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The Rejection Sensitivity Model: Sexual Minority Adolescents in Context

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Archives of Sexual Behavior (2020) 49:2259–2263
https://doi.org/10.1007/s10508-019-01572-2
COMMENTARY
The Rejection Sensitivity Model: Sexual Minority Adolescents
inContext
LauraBaams1· WouterJ.Kiekens2· JessicaN.Fish3
Received: 13 October 2019 / Revised: 18 October 2019 / Accepted: 19 October 2019 / Published online: 29 October 2019
© The Author(s) 2019
Introduction
Theoretical and empirical integration of the rejection sen-
sitivity (RS) model to sexual minority people is one of the
few attempts to extend existing theoretical frameworks that
explain mental health disparities for this population, namely
the minority stress framework (Meyer, 2003) and its exten-
sions (Hatzenbuehler, 2009; Testa, Habarth, Peta, Balsam,
& Bockting, 2015). Theoretical origins of RS are rooted in
the desire to understand how rejection from significant oth-
ers affects subsequent other close relationships (Downey &
Feldman, 1996). This was later extended to conceptualize
rejection based on membership of a stigmatized group and
modified to understand sexual orientation-related RS among
sexual minorities (Dyar, Feinstein, Eaton, & London, 2016;
Pachankis, Goldfried, & Ramrattan, 2008). Feinstein (2019)
brings new life to this adapted application by grounding and
integrating the basic tenets of sexual orientation-related RS
alongside a critical health compromising process of minority
stress: vigilance. Meyer theorized vigilance as a core form of
proximal minority stressors and explains that “LGB people
learn to anticipate—indeed, expect—negative regard from
members of the dominant culture. To ward off potential nega-
tive regard, discrimination, and violence, they must be vigi-
lant” and this vigilance is “related to feared possible (even if
imagined) negative events” (Meyer, 2003, p. 680–681). Fein-
stein explains that existing theoretical frameworks (Hatzen-
buehler, 2009; Meyer, 2003) mention vigilance and RS as
important processes, but lack a comprehensive integration of
these concepts. Given that schemas for RS are formed early in
the life course, we focus on the applicability to sexual minority
adolescents, and other marginalized groups.
How Rejection Sensitivity Might Expand
Understandings ofLGBTQ Adolescent
Mental Health
Overwhelmingly, research testing the negative impacts of
minority stress among sexual minority adolescents has focused
on mental health, and more specifically depression and suici-
dality. With good reason, studies show that sexual minority
adolescents experience depression (Lucassen, Stasiak, Samra,
Frampton, & Merry, 2017) and suicidality (Salway etal., 2019)
at much higher rates than heterosexual adolescents, sometimes
as young as age 11 (La Roi, Kretschmer, Dijkstra, Veenstra, &
Oldehinkel, 2016). A smaller subsection of this research has
enumerated anxiety as a correlate of minority stress (Jones,
Robinson, Oginni, Rahman, & Rimes, 2017). The RS frame-
work presented by Feinstein (2019) includes “anxiety” as an
important feature of RS: To “anxiously expect rejection” is
distinct from expecting rejection in the absence of anxiety or
fear. This is a crucial distinction, because it is the anxiety that
accompanies these expectations which activate RS as a detri-
mental process for sexual minority adolescents’ mental health.
The integration of the RS framework may also increase
understanding of other important consequences of differential
anticipatory emotions of rejection, namely anger and aggres-
sion. We may, for example, see different associations between
RS and externalizing or internalizing behaviors as a result of
anticipatory responses that reflect anger relative to anxiety. In a
study among lesbian and bisexual women, for example, results
showed that drinking expectancies of aggression and anger
This commentary refers to the article available at https ://doi.
org/10.1007/s1050 8-019-1428-3.
