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Sex is defined by biological aspects of an individual, including anatomy, chromosomes, and hormones (1). Gender is a social construct based on the behaviours and attributes labelled as feminine or masculine (1).  Gender identity is a personal perception of oneself (2). Sexual orientation refers to a person’s pattern of romantic and/or sexual attraction.


Gender Sex Risk

Risk Factor

In terms of gender identity, people may perceive themselves as, for example, a woman, man, gender neutral, gender fluid (moving between genders), non-binary, among others (2). Transgender refers to those whose gender identity is different from their sex, while cisgender describes those whose sex and gender identity are the same (2).

Rates of mental disorders vary by sex, gender, and gender identity. Eating disorders and self-harm are more frequent in young women than young men, while suicide is more frequent for young men (3). Being transgender and gender non-conforming may also be a risk factor for mental health, as this population has been associated with higher rates of depressive symptoms, suicidality, trauma exposure and anxiety than cisgender people (4).

Regarding, sexual orientation, people may identify as homosexual (attraction to same gender), heterosexual (attraction to opposite gender), bisexual (attraction to women and men), pansexual (attraction to all genders), asexual (no sexual attraction), or aromantic (no romantic attraction), among others (2).

Being lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) can be a risk factor for mental health, as these sexual orientations have been linked with a higher likelihood of depression and anxiety (3).

Reasons for poor mental health in the LGBTQ+ community include an increased exposure to violence (5) and stigma (6). Additionally, LGBTQ+ people may face barriers while accessing mental health services, due to a lack of staff understanding of their unique experiences (7) or being refused treatment (8); adding to poor mental health outcomes. LGBTQ+ people may experience and fear rejection from peers or family, which is associated with psychological distress (9,10). Parental support can impact mental health, and rejection for being lesbian, gay or bisexual has also been associated with poor mental health (11).



1.        What is the difference between sex and gender?  [Internet]. Office for National Statistics. 2019 [cited 2021 Feb 26]. Available from:

2.        American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol. 2015;70(9):832–64.

3.        Department of Health. No health without mental health. A cross-government mental health outcomes strategy for people of all ages [Internet]. 2011 [cited 2021 Jan 15]. Available from:

4.        Valentine SE, Shipherd JC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev. 2018 Dec 1;66:24–38.

5.        McDonald K. Social Support and Mental Health in LGBTQ Adolescents: A review of the literature. Issues Ment Health Nurs [Internet]. 2018 Jan 2 [cited 2021 Jan 21];39(1):16–29. Available from:

6.        Mink MD, Lindley LL, Weinstein AA. Stress, Stigma, and Sexual Minority Status: The Intersectional Ecology Model of LGBTQ Health. J Gay Lesbian Soc Serv [Internet]. 2014 Oct 2 [cited 2021 Feb 5];26(4):502–21. Available from:

7.        Rees SN, Crowe M, Harris S. The lesbian, gay, bisexual and transgender communities’ mental health care needs and experiences of mental health services: An integrative review of qualitative studies. J Psychiatr Ment Health Nurs [Internet]. 2020 Dec 19 [cited 2021 Jan 21];jpm.12720. Available from:

8.        James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. Executive Summary of the Report of the 2015 U.S. Transgender Survey [Internet]. Washington, DC; 2016. Available from: Summary - FINAL 1.6.17.pdf

9.        Rood BA, Reisner SL, Surace FI, Puckett JA, Maroney MR, Pantalone DW. Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals. Transgender Heal [Internet]. 2016 Jan 1 [cited 2021 Feb 5];1(1):151–64. Available from: /pmc/articles/PMC5685272/?report=abstract

10.      D’augelli AR. Mental Health Problems among Lesbian, Gay, and Bisexual Youths Ages 14 to 21. Clin Child Psychol Psychiatry [Internet]. 2002 Jul 26 [cited 2021 Feb 5];7(3):433–56. Available from:

11.      Bouris A, Guilamo-Ramos V, Pickard A, Shiu C, Loosier PS, Dittus P, et al. A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: Time for a new public health research and practice agenda. J Prim Prev [Internet]. 2010 Dec 15 [cited 2021 Jan 28];31(5–6):273–309. Available from:


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