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Abstract

Despite increasing scholarship on sexual minority youth (SMY), little is known about the experiences and outcomes of those who identify as asexual. This study investigates how internal and external stressors, mental health, and health risk behaviours differ between asexual youth and other SMY. The study uses a sub-group analysis (n = 5,314) of an online survey of self-identified sexual and gender minority youth (SGMY). Descriptive and inferential statistics compare asexual (n = 669) to non-asexual (n = 4,645) respondents across two developmental phases—adolescence (age 14-19) and young adulthood (age 20-25)—while accounting for gender minority (e.g., transgender) self-identification. Results indicate that asexual youth had significantly higher internalised LGBTQ-phobia and tended to have poorer mental health (e.g., higher rates of depression), while having experienced less interpersonal discrimination/prejudice and having engaged in fewer health risk behaviours (e.g., substance use). Findings have implications for clinical practice. Future research should continue to investigate the impact of risk and protective factors on outcomes for asexual young people.

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... Our study adds that LGBT persons were especially lonely during the pandemic, with extraordinary high loneliness scores for asexual, trans, and non-binary persons. This is in line with previous literature (Borgogna et al., 2019;McInroy et al., 2020). In addition, the present study illuminates an important role of loneliness in the association between depressive symptoms and sexual orientation/gender identity. ...
... For instance, Kuyper (2010) could show that minority stress is associated with increased levels of loneliness of elder gay men in the Netherlands: while older adults with a larger LGB network felt less socially lonely, factors like previous experience of or expectation of negative reactions led to high levels of loneliness (Kuyper & Fokkema, 2010). McInroy et al. (2020) showed asexual youth to have lower mental health and a significantly higher internalized LGBTQ-phobia than non-asexual individuals, and social stigma surrounding gender nonconformity as well as loneliness have been described to negatively impact mental health of transgender men and women (Bockting et al., 2016;Fernandez-Rouco et al., 2019;McInroy et al., 2020). Thus, it seems plausible with the existing literature that the minority stress of LGBT persons leads to an increased risk for loneliness, which is, in turn, associated with depressive symptoms. ...
... For instance, Kuyper (2010) could show that minority stress is associated with increased levels of loneliness of elder gay men in the Netherlands: while older adults with a larger LGB network felt less socially lonely, factors like previous experience of or expectation of negative reactions led to high levels of loneliness (Kuyper & Fokkema, 2010). McInroy et al. (2020) showed asexual youth to have lower mental health and a significantly higher internalized LGBTQ-phobia than non-asexual individuals, and social stigma surrounding gender nonconformity as well as loneliness have been described to negatively impact mental health of transgender men and women (Bockting et al., 2016;Fernandez-Rouco et al., 2019;McInroy et al., 2020). Thus, it seems plausible with the existing literature that the minority stress of LGBT persons leads to an increased risk for loneliness, which is, in turn, associated with depressive symptoms. ...
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During the COVID‐19 pandemic, physical distancing measures to prevent transmission of the virus have been implemented. The effect of physical distancing measures on loneliness especially for vulnerable groups remained unclear. Thus, we aimed to investigate loneliness in relation with depressive symptoms among lesbian, gay, bisexual, trans, inter, asexual, and queer (LGBT) persons compared with cis‐heterosexual persons during the pandemic. We conducted an online survey during the first two waves of the COVID‐19 pandemic in Germany. The survey contained self‐categorizations regarding sexual orientation and gender identity, questions on loneliness, social contacts, depressive symptoms, and healthcare. Descriptive and regression analysis and propensity score matching across cohorts was conducted using R; 2641 participants took part in first wave of the survey and 4143 participants in the second wave. The proportion of lonely people was higher in the second wave compared with the first wave. LGBT persons were more lonely than cis‐heterosexual persons. In both waves, being LGBT was associated with depressive symptoms, but loneliness mediated the effect, even when adjusting for social contacts. Psychologists and other practitioners should be aware that LGBT clients might have an increased risk for loneliness and depressive symptoms and of the potential burden of the pandemic measures.
... Additionally, many commonly studied outcomes among SGMY (e.g., family social support; Watson et al., 2019b) have yet to be investigated among asexual populations. Previous work that has been conducted among asexual youth and emerging adults note greater levels of depression, anxiety (Borgogna et al., 2019), and perceived stress (McInroy et al., 2020) compared to non-asexual lesbian and gay individuals. Thus, because research suggests there may be worse outcomes for asexual youth compared to non-asexual (including cisgender heterosexual) and other SM youth, the need for additional studies to better understand factors that may contribute to negative mental health outcomes in asexual youth is well documented (Yule et al., 2017). ...
... Asexuality is an emerging sexual identity that has not received proportionate scholarly attention relative to other sexual minorities; given recent research that indicates disparities relative to other heterosexual and sexual minority youth (e.g., asexual youth report greater anxiety than non-asexual SMY; McInroy et al., 2020), understanding relevant outcomes where asexual youth may be struggling is needed. Asexual is an identity label that encompasses people who experience little or no sexual attraction (Yule et al., 2017). ...
... Asexual people also report intersectional experiences that may not necessarily occur among other sexual identity groups. Previous literature suggests that individuals who identify as queer or pansexual are more likely to also identify under the transgender umbrella (e.g., transgender man, nonbinary; Morandini et al., 2017), and asexual youth might show a similar pattern (McInroy et al., 2020). One potential explanation as to why the individuals in these groups (e.g., asexual; Gressgård, 2013) identify with diverse gender identities is that these individuals may not feel the need to conform to conventional social norms, such as binary or cisgender identities, leading to a greater proportion of gender minority people (Morandini et al., 2017). ...
