Ana Warner & Callie Hilgendorf
With the onset of the COVID-19 pandemic, many public health officials expressed a serious concern regarding the ramifications for mental health (Hasan & Bao, 2020). In fact, preliminary findings on the lack of educational opportunities and the rise in social isolation and partner violence reveal troubling trends in the already burdening effects of the COVID-19 pandemic on both physical and mental health (Goodman & Epstein, 2020; Wang et al., 2020). The intensity of COVID-19 in the United States has had a profound effect on the mental health of various communities, including lesbian, gay, bisexual, transgender, and queer (LGBTQ+) college students (Meyer, 2013). Prior to the pandemic, LGBTQ+ individuals were more vulnerable to experiencing negative mental health outcomes, specifically anxiety, in comparison to their heterosexual peers (Price-Feeney et al., 2020 & Russell & Fish, 2016). LGBTQ+ young adults have endured suffering, social isolation, job insecurity, and a tremendous amount of community loss during the COVID-19 pandemic (Gonzales et al., 2020; Konnoth, 2020). These experiences may be unique to people in the LGBTQ+ community, as compared to their heterosexual counterparts, because they may also face housing and job discrimination, live with people who are not supportive of their identities, and may generally rely on in-person, queer, community support systems (Jackson, 2017). To add to these already high-stress situations, many college students have had to make the difficult and abrupt transition to online learning with little support (Perz et al., 2020). Yet, there is limited research that addresses the ways in which LGBTQ+ college students have experienced anxiety from the pandemic.
COVID-19 Effects on College Communities
The COVID-19 pandemic has led to dramatic and undeniable losses worldwide, particularly for college-aged students (World Health Organization, 2020). With the continuing rise of COVID-19 cases, many universities shut down or shifted to fully remote learning (Grether et al., 2020; Perz et al., 2020). Due to campus closings, many students abruptly moved off-campus, which, in turn, caused many to lose their jobs and endure significant financial loss (Hoyt et al., 2020; Perz et al., 2020). This is in addition to the challenges regarding food, housing, and financial insecurity that many college students experienced prior to the pandemic (Owens et al., 2020).
The logistical and mental strain on college-aged students brought on by the pandemic challenged many to adapt to social, physical, and mental isolation (Wang et al., 2020). Recent research has indicated that college students have been coping with high amounts of stress and anxiety related to academic performance, physical risk of themselves or a loved one contracting the virus, study habits, social habits, remote learning experiences, current labor market participation, and expectations about future employment or further degrees (Aucejo et al., 2020; Chen et al., 2020; Perz et al., 2020). Specifically, the pandemic led to many students to withdraw from classes and even delay graduation because of uncertainty surrounding future educational plans and the current unemployment climate in the United States (Aurcejo et al., 2020). Additionally, students indicated a decrease in hours committed to scholarly activities, resulting in an overall decrease in academic performance (Aurcejo et al., 2020).
Each of these factors contribute to a general concern that an already existing mental health crisis is likely to become exacerbated due to handling of the COVID-19 pandemic (Hasan & Bao, 2020; Perz et al., 2020). According to the 2019 Annual Report of the Center for Collegiate Mental Health, anxiety was the most reported issue amongst college-aged students and has increased since the beginning of the pandemic (Wang et al., 2020). Research has found that those who indicated an increase in stress frequently cited five main reasons: academics (i.e., grades, delayed graduation, and remote learning), general uncertainty, health related concerns, finances, and social isolation (Wang et al., 2020). As social distancing protocols and the closure of public spaces continue, researchers have presented evidence that individuals, particularly young adults, experienced significant levels of anxiety and stress while in quarantine (Salari et al., 2020), and students have felt unable to adequately cope with their stress during this difficult time (Wang et al., 2020). Yet, there is a clear gap in the support these students have been receiving, and universities need to take action to better support the mental health of their students (Wang et al., 2020).
