Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings

doi:10.1016/j.jadohealth.2016.02.005

Journal of Adolescent Health

Volume 59, Issue 1, July 2016, Pages 38-43

https://doi.org/10.1016/j.jadohealth.2016.02.005 Get rights and content

Abstract

Purpose

Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal self-injury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14–24 years).

Methods

Data were collected using the Behavioral Health Screen—a Web-based screening tool that assesses psychiatric symptoms and risk behaviors—during routine well visits.

Results

Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well.

Conclusions

Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females.

Section snippets

Participants

Participants were 2,513 youth (61.2% female and 38.7% male), ages 14 to 24 years (M, 17.24; standard deviation [SD], 2.86). About 75.4% of the sample identified as white (n = 1,894), 4.7% as black/African-American (n = 119), .7% as American-Indian/Alaskan Native (n = 17), 1.8% as Asian (n = 46), .8% as Native Hawaiian/Other Pacific Islander (n = 19), and 8.1% as Multiracial (n = 203). A little >7% (7.6%, n = 192) indicated they were unsure of their race. Over 16% (16.6%, n = 418) of the sample

Results

First, multivariate analyses of variance showed mean differences across the sexual orientation groups on level of depressive symptoms, anxiety symptoms, lifetime suicidality, current suicidality, and substance abuse for both females, F(18,4551) = 6.39, p < .001, partial η² = .025; and males, F(18,2862) = 3.36, p < .001, partial η² = .021. As the Levene test indicated unequal variances for some of the scales, we report the F statistic associated with the Pillai trace as it is most robust to

Discussion

Although most LGBQ youth lead happy, healthy lives, a substantial body of literature indicates that LGBQ youth are at increased risk for behavioral health problems [[1], [2], [3], [4], [5]; [9], [10], [11], [12], [13], [14], [15], [16], [17]]. Few researchers, however, have examined differences in mental health symptoms across LGBQ youth, and none to our knowledge have examined these differences using a broad measure of behavioral health symptoms implemented in PC settings. This study screened

Acknowledgments

The Behavioral Health Screening tool is owned by the Children's Hospital of Philadelphia and licensed to Medical Decision Logic, Inc., a health science informatics and computer science engineering company who make the screening tool commercially available. They had no role in the study design, collection, analysis or interpretation of the data; writing of the report; or the decision to submit the manuscript for publication.

