AHA News: Protecting LGBTQ People From the Health Risks of Social Isolation

FRIDAY, Oct. 21, 2022 (American Heart Association News) -- The ways Donald M. Bell and his Chicago neighbors connect with one another are as simple as they are significant.

"We have certain rituals that pull certain clumps of people together," said Bell, 73. Sometimes, it's gathering to watch "Jeopardy!" in the community room of their senior apartment building. Other times, they make meals for each other, because cooking for one can be hard, but sharing is easy.

They watch one another's pets and accompany each other on visits to the doctor and check in on their neighbors after medical procedures – such as the triple-bypass surgery Bell had about six years ago.

Such acts are healthy for anyone at any age. But as residents of the city's first LGBTQ-friendly senior housing development, Bell and his neighbors have had to overcome years of obstacles to be able to forge those connections.

"We try to show each other that we matter, after a lifetime of being told, 'You don't matter,'" Bell said.

Social connections can help protect health, research shows. But the lack of such connections – social isolation – has been associated with increased risk of premature death from all causes, according to a 2020 report by the National Academies of Sciences, Engineering, and Medicine. And poor social relationships have been associated with increased risk of coronary heart disease and stroke.

"We're social animals," said Dr. Benji Laniakea, an assistant professor in the LGBTQ+ clinical program at the Stanford University School of Medicine in Palo Alto, California. "We're wired to be together, to be able to talk to each other, to communicate to each other, to be with each other."

But LGBTQ people are more likely to say they are lonely, studies have shown. Several factors put older LGBTQ people at higher risk of isolation, Laniakea said. Many were shunned by their biological families, or have lost friends to AIDS. And societal discrimination might have interfered with opportunities to meet a life partner.

According to the LGBTQ+ elder advocacy and services organization SAGE, older LGBT people are more likely to be single and live alone and less likely to have children than their heterosexual peers, depriving them of a potential source of caregiving. And many fear discrimination when they seek help. "Some of our LGBTQ+ adults have had to go back into the closet in order to get care at a care facility," Laniakea said.

But social isolation is not just a problem for older people. Youth depend on many different support systems – family, schools, clubs, religious organizations – to shape their sense of self-worth, said Jonathan Garcia, an associate professor at Oregon State University in Corvallis, where he is director of the youth and young adult core of the Hallie E. Ford Center for Healthy Children and Families.

For LGBTQ teens, those would-be safe spaces can become sources of rejection, bullying and a repeated message that they don't belong. "So they don't feel like they can gain the support that they need in the places where they need it the most," Garcia said.

Social isolation among LGBTQ youth has been associated with problems such as depression, substance abuse and suicide attempts. Garcia led a review on the effects of social isolation and connectedness in LGBTQ youth that was published in 2019 in Global Public Health. He said the problem can be compounded in youth who also are members of marginalized racial or ethnic groups, who might feel isolated from families and religious institutions because of their orientation and shut out from LGBTQ groups when they experience racism.

The COVID-19 pandemic exacerbated many issues with isolation, Laniakea said. Adults who were just coming out were cut off from opportunities to connect with the LGBTQ world, while "for LGBTQ youth, especially those who maybe aren't out to their families, it meant going back effectively into the closet."

LGBTQ people have always had to find ways to build community, Laniakea said. The best-known historical event of the gay rights era, the 1969 Stonewall Uprising, was about the right to gather without being harassed by police. And there is a strong tradition of forming a "chosen family" among people who might have been cut off from the ones who raised them. "These connections that are found in someone who really sees you for who you are can be just as strong as biological family sometimes," Laniakea said.

Being among welcoming people can be crucial to health, Laniakea said, by providing an understanding, stress-relieving refuge from personal affronts and anti-LGBTQ rhetoric. Affirming people can send a message that "you are valid, that your gender and your way of living is reasonable, that you are not hurting anybody else by existing in a way that is true to yourself."

Garcia, who led a study about a program for building community among Hispanic LGBTQ youth, said society as a whole is responsible for addressing the causes of loneliness.

"Social isolation is not a result of personal failing," he said. "It's not just an individual experience. It's a result of that systemic oppression."

Volunteer work can be a way to both meet people and build community, Garcia and Laniakea suggested. "That in itself allows people to become useful and serve the community," Garcia said. "It addresses the isolation, but it also addresses some systemic issues."

People who want to be LGBTQ allies can help by supporting genders and sexualities alliance networks (formerly known as gay-straight alliances) and things such as school anti-bullying policies, which have been shown to reduce harm from social isolation and risk of attempting suicide.

An ally can also accompany someone to an LGBTQ community group, Laniakea said, "because going anywhere by yourself can be really daunting for the first time, regardless of your age."

Bell – who identifies as a gay or same-gender-loving man, as well as being a father of two and a third-generation Chicagoan of African, Indigenous and Scots-Irish heritage – has a community built into the Town Hall Apartments, the LGBTQ-friendly development created in a renovated police station not far from Wrigley Field.

He realizes that having space for a few dozen people in a city where tens of thousands identify as LGBTQ is far from a solution. But he's grateful for it.

The residents look out for each other, he said, "with the recognition that this is essential."

Born in 1949, he lived through an era when "there were no out places and safe places. No places like this," where he and his friends can share a joke without having to explain the context, or just let down their guard and be themselves. A place, he said, where "you're being told that you matter."

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email editor@heart.org.

By Michael Merschel, American Heart Association News