LGBTQ+ College Students and Anxiety
Academic interest in the wellbeing of LGBTQ+ students is relatively new (Leider, 2012). Until the early 2000s, the research published regarding LGBTQ+ college students was mostly concerned with anti-LGBTQ+ attitudes, as opposed to the experiences of LGBTQ+ students (Leider, 2012). Today there is a growing body of research working to address mental health concerns, such as anxiety, in the LGBTQ+ community (Leider, 2012; Ottenritter, 2012). One meta-analysis showed a pattern of lower rates of anxiety amongst heterosexual people as compared to their LGBTQ+ peers, even when controlling for other predictors of mental health complications (e.g., people who are HIV positive or experiencing housing insecurity), especially on college campuses (Meyer, 2013). Researchers have generally come to believe that this may be a result of LGBTQ+ identifying individuals experiencing microaggressions, overt aggressions, identity confusion, and internalized homophobia (Meyer, 2013; Ross et al., 2018).
College campuses also have the potential to improve mental health outcomes for LGBTQ+ students. When LGBTQ+ individuals have safe community-oriented queer spaces to process impactful events in their lives, they perceive less social isolation and are met with more wholly advantageous coping strategies (Jackson, 2017). Community building and consistent access to these different support networks are crucial for LGBTQ+ students to manage anxieties surrounding their identities and life experiences, so that they can fully commit themselves to flourishing during their time in school and beyond (Leider, 2012; Ottenritter, 2012). Given the nature of collegiate institutions, LGBTQ+ populations, compared to their heterosexual peers, are more likely to experience mental health disparities which may have been exacerbated since the COVID-19 pandemic (Salerno et al., 2020).
Current Study
There is currently very little research available that seeks to understand the connection between anxiety in LGBTQ+ college students and the COVID-19 pandemic (Meyer, 2013; Ross et al., 2018; Seelman et al., 2017). While it is understandable that this research is not widely available yet due to the recency of the pandemic and the number of subpopulations affected by it, it is especially important to look at LGBTQ+ college students, because they are already at a higher risk of anxiety than their peers (Meyer, 2013; Salerno et al., 2020). Additionally, by focusing on this community, research can strive to discover trends in LGBTQ+ college students’ experiences with anxiety and prevent them from becoming more prevalent in the future. Experience with anxiety, in this case, will focus on symptoms (e.g., panic attacks, increased heart rate, feelings of being out of control, etc.), access to support systems, and environmental factors. This qualitative study, thus, explored the following research question: How has the COVID-19 pandemic affected the experience of anxiety in LGBTQ+ college students?
Method
Participants
Fourteen LGBTQ+ identifying students from New York University (NYU), recruited via social media, class forums, and word of mouth, participated in the study. Participants were told they must identify as part of the LGBTQ+ community and be currently enrolled at NYU to be eligible for the study. Students were also given the opportunity to request a specific interviewer to reduce response biases and encourage more open responses. All respondents (N=14) identified as one or more of the following racial/ethnic identities: White (47.1%), Black (17.6%), Latine (23.5%), and Asian (11.8%), and one or more of the following LGBTQ+ identities: lesbian (24%), gay (16%), bisexual (12%), transgender (8%), pansexual (4%), queer (36%). The following gender identities were also represented: cisgender female (62.5%), transgender (12.5%), and nonbinary (25%) with differing combinations of she/her (62.5%), they/them (31.3%), and he/him pronouns (6.3%).
Procedure
This study was conducted via 20-minute semi-structured Zoom interviews where participants were asked to report demographic information such as pronouns, gender identity, LGBTQ+ identity, ethnicity, age, and year in college. For questions such as gender identity, LGBTQ+ identity, and ethnicity, participants were not given options to choose and were encouraged to list any and all terms that they identify with. Participants were also asked questions about their experiences since the beginning of the COVID-19 pandemic and anxiety. The questions about the participants’ experiences with anxiety and COVID-19 can be found in Appendix A.
Results
All interviews were recorded and then transcribed by the interviewers. Researchers used the principles of grounded theory to code the semi-structured interviews, by coding 21% of the transcripts and discussing and defining common themes related to the research question (Chun Tie et al., 2019). The codes that were generated based on the emergent themes are: anxiety surrounding routine (anxiety linked to changes in everyday life and uncertainties as a result of COVID-19), anxiety surrounding uncertainty (anxiety linked to unforeseen changes in previously secure long-term environments such as employment, housing, and community), social isolation (a decrease in daily interpersonal interactions and ultimate feelings of detachment from their communities), lack of normality (reported feelings of continued distress and inability to adjust comfortability into the world as affected by COVID-19), and less mental capacity (a lack of self-reported cognitive capabilities to perform everyday responsibilities such as homework, attending class or work, and personal maintenance).
