Does It Get Better? A Longitudinal Analysis of Psychological Distress and Victimization in Lesbian, Gay, Bisexual, Transgender, and Questioning Youth

doi:10.1016/j.jadohealth.2014.10.275

Journal of Adolescent Health

Volume 56, Issue 3, March 2015, Pages 280-285

https://doi.org/10.1016/j.jadohealth.2014.10.275 Get rights and content

Abstract

Purpose

The mental health and victimization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth have garnered media attention with the “It Gets Better Project.” Despite this popular interest, there is an absence of empirical evidence evaluating a possible developmental trajectory in LGBTQ distress and the factors that might influence distress over time.

Methods

This study used an accelerated longitudinal design and multilevel modeling to examine a racially/ethnically diverse analytic sample of 231 LGBTQ adolescents aged 16–20 years at baseline, across six time points, and over 3.5 years.

Results

Results indicated that both psychological distress and victimization decreased across adolescence and into early adulthood. Furthermore, time-lagged analyses and mediation analyses suggested that distress was related to prior experiences of victimization, with greater victimization leading to greater distress. Support received from parents, peers, and significant others was negatively correlated with psychological distress in the cross-sectional model but did not reach significance in the time-lagged model.

Conclusions

Analyses suggest that psychological distress might “get better” when adolescents encounter less victimization and adds to a growing literature indicating that early experiences of stress impact the mental health of LGBTQ youth.

Section snippets

Participants

Participants from this study were part of Project Q2, a longitudinal study of LGBTQ youth who were between the ages of 16 and 20 years at baseline. All participants were youth living in the Chicago area who self-identified as LGBT, “queer,” “questioning,” or indicated they were attracted to the same gender. Participants were recruited via multiple methods, including incentivized peer recruitment and e-mail advertisements, cards, and flyers distributed in LGBT-identified neighborhoods and

Developmental trajectories

The estimated intraclass correlation (ICC, .414) indicated that 41.4% of the variance of psychological distress existed between individuals and 58.6% existed within individuals over time. This can be interpreted to mean that individual measures of psychological distress vary substantially over time and that more variance is observed longitudinally within people versus between people. Age at each wave was entered into the model along with the between-subject covariates to test the hypothesis

Discussion

Our results suggest that the psychological distress of LGBTQ adolescents does decrease across adolescence and into young adulthood. In addition, our analyses suggest that the reduction in distress appears to be related to the co-occurring developmental decline in LGBTQ victimization. In a time-lagged model, prior rates of victimization predicted later levels of distress, whereas prior levels of support did not. Previous studies have shown the relationship between victimization and mental health

Funding Sources

This research was supported by the National Institute of Mental Health (grant, R21MH095413; PI, B.M.), an American Foundation for Suicide Prevention grant (PI; B.M.), the William T. Grant Foundation Scholars Award (PI; B.M.), and the David Bohnett Foundation (PI; B.M.), and by the IMPACT LGBT Health and Development Program, Northwestern University.

References (40)

D.E. Bontempo et al.
Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior
J Adolesc Health
(2002)
J. Zabora et al.
A new psychosocial screening instrument for use with cancer patients
Psychosomatics
(2001)
McKinley, J., Suicides put light on pressures of gay teenagers, in The New York Times. 2010, The New York Times...
Savage, D. It Gets Better Project. 2012 May 1, 2011; Available at: http://www.itgetsbetter.org/. Accessed May 1,...
The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding
(2011)
R. Garofalo et al.
The association between health risk behaviors and sexual orientation among a school-based sample of adolescents
Pediatrics
(1998)
S.L. Hershberger et al.
The impact of victimization on the mental health and suicidality of lesbian, gay, and bisexual youth
Dev Psychol
(1995)
G. Remafedi et al.
The relationship between suicide risk and sexual orientation: Results of a population-based study
Am J Public Health
(1998)
D.M. Fergusson et al.
Is sexual orientation related to mental health problems and suicidality in young people?
Arch Gen Psychiatry
(1999)
I.H. Meyer
Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence
Psychol Bull
(2003)

M.L. Hatzenbuehler

How does sexual minority stigma “get under the skin?” A psychological mediation framework

Psychol Bull

(2009)

A.R. D'Augelli et al.

Predicting the suicide attempts of lesbian, gay, and bisexual youth

Suicide Life Threat Behav

(2005)

J.S. McDaniel et al.

The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention

Suicide Life Threat Behav

(2001)

M. Birkett et al.

LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes

J Youth Adolesc

(2009)

M. Rosario et al.

Sexual identity development among gay, lesbian, and bisexual youths: Consistency and change over time

J Sex Res

(2006)

J.A. Bauermeister et al.

Relationship trajectories and psychological well-being among sexual minority youth

J Youth Adolesc

(2010)

M. Rosario et al.

Gay-related stress and emotional distress among gay, lesbian, and bisexual youths: A longitudinal examination

J Consult Clin Psychol

(2002)

T.R. Nansel et al.

Bullying behaviors among U.S. youth: Prevalence and association with psychosocial adjustment

JAMA

(2001)

J. Vincke et al.

Confidant support and the mental wellbeing of lesbian and gay young adults: A longitudinal analysis

J Community Appl Soc Psychol

(2002)

M.S. Kimmel

Masculinity as homophobia: Fear, shame and silence in the construction of gender identity

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Original articleDoes It Get Better? A Longitudinal Analysis of Psychological Distress and Victimization in Lesbian, Gay, Bisexual, Transgender, and Questioning Youth

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Participants

Developmental trajectories

Discussion

Funding Sources

J Adolesc Health

Psychosomatics

The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding

The association between health risk behaviors and sexual orientation among a school-based sample of adolescents

Pediatrics

The impact of victimization on the mental health and suicidality of lesbian, gay, and bisexual youth

Dev Psychol

The relationship between suicide risk and sexual orientation: Results of a population-based study

Am J Public Health

Is sexual orientation related to mental health problems and suicidality in young people?

Arch Gen Psychiatry

Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence

Psychol Bull

How does sexual minority stigma “get under the skin?” A psychological mediation framework

Psychol Bull

Predicting the suicide attempts of lesbian, gay, and bisexual youth

Suicide Life Threat Behav

The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention

Suicide Life Threat Behav

LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes

J Youth Adolesc

Sexual identity development among gay, lesbian, and bisexual youths: Consistency and change over time

J Sex Res

Relationship trajectories and psychological well-being among sexual minority youth

J Youth Adolesc

Gay-related stress and emotional distress among gay, lesbian, and bisexual youths: A longitudinal examination

J Consult Clin Psychol

Bullying behaviors among U.S. youth: Prevalence and association with psychosocial adjustment

JAMA

Confidant support and the mental wellbeing of lesbian and gay young adults: A longitudinal analysis

J Community Appl Soc Psychol

Masculinity as homophobia: Fear, shame and silence in the construction of gender identity

Original article
Does It Get Better? A Longitudinal Analysis of Psychological Distress and Victimization in Lesbian, Gay, Bisexual, Transgender, and Questioning Youth