Exploring Collegiate Trends in Diverse Sexual Orientation: The View from Above

CCMH is celebrating Pride Month by taking a closer look at the population of Lesbian, Gay, Bisexual, Queer, Questioning, and other (LGBQQ+) student clients with diverse sexual identities who received care at university and college counseling centers (UCCs).

This special Pride Month edition of the blog reports on data pertaining to sexual orientation. Although this construct is distinct from gender identity, CCMH recognizes the importance of including individuals who identify as transgender and gender non-binary in research findings, as well as in Pride Month celebrations. Transgender and gender non-binary people are an important part of the LGBTQIA+ community, and CCMH is committed to continuing to share findings related to transgender and non-binary student clients in the near future.

Over the course of the past decade, CCMH has refined our research and clinical instruments to be more inclusive and bring visibility to students with diverse sexual orientation identities. The evolution of the Standardized Data Set (SDS), as a particular example, is briefly summarized below:

  • 2012: introduction of a “Self-identify” option on the sexual orientation item to provide a write-in space for students whose orientation is not captured in the available language
  • 2012: order of options in the sexual orientation item was revised to match the order of the LGBQQ+ acronym
  • 2016: an option was added for people who do not experience sexual attraction
  • 2020: sexual orientation options were expanded to include more identities (i.e., asexual, pansexual, and queer), and the options were alphabetized as opposed to prioritizing the heterosexual identity

In honor of Pride Month, this blog examined nine years of data to answer the following questions:

  1. What are the trends in access to care at UCCs among LGBQQ+ clients?
  2. What are the top concerns with which LGBQQ+ clients are presenting to treatment?
  3. How prevalent are experiences of discrimination and unfair treatment for LGBQQ+ clients, and how do they correlate with other aspects of care for this population?

As we reported in our August 2021 blog post, 25.2% of students in the aggregate CCMH dataset identified themselves as LGBQQ+ during the 2019-2020 academic year, which rose to 29.2% in the 2020-2021 academic year. Marginalized sexual orientation in college students has been associated empirically with increased mental health distress, risk of suicidality, and need for counseling (Hayes et al., 2011; McAleavey et al., 2011; Meyer, 2003). Increased stress in this population can be further complicated by the typical identity development that occurs during college years (McAleavey et al., 2011). Data from CCMH member centers offers a unique perspective on LGBQQ+ issues from the perspective of those students who received counseling services.

Increases in access to care for LGBQQ+ clients over the past decade

CCMH examined trends in sexual orientation for students seeking college counseling services over the past decade. Overall, LGBQQ+ clients in our data represented 12.8% of clients seeking services in the 2011-2012 academic year and increased to represent 29.2% of clients in the 2020-2021 academic year.


When specific sexual identities were explored, the frequency of students identifying as bisexual demonstrated a consistent increase over the past ten years at CCMH centers, rising from 4.3% in 2012-2013 to 13.2% in 2020-2021. Students who consider themselves “questioning” their sexual identities also increased since 2012, growing from 2.0% to 3.6%. While lesbian and gay students demonstrated more modest changes, they were consistent with other LGBQQ+ identities in their growth (both increasing within a percentage point in frequency). These upward trends represent an increase in students with LGBQQ+ identities receiving services, which might be a hopeful sign of improved access to counseling services for these students over the past decade.

Interestingly, there was a notable decrease in individuals utilizing the “Self-identify” option after three new identities were included (i.e., asexual, pansexual, and queer) in 2020, indicating that the new response option language might better capture the identities of more students.


Presenting concerns and risk in LGBQQ+ student clients

Clients with LGBQQ+ identities may often present to counseling centers with concerns related to their sexual orientation and exploration of their identity. The graph below shows the rates of “Sexual Orientation” as a presenting concern for both LGBQQ+ clients and heterosexual clients. The percentage of LGBQQ+ clients whose therapists identified “Sexual Orientation” as a presenting concern have decreased over time, which might be an indication of more improved inclusive experiences in their everyday lives over the past 9 years.