* Laura Baams
l.baams@rug.nl
1 Department ofPedagogy andEducational Sciences,
University ofGroningen, Grote Rozenstraat 38,
9712TJGroningen, TheNetherlands
2 Department ofSociology/Interuniversity Center forSocial
Science Theory andMethodology, University ofGroningen,
Groningen, TheNetherlands
3 Department ofFamily Science, School ofPublic Health,
University ofMaryland, CollegePark, MD, USA
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2260 Archives of Sexual Behavior (2020) 49:2259–2263
1 3
were associated with alcohol abuse and dependency, whereas
expecting that drinking will help you forget your worries when
depressed was associated with heavy episodic drinking (Fish
& Hughes, 2018). Research investigating victimization and
bullying (Lereya, Copeland, Zammit, & Wolke, 2015) may
benefit from testing the role of different anticipatory emotions
as these might influence outcomes of aggression (anticipation
of anger) relative to poor mental health (anticipation of anxi-
ety). Aligning with Feinstein’s (2019) framework, we might
hypothesize that some adolescents who are rejected may be
more likely to respond with aggression. For example, a study
among Minnesotan adolescents showed that sexual minority
adolescents were more likely to be both victims and perpe-
trators of bullying behaviors than their heterosexual peers
(Eisenberg, Gower, McMorris, & Bucchianeri, 2015). At
the same time, there could be positive, adaptive features of
anticipation of anger in response to rejection: Shared anger
may bring about and strengthen community, activism, civic
engagement, and other forms of resilience among sexual
minority adolescents through, for example, Gender and Sex-
uality Alliances in schools (Poteat, Scheer, Marx, Calzo, &
Yoshikawa, 2015). Youth may also anticipate and cope with
negative experiences by hyper-engaging in school (Watson
& Russell, 2016). Whether anxious or angry expectations of
rejection bring about mental and behavioral problems, or posi-
tive change, likely depends on the context in which the rejec-
tion takes place and the support sexual minority youth might
find in other contexts. Importantly, the distinction between
these anticipatory emotions in relation to externalizing and
internalizing behaviors may also require different intervention
strategies (e.g., targeting anger versus targeting youth anxiety).
Critical Developmental Periods forRejection
Sensitivity
Research shows that sexual orientation disparities in victimiza-
tion are evident at young ages, well before many adolescents
acknowledge an awareness of their sexual orientation (Mar-
tin-Storey & Fish, 2019; Mittleman, 2019). Might these early
experiences of rejection become part of the learning history
that sets an early precedent for elevated sexual orientation-spe-
cific RS across the life course? Further, considering the declin-
ing age of coming out for adolescents, experiences with rejec-
tion and internalization of negative messaging around sexual
minority identity may come at a younger age than previous
generations, when both mental health (Russell & Fish, 2019)
and RS are more vulnerable to these unique social stressors.
According to Feinstein (2019), the cognitive social
learning history of sexual minority individuals might also
include vicarious experiences of rejection that impact their
own RS (e.g., witnessing victimization or hearing nega-
tive messages about sexual minority individuals in media).
Although media has become more inclusive of sexual (and
gender) diversity, debates around marriage equality, bath-
room access, and conversion therapy might also portray
negative views of sexual and gender diversity. Thus, in
addition to witnessing hate crimes, (social) media portray-
als of violence against sexual minority individuals might
impact young people’s anxious expectations of the world
(Paterson, Brown, & Walters, 2019). A parallel process can
be observed in children and youth of color, who experience
vicarious racism negatively impacting various health out-
comes (Heard-Garris, Cale, Camaj, Hamati, & Dominguez,
2018). Importantly, vicarious experiences may be more or
less impactful depending on when they occur in the life
course, in that contemporary cohorts of sexual minority
youth may be uniquely influenced by the negative politi-
cal rhetoric in ways that alter their RS and hypervigilance
across the life course. In fact, some might argue that the
degree to which contemporary youth engage in new media
may make this cohort of sexual minority youth particularly
susceptible to RS, and the negative mental health conse-
quences therein.
With rapid changes in social attitudes toward sexual and
gender diversity, research has increasingly included a focus on
cohort differences among sexual minority people. Our focus
on adolescence is in part due to the developmental stage and
its importance for the development of RS, but also because
contemporary sexual minority adolescents grow up in a social
environment that is unique from older cohorts of sexual
minority adults—and its impact on their lived experience
and health will likely play out in unforetold ways across their
life course. For example, in a study examining experiences of
discrimination across the life course, gay and bisexual men
in their 40s and 50s evidenced the highest rates of perceived
discrimination relative to lesbian, gay, and bisexual adults of
other ages (both older and younger). Rice, Fish, Russell, and
Lanza (2019) attributed this anomoly to the fact that these
men would have been in their late teens and early 20s during
the AIDS epidemic, therefore (potentially) heightening these
men’s perceptions of discrimination. We imagine, given the
tenets of RS, that these men might have altered attributions of
potentially neutral or ambiguous stimuli and elevated RS given
the social stigma they experienced during this contentious
time in history. Growing attention for cohort differences in
perceptions of discrimination and compromised health might
foreshadow how different cohorts have unique RS-inducing
experiences, and therefore unique health consequences.