Analysis of the data highlighted that 34% percent of participants indicated they were experiencing “anxiety surrounding uncertainty” over the past month. This included anxiety about relocating, changes in employment, and financial instability. Additionally, 13 out of the 14 participants indicated they were struggling with changes in everyday life, as well as “anxiety surrounding changes in routine” as a result of COVID-19. These changes included a shift to online learning due to COVID-19, adjusting to different workloads in employment or unemployment, moving locations during the pandemic, and shifting daily activities to a more indoor environment. Eighty-six percent of the participants reported that they were lacking a sense of normality in their daily interpersonal interactions. This included participants feeling equipped to adjust to a reorganized change in normality, and professors failing to recognize student accommodations due to COVID-19 related issues.
Throughout the pandemic, community engagement (e.g., through roommates, family, family-friends, or colleagues) has been a source of both reduced anxiety (21.4%) and increased anxiety (57.1%) for participants. Some specific examples of reduced anxiety that participants noted included a decrease in social anxiety given that social interactions decreased, and connecting with friends and family has switched to virtual communication. Out of the total responses, 13% of participants expressed that they had been experiencing “social isolation” through separation from their respective communities due to COVID-19. Potential causes for increases in anxiety levels that stem from “social isolation” include: living alone in an apartment, abrupt separation, limited social interactions, partner separation, contraction anxiety between partners, and NYU community seperation. Of the 14 interviews conducted, nine participants indicated that they were experiencing feelings of social isolation.
All 14 participants indicated at least once that they were struggling with less mental capacity to perform everyday responsibilities including homework, attending class or work, and personal hygiene or self-care. These experiences of anxiety focus specifically on the symptoms our population of study encounters. There was a noticeable trend in the participants’ quantity and quality of sleep; out of the 11 participants who chose to disclose their symptoms, six identified insomnia, or restlessness, as a significant source of their anxiety. These sleep disruptions totaled to 55% of the symptoms reported by the participants.
Another heavily represented symptom included trouble eating and nausea; five out of fourteen, or 35.7%, of participants expressed this manifestation of anxiety. Among the three participants who disclosed a medical diagnosis of Obsessive Compulsive Disorder (OCD,) two indicated that their obsessive thoughts or repetitive compulsions have increased because of an increase in anxiety related to COVID-19. Other common symptoms of anxiety that were expressed by our participants include: headaches, fidgeting, anxiety attacks (i.e., tightness in the chest, feeling an inability to breathe, and trouble thinking clearly), and dissociation from the present moment. Participants commonly reported struggling with one or more combinations of dissociation, lack of motivation, trouble focusing, and fatigue as symptoms of their anxiety. These symptoms combined with feelings of uncertainty, dramatic changes in routine, and intrusive thoughts and behaviors make it difficult to perform everyday tasks such as attending work and school and maintaining physical and mental hygiene. Some participants specifically said that they must be more strategic with planning their days around their available mental capacities. They also stated that they have had to significantly adjust their daily routines by increasing alone time, minimizing time on the computer, and scheduling daily outings.
Another aspect that was highlighted during the semi-structured interviews is that having access to mental health services is important for LGBTQ+ college students during the pandemic. Although it was not part of the formal interview questions, access to medication and counseling services came up organically in many conversations with the participants. Only five participants mentioned that they were taking medication to help manage their feelings and symptoms of anxiety and/or regularly seeing a mental health professional during the pandemic. In each of those cases, students reported a decrease in symptoms of anxiety and general improvement in their day-to-day lives.
Discussion
This study aimed to address the gaps in the literature surrounding the experiences of anxiety that LGBTQ+ college students face throughout the COVID-19 pandemic. The findings support past research by highlighting the anxiety experienced by LGBTQ+ college students (Goodman & Epstein, 2020; Meyer, 2013). One of the most common shared experiences from the participants was related to new or heightened stressors that have been increasingly difficult to manage since the pandemic. Specifically, individuals are forced to resume their lives with academics and work, but with less perceived mental capacity. Participants commonly reported struggling with one or more combinations of dissociation, lack of motivation, trouble focusing, and fatigue as symptoms of their anxiety. These symptoms combined with feelings of uncertainty, dramatic changes in routine, and intrusive thoughts and behaviors make it difficult to perform everyday tasks such as attending work and school and maintaining physical and mental hygiene.
