexual and gender minority (SGM)] groups and non-SGM counterparts, and recent literature within the pandemic context illustrates concerning mental health outcomes among SGM populations; however, there is limited research that directly compares SGM and non-SGM populations,” Allie Slemon, a PhD student at University of British Columbia School of Nursing, and colleagues wrote in Psychiatry Research.

“Yet, there is increasing concern that SGM populations may be overlooked in public policy and research responses to COVID-19,” they continued. “To ensure that public policy and mental health resources and supports appropriately respond to the needs of SGM people, it is crucial to build an evidence base monitoring the relative mental health status of this priority population.”

Slemon and colleagues conducted a two-round survey: 2,984 people responded in round one, conducted from May 14, 2020, to May 19, 2020, and 3,009 people responded in round two, conducted from Sept. 14, 2020, to Sept. 21, 2020. The researchers collected information on participants’ sociodemographic characteristics, self-reported mental health deterioration since the beginning of the COVID-19 pandemic and self-reported history of mental health conditions.

They considered participants who responded “yes” or “unsure” to a question about identifying as LGBT2Q+ — defined as lesbian, gay, bisexual, transgender, Two-Spirit (gender variant member of indigenous community) and queer — as SGM participants.

Among 6,027 total participants, 7.5% identified as SGM and 18.2% reported a preexisting mental health condition.

In both survey rounds, the SGM group had higher proportions of participants reporting deterioration of mental health, poor coping, suicidal thoughts, self-harm, alcohol use and cannabis use compared to the non-SGM group. Round two surveyed use of substances to cope, which was also more common among SGM participants.

Generally, a preexisting mental health condition was consistently associated with a higher risk for a negative mental health outcome, Slemon and colleagues wrote. Being younger than 25 years old, indigenous and having a household income below $25,000 were also associated with negative mental health outcomes, although less consistently.

Household income and rural living were significantly associated with a higher risk for specific substance use outcomes, while having a preexisting mental health condition was significantly associated with cannabis use and use of substances to cope.

“Research prior to the pandemic suggests that higher rates of substance use among SGM populations can be explained as ‘maladaptive’ coping mechanisms in response to various stressors, including minority stress and mental health challenges,” Slemon and colleagues wrote. “Predictably, the health and socioeconomic impacts of COVID-19 are adding to this population’s (and others’) burden of stress; however, we are concerned for the continuation of these pronounced increases in substance use among SGM adults, particularly as a coping strategy for mental distress throughout the pandemic and its aftermath.

“Given the existing and widening inequities faced, decisive and tailored public mental health actions are needed to safeguard the mental health and well-being of SGM people over the remainder of the pandemic and beyond,” they added.