The invisible cost of LGTBIfobia on mental health

Discrimination, rejection, and violence leave marks that go beyond physical aggression. Those of us who are part of the LGTBI+ community know that living in a society that still questions our diversity also impacts our mental health.

There are wounds that do not show up on an X-ray, that do not leave bruises, and yet can accompany us for years. They are in those who think twice before showing affection in public, in those who measure their words to avoid uncomfortable questions, or in those who learn to identify which spaces are safe and in which it is better not to draw attention. For many LGTBI+ people, these situations are not exceptional: they are part of our daily experience. And talking about mental health and sexual and gender diversity also means talking about the environment we live in, the prejudices that still surround us, and the violence that, to a greater or lesser extent, permeates our lives.

The data helps to dimension this reality. The report The Situation of Mental Health in Spain, prepared by the Confederation of Mental Health Spain and the Mutua Madrileña Foundation, indicates that 32.1% of LGTBI+ people report having experienced suicidal thoughts or attempts, compared to 14.5% of the general population. It also notes that 64.9% have suffered anxiety attacks and that only 43.6% consider their mental health to be good or very good.

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In Catalonia, the Observatory against LGTBI-phobia has recorded 246 incidents of LGTBI-phobia since January 1, 2026. These are registered situations that allow us to quantify a reality that is not always reported. Behind each incident is a person, a story, and an experience of discrimination that can have consequences far beyond the moment it occurs. We are not talking about abstract statistics, but about situations that affect people in our environment and our own community.

Social psychology has been studying this phenomenon for decades through the concept of minority stress. Continuous exposure to stigma and discrimination generates a weariness that goes beyond specific episodes of violence. It is not necessary to suffer a physical aggression to experience its consequences: anticipating rejection, hiding a relationship for fear of the reactions of the environment, or fearing the loss of job opportunities also generates tension. When these situations are repeated, the need to remain alert can affect rest, increase anxiety, and hinder personal relationships. The study State of Hate 2026, prepared by the State Federation LGTBI+ along with researchers from the Institute of Policies and Public Goods of the CSIC, points to this relationship between experiences of hate and higher levels of anxiety, depression, loneliness, fear, and anger.

LGTBI-phobic violence does not necessarily end when an aggression stops. Its consequences can remain in memory, in trust towards others, and in our way of relating to the environment. Those of us who are part of the community know that sometimes fear does not disappear when a situation of violence ends: it can condition decisions, relationships, and spaces that we previously felt were our own. Combating hate also means preventing its effects on health and ensuring adequate care for those who suffer it.

This relationship between diversity and mental health also has a history marked by pathologization. For decades, homosexuality and trans* identities were interpreted from certain medical and psychiatric models as realities that needed to be corrected or treated. In 1973, the American Psychiatric Association removed homosexuality as a diagnosis from the DSM. Decades later, the World Health Organization advanced in the same direction regarding trans* identities: with the approval of the ICD-11 in 2019, gender incongruence was no longer classified as a mental disorder and moved to the realm of sexual health. These changes represented a step forward in recognizing the right of individuals to receive healthcare that respects their identity and autonomy.

De-pathologizing does not mean stopping talking about mental health, but ensuring that anyone can access the psychological support they need without their sexual orientation or gender identity becoming a reason for suspicion or discrimination. We need care that starts from listening, respect, and accompaniment, and that does not turn our identity into something that needs to be explained or justified.

Also outside the healthcare field, there are factors that can make a difference. Family acceptance, especially during adolescence and youth, can be an important protection against social rejection. Friendships, associations, and community spaces also allow for building relationships where it is not necessary to constantly justify who we are. Organizations like the Observatory against LGTBI-phobia in Catalonia, Ikusgune, and COGAM offer support, meeting spaces, and tools against discrimination. Their work reminds us that the community can be a protective network against loneliness and isolation.

That does not mean that within the community itself there are no contradictions. Aesthetic pressure, the invisibility of certain identities, and difficulties in finding spaces of belonging can also generate suffering. Building community involves recognizing these realities and working to ensure that no one is left out.

In recent years, significant advances have been made in the legal and social recognition of LGTBI+ people. But those of us who are part of the community know that formal recognition does not guarantee a life free from discrimination. Aggressions, harassment, hate speech, and barriers to accessing adequate healthcare are still present. We cannot constantly ask for resilience from those who suffer discrimination while leaving intact the conditions that generate that suffering.

We need a public healthcare system with sufficient resources, professionals trained in sexual and gender diversity, accessible psychological care, educational policies that prevent harassment, and safe work environments.

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Defending LGTBI+ mental health is defending our right to live without fear, to build free affectionate relationships, to express ourselves without having to give explanations, and to receive healthcare without prejudice. Because equality is not just about recognizing the same rights on paper, but ensuring that exercising them does not come at a cost to our health, our peace of mind, or our dignity.