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Sexual Orientation Disparities: Starting in Childhood and Observable in Adolescence?

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... Yet, these studies relied on self-reports, and thus cannot rule out that shared method variance confounded associations. Tackling this limitation, we employed a sociometric approach and used information from adolescents themselves as well as their peers, thereby answering a recent call for multiple informant research to map the social experiences of sexual minority youth (Baams, 2019). ...
... In conclusion, we studied the extent to which differences in school peer relationships explained depressive symptoms disparities between heterosexual and sexual minority adolescents, combining evidence from three samples from the Netherlands and Belgium. Our sociometric perspective complements existing work relying on self-reports only and replies to a call for implementing multi-informant methodology to improve our understanding of the social experiences of sexual minority youth (Baams, 2019). Our results contain little evidence suggesting that sexual minority students occupy a marginalized position within the adolescent peer context. ...
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Sexual minority youth report poorer mental health than heterosexual youth. According to the minority stress framework, this results from sexual minority individuals being societally marginalized, which for sexual minority youth may include being poorly integrated in the peer context. A sociometric approach was used to test whether peer relationships, measured broadly as friendship, acceptance, disliking, and bullying relationships, mediated the link between a sexual minority orientation and depressive symptoms in adolescence. Analyses were conducted across three samples from the Netherlands and Belgium (N = 352; N = 1848; N = 263). Sexual minority respondents reported higher levels of depressive symptoms than heterosexual respondents, yet sexual orientation differences in peer relationships were small. Moreover, no link between peer relationships and depressive symptoms was found. Consequently, indirect effects were small too.
... 10,11 Pervasive stigma and discrimination in school, family, and healthcare settings have been linked to a range of health disparities among SGM youth, including mood disorders, disordered eating, cigarette smoking, substance use disorders, suicidality, violence victimization, HIV, and sexually transmitted infections. [12][13][14][15][16][17][18][19][20] To promote more positive health outcomes, it is beneficial for pediatric primary care clinicians to know their patients' SOGI so they can provide space for discussing concerns, make appropriate referrals, and encourage family acceptance of SGM identities, which is critical for positive psychosocial outcomes. 21,22 Developing clinical decision tools in EHRs to prompt providers to ask about and update a pediatric patient's SOGI can further support these important conversations. ...
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The systematic documentation of sexual orientation and gender identity data in electronic health records can improve patient-centered care and help to identify and address health disparities affecting sexual and gender minority populations. Although there are existing guidelines for sexual orientation and gender identity data among adult patients, there are not yet standard recommendations for pediatric patients. In this article, we discuss methods that pediatric primary care organizations can use to collect and document sexual orientation and gender identity information with children and adolescents in electronic health records. These recommendations take into consideration children's developmental stages, the role of caregivers, and the need to protect the privacy of this information. We also focus on the current limitations of electronic health records in capturing the nuances of sexual and gender minority identities and make suggestions for addressing these limitations.
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In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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Disparities in African American health remain pervasive and persist transgenerationally. There is a growing consensus that both structural and interpersonal racial discrimination are key mechanisms affecting African American health. The Biopsychosocial Model of Racism as a Stressor posits that the persistent stress of experiencing discrimination take a physical toll on the health of African Americans and is ultimately manifested in the onset of illness. However, the degree to which the health consequences of racism and discrimination can be passed down from one generation to the next is an important avenue of exploration. In this review, we discuss and link literature across disciplines demonstrating the harmful impact of racism on African American physical health and the health of their offspring.
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In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
Article
Purpose: Sexual minority adolescents face well-documented disparities in terms of peer victimization and mental health. Less is known about how these disparities emerge and change throughout childhood. Providing prospective evidence on sexual minorities' peer victimization and mental health from early childhood through adolescence, the current study addresses this gap. Methods: Analyses used data from the Fragile Families and Child Wellbeing Study, a population-based cohort study of children born in twenty American cities between 1998 and 2000. Teens reported sexual minority status during interviews conducted (primarily by phone) between 2014 and 2017. Multivariate regression analyses examined disparities in peer victimization and mental health at ages 5, 9, and 15. Results: Compared to their peers, sexual minorities experienced similar rates of peer victimization at age 5 but substantially higher rates at ages 9 and 15. Sexual minority children's elevated bullying rates at age 9 were confirmed using independent reports from both parents and the children themselves. Disparities in depressive/anxious symptoms were not documented until age 15, at which time large disparities were reported across three diagnostic scales and two measures of professional diagnosis/treatment. Both current and prior peer victimization were robust predictors of adolescent mental health, explaining about 20% of the disparities between sexual minority teens and their peers. Conclusions: Sexual minority children's social vulnerabilities appear to emerge between ages 5 and 9, followed by the emergence of mental health disparities between 9 and 15. Results underscore the importance of intervening early to prevent the emergence of bullying behaviors.
