LGBQ+ adults reporting a change in identity also report mental health struggles

As National Coming Out Day approaches on Oct. 11, a new Tulane University study emphasizes the need for mental health support for individuals navigating changes in their sexual identity. The study, published in the American Journal of Psychiatry, followed a national sample of LGBQ+ adults over two years, exploring how changes in sexual identity affected their mental health.

Researchers found that around 9% of participants reported a shift in how they identified their sexual orientation during a two-year period. Some participants who initially identified as gay or lesbian later identified as bisexual, pansexual, or queer, while others moved in the opposite direction. These changes, though part of many people’s natural evolution in understanding themselves, may come with added stress and subsequent emotional challenges.

“For example, compared to women who maintained a consistent monosexual identity, such as identifying as lesbian, those who transitioned from a monosexual to a plurisexual identity, like bisexual or pansexual, reported higher levels of psychological distress,” said lead author Evan Krueger, PhD, assistant professor of social work at Tulane University School of Social Work. “They also had more days where their mental health wasn’t good and had lower social well-being, meaning they felt less positive about their current circumstances and how they fit into society.”

The findings highlight the importance of understanding sexual identity as a developmental process. These identities are not always fixed, but can change and unfold across one’s life.

Evan Krueger, PhD, MPH, LMSW

For men, the challenges were different. Men who experienced any change in their sexual identity—whether from gay to bisexual or the other way around—tended to struggle more with substance use than those whose identities stayed the same. This suggests that the process of adjusting to a new sexual identity, regardless of which direction it goes, can be a stressful experience, potentially leading to harmful coping mechanisms.

“The findings highlight the importance of understanding sexual identity as a developmental process. These identities are not always fixed, but can change and unfold across one’s life,” Krueger said.

He also stressed that the findings do not support so-called conversion therapy as research has shown that outside efforts to influence the ways in which sexual minority people identity are harmful to health and well-being.

“Coming to understand one’s identity and adopting new labels that better ‘fit’ how one sees oneself can be an empowering process. But change, even good change, can be hard,” Krueger said. “So it is understandable that in the period immediately following a change in identity, folks might need a little more support. We may need to think about how to better mobilize mental health supports during this ‘developmental’ period so that folks can explore their identities (and all that goes along with it) healthily.”

Study co-authors include Meg D. Bishop, PhD; Allen B. Mallory, PhD.; Ankur Srivastava, PhD, and Stephen T. Russell, PhD.