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2261Archives of Sexual Behavior (2020) 49:2259–2263
1 3
Sociocontextual Perspectives onRejection
Sensitivity Processes
Existing theoretical frameworks, including the current RS
framework, pay little attention to the context in which people
develop RS or experience early rejection. As Feinstein (2019)
outlines, context matters both for the occurrence and salience
of rejection and may impact the development of RS. In addi-
tion, experiencing rejection in spaces that are thought to be
“safe” might have a stronger impact on RS than experiencing
rejection in historically unaccepting spaces. For example,
when bisexual individuals experience rejection in the LGBTQ
community, this may impact their RS to a larger extent than
when they experience rejection in historically heterosexual
spaces (Bostwick & Hequembourg, 2014). Additionally, expe-
riencing RS in “safe” spaces might elicit different anticipatory
emotions (e.g., anxiety, anger) compared to experiencing RS
in more traditionally unaccepting spaces. Further, many sex-
ual minority adolescents experience victimization in multiple
contexts: their family home, school, or in public (Goldbach
& Gibbs, 2017). Experiences in one context might translate
to elevated RS in other contexts. For RS in particular, it is
important to attend to multiple intersecting contexts and how
experiences with rejection in one context does not preclude
the experience of rejection in another, and may even set in
motion the development of “generalized” RS, because it likely
manifests as the result of experiences across multiple contexts.
Alternatively, sexual minority adolescents might also gradu-
ally select more supportive social environments (i.e., friends,
LGBTQ community) limiting experiences with rejection
and increasing positive and supportive experiences (Cohen,
Padilla, & Aravena, 2006).
Applicability toOther Marginalized/
Minority Groups
Preliminary research on RS supports the notion that pro-
cesses of RS explain the associations between minority
stress and health outcomes, and that this mechanistic pro-
cess holds for different sexual minority subgroups (e.g.,
men/women, monosexual/bisexual sexual minority people;
Feinstein, 2019), which is what one hopes to see when the-
ory building. However, Feinstein reflects on how anxious
expectations of rejection might differ when we account for
intersections with gender, race/ethnicity, and age, and that
cues triggering anxious expectations may be different from
cues triggering angry expectations among specific groups.
A focus on intersecting experiences of rejection is crucial
in understanding the development of RS for many sexual
minority youth. That is, sexual minority youth of color likely
develops RS related to two social statuses: sexual orientation-
related RS from society in general, as well as race/ethnicity-
related RS from both society in general, but also within the
LGBTQ community, whereas White sexual minority people
likely do not experience RS related to racial/ethnic identity.
Along these same lines, however, RS related to different iden-
tities—such as a racial/ethnic identity—may also cultivate
unique strategies to combat the negative influence of rejec-
tion, staving off RS. For example, parents of youth of color
often engage in conversations around race-related experi-
ences, including race-related rejection (i.e., family racial/eth-
nic socialization practices), which has been shown to have
positive effects for mental health and academic achievement
among youth of color (Hughes etal., 2006). It could be that
these strategies to address race-related rejection could help
sexual minority youth of color cope with sexual orientation-
related rejection. Thus, intersectional views on the devel-
opment of RS could provide new perspectives on “multiple
minority stressors” and how these experiences are linked to
resilience, but also compromised mental health.
In addition, although Feinstein (2019) acknowledges the
applicability of the RS framework to different genders, there
is currently very little research on the development of RS
among transgender and other gender minority adolescents.
Theoretical work on gender minority stress mentions nega-
tive expectations from the future as an important precursor of
vigilance (Rood etal., 2016; Testa etal., 2015) and suggests
that experiences with rejection and trauma in transgender
persons form a “trauma history” which then creates vigi-
lance similar to how it would in sexual minority populations
(Hendricks & Testa, 2012). However, because we currently
lack a measure of RS that is applicable to multiple groups and
groups with multiple minority identities, we have very little
knowledge of the experience and development of RS among
gender minority adolescents. Further, the emergence of new
identity labels among sexual and gender minority youth
(e.g., pansexual, genderqueer, gender nonbinary) underline
the need for measurement development for a diverse and
dynamic sexual and gender minority population (Galupo,
Ramirez, & Pulice-Farrow, 2017).