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Purpose: Sexual minority youth (SMY) are more likely to use alcohol than their heterosexual peers, yet a lack of research on within-group differences and modifiable mechanisms has hindered efforts to address alcohol use disparities. The purpose of the current study was to examine differences in the mediating role of homophobic bullying on the association between sexual orientation identity and drinking frequency and heavy episodic drinking frequency by sex and race/ethnicity. Methods: We used data from a subsample of 20,744 youth in seven states from the 2015 Youth Risk Behavior Survey, a population-based data set of 9-12th grade high school students in the United States. We included youth who self-identified as male or female; heterosexual, lesbian/gay, bisexual, or unsure of their sexual orientation identity; and White, Black, or Latino. Results: Within-group comparisons demonstrated that SMY alcohol use disparities were concentrated among Latino bisexual and unsure youth. All subgroups of SMY at the intersection of race/ethnicity and sex were more likely than their heterosexual counterparts to report homophobic bullying. Homophobic bullying mediated alcohol use disparities for some, but not all, subgroups of SMY. Conclusion: Homophobic bullying is a serious risk factor for SMY alcohol use, although youths' multiple identities may differentiate degrees of risk. Sexual orientation identity-related disparities in alcohol use among Latino, bisexual, and unsure youth were not fully attenuated when adjusted for homophobic bullying, which suggests that there may be additional factors that contribute to rates of alcohol use among these specific subgroups of SMY.
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Mental health disparities between heterosexual and sexual minority youth are partly explained by the higher rates of victimization experienced by sexual minority youth. The onset and progression of these victimization disparities, however, are poorly understood. Using multirater longitudinal data, trajectories of victimization starting at age 9 were compared among youth who did and did not report same‐sex attraction at age 15 (N = 310). Self and teacher, but not primary caregivers, reported victimization was significantly higher among sexual minority youth starting at age 9, but did not vary across time. The findings underscore the importance of understanding homophobic experiences of sexual minority youth during late childhood and early adolescence in order to inform prevention programs.
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Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified. Expected final online publication date for the Annual Review of Clinical Psychology Volume 12 is March 28, 2016. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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The experience of minority stress is often named as a cause for mental health disparities among lesbian, gay, and bisexual (LGB) youth, including higher levels of depression and suicidal ideation. The processes or mechanisms through which these disparities occur are understudied. The interpersonal-psychological theory of suicide posits 2 key mechanisms for suicidal ideation: perceived burdensomeness and thwarted belongingness (Joiner et al., 2009). The aim of the current study is to assess the mental health and adjustment among LGB youth emphasizing the minority stress model (Meyer, 2003) and the interpersonal-psychological theory of suicide (Joiner et al., 2009). With a survey of 876 LGB self-identified youth, levels of coming-out stress, sexual orientation victimization, perceived burdensomeness, thwarted belongingness, depression, and suicidal ideation were examined. The results of a multigroup mediation model show that for all gender and sexual identity groups, the association of sexual orientation victimization with depression and suicidal ideation was mediated by perceived burdensomeness. For gay, lesbian, and bisexual girls coming-out stress was also found to be related to depression and suicidal ideation, mediated by perceived burdensomeness. The results suggest that feeling like a burden to "people in their lives" is a critical mechanism in explaining higher levels of depression and suicidal ideation among LGB youth. These results have implications for community and social support groups, many of which base their interventions on decreasing social isolation rather than addressing youths' beliefs of burdensomeness. Implications for future research, clinical and community settings are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Article
Objective: The authors examined midlife outcomes of childhood bullying victimization. Method: Data were from the British National Child Development Study, a 50-year prospective cohort of births in 1 week in 1958. The authors conducted ordinal logistic and linear regressions on data from 7,771 participants whose parents reported bullying exposure at ages 7 and 11 years, and who participated in follow-up assessments between ages 23 and 50 years. Outcomes included suicidality and diagnoses of depression, anxiety disorders, and alcohol dependence at age 45; psychological distress and general health at ages 23 and 50; and cognitive functioning, socioeconomic status, social relationships, and well-being at age 50. Results: Participants who were bullied in childhood had increased levels of psychological distress at ages 23 and 50. Victims of frequent bullying had higher rates of depression (odds ratio=1.95, 95% CI=1.27-2.99), anxiety disorders (odds ratio=1.65, 95% CI=1.25-2.18), and suicidality (odds ratio=2.21, 95% CI=1.47-3.31) than their nonvictimized peers. The effects were similar to those of being placed in public or substitute care and an index of multiple childhood adversities, and the effects remained significant after controlling for known correlates of bullying victimization. Childhood bullying victimization was associated with a lack of social relationships, economic hardship, and poor perceived quality of life at age 50. Conclusions: Children who are bullied-and especially those who are frequently bullied-continue to be at risk for a wide range of poor social, health, and economic outcomes nearly four decades after exposure. Interventions need to reduce bullying exposure in childhood and minimize long-term effects on victims' well-being; such interventions should cast light on causal processes.
The 2015 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation's schools
  • J G Kosciw
  • E A Greytak
  • N M Giga
Kosciw JG, Greytak EA, Giga NM, et al. The 2015 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation's schools. New York, NY. 2016. Available from: https:// www.glsen.org/article/2015-national-school-climate-survey. Accessed December 18, 2018.