Discrepancies in reporting of mental illness among foreign-born lesbian and bisexual women

Background: In many cultures, social stigma is associated with mental illness and is a commonly cited barrier to treatment among foreign-born individuals. LGBT individuals often experience stress due to their sexual orientation, and are at higher risk for mental illness than heterosexuals. Very little is known about the potentially interactive effects of being foreign-born and a sexual minority with respect to mental health.

Method: Using the National Health Interview Survey 2013 data, we estimated the prevalence of serious mental illness (SMI), as defined by the Kessler-6 psychological distress scale, among foreign-born lesbian and bisexual women (LB) aged ≥18 years. Self-reported mental illness, and mental health service and medication use were also analyzed. Comparisons were made between foreign-born and US-born LB and heterosexual women.

Findings: In 2013, 2.3% of US women identified as LB; among these approximately one-eighth was foreign-born. Thirteen percent of foreign-born LB screened for SMI, compared to 6.8% and 4.3% of US-born LB and heterosexual women, respectively. However, self-reported data offered a different picture. Compared to foreign-born LB, more US-born LB reported frequent depression (21.1% vs. 2%) and anxiety (54.0% vs. 24.1%). Use of medication for depression and anxiety was also significantly higher among US-born LB. Delaying mental health service due to costs was reported significantly more frequently among foreign-born LB.

Implications: Foreign-born LB were more likely to experience SMI, but less likely to recognize and/or report it. Findings suggest the importance of mental health screening and support for foreign-born LB, and additional research.