Community connection is associated with lower psychological distress for sexual minority women who view community connection positively.

We examined factors associated with sexual minority women's evaluations of belonging to the lesbian, gay, bisexual, transgender and queer (LGBTQ) community in Australia, and assessed whether a positive view of community participation impacted levels of psychological distress. 2424 cisgender sexual minority women participated in a national, online, cross-sectional survey of LGBTIQ adult Australians' health and well-being. Multivariable regression analyses were conducted to investigate sociodemographic factors associated with sexual minority women's belonging to the LGBTQ community, feelings towards community connection, and associations between community connection and recent psychological distress. Most sexual minority women (58.9%) reported feeling that they are part of the LGBTQ community, and a majority of the participants felt positive about being connected to this community (68.5%). Participants who were bisexual, non-university educated, and who resided in an outer-suburban location were least likely to evaluate participation in the LGBTQ community positively. Feeling positive about community connection was associated with lower levels of psychological distress. Feeling a part of LGBTQ community was associated with lower psychological distress, but this link appears contingent upon positive feelings about community participation. Sexual minority women's' relationships to the LGBTQ community are often complex, and community connection and participation in and of itself is not a panacea for the negative outcomes associated with sexual minority stressors.

The influence of care continuity and disclosure of sexual orientation in general practice on lesbian, bi+ and queer cisgender women's engagement with mental health services.

BACKGROUND: Lesbian, bisexual+ and queer (LBQ+) cisgender women have considerable unmet mental health needs. The aims of this study were to examine LBQ+ cisgender women's prior engagement with general practitioners (GPs), and how this relationship shaped their mental health service use. METHOD: Data from 2707 cisgender LBQ+ women were drawn from a national survey of adults who are lesbian, gay, bisexual, trans, intersex, queer or questioning, asexual and other diverse sexuality and gender identities (LGBTIQA+) in Australia. Multivariable logistic regression analyses examined demographic predictors of continuity of care with GPs and GPs' awareness of LBQ+ women's sexual orientation. The relationship between these variables and recent mental health service use was then analysed, comparing LBQ+ women's engagement with services known to be LGBTIQA+ inclusive and those without an inclusive reputation. RESULTS: LBQ+ cisgender women with a regular GP had greater odds of having accessed mental health services in the last 12months. Two-thirds had a regular GP, with the lowest odds among women aged 18-35years and highest odds among women with a disability. LBQ+ women who did not believe their regular GP knew of their sexuality had lower odds of having accessed LGBTIQA+ inclusive mental health services. These individuals were typically aged below 25years, bisexual+ or queer identified, had below undergraduate-level education, earned <$2000 AUD per week, or lived in an outer-suburban or regional area. CONCLUSION: GPs may be missing opportunities to promote continuity of care through developing trusting relationships with specific sub-populations of LBQ+ women, which in turn appears to sustain inequitable access to mental health care. To offer appropriate care and referrals for this population, GPs should provide safe and inclusive environments to enable comfortable and supportive discussions about sexual orientation when this is relevant to a person's health care.

Factors Associated With Experiences of Harassment or Abuse Among Lesbian, Gay, Bisexual, Trans, Queer, and Asexual Young People With Disability in Australia.

Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) young people with disability are known to experience higher rates of harassment or abuse than LGBTQA+ young people without disability. This study focused on participants in Australia and identified factors associated with harassment or abuse among LGBTQA+ adolescents and young adults who reported a disability as well as associations with mental health outcomes. Analyses were conducted from a national survey that included 2,500 LGBTQA+ people who reported a disability and were aged 14 to 21 years. Measures included experiences in the past 12 months of verbal and physical harassment or abuse due to one's sexual orientation or gender identity, sexual harassment or abuse, mental health, suicidality, and sociodemographic traits. Overall, 48.4% of participants with disability reported experiencing verbal harassment or abuse, 12.4% physical harassment or abuse, and 29.7% sexual assault or harassment. In multivariable regression analyses, verbal harassment or abuse was significantly more likely among trans men, participants with an intellectual disability, and those who were "out" to most or all of their family. Physical harassment or abuse was significantly more likely among participants with a physical or sensory disability. Sexual harassment or abuse was significantly more likely among trans women and participants with a physical or sensory disability. Participants who experienced harassment or abuse were also significantly more likely to have attempted suicide in the past 12 months. These findings will assist policymakers and practitioners in identifying contexts linked to a heightened risk of abuse among LGBTQA+ young people with disability and further underscore an immediate need to address and prevent harm in this population.

