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Leveling Up Together: Nurturing LGBTQIA+ Mental Health in Gaming Communities
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Key Takeaways
- Video games have become vital for LGBTQIA+ representation and community-building, especially during the COVID-19 pandemic.
- Positive LGBTQIA+ representation in games fosters inclusivity and empowerment, while negative portrayals can harm mental health.
The LGBTQIA+ community has faced marginalization and stereotyping in media, including video games. Let’s examine the intersection of identity, mental health, and video gaming.
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The lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual (LGBTQIA+) community has historically faced marginalization in mainstream media, often subjected to harmful stereotypes and negative portrayals.1 These narratives have evolved, but their impact on LGBTQIA+ mental health remains significant. Historically, representation in media was limited, with queer characters often portrayed as villains or subjected to harmful stereotypes.1 Over time this representation has become more nuanced, portraying the community in a more positive light.As the media landscape evolves, video games have emerged as an essential platform for representation and community-building, particularly for LGBTQIA+ individuals.2 This article explores the role of gaming communities in supporting LGBTQIA+ mental health.
Historical Increase in Representation and Impact of COVID-19
A study conducted a thematic analysis to examine how LGBTQIA+ emerging adults in Australia interacted with online LGBTQIA+ content during the pandemic and perceived its influence on their sexual and gender identities.3 Identity development is deeply intertwined with social dynamics, so the findings were interpreted using social identity theory. Thirty-five participants completed a qualitative survey, revealing that, despite pandemic-driven disruptions, the enforced separation from regular routines served as an unprecedented chance for participants to engage in self-exploration and identity-building, largely supported by online content and community spaces.3 The study also highlighted a notable shift in younger LGBTQIA+ cohorts, who are employing more expansive identity labels. These results underscore the influence of online LGBTQIA+ content in shaping identity formation, particularly in the socially isolating conditions of COVID-19.3
This influence can concretely be seen in gaming media consumption. During the pandemic, video game usage surged with a 63% increase in sales, although specific data on LGBTQIA+ engagement remains limited,4 and there was an increase in representation of queer characters in video games.5 Characters like Ellie from The Last of Us and Chloe from Life is Strange mark progress toward LGBTQIA+ inclusivity, yet there is still much to improve in their portrayal. Online gaming spaces, moreover, have become an example of platforms for social interaction and exploration for LGBTQIA+ individuals, especially for those with limited access to in-person support networks. This is especially relevant in a post-COVID-19 world.
The Impact of Representation on LGBTQIA+ Mental Health
Representation in media plays a crucial role in shaping self-perception and identity for many communities. Positive LGBTQIA+ representation in video games can foster a sense of inclusivity, validation, and empowerment for gamers. However, harmful or stereotypical portrayals can have the opposite effect, reinforcing negative biases and damaging mental health.6
A study by Hughto et al, involving 545 transgender individuals, highlighted the adverse mental health outcomes—such as depression, anxiety, and posttraumatic stress disorder—associated with negative media depictions of transgender individuals.7 This underscores the need for thoughtful representation of LGBTQIA+ characters in video games. As psychiatrists and health care providers, it is vital to encourage the consumption of media that promotes positive and diverse portrayals of LGBTQIA+ identities, as it can significantly impact mental health and self-esteem.
Supporting LGBTQIA+ Mental Health in Gaming Communities:
Gaming communities serve as a lifeline for many LGBTQIA+ individuals, providing spaces for social connection, identity exploration, and emotional support. For those who lack acceptance or support in the offline world, these virtual environments can offer a sense of belonging. Mental health professionals should be aware of the importance of these spaces and incorporate discussions about media and gaming consumption into clinical assessments.
Incorporating questions about gaming habits and preferences into social history gathering is vital because it acknowledges an important aspect of the patient’s life. Asking, “What kind of video games do you consume?” or “Do you prefer to play as queer-identifying characters?” helps healthcare providers understand how media representation affects the patient’s mental health and identity. Additionally, it demonstrates the doctor’s investment in how their consumption of media and identity as a gamer intersects with their queer identity. Furthermore, the type of media a patient chooses to engage with can reflect conscious or subconscious views of themselves, offering valuable insights regarding their self-perception by exploring their consumption patterns. Another aspect to explore would be whether this consumption may reinforce harmful stereotypes.
Concluding Thoughts
As video games continue to grow as a medium, online gaming communities can offer vital social support and a space for positive representation. Still, they also carry risks such as internet gaming addiction and exposure to negative stereotypes. Psychiatrists and mental health professionals must engage with patients' gaming habits, advocating for thoughtful representation in video games while also addressing the potential mental health impacts of time spent online. Our roles as mental health care providers lie in encouraging patients to engage with media that promotes positive representation and helps reinforce a positive self-image, inviting patients to analyze their video game consumption material, and how the media they consume can reflect some conscious or subconscious view of themselves and identities, while also recognizing and addressing risks like internet gaming disorder.
Dr Noureddine is a psychiatry resident at Icahn School of Medicine at Mount Sinai, in New York, NY. Dr Parkerson is a psychiatry resident at Icahn School of Medicine at Mount Sinai, in New York, NY.
Disclaimer: The views in this article are our own and do not represent that of our institutions.
Acknowledgment: We would like to acknowledge Petros Levounis, MD, MA, for his support.
References
1. Where we are on TV ‘17-‘18: GLAAD's annual report on LGBTQ inclusion. GLAAD. 2018. Accessed March 20, 2025. https://assets.glaad.org/m/4dc56038673033fd/original/GLAAD-2017-18-Where-We-Are-on-TV.pdf
2. Brewer J, Romine M. Breaking barriers in mobile game development. Proceedings of the ACM on Human-Computer Interaction. 2024;8(296):1-20.
3. Williamson CA. Twitch.tv and its LGBTQIA+ tag: a digital ethnography investigating how LGBTQIA+-affirming video game streamers and viewers interact and build LGBTQIA+ spaces online. Sociology Theses, Dissertations, & Student Research. 2021;68.
4. Increase in video game sales during the coronavirus (COVID-19) pandemic worldwide as of March 2020. Statista. 2020. Accessed March 20, 2025. https://www.statista.com/statistics/1109977/video-game-sales-covid/
5. Shaw A, Lauteria EW, Yang H, et al. Counting queerness in games: trends in LGBTQ digital game representation, 1985–2005. International Journal of Communication. 2019;13:1544-1569.
6. McInroy LB, Craig SL. Perspectives of LGBTQ emerging adults on the depiction and impact of LGBTQ media representation. J Youth Stud. 2017;20(1):32-46.
7. Hughto JMW, Pletta D, Gordon L, et al. Negative transgender-related media messages are associated with adverse mental health outcomes in a multistate study of transgender adults. LGBT Health. 2021;8(1):32-41.
