By Lenzy Krehbiel-Burton / Native Health News Alliance
Sierra Concha has heard it all.
Now a 20-year-old student at Black Hills State University in Spearfish, South Dakota, Concha, who is Lakota, Taos Pueblo and Ojibwe, has known since she was 9 that she is bisexual.
Her struggle to reconcile her sexual identity, while repeatedly hearing dismissive comments made by her friends, family and classmates eventually led to depression at the age of 13.
“I was already struggling with being happy with myself and being told that my sexuality was merely a phase really hurt,” she said. “Having to prove who I was multiple times throughout my life definitely took a toll on me especially because I wasn’t proud of my identity anyway.
“Even the people closest to me told me that I wasn’t really bisexual and that’s what broke me the most: knowing the ones I trusted the most didn’t even believe in who I was.”
Concha’s experience is not uncommon among youth who identify as LGBTTQ, or gay, lesbian, bisexual, transgender, two-spirit or are questioning their sexual preferences.
Dr. Lawrence D’Angelo is the executive director for The Diana L. and Stephen A. Goldberg Center for Community Pediatric Health and section chair for the Adolescent and Young Adult Medicine at Children’s National Health System in Washington, D.C. He noted that LGBTTQ youth are three to four times more likely to experience depression and other mental health issues.
As a whole, the suicide rate is also four times higher among LGBTTQ youth than their peers who identify as heterosexual. The data, though scarce, suggests an even higher rate among American Indian and Alaska Natives. In a 2008 national survey, 56 percent of Native transgender and gender non-conforming teen participants had attempted suicide, compared to 41 percent of their non-Native transgender peers.
“Unfortunately, many of them (LGBTTQ youth) feel they’re experiencing these risks alone without appropriate support from family, parents or the medical care system,” he said.
Bullying, victimization, dating violence and assault contribute to the elevated rates of depression and suicide.
In a 2013 survey on school climate conducted by the Gay Straight Lesbian Education Network, 85 percent of LGBT respondents nationwide were subject to verbal harassment by their classmates within the last year and almost two-thirds of participants regularly heard homophobic words used.
The numbers were even higher in several states with large Native populations, including Oklahoma, Arizona and North Carolina.
A 2008 report from the National Center for Transgender Equality featured similar rates with 86 percent of transgender American Indian and Alaska Native students ranging in age from kindergarten through 12th grade reporting some form of in-school harassment. Almost one-fifth of respondents either switched schools or dropped out altogether because of gender-based persecution.
Additionally, according to a 2010 study published by the American Public Health Association, LGBTTQ youth were more likely to meet the criteria for post-traumatic stress disorder.
That data matches the experiences of Summer Welcher-Duke, the director of behavioral health at the Oklahoma City Indian Clinic.
The clinic, which offers individual, group and family therapy, regularly provides outside referrals to suicide prevention hotlines and the local equality center to clients. Welcher-Duke said many of the mental health issues facing the LGBTTQ youth she’s worked with stem from negative cognitions, which are characterized by believing negative thoughts and experiences about one’s self.
“If you are told early in life…that you are different or wrong or disgusting or a sinner, then ultimately what you might believe in your core is exactly that,” she said. “You may begin to believe that every day. You may even see it play out in your life.
“This can leave someone feeling very lonely and afraid, on top of all of the other negative cognitions they may be suffering from.”
That was the case for Concha, who regularly heard during her teen years that bisexuality simply did not exist. Since she did not know anyone else interested in both genders and did not want anyone to think differently of her, she simply kept her fears and concerns to herself.
“I grew up in a household where bisexuality wasn’t even considered a real thing,” she said. “For as long as I can remember, that’s what I was told. I was mainly scared because then I thought maybe I was lesbian, but I still had crushes on boys. It was really hard to process at such a young age when the one sexuality I identified with wasn’t acknowledged.”
Her reticence mirrors one of the other factors behind the higher rates of depression among LGBTTQ youth: the process of coming out of the closet and publicly disclosing their sexual orientation or gender identity.
“The real question (to patients) is are you out and if you are, to whom?” D’Angelo said. “To your family? Your school? Your friends?
“Their rate and willingness…depends on the reception they get. It’s not unlikely for a patient to say that they’re out to their parents. Although that’s a major step, it doesn’t speak to the additional steps that come with being out to their friends, their school and so on.”
Getting a favorable reception from friends and family is shown to lower the risk of depression and suicide attempts. Among the LGBT participants in 2010 study published by the Journal of Child and Adolescent Psychiatry, those from more accepting families were half as likely to attempt suicide or have regular suicidal thoughts than those from families who balk at the news.
After coming out to some friends and family during her teen years, Concha fully disclosed her status as a bisexual woman in December 2015 via a blog post. She is still getting feedback, both in-person and electronically, and most of the comments she has received have been supportive. Among the responses have been several apologies from relatives who were unaware of the impact their words and dismissive attitude had had on her and her mental health.
“It’s taken me years to open up about my sexuality and I still have issues with some family members regarding my blog post,” she said. “It’s not easy coming out, but it’s worth it. I feel like a weight has been lifted off my shoulders and I’m finally able to breathe.”
The statistical data included in the story relies on self-identification, so the estimates might not match reality due to the stigma attached to non-heterosexual behavior in many communities.
According to the 2009 Youth Risk Behavior Survey, an estimated 7 percent of all 13-24-year-olds are LGBTTQ, with half considered questioning, or unsure of how to define their sexual preference. Additionally, few national, state or tribal health organizations compile information on youth sexual orientation and those that do don’t necessarily ask the same questions.
Nationwide resources are available for LGBTTQ youth struggling with depression or other mental health issues.
The National Suicide Prevention Hotline: 1-800-273-TALK (8255)
The Trevor Project (24/7 confidential crisis intervention and suicide prevention hotline for LGBTTQ youth): 1-866-488-7386
GLBT National Help Center Youth Talkline: 1-800-246-7743
Kids’ Help Phone (Canada only): 1-800-668-6868
LGBT Youth Line (Canada only): 1-800-268-9688 or via text at 647-694-4275