Cervical screening among LGBTQ people: how affirming services may aid in achieving cervical cancer elimination targets.

To reach cervical cancer elimination targets it is necessary to increase screening rates among underserved populations such as LGBTQ communities. This paper examines rates of attendance and associated factors of cervical screening in LGBTQ communities. Data from 2,424 people aged 25 to 74 years and assigned female at birth were drawn from an online national Australian survey of LGBTQ adults. Over half of the sample had accessed cervical screening in the past 2 years. Using a multivariable logistic regression analysis, significant associations were found between screening, sociodemographic traits and health-care access. Trans men were least likely to access cervical screening, while bisexual, pansexual and queer identified participants were most likely to access screening. People who lived outside inner-suburban areas and those who had a disability were less likely to have had screening. Evidence of trusting relationships with a general practitioner (having a regular GP and GP's knowledge of the individual's LGBTQ identity) increased the likelihood that participants had screened, as did recent access to a medical service that was LGBTQ-inclusive or catered specifically to LGBTQ communities. The findings suggest the importance of training health providers, as well as targeted public health messaging for increasing uptake of cervical screening among LGBTQ people.

'It feels meaningful': How informal mental health caregivers in an LGBTQ community interpret their work and their role.

Many members of lesbian, gay, bisexual, trans and gender diverse, and queer (LGBTQ) communities provide informal mental health support to peers. This type of support is valuable for people who receive it - even helping to prevent suicide. It is also meaningful to those who provide it. In this article, we focus on how LGBTQ people derive meaning from their experiences of supporting peers. In-depth interviews with 25 LGBTQ people in Melbourne, Australia, indicate that those providing informal mental health support to fellow community members recognise their roles as meaningful in three main ways: in terms of self, relationships and communities. Recognising the meanings that LGBTQ caregivers derive from helping fellow community members provides useful information service providers and policymakers seeking to better address mental distress in LGBTQ communities and support caregivers. It is useful to understand this meaningful work in an LGBTQ context as caregiving that challenges gendered and heteronormative assumptions about what care is, and who provides it.

Affirming educational and workplace settings are associated with positive mental health and happiness outcomes for LGBTQA + youth in Australia.

BACKGROUND: Affirming socio-cultural settings are essential for protecting the mental health and wellbeing of lesbian, bisexual or pansexual, trans and gender diverse, asexual and queer (LGBTQA +) youth. However, limited research has explored the role of affirming educational and workplace settings, as reported by LGBTQA + youth themselves, with respect to their mental health and wellbeing. Moreover, existing research maintains a focus on mitigating poor mental health outcomes, with little attention to positive wellbeing outcomes among LGBTQA + youth. METHODS: Using data from the largest national survey of LGBTQA + youth aged 14-21 in Australia, multivariable regression analyses were conducted to explore associations between affirming educational and workplace settings and psychological distress and subjective wellbeing among 4,331 cisgender and 1,537 trans and gender diverse youth. Additionally, a series of multivariable regression analyses were conducted to explore individual sociodemographic traits that are associated with reporting affirming educational or workplace settings. RESULTS: Both cisgender and trans or gender diverse participants who reported that their education institution or workplace were affirming of their LGBTQA + identity reported lower levels of psychological distress as well as higher levels of subjective happiness. Additionally, affirming environments were not experienced equally across all subsections of LGBTQA + youth, with reporting of an affirming educational or workplace setting differing most noticeably across gender, type of educational institution and residential location. CONCLUSION: The findings demonstrate that affirming educational and workplace settings can result not only in better mental health, but also greater levels of subjective happiness among LGBTQA + youth. The outcomes illustrate the importance of ensuring all LGBTQA + youth are afforded the opportunity to thrive in environments where they feel validated and confident to express their identities. The findings further highlight a need to target education institutions and workplaces to ensure the implementation of policies and practices that promote not just inclusion of LGBTQA + youth but affirmation of their identities.

Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among trans and gender diverse people in Australia.

INTRODUCTION: Correlates of suicidal ideation and suicide attempts among a large cross-section of trans and gender diverse populations in Australia were examined. METHODS: A national survey was conducted that included 1466 trans and gender diverse participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. RESULTS: Overall, 62.4% reported suicidal ideation and 9.5% suicide attempt in the past 12 months. The likelihood of suicidal ideation was higher for younger participants or those who felt treated unfairly or socially excluded due to their gender identity in the past 12 months. It was lower for those with a postgraduate degree, who felt accepted by family or work, or who felt their gender identity was respected when accessing a mainstream medical clinic in the past 12 months. The likelihood of suicide attempts was greater for those aged younger or who had recently experienced sexual harassment based on their sexual orientation or gender identity, and lower for those who were non-binary. CONCLUSION: Urgent attention for suicide prevention is necessary for trans and gender diverse communities. These findings point to a range of risk and protective factors, which may help inform the targeting and design of suicide prevention strategies.

Predictors of Loneliness Among Older Lesbian and Gay People.

This study sought to understand the social and individual factors that predict loneliness among older lesbian and gay people in Australia. A sample of 508 gay men and 241 lesbian women, aged 60 and over, completed a survey including measures of loneliness, internalized homonegativity, sexual orientation discrimination, and connectedness to lesbian and gay communities. A multivariable linear regression predicting loneliness was conducted. Not being in an intimate relationship and having less connection to lesbian and gay communities were significant predictors of loneliness for both older lesbian women and gay men. For the men, younger age, internalized homonegativity and more frequent lifetime experiences of sexual orientation discrimination also appeared to predict greater likelihood of loneliness. More frequent recent experiences of sexual orientation discrimination predicted loneliness for the women. The findings confirmed loneliness as an issue of concern among older lesbian and gay people and identified factors amenable to intervention to address loneliness.

Antiretroviral Therapy Use, Viral Detectability and Fear of Onward Transmission Among People Living with HIV in Australia: Changes Between 1997 and 2018.

This paper examines how antiretroviral therapy (ART) use and fears towards the onward transmission of HIV have changed among people living with HIV (PLHIV) in Australia between 1997 and 2018. Participants were recruited as part of the HIV Futures study, a large cross-sectional survey of PLHIV in Australia, in 1997, 2003, 2012 and 2018 (total n = 3889). ART use, viral load detectability, and fear of onward HIV transmission were compared between years. Predictors of onward transmission fear were assessed among the 2018 subsample. While ART use within our sample decreased between 1997 and 2003, it subsequently increased to 97% in 2018. Self-reported viral load undetectability steadily increased over time, up to 88% in 2018. Notably, fewer PLHIV reported being fearful of transmitting HIV in 2018 compared to all other years. Being unfamiliar with the undetectable = untransmissible health movement, and having a detectable or uncertain viral load at last test, were significant predictors of being fearful of onward HIV transmission. Beyond the immediate medical considerations of HIV treatment, these results suggest that the undetectable = untransmissible movement may play a critical role in attenuating burdens experienced by PLHIV in Australia and that such messaging, in tandem with early and consistent ART use, should remain a salient feature of heath messaging among this population.

Illicit drug use among lesbian, gay, bisexual, pansexual, trans and gender diverse, queer and asexual young people in Australia: Intersections and associated outcomes.