Intervention versusPrevention
Feinstein (2019) broadly discusses currently available interven-
tions that target RS, such as cognitive behavioral therapy (CBT).
An alternative to CBT may be to target the memory bias—an
important aspect of RS—through trauma-informed care or eye
movement desensitization and reprocessing (EMDR) therapies
(Pantalone, Valentine, & Shipherd, 2017). However, a common-
ality among these psychological approaches is that they rely
on people finding their way to, and accessing, mental health
providers. Adolescents with high levels of RS might struggle
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2262 Archives of Sexual Behavior (2020) 49:2259–2263
1 3
to do so, may not be out to parents, and might prefer not to
disclose their sexual orientation to health providers (Fuzzell,
Fedesco, Alexander, Fortenberry, & Shields, 2016). Similarly,
although people may suffer from mental health and substance
use disorders, relatively few people engage in formal counseling
or therapy (Lipari, Park-Lee, & Van Horn, 2016; SAMHSA,
2016). It is therefore necessary to understand how large-scale
intervention strategies might be developed or adapted to address
and intervene in RS processes for sexual minority youth.
Further, Feinstein (2019) and the RS literature, more broadly,
do not pay much attention to how RS might be prevented. For
example, rejection might occur in one context (e.g., school) but
if other contexts are supportive (e.g., home), the development
of RS might be slowed down or prevented. For sexual minority
adolescents, the school context might be particularly amenable
to change by implementing inclusive policies and programs
that reduce bullying and improve acceptance (Day, Ioverno, &
Russell, 2019). LGBTQ community centers (see Fish, Moody,
Grossman, & Russell, 2019; Williams, Levine, & Fish, 2019)
may also be uniquely positioned to deliver programs that
increase sexual minority youth’ self-esteem and develop cop-
ing strategies to address RS and the associated mental health
consequences. Additionally, psychoeducation and advocacy has
improved support and acceptance in the family context (Parker,
Hirsch, Philbin, & Parker, 2018), while medical systems might
benefit from education and training to improve accessibility and
cultural competence (Bidell & Stepleman, 2017).
Conclusion
In addition to the applicability of the RS framework for sexual
minority individuals from various cohorts, the applicability of
this framework to different sexual and gender minority popu-
lations remains to be seen. Research among diverse groups
of sexual and gender minority individuals should consider
important aspects of identity development, such as identity
centrality (Dyar etal., 2016). Although identity development
clearly plays a role in the development of RS, these mecha-
nisms are likely universal, whereas the trigger of RS is minor-
ity (or status)-specific. What Feinstein’s (2019) visioning does
is portray a close-up of one aspect of the minority stress frame-
work, which enables us to more rigorously test hypotheses
and improve the specificity of the minority stress framework.
By doing so, Feinstein offers an example of what scholars can
do to continue to innovate minority stress theory and thereby
improve our understanding of how minority stress impacts
health and the ways we can disrupt this process.
Open Access This article is distributed under the terms of the Crea-
tive Commons Attribution 4.0 International License (http://creat iveco
mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribu-
tion, and reproduction in any medium, provided you give appropriate
credit to the original author(s) and the source, provide a link to the
Creative Commons license, and indicate if changes were made.
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... In my Target Article, I noted that a number of interventions have been developed to reduce sexual minority stress and its consequences (see Chaudoir, Wang, & Pachankis, 2017), and I described how one intervention-ESTEEM (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015a)-targets sexual orientation-related RS using an ambiguous picture exercise (Burton, Wang, & Pachankis, 2019). 2 I also noted that the broader literature on RS points to additional strategies for reducing RS, such as identifying and challenging negatively biased interpretations of ambiguous situations (Normansell & Wisco, 2017) and targeting deficits in social problem-solving associated with RS using problem-solving therapy (Kraines & Wells, 2017). In their Commentaries, LeBeau (2019) and Baams et al. (2019) identified a number of additional interventions that potentially could be used to reduce sexual orientation-related RS. LeBeau described how attention bias modification (ABM) could be used to target biased attention to threat cues, how cognitive bias modification for interpretation (CBM-I) could be used to target dysfunctional thought patterns that contribute to perceiving threat in ambiguous situations, and how behavioral activation (BA) could be used to target avoidance of situations where rejection might occur by increasing engagement in a variety of activities. ...