Discrimination and unfair treatment in LGBQQ+ student clients

It is crucial for those working with students of marginalized sexual orientations to acknowledge a critical paradox – that even as “things seem to be getting better” with regard to increased acceptance and tolerance in the general public, LGBQQ+ students seeking services are often at increased risk of adverse experiences (Russell & Fish, 2016), including discrimination. To further explore this set of experiences in a treatment-seeking population, CCMH implemented novel items on the SDS in 2021 capture the rate of “discrimination or unfair treatment due to any of the following parts of their identity” in the past six months: (1) disability; (2) gender; (3) nationality/county of origin; (4) race/ethnicity/culture; (5) religion; (6) and sexual orientation. We now report on the percentage of clients self-reporting any such experiences and if those rates fall along lines of diverse sexual orientation.

Of all the student clients in the sample:

  • 6.1% reported discrimination due to sexual orientation
  • Therapists of 2.7% reported that sexual orientation was a presenting concern
  • Therapists of 1% reported that discrimination was a presenting concern
Of LGBQQ+ student clients (n = 21,555) in the sample:
  • 32% reported discrimination based on at least one area of their identity
  • 16.8% reported discrimination specifically based on their sexual orientation

Experiences of discrimination or unfair treatment on the basis of sexual orientation is associated with increased levels of distress. Compared to students reporting no discrimination, those clients indicating discrimination pertaining to their sexual identity were significantly more distressed in areas of Depression, Generalized Anxiety, Social Anxiety, Academics Concerns, Eating Concerns, Anger/Frustration, and overall distress. The asterisks represent statistically significant differences.


It is important to acknowledge the impact of intersectional identities; that is, any one LGBQQ+ person’s experience is not only affected by sexual orientation, but also race, ethnicity, gender, religion, and other identities that intersect with one other. For example, 11% of the LGBQQ+ students in the sample reported discrimination on the basis of both sexual orientation and one or more other identities. Table 3 shows percentages of LGBQQ+ student clients endorsing discrimination or unfair treatment on the basis of identities other than sexual orientation.

Summary of findings

  • Trends have shown a general increase in proportion of LGBQQ+ students seeking counseling services nationally, which might be a hopeful sign of improved access to counseling services for these students over the past decade.
  • Students identifying as LGBQQ+ have decreasingly entered counseling services with “Sexual Orientation” as their primary concerns, which possibly might be an indication of increased inclusive experiences in their everyday lives.
  • A substantial portion (32%) of students identifying as LGBQQ+ report experiences of discrimination in the past 6 months. Clients who report discrimination based on their sexual orientation are significantly more distressed in numerous areas (Depression, Generalized Anxiety, Social Anxiety, Academics Concerns, Eating Concerns, Anger/Frustration, and overall distress) compared to clients reporting no discrimination. It is critical for therapists to recognize when LGBQQ+ share experiences of discrimination and how those are associated with increased distress.

CCMH continues to evolve its understanding and advocacy of all sexual orientations and strives to capture the experiences and concerns of this diverse group. In closing, it is also important to highlight the evolution of the diverse make-up of college counseling center staff, as there are growing numbers of individuals with diverse sexual orientations seeking care nationally. In fact, research has shown that counseling centers tend to employ greater proportions of LGBQQ+ professionals compared to other campus departments and sites (Mandala & Ortiz, 2021). While this can be celebrated, macro-level challenges and threats persist as centers are still rooted within a greater heteronormative systemic context.

This blog post (as well as the August 2021 blog post "Sexual Minority Clients in College Counseling Centers") was written by CCMH Business Team member, Katie Davis, M.S.

Katie is a Doctoral Student in Clinical Psychology at PSU and a part of the Castonguay Lab. 


  • Hayes, J. A., Chun-Kennedy, C., Edens, A., & Locke, B. D. (2011). Do double minority students face double jeopardy? Testing minority stress theory. Journal of College Counseling, 14(2), 117–126. https://doi.org/10.1002/j.2161-1882.2011.tb00267.x
  • Mandala, C. R., & Ortiz, S. M. (2021). Queerness Is a Particular Liability: Feeling Rules in College and University LGBTQ Centers. Journal of Homosexuality, 0(0), 1–21. https://doi.org/10.1080/00918369.2021.1984754
  • McAleavey, A. A., Castonguay, L. G., & Locke, B. D. (2011). Sexual Orientation Minorities in College Counseling: Prevalence, Distress, and Symptom Profiles. Journal of College Counseling, 14(2), 127–142. https://doi.org/10.1002/j.2161-1882.2011.tb00268.x
  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
  • Russell, S. T., & Fish, J. N. (2016). Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annual Review of Clinical Psychology, 12(1), 465–487. https://doi.org/10.1146/annurev-clinpsy-021815-093153
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