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Suicide is a serious public health problem among adolescent and young adults. Indeed, 12.1% of adolescents contemplate suicide, 4.0% make a plan, and 4.1% make an attempt (Nock et al., 2013). LGBTQIA+ youth (i.e., lesbian, gay, bisexual, transgender, questioning/queer, intersex and/or asexual adolescents and young adults) are particularly vulnerable to suicide (CDC, 2016; Liu & Mustanksi, 2012; Peters et al., 2019). While many LGBTQIA+ youth are healthy and resilient (Ream & Savin-Williams, 2005) they often report higher rates of both suicidal ideation and behavior than their heterosexual (Haas et al., 2011) and cisgender (James et al., 2016) peers. The purpose of this paper is to provide a structured review the state of suicide treatment research for LGBTQIA+ youth and offer recommendations for future directions.
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Barriers such as stigma, financial costs, and provider shortages prevent large portions of youth with depression and related difficulties from accessing treatment; lesbian, gay, bisexual, transgender, queer/questioning sexual orientation, or other non-heterosexual identity (LGBTQ+) youth are burdened with additional barriers related to minority stress. Single-session interventions (SSIs) have been found to benefit youth and help reduce depression symptoms, and since many SSIs are brief, cost-free, and accessible online, they may circumvent several access barriers. However, prior to recommending non-community-tailored SSIs as a useful resource for minoritized youths, we first assessed whether LGBTQ+ youth respond as positively to SSIs as do cisgender heterosexual youth. In a subsample of youths recruited via online advertisements from September 2019 to August 2020 (N = 258, 81.4% female-assigned sex at birth, 60.5% LGBTQ+, 47.3% youth of color), we investigated whether changes in hopelessness, agency, and self-hate from before to after completing online self-directed SSIs differed as a function of LGBTQ+ identity. We also quantitatively and qualitatively compared intervention acceptability ratings and feedback across LGBTQ+ and cisgender heterosexual youths. Analyses revealed no significant differences between cisgender LGBQ+, trans and gender diverse, and cisgender heterosexual youths for any intervention outcomes. Likewise, no group differences emerged in intervention acceptability ratings or written program feedback. Self-selection bias and underrepresentation of certain populations, such as American Indian and Alaskan Native youths, may limit generalizability of results. Results suggest that online mental health SSIs are equally acceptable and useful to LGBTQ+ and cisgender heterosexual youth alike, even prior to culturally specific tailoring.
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Bullying is associated with increased suicide risk and maladaptive development for sexual minority youth (SMY). The purpose of this study is to determine whether multiple forms of bullying mediate the relationship between biological sex and suicide risk among SMY and to determine whether sexual identity moderates these relationships (i.e., moderated mediation). Data from the 2015–2019 National Youth Risk Behavior Surveillance Survey was analyzed using multiple group structural equation modeling with the 5967 youth that self-identified as Lesbian/Gay, Bisexual, or Not sure of their sexual identity. All forms of bullying were associated with suicide risk. After controlling for bullying, Male SMY reported less suicide risk in comparison to female SMY. Female SMY were more likely to be cyberbullied while male SMY were more likely to be threatened or injured with a weapon. Sexual identity did not moderate these relationships. These finding align with the minority stress theory which posits the victimization experiences are linked to negative mental health outcomes among minority youth. Although sexual identity did not moderate these relationships, this study reveals new mechanistic pathways influencing sex-based suicide risk disparities among SMY. Findings can inform future research and the development of suicide prevention interventions that address the unique needs of SMY occurring at the intersection of sex and sexual identity.
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Very little research has described risk of suicidal ideation and suicide attempt among transgender youth using high-quality, nationally representative data. We aimed to assess risk of suicidality among transgender and sexual minority adolescents in Canada.
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We included 6800 adolescents aged 15–17 years, including 1130 (16.5%) who indicated some degree of same-gender attraction, 265 (4.3%) who were unsure of their attraction and 50 (0.6%) who reported a transgender identity. Compared with cisgender, heterosexual adolescents, transgender adolescents showed 5 times the risk of suicidal ideation (95% confidence interval [CI] 3.63 to 6.75; 58% v. 10%) and 7.6 times the risk of suicide attempt (95% CI 4.76 to 12.10; 40% v. 5%). Among cisgender adolescents, girls attracted to girls had 3.6 times the risk of previous-year suicidal ideation (95% CI 2.59 to 5.08) and 3.3 times the risk of having ever attempted suicide (95% CI 1.81 to 6.06), compared with their heterosexual peers. Adolescents attracted to multiple genders had 2.5 times the risk of suicidal ideation (95% CI 2.12 to 2.98) and 2.8 times the risk of suicide attempt (95% CI 2.18 to 3.68). Youth questioning their sexual orientation had twice the risk of having attempted suicide in their lifetime (95% CI 1.23 to 3.36).
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View all citing articles on Scopus

: The authors have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

: Conflicts of Interest: G.D. will receive some minor royalty payments if and when the Behavioral Health Screen, which was used to collect the data, is made public. None of the other authors have any conflicts of interest to report.

: Disclaimer: The sponsors have no role in the study design, collection, analysis, or interpretation of the data; writing the manuscript; or the decision to submit the article for publication.

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Original articleDifferences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Participants

Results

Discussion

Acknowledgments

Am J Prev Med

J Adolesc Health

J Am Acad Child Adolesc Psychiatry

Eat Behav

J Adolesc

Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21

Clin Child Psychol Psychiatry

Adolescent sexual orientation and suicide risk: Evidence from a national study

Am J Public Health

Mental health and suicidality among racially/ethnically diverse sexual minority youths

Am J Public Health

Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12: Youth risk behavior surveillance

MMWR Surveill Summ

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth

Pediatrics

Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth

Arch Pediat Adol Med

Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002

Adv Data

Sexual orientation and mental health: Results from a community survey of young and middle-aged adults

Br J Psychiatry

Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study

Aust NZ J Psychiatry

Peer victimization, social support, and psychosocial adjustment of sexual minority adolescents

J Youth Adolesc

Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have?

Sch Psych Rev

Nonsuicidal self-injury, coping strategies, and sexual orientation

J Clin Psychol

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

J Youth Adolesc

The new gay teenager

Beyond risk: Resilience in the lives of sexual minority youth

J Gay Lesbian Issues Educ

Original article
Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings