Minority stress, social integration, and the mental health needs of LGBTQ asylum seekers in North America

Objective: Drawing on theoretical accounts of LGBTQ minority stress and models of social integration and immigrant health, the present study examines sexual and gender minority status – heretofore overlooked in crossnational frameworks of immigrant health – as an important determinant of asylum seeker mental health. With the goal of spurring intervention development among this population, this study also aims to characterize LGBTQ asylum seekers’ interest in interventions aimed at alleviating minority stress, barriers to social integration, and associated mental distress. Method: Respondents (n = 308) completed an online survey which included the Refugee Health Screener (RHS-15), and a battery of measures of minority stressors and barriers to social integration. Results: Most respondents (80.20%) screened positive for mental distress. Consistent with minority stress theory, loneliness (OR = 1.14, 95% CI = 1.11, 1.16) and LGBTQ identity disclosure (OR = 3.46, 95% CI = 1.85, 6.50) were strongly associated with screening positive for mental distress. Consistent with theories of immigrant social integration, those who had been granted asylum (OR = 0.36, 95% CI = 0.25, 0.53) or had higher English language proficiency (OR = 0.35, 95% CI = 0.21, 0.60) were less likely to screen positive. In an exploratory analysis, the association between transgender identity and mental distress approached significance (OR = 3.60, 95% CI = 1.00, 7.2). As preliminary justification for applying these findings to practice, most of those who screened positive for distress were interested in receiving mental health counseling (70.45%). Most participants wanted more LGBTQ friends (83.1%), wanted to mentor an LGBTQ newcomer (83.8%), and were interested in joining an LGBTQ community center (68.2%). Conclusion: This study demonstrates that LGBTQ asylum seekers are highly likely to experience mental distress that is influenced by unique social factors, including barriers to social integration, and are motivated to participate in interventions aimed at addressing their mental health needs. © 2019 Elsevier Ltd