What you need to know
2SLGBTQ+ youth make up 20%–40% of the homeless youth population in North America. Due to the COVID-19 pandemic and public health measures, there has been a lack of safe and inclusive housing options, and limited access to health care and social supports. This has impacted the mental health of 2SLGBTQ+ youth at risk of, and experiencing, homelessness, increasing suicidality, depression, anxiety and substance use.
Efforts are required to ensure that inclusive and affirming health care and support services are accessible to 2SLGBTQ+ youth experiencing homelessness and to those unable to access services virtually. Preventive and longer-term specialized mental health support and treatment, in addition to emergency/crisis services, are also required.
What is this research about?
2SLGBTQ+ youth experience significantly higher rates of mental health issues compared to heterosexual and cisgender youth, due to stigma, discrimination and identity-based rejection. During the COVID-19 pandemic, 2SLGBTQ+ youth are experiencing these stressors in increased and new ways, which are seeming to have devastating effects for this population. For example, due to a lack of alternative housing options heightened by the pandemic, some youth have been forced to isolate at home with unsupportive and abusive family members. A number of youth have also had difficulties receiving the support they rely on or accessing new services, as these crisis services have had to close their doors or limit the number of clients they can serve due to COVID-19 restrictions.
This study examined the impacts of the COVID-19 pandemic on 2SLGBTQ+ youth at risk of, and experiencing, homelessness in the Greater Toronto Area (GTA) and surrounding areas in Ontario, Canada, to understand the specific challenges, coping strategies and mental health responses of this group during the COVID-19 pandemic.
What did the researchers do?
The researchers used a mixed-methods design and a rolling enrollment strategy to recruit 2SLGBTQ+ youth who were either at risk of or experiencing homelessness to participate in virtual surveys and virtual, one-on-one interviews. The inclusion criteria were:
- self-identify as 2SLGBTQ+
- aged 14–29
- at risk of, or experiencing, homelessness (i.e., from a range of housing and shelter experiences, including unsheltered; staying at a shelter or housing program; provisionally accommodated; living with unsupportive family; struggling to pay rent; living independently of parents/caregivers but unable to secure stable, safe or consistent housing; or their housing situation is severely lacking security or stability)
- living in the GTA or surrounding areas (e.g., Barrie, Guelph, Kitchener, Waterloo)
The researchers collaborated with youth-serving organizations and hired a Peer Support Worker who identified as 2SLGBTQ+ and was in the same age range as the participants. The Peer Support Worker coordinated online recruitment of participants through virtual information sessions and paid social media advertisements. The survey included questions on demographics, impacts of the COVID-19 pandemic, health service use and health outcomes, including depression, anxiety and suicidality.
Researchers used validated and standardized scales to measure mental health outcomes, including the General Anxiety Disorder-7 item scale (GAD-7) for anxiety, the Patient Health Questionnaire (PHQ-9) for depression, and the CAGE-AID Questionnaire adapted to screen for alcohol and drug use. The one-on-one interview guide included questions on COVID-19 related challenges and barriers, mental health, coping strategies, family life and access to services. Data collection began in January 2021, during the second wave of COVID-19 in Ontario, at a time when lockdown restrictions were in place.
What did the researchers find?
Participants had an average age of 21 years and represented diverse ethno-racial backgrounds including Indigenous, Black, Asian, mixed-background, and White. The majority of participants identified their gender as transgender or gender diverse, and their sexual orientation as bisexual. Youth also described their sexual orientation as gay, lesbian, pansexual, queer and asexual. The average age at which participants first experienced homelessness was approximately 16 years.
Numerous youth were unable to secure safe, affirming and affordable housing during the COVID-19 pandemic. Youth also reported living with unsupportive or abusive parents and/or family members due to the reduced availability of housing options. Also, because of public health measures, some youth were not able to stay at the homes of friends’ parents. The number of participants staying at a shelter, transitional housing program or group home prior to the pandemic doubled since the start of the pandemic. Prior to the pandemic, about 13% of youth participants reported living in a public space, vehicle or vacant building, compared to about 33% of youth since the pandemic began.
As a result of the pandemic, some youth also reported losing their jobs. Over half of the participants reported that their main source of income included Ontario Works (OW), Ontario Disability Support Program (ODSP), Canada Emergency Response Benefit (CERB), Employment Insurance (EI) or Canada Emergency Student Benefit (CESB).
Approximately 81% of youth engaged in non-suicidal self-injury and about 36% of participants reported attempting suicide since the start of the COVID-19 pandemic. The majority of respondents reported experiencing poor mental health, depression, and anxiety, due to staying with unsupportive parents or relatives, overall pandemic stress, being lonelier, and not being able to access safe and affordable housing.
The majority of youth scored in the range of clinically significant for problematic alcohol and/or substance use. Participants reported that this increase of use was due to job loss, difficult living situations, loss of connection to friends and community, and identity-based discrimination.
Impact on health care access
The majority of youth experienced changes to their access to health care since the start of the COVID-19 pandemic. About half of youth reported missing a scheduled appointment with a health care provider over the past month for a variety of reasons, including cancelled appointments due to COVID-19, forgetting to go to appointments, and to avoid other people. Three-quarters of youth reported delaying or not getting the health care they thought they needed. Approximately a third of youth reported mild changes, such as appointments being moved online instead of in-person visits. A quarter of participants had moderate changes, such as delayed appointments or delays getting prescriptions, while about 16% reported severe changes and were unable to access needed care, resulting in negative impacts to their health.
About a third reported severe changes to accessing mental health services and were unable to access the care they needed, resulting in negative impacts to their mental health. Participants described numerous barriers accessing counselling and/or support groups since the start of the pandemic, resulting in over half of youth being unable to access counselling and/or support groups.
Since the beginning of the pandemic, approximately a quarter of youth were unable to access alcohol or substance use treatments, including interventions for smoking and cannabis use.
Among transgender participants, over half reported that their transition-related medical appointments and/or surgery(ies) had been postponed or canceled, including access to hormone therapy and gender-affirming interventions, which had detrimental impacts on their mental health.
Numerous health care services switched to offering virtual care because of the COVID-19 pandemic and public health restrictions. Youth experienced both benefits and disadvantages in this shift. Some youth reported saving money on transportation costs, decreased levels of social anxiety and feeling less vulnerable to judgement. Other youth described barriers making it difficult or not possible to access virtual care, including not having access to the Internet/poor connection, difficulty navigating online services and major privacy concerns due to living with unsupportive parents and/or family members.
How can you use this research?
The results highlight an urgent need for 2SLGBTQ+-inclusive and affirming services focusing on preventive and longer-term specialized mental health support and treatment, in addition to emergency and crisis services. Efforts are required to ensure that services are more accessible to youth experiencing homelessness and to those unable to access services virtually.
About the researchers
Alex Abramovich1,2,5, Nelson Pang1, Amanda Moss1, Carmen H. Logie3,4, Michael Chaiton1,2, Sean A. Kidd5, Hayley A. Hamilton1,2
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada