A column in Psychiatric Services in Advance discussed strategies to improve digital mental health content for lesbian, gay, bisexual, transgender, queer, plus (LGBTQ+) youth.

In recent years, psychiatric treatment for LGBTQ+ youth has advanced, however, this community still experiences disproportionate psychiatric morbidity compared with their counterparts.

Psychiatric outcomes can be improved by adapting evidence-based treatments which affirm LGBTQ+ identities and abandoning the harmful history of diagnosing these populations as having ego-dystonic homosexuality or gender identity disorder.


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Almost half of LGBTQ+ youth have expressed a desire to receive psychotherapy but have limited access to providers trained in affirmative evidence-based care. In addition, some youth fear that seeking care will “out” them to their caregivers.

Digital mental health (DMH) could address some of the unmet needs of LGBTQ+ youth, however, as of February of 2022 there was only 1 high-value DMH application targeted at LGBTQ+ youth available.

Many mental health start-ups which offer DMH often focus on rapid growth, with the outcome that they tend to cater to the general heterosexual, cisgender population.

Despite the current DMH landscape, studies have found that LGBTQ+ youth are more likely than their peers to use DMH and isolated LGBTQ+ often look online for support and community. LGBTQ+-focused DMH could provide evidence-based information, facilitate positive identity development, and include opportunities for interpersonal connections.

In order to provide the best care and to retain use, the column authors emphasized the importance of updating existing content about LGBTQ+ youth to be more inclusive of diversity and to ensure that outdated language and mental illness models are removed. Content creators should be cognizant that there are more than 2 genders and should use gender-neural pronouns.

In addition to addressing the “minority stress” associated with belonging to a marginalized group, content should acknowledge the unique stressors experienced by many LGBTQ+ youth, including familial rejection, misgendering, and lack of dedicated public sanitary facilities.

Many LGBTQ+ youth would benefit from help with “coming out.” Youth that are contemplating disclosure often need tools to use when embarking on such discussions with loved ones and could benefit from practicing their disclosure. To do this, the authors suggested using chatbots that could be programmed to respond to common themes about coming out.

Some of the psychiatric morbidity among the LGBTQ+ community is from “internalized stigma.” This stigma could be addressed with DMH using information-busting myths and prompt users to reflect on the sources of negative messages.

DMH can also be used to amplify resilience among LGBTQ+ youth by helping to foster a community and stress the importance of LGBTQ+ pride. This could be achieved by highlighting successful LGBTQ+ personalities or by making connections to other LGBTQ+ youth virtually who may not have access to an in-person LGBTQ+ community.

In general, content creators should ask for feedback from users such that they maintain diverse and inclusive information.

The authors concluded, “LGBTQ+ youths are overrepresented among users of DMH; however, there is a lack of content targeting minority stress reactions, and most applications do not collect sufficient diversity-, equity-, and inclusion-related user feedback. The recommendations in this column offer a blueprint for moving toward inclusive and equitable care for LGBTQ+ youths.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Cohen JM, Feinstein BA, Fox K. The promise of digital mental health for LGBTQ+ youths. Psychiatr Serv. 2022;appips202100569. doi:10.1176/appi.ps.202100569