Exploring the Mental Health Disparities Faced By LGBT+ Students in Canada: A Multilevel Structural Equation Modeling Approach

Background/Purpose: A growing body of research, including national studies, examines the experiences, wellbeing, and academic development of LGBT+ college students in the United States. These studies find that LGBT+ students face more discrimination and report higher rates of distress, mental health problems, and academic stressors than their peers. Little is known about the situation for LGBT+ higher education students in Canada, including the absence of national studies comparing the outcomes of LGBT+ and heterosexual cisgender students.

To inform policies and programs designed to promote LGBT+ students’ wellbeing, alongside documenting LGBT+ disparities it is important to identify the mechanisms underlying them, which national US studies fail to do. Furthermore, to holistically support students’ mental health, it is necessary to move beyond concern for only negative outcomes (e.g., distress) by examining positive outcomes (e.g., flourishing), which may contribute to resilience. Finally, in multi-institution studies researchers should use multilevel modeling that recognizes the nested nature of higher education datasets in which students are nested within institutions; however, such an analytical approach is rarely used, leading to potential biases.

Analyzing Canadian data from the 2016 National College Health Assessment, our objectives are to: (1) explore the relationships between LGBT+ status and positive and negative wellbeing, (2) examine the campus climate and academic mediators of these relationships.

Methods: Participants (N=37,984; 15.5% LGBT+, 38.3% people of color; 83.1% undergraduate) were randomly sampled from 41 Canadian universities/colleges (19.2% response rate). We measured positive mental health with the 14-item Mental Health Continuum-Short Form (MHC-SF). The total number of critical distress symptoms (self-harm, suicidal ideation, and suicide attempts) experienced in the past year was used as an indicator of negative mental health. Campus climate included perceptions of safety (4 items) and victimization (3 items; past year). A 7-item index measured how various challenging situations have impeded academic performance (past year).

To account for the nested data structure, we ran a Multilevel Structural Equation Mediation Model with random effects in the Mplus software.

Results: Within each institution, on average, LGBT+ status had a negative relationship with positive mental health, partially explained by indirect effects: LGBT+ students experienced lower perceived safety and more academic impediments, in turn associated with less positive mental health (respective indirect effects, b=-0.593, 95%CI[-1.016, -0.169]; b=-2.433, 95%CI[-3.083, -1.783]). Within each institution, LGBT+ status was also associated with the number of critical distress symptoms. It was partially explained by indirect effects, with LGBT+ students experiencing greater victimization and more academic impediments, in turn associated with more distress symptoms (b=0.012, 95%CI[0.008, 0.017]; b=0.033, 95%CI[0.017, 0.049]). No mediation effects were observed at the between-institution level. 

Conclusions/Implications: These results provide a national snapshot of LGBT+ students in Canada. They highlight the role of negative experiences and perceived safety in students’ positive and negative wellbeing. The findings indicate that policies and practice interventions need to address students’ experiences and safety on campus, and academic stressors. Research implementing similar multilevel analysis is needed to explore the roles of additional intersecting identities (e.g., racialized) in the relationships between campus experiences and wellbeing in LGBT+ students.