Santé mentale des minorités sexuelles : disparités, modèles et interventions

Abstract

Objectives

The term sexual minorities refers to an aggregation of various minority groups defined on the basis of sexual orientation, the main ones being lesbians, gays, bisexuals and asexuals. In the field of psychology, there is little research into sexual minorities. Moreover, they are mainly conducted in Anglo-Saxon countries. The limited amount of research on the subject in France is the result of a principle of equality implicit in the scientific community, according to which minority specificities must be erased in favour of an overall perspective that is intended to be non-stigmatising. However, the erasure of these specificities makes the specific needs of sexual minorities invisible and contributes to a gap in the effectiveness of the care offered compared to the sexual majority. The aim of this article, from a psychopathological perspective, is to examine the link between mental health and sexual minorities and to analyse the various interventions tailored to sexual minorities that can reduce psychopathological difficulties. If psychotherapists were to take these specific characteristics into account, they would be able to provide better care for this population and consequently reduce the risk of mental disorders developing or persisting.

Methods

The literature review was carried out on the EBSCOHOST and CAIRN databases using the following keywords “sexual minorities OR LGBT+ OR homosexuality OR bisexuality OR asexual”; “mental health OR mental disorders OR psychiatric disorders OR depression OR anxiety OR PTSD OR well-being OR social well-being”.

Results

The proportion of sexual minorities in the general population depends on the age of respondents. People born after 1997 identify more as a sexual minority than those born before 1948, with an increase in bisexual identity. Sexual orientation conceptualization could include sexual fluidity and gender expression along with sexual identity, sexual behaviour, romantic attraction and sexual attraction. Sexual minorities are more likely to present depressive and anxiety symptoms and disorders, eating disorders such as anorexia, bulimia and binge eating, and post-traumatic stress disorders. Bisexuals and asexuals are particularly affected. Other minority statuses are also factors to be taken into account. The minority stressors model explains these differences by the pressure of the stigmatising environment and the individual resources available. The closet model approaches them from a developmental point of view. This model, built around coming out, articulates the effect of a stigmatising environment prior to awareness of sexual orientation, awareness which can lead to concealment, and revelation and affirmation of orientation. The interventions identified to directly reduce the psychopathological difficulties of sexual minorities focus on affirmation in the form of psychotherapy. Such therapy aimed the valorisation of one's sexuality. The interventions that seek to indirectly reduce psychological difficulties focus on reducing discriminatory behaviour through education or by modifying the environment. Approaches that focus on minority strengths enable the minority experience to be revalued by improving self-esteem. In addition, the minority strengths model emphasises the important role played by proximity to the community in the development of healthy mental health.

Discussion

The research sometimes lacks robustness and therefore requires the development and use of validated and standardised tools and methods. Most of the research has been carried out with homosexual men, despite the diversity of the public grouping under the term sexual minorities. More recently recognised sexualities, such as bisexuality and asexuality, are the most invisible. The majority of interventions are not yet validated or require a greater variety of methods and populations for validation. The interventions identified occur either after exposure to stress or before the stressful event. Minorities dedicated therapies value the coping resources of sexual minorities and thus allow them to resist minority stress. Some studies have shown that acceptance of one's sexual identity, or at least a positive perception of this identity, is central to adapting to stress. Dedicated therapies therefore seem to be almost essential for the positive reinforcement of identity through valorisation. Of course, these therapies are not substitutes for training professionals on minority stress (psychologist, psychiatrist, doctor, nurse, etc.). Therapies focus on valuing identity while training professionals provides a different perspective on the patient's pathology but also on their attitude towards them “as affirmative perspective can propose”. This latter being more in line with an inclusion approach. Current models focusing on the mental health of sexual minorities concentrate on minority stress and the disclosure of sexual orientation, placing them within the context of individual resources and life circumstances. However, these models remain centered on pathology. Adopting a more positive approach to minority sexualities would allow minority issues to be removed from the realm of pathology and thus revalued. Identifying their strengths is a first step towards valuing their uniqueness and towards a more complete and balanced portrait of this population.

Conclusion

Future research should focus on the quality of the methods used both experimentally and clinically, the inclusion of minority publics and propose a more positive perspective of the minority experience.