Another aspect which has appeared to contribute to how LGBTQ+ students are re-prioritizing their available time and energy is their individual engagement in their classes. The rise of COVID-19 has created or heightened anxiety surrounding uncertainty with employment, finances, and housing amongst students and thus impacts individuals’ motivation and ability to be engaged in their coursework which is consistent with previous literature (Aucejo et al., 2020; Chen et al., 2020; Perz et al., 2020;). One student specifically mentioned that, “online school is not fun or easy, especially with professors who are not trained to teach online and when everything else in the world is a mess.” When participants were asked about how they were able to adjust their priorities and maintain engagement in school and work, every response mentioned the impact of their professors’ attitudes and/or policies in some way. Based on the findings, it appears that the attitudes of professors are impactful to LGBTQ+ students’ experiences with anxiety during COVID-19, which could be beneficial to take into account when planning lessons, deadlines, and general class structure in the future to better support students during this time.
Identity also seemed to play a role in the reported experiences of anxiety in this study. One person went as far as to mention that “some of [their] anxiety is specifically because [they] are LGBTQ+ and exist during the COVID-19 pandemic.” This feeling seemed to resonate in a few respondents who mentioned having to move out of their own spaces on or around campus and moving in with family or friends for extended periods of time in early 2020. Experiences ranged from not being able to engage in meaningful discussions with like-minded individuals about their lives or identities to entirely having to act as though they were not part of the LGBTQ+ community, which correspond to increased feelings of anxiety surrounding routine, anxiety surrounding uncertainty, social isolation, lack of normality, and less mental capacity based on the study’s coding measures. When LGBTQ+ college students are living through these experiences, it impacts their ability to perform at work and school as well as their ability to adequately take care of themselves. In order to address the ramifications of these experiences, it is especially important for institutions such as businesses, universities, and community organizations to prioritize the accessibility of a variety of mental health services (e.g., counseling, medication, etc.), as well as creating community support to re-engage young people in dialogue and action that empowers them in their identities. Organizations should also seek to utilize avenues that allow the individual to maintain their security within their living environment such as having e-book clubs, pen pals, and virtual affinity groups. It is important that research is able to center LGBTQ+ people to address existing disparities in mental health outcomes and prevent these from becoming exacerbated as a result of COVID-19.
Limitations and Future Directions
The researchers chose to identify patterns in experiences with anxiety amongst LGBTQ+ students at New York University in order to get the most representative sample for this context. With the resources available, if the study had included other universities there may not have been enough representation from any one place to get an accurate depiction of students’ experiences. Future research might explore how the experiences of LGBTQ+ identifying students at other universities are the same or different so that administrators and other stakeholders can adequately support their students.
Aside from universities, one aspect that was often touched on in this study was respondent’s experiences with finances and employment. No participants discussed the level of support and communication that they received from their employers during the pandemic. Given that many of the participants mentioned being employed at some point before or during the pandemic, it may also be beneficial for future research to explore how LGBTQ+ individuals’ employment has been affected by the pandemic to better address potential financial discrepancies and discern how employers can best support their employees during this time. Additionally, it is common for people with anxiety to experience other mental health complications at the same time, such as depression and phobias (Kaufman & Charney 2020; Last et al., 1987). This study did not examine comorbidities of anxiety, but in order to get a more holistic understanding of the needs and experiences of LGBTQ+ individuals during COVID-19 future qualitative research should investigate intersectional mental health concerns as well.
Shedding-light on the experience of anxiety that college students are currently facing has a positive impact on the amount of attention this topic receives in psychology research. Future studies can address some of the limitations of this study in order to develope a more well-rounded understanding of how to support different LGBTQ+ communities. By highlighting the need for more anxiety-related mental health support for the LGBTQ+ community, further research can also expand to other mental health conditions that are prevalent in adolescents’ lives. As the pandemic progressively becomes under control, it is important to continue to support vulnerable communities.
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