Social Integration And The Mental Health Needs Of Lgbtq Asylum Seekers In North America

Yale University

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Yale Medicine Thesis Digital Library School of Medicine

January 2019

Social Integration And The Mental Health Needs

Of Lgbtq Asylum Seekers In North America

Samara Danielle Fox

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Recommended Citation

Fox, Samara Danielle, "Social Integration And The Mental Health Needs Of Lgbtq Asylum Seekers In North America" (2019). Yale

Medicine Thesis Digital Library. 3493.

https://elischolar.library.yale.edu/ymtdl/3493

Social Integration and the Mental Health Needs

of LGBTQ Asylum Seekers in North America

A Thesis Submitted to the

Yale University School of Medicine

in Partial Fulfillment of the Requirements for the

Degree of Doctor of Medicine

by

Samara Fox

2019

Abstract

This study examined the mental health burden of LGBTQ asylum seekers and

associated psychosocial risk factors with a focus on barriers to social integration. This

study also characterized LGBTQ asylum seekers’ interest in interventions aimed at

alleviating mental distress and social isolation. Respondents (n = 308) completed an

online survey which included the Refugee Health Screener (RHS-15), the NIH Loneliness

scale, and an adapted scale of sexual identity disclosure. Most respondents (80.20%)

screened positive for mental distress. Loneliness (OR = 1.14, 95% CI = 1.09, 1.19) and

LGBTQ identity disclosure (OR = 3.46, 95% CI = 1.01, 12.02) were associated with

screening positive for mental distress. Transgender identity (OR = 3.60, 95% CI = 1.02,

16.02) approached significance for a positive association with mental distress. Those

who had been granted asylum (OR = 0.36, 95% CI = 0.169, 0.75) or had higher English

language proficiency (OR = 0.35, 95% CI = 0.12, 0.94) were less likely to screen

positive. Most of those who screened positive (70.45%) were interested in receiving

mental health counseling. Almost all participants wanted more LGBTQ friends (83.1%),

wanted to mentor an LGBTQ newcomer (83.8%), and were interested in joining an

LGBTQ community center (68.2%). LGBTQ asylum seekers are highly likely to

experience mental distress and are interested in participating in mental health

treatment and LGBTQ community building. Loneliness, outness, indeterminate

immigration status, and low English proficiency are unique risk factors associated with

mental distress.

Table of Contents

INTRODUCTION 1

BACKGROUND 1

PERSECUTION EXPERIENCES 2

MENTAL HEALTH 3

SOCIAL INTEGRATION 4

OUTNESS 6

DEMOGRAPHIC CHARACTERISTICS 8

STUDY OBJECTIVES 8

METHODS 9

PARTICIPANTS 9

SURVEY DEVELOPMENT 10

MEASURES 10

DATA ANALYSIS 17

RESULTS 18

PARTICIPANT CHARACTERISTICS 18

DESCRIPTIVE STATISTICS 20

PREDICTORS OF MENTAL DISTRESS 22

DISCUSSION 23

MENTAL HEALTH 24

SOCIAL INTEGRATION 25

DEMOGRAPHIC CHARACTERISTICS 28

INTERVENTION INTEREST 30

IMPLICATIONS 30

LIMITATIONS 31

CONCLUSION 33

REFERENCES 35

1

Introduction

Background

In the 1990s in North America, a series of federal court cases and statutory

reforms transformed an individual’s sexual orientation from being a basis for

immigration exclusion to being a basis for immigration relief under international human

rights law (1)(2). Decisions from immigration courts extending similar relief on the basis

of gender identity soon followed (3). Since that time, LGBTQ (Lesbian, Gay, Bisexual,

Transgender, Queer)1 immigrants have claimed asylum on the basis of sexual

orientation or gender identity every year, coming from over 80 countries around the

world where it is a crime or generally unsafe to be LGBTQ (4). The United States and

Canadian Governments do not publish records on the number of individuals who claim

or receive asylum on the basis of sexual orientation or gender identity. However, one

inquiry to the Canadian government revealed that 1,351 asylum claims on the basis of

sexual orientation had been made in 2004 (5). The Williams Institute has estimated that

2.4% of documented immigrants and 2.7% of undocumented immigrants to the United

States identify as LGBTQ (6). Applying an even more conservative estimate of 2% to the

225,750 individuals who filed for asylum in the U.S. in 2016 (7) would suggest that at

least 4,515 of them were LGBTQ. In addition to a paucity of population data, there are

1 The acronym LGBTQ is frequently used in Western academic and activist circles as an umbrella term for all sexual and

gender minorities. It does not reflect the full diversity of identities articulated across cultures, such as hijra people in

Southeast Asia, or two-spirit people in various Native American tribes. For the sake of brevity, the term will be used to

refer to all immigrants claiming asylum on the basis of sexual orientation or gender identity in the common law court

systems of the United States and Canada. The term LGB will be used to refer to sexual minorities only, as opposed to

gender minorities including transgender and other gender non-conforming individuals.