We are in LGBTQIA+ Pride Month, a time dedicated to reinforcing the importance of discussing issues related to a population historically marginalized and subjected to violence. The choice of this month originates from a struggle over 50 years ago at a bar in New York City, USA. It’s essential to remember, however, that this fight has been ongoing for far longer.
In addition to highlighting its history, I recognize that capitalism consumes everything and everyone, and Pride Month is no exception.
Celebrating bodies and their right to exist free from discrimination is both legitimate and essential. Yet, we must not forget—under the veil of commercialization—the psychological scars this population bears, which, of course, manifest in countless variations and contexts.
While celebrating the achievements made to date, we must not let this pride obscure the painful aspects of the community that deserve more attention. For instance, I think of rainbow flags displayed at the entrances of some spaces to signify "LGBT-friendly" environments. I rarely see such inclusivity in public healthcare spaces—outside of or even during Diversity Month. Everyone deserves to feel welcomed in healthcare spaces, yet I’ve heard patients express fear of discrimination simply by stepping into these environments.
The LGBTQIA+ population faces unique challenges that can significantly impact their mental health and overall well-being. In Brazil—a country theoretically celebrated for its rich cultural diversity—the LGBTQIA+ community often endures social stigma, discrimination, and limited access to healthcare services.
Numerous studies have shown that LGBTQIA+ individuals face a higher risk of mental health disorders compared to heterosexual individuals. A study by Mello et al. (2018) revealed higher rates of depression, anxiety, and suicidal behavior among LGBTQIA+ individuals in Brazil. The prevalence of mental health disorders among LGBTQIA+ youth is particularly alarming, with Souza et al. (2020) reporting significantly higher rates of suicidal ideation and self-harm.
Social stigma and discrimination play a substantial role in the mental health challenges faced by Brazil's LGBTQIA+ population. Homophobic and transphobic attitudes in society can lead to internalized homophobia or transphobia, contributing to feelings of shame, low self-esteem, and psychological distress. Rocha et al. (2021) found that experiences of stigma and discrimination are associated with increased rates of depression, anxiety, and substance abuse among LGBTQIA+ individuals.
The Minority Stress Theory, proposed by Meyer (2003), explains the negative impact of chronic social stressors on the mental health of marginalized populations, including the LGBTQIA+ community. This theory suggests that prolonged exposure to discrimination and prejudice leads to adverse psychological outcomes. Multiple studies in Brazil, including those by Almeida et al. (2019) and da Silva et al. (2021), have validated the applicability of Minority Stress Theory in understanding mental health disparities within the LGBTQIA+ population. This framework also aligns with concepts of "Historical Trauma" and "Collective Trauma," acknowledging the shared experiences and emotional struggles of LGBTQIA+ individuals across different contexts—such as a trans person from rural Bahia and a trans person across the Atlantic sharing similar challenges.
Limited access to inclusive healthcare services remains a significant challenge for Brazil’s LGBTQIA+ community. Discrimination and the lack of culturally competent care within the healthcare system deter LGBTQIA+ individuals from seeking help for mental health concerns. A study by Coloma et al. (2022) emphasized the importance of training healthcare professionals to provide affirming and inclusive care for LGBTQIA+ patients. Unfortunately, such professional care is often compromised by personal (religious or otherwise) beliefs about LGBTQIA+ individuals, making the issue even more challenging.
Despite the significant challenges faced by Brazil's LGBTQIA+ population, it is crucial to acknowledge their resilience and the protective factors that promote positive mental health outcomes. Supportive families, social networks, and access to LGBTQIA+-affirming communities and organizations have been linked to improved mental health among LGBTQIA+ individuals. Nardi et al. (2018) highlighted the role of social support in mitigating the impact of minority stress on mental health outcomes.
As a psychiatrist, educator, and individual sharing this world with others, I strive daily to contribute in every way possible so that everyone—regardless of identity—feels they deserve a place in this world, free from violence.
Dr. André Luiz Figueirêdo, MD
Psychiatrist
CRM-SP¹ 224805 | RQE² 95913
¹REGIONAL COUNCIL OF MEDICINE REGISTER #
²SPECIALIST QUAILIFICATION REGISTER #
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