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Healthcare
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Mental Health and Stigma of Sexual Minorities
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Mental Health and Stigma of Sexual Minorities

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (31 August 2025) | Viewed by 8328

Special Issue Editor

Dr. Amanda Wilson

E-Mail Website
Guest Editor
Psychology Division, De Montfort University, Leicester LE1 9BH, UK
Interests: public health psychology; marginalization and health; sexual health; sexual minorities; well-being and psychiatry

Special Issue Information

Dear Colleagues,

Sexual minorities have an increased risk of poor mental health compared to the heterosexual community, particularly in terms of self-harm, suicide, mood disorders, and substance disorders. Poor mental health is often related to both structural and internal stressors in the individual’s environment, which can facilitate or restrict help-seeking. As such, both external and internal stigma play a large part in shaping mental health within this community.

External stigma refers to the persistent discrimination from society, family, and intimate partners, whereas internal stigma takes the form of concious or unconcious messages around homonegativity. It is also suggested that mental health issues of sexual minorities share general similarities across the community, and that there is unique mental health stigma within specific sub-groups.

This Special Issue aims to highlight studies from high-, middle-, or low-income counties, employing a global perspective, as the conceptualization of mental health stigma has predominantly focused on white Western ideology thus far, ignoring the role of cuture in mental health. This Special Issue aims to cover a wide variety of mental health issues and internal or external stressors that affect either the whole community or specific subgroups under the LGBTQQIP2SAA umbrella.

Dr. Amanda Wilson
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sexual minorities
  • LGBTQQIP2SAA
  • mental health issues
  • external and internal stigma
  • environmental stressors
  • substance use disorders
  • help-seeking
  • global perspectives
  • cultural influences
  • prevalence in general community/ies

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Published Papers (5 papers)