... While these intervention adaptations will need to be tested among SGM people, they point to a number of potentially promising avenues for reducing sexual orientation-related RS. However, Baams et al. (2019) called our attention to the importance of preventing the development of sexual orientation-related RS as opposed to simply intervening once it has already developed. They noted that adolescents with high levels of RS may struggle to find their way to mental health providers and that there may be unique challenges for sexual minority youth who may not be out to their parents or who may not feel comfortable disclosing their sexual orientation to their provider. ...
... In my Target Article, I briefly noted that interventions that seek to reduce stigma and improve attitudes toward sexual minorities may prevent or disrupt the development of sexual orientation-related RS. Baams et al. (2019) went further and described a number of additional strategies that have the potential to prevent the development of sexual orientationrelated RS. They suggested that schools could implement inclusive policies and programs to reduce bullying and improve acceptance, that LGBTQ community centers could deliver programs to help sexual minority youth develop coping strategies for RS and its associated mental health consequences, that psychoeducation and advocacy could be used to improve support and acceptance in the family context, and that education and training could be used to improve cultural competence in the medical system. ...
... internalisierte Homo-, Bi-bzw. Transnegativität) [4], eine erhöhte Empfindlichkeit gegenüber Zurückweisung [17] oder die Verheimlichung der LGBT*-Identität [18] auslösen. Der ...
... Heutige LGBT*-Jugendliche erfahren eine erhöhte gesellschaftliche Akzeptanz in einer besonders sensiblen Entwicklungsphase [17,25], die Veränderungen in Bezug auf die ...
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A robust body of international evidence documents that lesbian, gay, bisexual, transgender, and other youth with diverse sexual orientations and/or gender identities (i.e., sexual and gender minority youth) face unique mental health vulnerabilities but are also equipped with unique resources. However, it is unclear to what extent these findings are applicable to sexual and gender minority youth in Austria, because the sociolegal and developmental contexts differ across countries. According to PRISMA guidelines, we conducted a systematic scoping review (1) to identify published studies on the mental health of sexual and gender minority youth in Austria, and, based on this, (2) to derive research recommendations supplemented by international evidence. We searched five scientific databases (PsycInfo, PSYNDEX, PubMed, Scopus, Web of Science; March 2022) and additionally contacted researchers and community leaders to find pertinent studies. Only two published empirical studies on the mental health of sexual and gender minority youth in Austria could be located, reflecting the sparse state of research in Austria. Against this background, we outline a detailed research agenda following a socio-ecological approach. Including sexual orientation and non-binary gender identities in population-based studies to assess onset, prevalence, and trajectory of mental health burdens, as well as conducting targeted, resource-based, and developmentally sensitive research on all levels seem paramount to reduce health disparities and societal stigma and to support sexual and gender minority youth in their development.
... Rejection sensitivity should be considered in case formulation of GSMs when the anxiety-fuelled anticipatory expectations of rejection leads to maladaptive coping consequencese.g. anger and aggression (Baams et al., 2020), and when it leads to avoidance behavior that hinders GSMs' healthe.g. avoiding healthcare services (Hughto et al., 2018). ...
Article
In a cisheteronormative culture, gender and sexual minorities (GSMs) may experience additional challenges that get in the way of a meaningful life. It is crucial that clinicians are mindful of these challenges and cognizant about the specificities of clinical work with GSMs. This article points out how societal structure interferes with mental health, and clarifies what clinicians must take into account when using affirmative cognitive behavioural therapy (CBT) interventions. Knowledge of up-to-date terminology and use of affirmative language are the first steps that contribute to clients’ experience of respect, which is paramount for the development of a good therapeutic relationship. Considering a conceptual framework of minority stress to understand vulnerability in GSM, specificities in formulation and key psychological processes are discussed. Moreover, guidelines and practical tools for intervention are presented within a CBT approach. Some reflections on therapists’ own personal biases are encouraged, in order to increase the efficacy of interventions. Key learning aims After reading this article you will be able to: (1) Recognize the uniqueness of gender and sexual minorities (GSM) stressors in broad and specific contexts, and their impact on mental health. (2) Identify the underlying key processes and specificities in therapeutic work with GSMs, from a CBT perspective. (3) Recognize the importance of a culturally sensitive approach in affirmative CBT interventions.
