Reacción a "A comprehensive scientific review confirms inequalities in mental health amongst LGBTQIA+ people"

For me, the starting point is that sexual and gender diversity is not a pathology. I would focus on those who orchestrate, perpetrate and legitimise violence, and on the institutions that allow it to continue. Sometimes we scrutinise the distress of those on the receiving end of the attacks whilst largely overlooking those who perpetrate them. The minority stress model helps us to understand how one thing is connected to the other. On top of the difficulties anyone might face, there is an additional burden linked to discrimination. There are insults, attacks or rejection by one’s family, but the strain continues when you have to anticipate the next incident, watch what you say or work out where you can mention your partner without putting yourself at risk. You may even end up internalising the negative messages you receive. Hiding oneself can offer protection in a hostile environment, but having to make these calculations constantly takes its toll. This build-up of stress can contribute to anxiety, depression or suicidal behaviour. It is not an inevitable consequence of being LGTBIQA+.

I find the article to be a well-structured piece of work that organises the evidence and distinguishes which associations have the strongest statistical backing. Among its most robust findings, lesbian, gay and bisexual people are at approximately twice the risk of depressive disorders and 2.5 times the risk of suicide attempts during the previous year, compared with the control group. It also finds more symptoms of anxiety and non-suicidal self-harm amongst bisexual people than amongst lesbians and gay men, and a higher frequency of certain eating behaviours, such as purging, amongst gay teenage boys compared with their heterosexual peers. That said, I would distinguish the quality of this review from that of the studies it brings together. The included reviews are of low or critically low methodological quality; cross-sectional studies predominate; and a large proportion of the research originates from North America. Some associations have consistent statistical support, but this does not prove causality nor does it allow the figures to be simply extrapolated to Spain or to all the contexts encompassed by the acronym.

These findings are consistent with evidence accumulated over decades. In our review on protective factors, we identified the importance of support from family, school and friends. Our study with professionals in Spain revealed shortcomings in training and resources. And in the Spanish national CLICK report, we document both experiences of violence and vulnerability, as well as pride, joy and a sense of belonging when safe spaces exist. I am keen to highlight both aspects, because LGBTIQA+ lives are not reduced to suffering, and the support available can significantly change the experience of growing up.

Nor would I overlook the social and political context. The rhetoric of VOX, Milei, Trump or Bolsonaro—which portrays LGBTIQA+ diversity as a threat or its recognition as indoctrination—can contribute to normalising rejection. This is not merely a discussion for the airwaves. Drawing on the minority stress model, we need to analyse how such messages can legitimise discrimination and heighten the sense of threat felt by those who are singled out. The article does not assess the specific impact of such rhetoric, but I highlight it as part of the context we need to investigate and transform. For me, the implications involve intervening with those who perpetrate abuse, ensuring institutional responses, and sustaining support networks. Psychological care is necessary when distress is present, of course, but it makes little sense to ask a teenager to learn to cope better whilst leaving the environment that is harming them untouched.