INTRODUCTION: High rates of illicit drug use have been reported among gay and bisexual young men, however limited research has examined patterns of drug use among the broader population of lesbian, pansexual, trans and gender diverse, asexual and queer (LGBTQA) young people. We examined factors associated with illicit drug use in the past 6 months and lifetime experiences of self-reported concern with drug use among LGBTQA youth in Australia. METHODS: A cross-sectional survey was conducted involving 6418 LGBTQA participants aged 14-21 years, 5914 of whom provided information relating to their use of illicit drugs. Multivariable logistic regressions examined demographic factors and life experiences associated with drug use in the past 6 months and lifetime experiences of self-reported concern with drug use. RESULTS: Overall, 26.4% of participants aged 14-17 and 41.9% aged 18-21 reported any drug use in the past 6 months, of whom 23.5% had ever been concerned about their drug use. Cannabis use was most commonly reported (28.3%), followed by ecstasy/MDMA (7.1%), antidepressants (5.6%) and LSD (3.5%). Higher odds of drug use were reported among cisgender men and those who had experienced homelessness or sexual harassment in the past 12 months. Higher odds of self-identified concern about drug use were observed among participants reporting challenging life experiences. DISCUSSION AND CONCLUSIONS: Rates of illicit drug use among LGBTQA young people in this study were considerably higher than those observed in general population youth studies in Australia and were further elevated among those who had experienced LGBTQA-related prejudice or harassment, or homelessness.

Factors associated with experiences of abuse among lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) adults with disability in Australia.

BACKGROUND: Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) people with disability report greater levels of abuse than those without disability. OBJECTIVE: This study sought to further understand these experiences by examining factors associated with experiences of abuse among LGBTQA+ adults who reported a disability in Australia. METHODS: A national survey was conducted that included 2629 LGBTQA+ people who reported a disability aged 18 years and older, with data collected on experiences of verbal abuse, sexual assault, and social exclusion in the past 12 months as well as demographic characteristics. RESULTS: Of participants with disability, 42.5% reported experiencing verbal abuse, 17.4% sexual assault, and 50.3% social exclusion based on their sexuality or gender identity in the past 12 months. From multivariable analyses, verbal abuse was significantly more likely among trans women and non-binary participants and among those classified with more severe disability. Sexual assault was significantly more likely among those who lived in a rural area or had a higher income. Social exclusion was significantly more likely among those who were trans woman or non-binary, identified as bisexual, aged 18-24 years, or born in an English-speaking country other than Australia. CONCLUSIONS: These findings illustrate contexts for heightened risks of specific forms of abuse and highlight an urgent need to understand and address experiences of abuse and their consequences among LGBTQA+ people with disability.

Coping with the stress of providing mental health-related informal support to peers in an LGBTQ context.

Many lesbian, gay, bisexual, trans or gender diverse, or queer-identifying (LGBTQ) people provide informal support to peers experiencing mental ill health. This reflects both the high prevalence of mental ill health in their communities - often a product of discrimination - and barriers to accessing formal services. In this article, we explore how LGBTQ people who help peers with their mental health seek to cope with the stress of providing such support. Drawing on interviews with 25 LGBTQ people in Melbourne, Australia, we consider how community members being 'leant on' engage in self-care practices and seek help from their communities to cope with the stress of their support roles. We demonstrate that participants' ways of coping, even when similar, can vary in effectiveness and often come with limitations. Thus, we conclude that LGBTQ people providing informal support to peers should be better assisted to do so, in ways that acknowledge the diversity of support provided in LGBTQ communities.

Naming and Recognition of Intimate Partner Violence and Family of Origin Violence Among LGBTQ Communities in Australia.

Dominant framings of intimate partner violence (IPV) construct the experience as one where a cisgender man enacts violence against a cisgender woman. While often the case, this framing obfuscates the experiences of people who identify as lesbian, gay, bisexual, transgender diverse, or queer (LGBTQ) and may challenge their ability to conceive of their relationship-based experiences as abusive or violent. The extent to which hostile experiences from family of origin violence (FOV) members are conceived or named as violence is also unclear. A large, online, national survey of LGBTQ adults separately assessed experiences of IPV and FOV in two ways: a direct question relating to abuse from a partner/s or family member/s, and a second question (asked irrespective of the previous answer) which sought to establish experience of a nuanced list of abusive acts that can constitute violence (including emotional abuse, LGBTQ-specific forms of violence, and enforced social isolation). Following comparison of responses, multiple regression analyses were performed to assess variation by demographic characteristics. Among the full sample of 6,835 individuals, when asked directly, 30.93% (n = 2,108) of participants indicated that they had ever experienced FOV and 41.73% (n = 2,846) indicated that they had ever experienced IPV. However, when asked about experiences of FOV using the second nuanced question, 43.18% (n = 2,675) responded in ways that indicated that they had ever experienced FOV and 60.71% (n = 3,716) with respect to IPV. The recognition of violence, as indicated by responses to the direct question varied by numerous characteristics, including age, gender, and educational attainment. These findings indicate some LGBTQ people may struggle to recognize or name their family or relationship experiences as abusive or violent, which may complicate their ability or willingness to access professional support. More expansive framings, policies, and responses to IPV and FOV are required.

