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Asian sexual and gender minorities (ASGM) in the U.S. occupy a unique position where multiple marginalized identities intersect, and their compounded minority experiences reflect stressors that operate across multiple systems, including stigmatizing narratives, violence rooted in heterosexism and racism, and underrepresentation in media and research. Research on the mental health of ASGM people has been scattered across studies focusing on different outcomes and factors. Given the under investigation of ASGM mental health in the U.S. and the growing but fragmented evidence base, a comprehensive synthesis is needed to provide a clearer picture of what is known about mental health challenges in this population. Three research questions were answered in this review: (1) What mental health challenges do ASGM individuals experience in the U.S.? (2) How do mental health challenges differ between Asian SGM populations and their non-Asian counterparts, and between SGM and non-SGM Asian individuals? and (3) What factors are associated with mental health challenges for ASGM populations in the U.S.?
Methods
This systematic review was conducted across four bibliographic databases (APA PsycINFO; PubMed; Social Services Abstracts; Sociological Abstracts) for studies published between January 2014 and February 2024. Double independent screening was applied to identify eligible studies. Studies were included if they empirically examined mental health challenges among ASGM in the U.S. Data extraction and synthesis results of were performed using a thematic synthesis approach.
Results
A total of 28 studies were included in this review. The synthesis of mental health challenges faced by ASGM included five domains: (1) internalized psychological problems; (2) suicidality and self-harm; (3) substance use; (4) internalized stigma and identity-related distress; and (5) intrapersonal and belong-related struggles. Most studies found that ASGM had higher levels of mental health challenges than non-SGM Asian individuals, and that ASGM had no significant difference with White peers regarding suicidality and psychological disorders, but higher levels of internalized stigma and belonging-related struggles. Mental health associated factors include intersectional discrimination, abuse and violent victimization, and lack of social support.
Conclusions and Implications
To our knowledge, this is the first systematic review focusing on ASGM mental health in the U.S. context. Although Asians are often portrayed as societally successful under the model minority stereotype, the findings reveal key mental health challenges experienced by ASGM populations and intersectional minority-related factors. The phenomenon of low internalized psychological problems and high internalized stigma and identity-based struggles among ASGM populations warrants further investigation to develop interventions and measurement instruments that account for the ASGM population’s unique mental health challenges and experiences of stigma within social systems of oppression. Future research is needed to clarify the underlying mechanism and contexts and to investigate what forms of support are most meaningful and protective for ASGM populations’ mental health. Additionally, future research should use rigorous sampling methods to include larger and more diverse samples of ASGM individuals, allowing for a more thorough examination of the complex and intersectional challenges faced by ASGM subgroups.