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Research

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25 pages, 313 KB  
Article
Sexual Victimization in LGB+ Persons in Belgium: Consequences, Help-Seeking Behavior, and Othering-Based Stress
by Lotte De Schrijver, Elizaveta Fomenko, Barbara Krahé, Joz Motmans, Kristien Roelens, Tom Vander Beken and Ines Keygnaert
Healthcare 2025, 13(21), 2744; https://doi.org/10.3390/healthcare13212744 - 29 Oct 2025
Viewed by 572
Abstract
Background/Objectives: Persons identifying as lesbian, gay, bisexual, pansexual, omnisexual, queer, questioning, fluid, asexual, or other non-heterosexual orientations (LGB+ persons) have been identified as a risk group for sexual victimization (SV), which can have long-lasting negative effects on well-being and physical, mental, sexual, [...] Read more.
Background/Objectives: Persons identifying as lesbian, gay, bisexual, pansexual, omnisexual, queer, questioning, fluid, asexual, or other non-heterosexual orientations (LGB+ persons) have been identified as a risk group for sexual victimization (SV), which can have long-lasting negative effects on well-being and physical, mental, sexual, and reproductive health. Othering-Based Stress (OBS)—reflecting societal processes of othering and resulting from stigma, prejudice, and discrimination—may contribute to increased vulnerability to SV and its consequences in LGB+ persons and affect help-seeking behavior following victimization. This study examines the impact of SV on LGB+ persons and their help-seeking behavior after victimization. Methods: Using a mixed-methods explanatory sequential design, first survey data from a nationally representative sample of the Belgian population on SV, its consequences, and subsequent help-seeking behavior were collected from 4632 individuals. Of these, 2965 participants (2601 heterosexual and 364 LGB+ individuals) experienced SV and represented the final sample for the quantitative analyses. In a second phase, in-depth interviews were conducted with 40 LGB+ victims to explore their experiences more thoroughly. Results: LGB+ individuals reported more negative consequences following SV than heterosexual persons, particularly regarding identity-related processes such as questioning gender expression and decreases in self-esteem. They also reported additional barriers to disclosing SV and seeking help from professional services or the police, including fears of stigma, invalidation, and concerns about professionals’ LGB+ competence. No significant differences were found between LGB+ persons who explicitly identified as belonging to a sexual minority group and those who did not, neither in the perceived consequences of SV nor in help-seeking barriers. Conclusions: LGB+ victims of sexual violence experienced more severe identity-related consequences and faced greater barriers to professional support than heterosexual victims. These results highlight the urgent need for trauma-informed, LGB+-inclusive services and structural policy measures to improve access to appropriate care. Full article
(This article belongs to the Special Issue Mental Health and Stigma of Sexual Minorities)
16 pages, 1489 KB  
Article
Voices from the Rainbow: Exploring Participants’ Experiences in an Online LGBTIQ+-Affirmative Psychoeducation Program
by Ruth A. Ancín-Nicolás, João Carlos Collado, Miguel A. Lopez-Sáez and António-José Gonzalez
Healthcare 2025, 13(2), 115; https://doi.org/10.3390/healthcare13020115 - 9 Jan 2025
Cited by 2 | Viewed by 2294
Abstract
Background/Objectives: This article highlights the importance of addressing the mental health of LGBTQ people, specifically through psychoeducation/intervention programs. The primary objective was to understand the effects of participating in an online affirmative program. The theoretical frameworks of the minority stress model and [...] Read more.
Background/Objectives: This article highlights the importance of addressing the mental health of LGBTQ people, specifically through psychoeducation/intervention programs. The primary objective was to understand the effects of participating in an online affirmative program. The theoretical frameworks of the minority stress model and the concept of decompensation were used to understand and address disparities with the general population. Methods: A detailed protocol was designed to understand the participants’ experiences. An analysis of the results was carried out using a content analysis of the data collected from a convenience sample of participants from two groups. Results: The findings show that the participants’ experiences were satisfactory, especially with developing coping skills and changing their attitudes towards homophobia, also showing improvements in mental health indicators. Conclusions: This study concludes that online LGBTQ-affirmative psychoeducation programs can be positive in enhancing the mental health and well-being of the LGBTQ population. The research highlights the importance of extending these programs to LGBTQ family members. It is also important to acknowledge the specificities of each subgroup. Full article
(This article belongs to the Special Issue Mental Health and Stigma of Sexual Minorities)
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21 pages, 323 KB  
Article
“Navigating Risk and Responsibility?”: A Mixed-Methods Study Addressing Stigma and Well-Being Among Men Who Have ‘Sex on Chems’ with Other Men in the English Midlands
by Amanda Wilson and Iain R. Williamson
Healthcare 2024, 12(23), 2479; https://doi.org/10.3390/healthcare12232479 - 8 Dec 2024
Cited by 1 | Viewed by 1696
Abstract
Background: Most research on ‘Chemsex’ has been conducted with gay, bi-sexual, and men who have sex with men (GBMSM) in large cities with well-established infrastructures. Therefore, this study aimed to explore the ‘Chemsex’ risks and responsibilities of GBMSM who lived outside of the [...] Read more.
Background: Most research on ‘Chemsex’ has been conducted with gay, bi-sexual, and men who have sex with men (GBMSM) in large cities with well-established infrastructures. Therefore, this study aimed to explore the ‘Chemsex’ risks and responsibilities of GBMSM who lived outside of the queer metropolis. This study also aimed to understand how stigma and mental health present in the absence of a well-established community infrastructure. Methods: This study utilized mixed methods in Leicester, Leicestershire, and Rutland, a location in the East Midlands of England. The quantitative component consisted of a survey. The qualitative component comprised three case studies based on in-depth interviews, using interpretative phenomenological analysis. Results: Of the 123 survey respondents, 86% engaged in riskier sex during sessions and 35% no longer enjoyed sober sex. In the interviews, the three men balanced risk management and personal responsibility, positioning themselves as mature, considerate, and well-educated users. All were alienated by the term ‘Chemsex’. The findings are considered using theoretical frameworks, or how discourses of ‘moral threat’ operate within the micro-politics of regulating GBMSM’s pleasure and stigma. Conclusions: The complexities of understanding this practice for researchers and practitioners are discussed and recommendations are made for reframing education and support services for GBMSM. Full article
(This article belongs to the Special Issue Mental Health and Stigma of Sexual Minorities)
12 pages, 216 KB  
Article
Preliminary Psychometric Evaluation of Novel Measures of Therapist Practice Related to LGBTQ+ Clients
by Rodman Turpin, Jessica N. Fish, Evelyn King-Marshall and Bradley Boekeloo
Healthcare 2024, 12(1), 110; https://doi.org/10.3390/healthcare12010110 - 3 Jan 2024
Cited by 1 | Viewed by 1700
Abstract
Background: Culturally competent and equitable mental healthcare for LGBTQ+ people is critical for addressing mental health inequities for this population. Tools to assess therapists’ practice with LGBTQ+ clients are needed for research and clinical efforts related to mental healthcare equity goals. Methods: We [...] Read more.
Background: Culturally competent and equitable mental healthcare for LGBTQ+ people is critical for addressing mental health inequities for this population. Tools to assess therapists’ practice with LGBTQ+ clients are needed for research and clinical efforts related to mental healthcare equity goals. Methods: We conducted a preliminary assessment of the reliability and validity of a novel 28-item self-report measure assessing therapist practice with LGBTQ+ clients. We examined the construct validity using factor analyses, the convergent and criterion validity using intercorrelations with LGBTQ-affirming knowledge, self-efficacy, and attitudes, and the internal consistency using Cronbach alpha. Results: Our overall total LGBTQ+ practice measure demonstrated excellent internal consistency (Cronbach’s alpha = 0.91) and was strongly associated with LGBTQ+ knowledge (rho = 0.377), self-efficacy (rho = 0.633), and LGBTQ+ attitudes (rho = 0.305). We also identified two subscales: “Commitment to Continued Learning” and “Affirmative Practices”, which demonstrated similarly strong internal consistency and tests of validity. Conclusions: Our novel measure of overall LGBTQ+ practice, including two subscales, demonstrated strong reliability and validity. These findings have important implications for practice and research in mental healthcare for LGBTQ+ clients. Future research exploring these measures in relationship to mental healthcare outcomes is recommended. Full article
(This article belongs to the Special Issue Mental Health and Stigma of Sexual Minorities)