Health intervention experiences and associated mental health outcomes in a sample of LGBTQ people with intersex variations in Australia.

People with intersex variation/s have sex characteristics determined by reproductive anatomy or chromosomal, gonadal, or hormonal expressions that are not typical of medical and societal norms for male or female bodies and are widely subjected to irreversible medical interventions at an early age to reinforce sex assignment. These interventions may be accompanied by experiences of lack of autonomy for the individual and, at times, lack of fully informed consent on the part of the individual or their parents/carers. People with intersex variations additionally experience high rates of mental health concerns relating to stigma, discrimination and poor healthcare experiences. The intersections between LGBTQ identities and intersex variations are poorly understood but are important given a high proportion of people with intersex variations identify as LGBTQ. This study explored associations between healthcare experiences and mental health outcomes among 46 LGBTQ people aged between 18 and 67 years old with intersex variations in Australia. Findings provide evidence of associations between suicidal thinking, suicidal attempts, depression or anxiety and negative healthcare experiences, including limited autonomy and consent, and challenges accessing psychological support. These highlight the need for further research and proactive intervention to advance human rights and improve health outcomes for this population.

Health literacy, financial insecurity and health outcomes among people living with HIV in Australia.

It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant's confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care.

Modeling the effect of random roughness on synthetic aperture sonar image statistics.

A model has been developed to predict the effect of random seafloor roughness on synthetic aperture sonar (SAS) image statistics, based on the composite roughness approximation-a physical scattering model. The continuous variation in scattering strength produced by a random slope field is treated as an intensity scaling on the image speckle produced by the coherent SAS imaging process. Changes in image statistics caused by roughness are quantified in terms of the scintillation index (SI). Factors influencing the SI include the seafloor slope variance, geo-acoustic properties of the seafloor, the probability density function describing the speckle, and the signal-to-noise ratio. Example model-data comparisons are shown for SAS images taken at three different sites using three different high-frequency SAS systems. Agreement between the modeled and measured SI show that it is possible to link range-dependent image statistics to measurable geo-acoustic properties, providing the foundation necessary for solving problems related to the detection of targets using high-frequency imaging sonars, including performance prediction or adaptation of automated detection algorithms. Additionally, this work illustrates the possible use of SAS systems for remote sensing of roughness parameters such as root mean square slope or height.

Internalized Homonegativity and Mental Health Among Chinese Gay and Bisexual Cisgender Men: Exploring the Moderating Influences of Psychosocial and Sexual Identity Factors.

Much research on Chinese gay and bisexual men has focused on sexual health and, in particular, HIV-related issues. However, relatively little research has considered psychosocial aspects of being a gay or bisexual man in China. The present study was designed to address this gap by examining psychosocial predictors of mental health from a minority stress perspective. Results from an online survey of 1,786 Chinese gay and bisexual cisgender men revealed that higher levels of internalized homonegativity predicted greater psychological distress and a lower sense of positive well-being. Higher self-esteem, social support, and resilience were strong predictors of lower psychological distress and higher well-being, but these psychosocial factors mostly did not moderate associations between internalized homonegativity and mental health. A stronger sense of sexual identity superiority weakened the associations between internalized homonegativity and both mental health measures, but sexual identity centrality only moderated the association between internalized homonegativity and positive well-being. This study is among the first to examine minority stressors and psychosocial factors, distinct from the HIV-focussed literature, in a Chinese context. These findings may inform interventions targeting increased self-esteem, social support, and resilience, which could be beneficial for the mental health of Chinese gay and bisexual cisgender men.

