Experiences of adults with intellectual disabilities who identify as lesbian, gay, bisexual, or transgender within mainstream community: a systematic review of qualitative studies
Authors: Ramasamy Vemel (Resh) , Rillotta Fiona , Alexander June 
Published: October 2020

ABSTRACT

Objective:
The objective of this review is to identify, appraise, and synthesize the available qualitative evidence on the lived experiences of adults with intellectual disabilities who identify as lesbian, gay, bisexual, or transgender in mainstream society.

Introduction:
People with intellectual disabilities who identify with a non-normative sexual orientation and gender identity (eg, lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual) are dually stigmatized due to the prevailing notion of ableism and heteronormativity within the wider society. This layered stigma can generate further segregation within society, increasing vulnerability in this population and limiting their facilitation of a meaningful and satisfying life. To date, there are no existing systematic reviews that have explored the proposed study.

Inclusion criteria:
The review considered qualitative studies that explored adults (aged 18 and over) who have a formal diagnosis of intellectual disability or mental retardation (preceding diagnosis) in conjunction with their lesbian, gay, bisexual, transgender, queer or questioning, intersex, or asexual identity.

Methods:
The search strategy of eligible papers followed a three-step process. The search strategy aimed to locate published and unpublished studies in English from 1990 onward. The databases within the designated platforms that were searched included CINAHL, MEDLINE, PsycINFO, ScienceDirect, ERIC, ProQuest Dissertations and Theses Global, Scopus, PubMed, REHABDATA Database, Wiley Online Library, Google Scholar, and Google Advanced. The search was conducted in April 2017 and updated in January 2020. Titles and abstracts were screened by two independent reviewers for alignment with the inclusion criteria. Eligible studies underwent critical appraisal by three independent reviewers for methodological quality. Findings were assigned a level of credibility and synthesized using JBI's meta-aggregative method.

Results:
Following critical appraisal, 15 studies were included in this review. These studies were published between 1995 and 2018. The majority of the studies included in each synthesized finding scored either four or five "yes" responses or two or three "yes" responses on the relevant critical appraisal questions; therefore, the dependability scores were downgraded one level. With reference to the level of credibility, all findings in this systematic review were rated as unequivocal (U). Each synthesized finding was rated as moderate on the ConQual score. Data extracted from these studies resulted in 184 findings, which were then aggregated into 26 categories based on the similarities of meanings to form the eight synthesized findings. The synthesized findings provide a deeper and more comprehensive understanding of the lives of the participants. None of the participants in this review identified as queer or questioning, intersex, or asexual. Therefore, the findings in this review solely report on the lived experiences of participants with intellectual disabilities who identify as lesbian, gay, bisexual, or transgender.

Conclusions:
The synthesized findings indicated participants experienced a myriad of intersecting issues and multilevel environmental challenges that had a profound and adverse impact on their daily lives and development of a positively evaluated sense of self. Recommendations for policy and practice are provided to initiate further awareness and give precedence to a minority group within society that tends to be under-represented and overlooked.