... To better understand the risk of alcohol consumption among SGM youth, future research should focus on other drivers of alcohol use besides minority stress, for example rejection sensitivity (Feinstein, 2020). It may be that youth high in rejection sensitivity react to perceived ambiguous events with alcohol use (Baams et al., 2020), although research among sexual minority men did not find a direct effect of rejection sensitivity on alcohol use (Pachankis et al., 2014). ...
Article
Full-text available
Rationale Sexual and gender minority (SGM) youth consume more alcohol than their heterosexual, cisgender peers. The experience of minority stress is theorized to explain these disparities. Research often neglects the day-to-day variability in minority stress that SGM youth encounter and whether alcohol use is associated with daily experiences of minority stress. Further, there is heterogeneity in alcohol use among SGM youth. Sex assigned at birth and gender identity could potentially explain this heterogeneity. Objective Therefore, this study aimed to examine whether daily experiences of minority stress were associated with daily alcohol use among SGM youth and how these associations differed by sex assigned at birth and gender identity. Methods A 14-day daily diary study was conducted among 393 Dutch SGM youth (M age = 18.36 SD = 2.65). Results Results showed few significant associations between both mean levels of minority stress and daily experiences with minority stress with alcohol use. However, higher mean levels of prejudice events were associated with higher odds of daily alcohol use (OR = 7.01, 95% CI: 1.20–40.89). Daily experiences with identity concealment were associated with lower odds of daily alcohol use for males (OR = 0.72, 95% CI: 0.60–0.86), but not for females (OR = 1.11, 95% CI: 0.93–1.32). Further, for cisgender youth, daily experiences with prejudice events were associated with higher odds of alcohol use (OR = 1.99, 95% CI: 1.05–3.78), but this was not the case for gender minority youth (OR = 0.42, 95% CI: 0.15–1.18). Conclusions The findings showed few significant associations between minority stressors and alcohol use, but daily experiences of concealment and prejudice events were associated with daily alcohol use and these associations varied by sex assigned at birth and gender identity, respectively.
... For example, rejection sensitivity (Downey & Feldman, 1996;Feinstein, 2020) may be a relevant construct to consider in research on the impact of microaggressions. Youth high in rejection sensitivity may perceive ambiguous events as microaggressions and learn to anxiously expect these events in the future (Baams et al., 2020), increasing the impact on their health and wellbeing. ...
Article
Full-text available
Research describes several sexual and gender identity-based microaggressions that sexual and gender minority (SGM) people might experience. We aimed to examine the occurrence of different sexual and gender identity-based microaggressions among SGM youth and to identify differences by sexual and gender identity, and sex assigned at birth. Open-ended questions about daily experiences were coded for 16 types of sexual and gender identity-based microaggressions in two daily diary studies among Dutch SGM youth (Study 1: N = 90, M age = 17.64 SD = 1.78; Study 2: N = 393, M age = 18.36 SD = 2.65). Several types of microaggressions were identified, and there was sizable variability in the reported frequency. Overall, lesbian women and bisexual youth were less likely to report microaggressions than gay youth. Bisexual youth were less likely to report use of heterosexist or transphobic terminology than gay youth and youth assigned male at birth were less likely to report invalidation of LGBTQ identity than youth assigned female at birth. Last, gender minority youth were more likely to report familial microaggressions, invalidation of LGBTQ identity, and threatening behaviors than cisgender youth. Overall, this study provides empirical support using mixed qualitative and quantitative methods for theorized typologies of microaggressions among Dutch SGM youth.
Article
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The field of HIV/STI prevention has primarily focused on gay men (or “men who have sex with men” [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
Article
Full-text available
LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21; M = 18.81; n = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.