Review

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19 pages, 627 KB  
Review
Mpox-Related Stigma Among Gay, Bisexual, and Other Men Who Have Sex with Men: A Narrative Review
by Matthew N. Berger, Chenoa Cassidy-Matthews, Marian W. A. Farag, Cristyn Davies, Rohan I. Bopage and Shailendra Sawleshwarkar
Healthcare 2025, 13(21), 2690; https://doi.org/10.3390/healthcare13212690 - 23 Oct 2025
Viewed by 890
Abstract
Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated [...] Read more.
Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated with Mpox among GBMSM from July 2022, when mpox was declared a public health emergency of international concern. Methods: The PICO framework guided this narrative review. A search was conducted across the following databases from inception to June 2025: PubMed/MEDLINE, Embase, CINAHL, and Web of Science. The literature had to be empirical, peer-reviewed research that focused on mpox-related stigma in GBMSM. Results: Forty-seven studies were included in this review. The following themes were derived: (1) healthcare experiences, (2) media influence, (3) internalised and anticipated stigma, (4) public health messaging, (5) community responses, and (6) psychosocial impact. Healthcare experiences were marked by anticipated discrimination; many GBMSM delayed testing or vaccination for fear of being disclosed or labelled promiscuous. This was especially apparent in contexts where same-sex relationships are criminalised, leading some men to self-medicate or seek clandestine services. Media analyses revealed that social and traditional platforms often amplified blame and homophobia, though community-led counter-messaging helped shift narratives. Internalised and anticipated stigma resulted in shame, concealment of symptoms, avoidance of care, and heightened anxiety. Public health messaging that framed mpox as a behaviour-linked rather than identity-linked risk was more acceptable, and flexible vaccination strategies (e.g., offering less conspicuous injection sites) increased uptake. Stigma contributed to psychosocial distress and may have impeded outbreak control. Conclusions: Mpox-related stigma among GBMSM operates at individual, community, and structural levels, echoing patterns from the HIV era. Effective mitigation requires rights-based, destigmatising communication, culturally competent care, and collaboration. Addressing stigma is vital to controlling future outbreaks and ensuring equitable healthcare access. Full article
(This article belongs to the Special Issue Mental Health and Stigma of Sexual Minorities)
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