Experiences of informal caregiving among older lesbian and gay adults in Australia.

OBJECTIVE: This study examined older lesbian and gay adults' experiences regarding informal caregiving, including challenges and positive aspects of caregiving. METHODS: Interviews were conducted with 16 lesbian women and gay men in Australia, aged 60+, who were engaged in informal caregiving. Analyses involved a qualitative thematic approach. RESULTS: Most participants were caring for a friend or partner and regarded caregiving as a form of love and did not seek external support despite noting several impacts. Some participants found that they too were beginning to require care. For some, formal care was being considered, but with a degree of reluctance. CONCLUSIONS: Older lesbian and gay adult caregivers experience a range of challenges and support needs in relation to their experiences with the caregiving role. This research highlights a need for ensuring that caregiving policies and practices be responsive to the experiences and challenges faced by older lesbian and gay people.

Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience.

Purpose: This article examines factors associated with suicidal ideation and suicide attempts in the past 12 months among lesbian, gay, bisexual, pansexual, queer, asexual, or other non-heterosexual identifying youth (LGBQA+). Methods: A national Australian cross-sectional online survey was conducted involving 4370 cisgender LGBQA+ participants aged 14-21 years from September to October 2019. Multivariable logistic regression analyses were performed to examine significant factors associated with suicidal ideation and suicide attempts in the past 12 months. Research ethics approval for the WTI4 study was granted by the La Trobe University Human Research Ethics Committee and the ACON Research Ethics Review Committee. Results: Overall, 56.4% of participants reported suicidal ideation and 8.9% a suicide attempt in the past 12 months. Multivariable regression results show that participants aged younger than 18 years, lesbian (compared with gay) identifying, those living in rural or remote locations (compared with inner city), those reporting any verbal, physical, or sexual harassment or assault based on sexual orientation or gender identity, or who had a religious family or household, or had experienced conversion practices in the past 12 months reported higher levels of suicidal ideation or suicide attempts. Those who reported feeling part of their school reported lower levels of suicidal ideation and suicide attempts. Conclusion: High levels of suicidal ideation and suicide attempts among young LGBQA+ people in Australia highlight a need for the ongoing inclusion of LGBQA+ youth as a priority population for suicide prevention. The findings illustrate key factors associated with a greater risk of suicidality among young LGBQA+ people. These findings can be used to inform the provision of tailored support services, including culturally safe suicide prevention programs and efforts to address stigma, discrimination, and conversion practices.

The Nature and Impact of Informal Mental Health Support in an LGBTQ Context: Exploring Peer Roles and Their Challenges.

Background: Research shows that LGBTQ communities experience high levels of suicidality and mental ill health. They also face significant barriers to accessing adequate mental health treatment in service settings. In response to these factors, it is likely that LGBTQ community members turn to their peers for informal mental health-related support. Such support, however, is largely undefined, the extent of it poorly understood and its impacts on those who perform it underexplored. Methods: We explored the nature and impact of informal mental health-related support provided by peers in LGBTQ communities in Melbourne, Australia. Drawing on semi-structured in-depth interviews with 25 LGBTQ adults in 2020, we explored how and why peers provided mental health support to friends, partners, housemates and even strangers and the impact this had on them. Results: We found that participants performed support roles as extensions of their existing relationships. We demonstrate that the support roles of the safe friend, housemate and partner, among others, represent everyday relationships stretched-even to breaking point-to incorporate informal mental health support. Each of these support roles is distinct, but they can all potentially result in similar impacts on those performing them. One of the more significant of these is burnout. Conclusions: LGBTQ community members face a diverse range of challenges when they support peers with their mental health. Informal peer-support roles are a significant responsibility for those performing them. LGBTQ community members stepping up to support others should be better supported to help manage their roles and the impacts of performing them. Policy Implications: Findings can contribute to policy that not only addresses high levels of mental ill health in LGBTQ communities, but also seeks to help peers in support roles to prevent them from being negatively impacted.