Article
Full-text available
Sexual minorities are disproportionately affected by mental health problems (e.g., depression, anxiety, substance use disorders, suicidality). Minority stress theory and the psychological mediation framework have become the predominant conceptual models used to explain these disparities, and they have led to substantial advances in research on stigma-related stress and mental health. However, the field’s reliance on these models has limited the extent to which other theories have been considered as potential frameworks for further advancing our understanding of sexual minority mental health. In this article, I discuss how the rejection sensitivity (RS) model can be used to complement and extend minority stress theory and the psychological mediation framework by: (1) emphasizing the role of perception in stigma-related experiences; (2) acknowledging the unique consequences of different anticipatory emotions; (3) describing additional mechanisms linking proximal minority stressors to mental health; and (4) further specifying the temporal order of these processes. I conclude by discussing the importance of attending to developmental processes in research on sexual orientation-related RS and describing important directions for future research.
Article
Full-text available
A longitudinal study ( N = 774) explored the short and longer term impacts of anti-Lesbian, Gay, Bisexual, and Trans (LGBT) hate crime experienced directly, indirectly, and through the media. In the short term, being a victim (direct) or personally knowing of a hate crime victim (indirect) was positively associated with vulnerability, emotional responses, and behavioral intentions after reading about a hate crime. Direct victims were also less empathic toward other victims and engaged in more victim-blaming. A structural equation model showed direct experiences (via personal vulnerability and empathy) and media experiences (via group-threat and victim-blaming) to be cross-sectionally associated with behavioral intentions. Media experiences also had lasting demobilizing impacts on actual behaviors, again serially mediated by group-threat and victim-blaming. The findings highlight the emotional and behavioral impacts of hate crimes on both direct victims and on the wider LGBT community. They also raise questions about media reporting of hate crimes and the role of victim-blaming.
Article
In the United States, sexual minority (SM) status is associated with a number of health disparities. Based on mounting evidence, stigma and discrimination have been cited as key barriers to health equity for this population. We estimated the prevalence of three types of discrimination as a function of age among SM adults from the National Epidemiological Study of Alcohol Use and Related Conditions III (NESARC-III) (2012–2013). Among SM adults, reports of past-year general discrimination, victimization, and healthcare discrimination varied by age, with peaks in early adulthood and again in midlife. Age trends varied by biological sex, with males experiencing significantly more general discrimination, victimization, and healthcare discrimination at specific ages. Age trends also varied by sexual identity, as LGB-identifying SMs were significantly more likely to experience all forms of discrimination across all ages. Policies preventing homophobic discrimination and victimization are necessary given the pervasiveness of these experiences across adulthood.
Article
Inclusive policies that attend to sexual orientation and gender identity (SOGI) are associated with more supportive school environments for lesbian, gay, bisexual, and transgender (LGBT) youth. We use the 2013-2015 California Healthy Kids Survey (n = 113,148) matched with principal reports of school policies from the 2014 California School Health Profiles to examine differential effects of SOGI-focused policies for LGB and transgender youth. SOGI-focused policies had a direct association with less truancy, and moderated the association between sexual orientation/gender identity and other school outcomes. SOGI-focused policies were associated with more positive experiences and perceptions of school climate for LGB youth and, to a lesser extent, transgender youth. Findings underscore the importance of inclusive policies, especially those that address the unique needs of transgender students.
Article
Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people—perhaps particularly for youth—has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. The authors suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility.
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.
Article
Purpose This scoping study sought to provide an overview of existing interventions, programs and policies that address family-based stigma and discrimination against LGBTQ youth. Methods A keyword search in three online databases identified relevant scientific publications. Because it located a relatively small number of peer-reviewed publications, additional grey literature references were included, identified through consultation with specialists and through anonymous peer-review. Research, policies and interventions were categorized using an adapted ecological framework. Results There is very little peer-reviewed research on interventions to reduce family stigma and discrimination against LGBTQ youth. Most on-going work to improve family environments for LGBTQ youth appears to be currently conducted by city governments and non-governmental organizations. Very few interventions or programs provide any outcome data. Theoretical frameworks and approaches vary widely. Conclusions Given the widely recognized importance of a supportive family environment for a healthy transition to adulthood for LGBTQ youth, there is an urgent need for scientific research on policies and interventions to address stigma and discrimination and create supportive environments within families. Tackling family-based stigma and discrimination will require interventions and policies at each level of the ecological framework, including individual- and interpersonal-level interventions as well as community-level programs and structural-level policymaking.
Article
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.