Qualitative exploration of mental health and its drivers in lesbian, bisexual and queer identifying women at a South African higher education institution

Background Many university students have poor mental health and sexual minority students may be particularly vulnerable. This study explored lived experiences and drivers of poor mental health among self-identifying lesbian and bisexual students in a South African university. Methods Three focus group discussions were conducted in isiZulu on three campuses, with 56 participants between 18–30 years old, identified through participant-driven sampling through the campus LGBTQI + forum. Thematic analysis and member checking with a sub-sample of participants were conducted. Results Poor mental health was a common experience among participants, with depression, anxiety, and substance use frequently discussed. Participants articulated a deep self-awareness of their distress and the impact on their academic and personal lives, with self-harm and suicidal ideation being normalized experiences. They described how their poor mental health impacted their academic performance, self-care, and relationships, contributing to a sense of overwhelm and a cycle of worsening mental health. Substance use, particularly alcohol and marijuana, was widely reported; however, only a sub-group of participants acknowledged its negative consequences, and many viewed it as a useful coping mechanism. The drivers of poor mental health identified by participants included rejection by family based on their sexuality, the burden of meeting societal expectations of women in their cultural context, and the pressures created by religious beliefs about minority sexual identities. Participants highlighted the strain of navigating their sexual identity in unaccepting environments, which led to feelings of self-stigma and emotional exhaustion. Homophobia on campus further exacerbated their distress, with participants highlighting experiences of verbal abuse and discrimination. Despite these challenges to mental health, participants also identified resilience factors, chief among which was social interaction through supportive friendships and connections within the LGBTQI + community. Conclusion This study describes experiences of poor mental health of sexual minority women students in South Africa. Mental health promotion interventions for campus environments, including approaches that build self-acceptance and foster social support, are urgently needed to address drivers of poor mental health. This should include multi-component psychoeducational interventions that affirm gender and sexuality, and promote mental health literacy, self-acceptance, and enhance healthy coping strategies and resilience.