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Despite increasing efforts to better understand sexual and gender minority youth (SGMY), asexual youth remain understudied. This study examines differences in health, family support, and school safety among asexual youth (n = 938) from a national study of SGMY (N = 17,112) ages 13–17. Compared to non-asexual youth, asexual youth were more likely to identify as transgender and report a disability, and less likely to identify as Black or Hispanic/Latino. Transgender (versus cisgender) asexual youth fared worse on most study outcomes. Cisgender asexual (versus cisgender non-asexual) youth fared worse on all study outcomes. Transgender asexual (versus transgender non-asexual) youth reported lower sexuality-related family support. These findings underscore the role of gender identity in understanding the experiences of asexual youth.
... Those questioning their sexuality, on the asexual spectrum, and with lesser recognized identities under the bisexual+ umbrella have often been excluded from sexual minority research. However, the existing evidence suggests that, like bisexual+ people, they may experience poorer wellbeing outcomes than their lesbian, gay, and heterosexual peers (Borgogna et al., 2019;McInroy et al., 2020;McNair & Bush, 2016;Yule et al., 2013). There is a lack of strengths-based and intersectional research on the wellbeing of bisexual+ youth and their unique challenges and supportive factors. ...
... Consistent with previous literature, bisexual+ TGD young people experienced added challenges relative to cisgender youth, particularly in communicating their identity with families (Galupo et al., 2016;Mathers et al., 2018;Schudson & van Anders, 2019). Bisexual+ youth on the asexual + spectrum also experienced less visibility and more dismissal of their identity than other bisexual+ young people (McInroy et al., 2020;Van Houdenhove et al., 2015). Young people living in regional and outer metropolitan areas were less likely to have access to supportive environments and were more likely to experience overt discrimination and threats to safety relating to their sexuality or gender than those in metropolitan areas (Robards et al., 2018;. ...
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Multi-gender attracted (bisexual+) youth experience a high risk for suicide and mental health problems, but little is known about their protective factors. This study explored the challenges and supporting factors for wellbeing in a sample of diverse bisexual+ young people through semi-structured qualitative interviews. Participants (n = 15) were aged 17–25 years and were multi-gender attracted. The sample included young people who were transgender and gender diverse (TGD), culturally and linguistically diverse (CALD), Aboriginal, living in regional areas, and on the asexual spectrum. This research demonstrated unique challenges and protective factors for bisexual+ wellbeing compared to other sexual minority youth. In particular, the findings highlight the exclusion and stigmatization that many bisexual+ young people face, including from within the LGBTQIA+ community. These experiences were more pronounced for some bisexual+ youth, including TGD or CALD young people. Consequently, bisexual+ youth often had limited social support and a sense of belonging, which can buffer against the impact of marginalization among lesbian and gay youth. Despite these challenges, young people were resilient, empathetic and tolerant of others. Those who had access to supportive environments, visibility, and information on their diversity found these healing. Wellbeing in bisexual+ youth was impacted by a myriad of intersecting aspects of identity and experience, highlighting the importance of intersectional approaches in understanding minority experiences. The findings underscore the need for targeted and intersectional services for sexually diverse youth to address the wellbeing needs of this diverse group.
... However, the poorest outcomes observed were among those with lesser-recognized identities, including pansexual, asexual, and demisexual individuals (Borgogna et al., 2019). While there is minimal research with asexual individuals, the existing evidence suggests there may be important differences between asexual and other LGBQ youth in mental health outcomes (McInroy et al., 2020). Finally, some evidence suggests that questioning young people may be at increased risk for mental health problems, suicidal ideation, self-harm, and bullying compared to both their heterosexual and LGBQ peers (Shearer et al., 2016;Zhao et al., 2010). ...
... Our findings highlighted questioning and queer+ youth had significantly poorer outcomes than their heterosexual peers (Borgogna et al., 2019;McInroy et al., 2020;Zhao et al., 2010). The results demonstrated similarities in the mental health outcomes for bisexual, queer+, and questioning young people. ...
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The mental health disparities for lesbian, gay, bisexual and queer (LGBQ) compared to heterosexual youth are well established. However, emerging evidence indicates there may be diversity in risk for mental health outcomes within sexual minority youth. This study examined mental health outcomes in 1,933 young people (aged 16 − 25 years) who used the online mental health platform ReachOut. We explored mental health outcomes, including mental health service use and hospitalization, depression, anxiety, stress, and risk for suicide among heterosexual, gay/lesbian, bisexual, queer+, and questioning young people. Compared to their heterosexual peers, bisexual, queer+, and questioning young people had significantly higher levels of depression, anxiety, and risk for suicide. Bisexual and queer + young people also had significantly higher levels of stress compared to heterosexual youth. Bisexual and young people questioning their sexuality were significantly more likely to have a previous mental health hospitalization. Lesbian/gay youth did not significantly differ from heterosexuals on depression, anxiety, stress, or previous hospitalization, but did for risk of suicide. These findings underscore the importance of measuring, reporting, and addressing the distinct mental health experiences of sexual minority youth.
... Yet, youth reporting no attractions also demonstrated greater age 9 depression symptoms and greater age 12 poor maternal relationships. These findings contradict the scant emerging research on asexual youth, which has found that asexual youth and young adults experience greater depression and anxiety symptoms than gay and lesbian youth and young adults (Borgogna et al., 2019;McInroy et al., 2020). However, the present finding that youth reporting no attractions experienced lower peer victimization than exclusively other-sex-attracted youth partially coheres with findings of an online survey study showing that asexual youth report less discrimination than other sexual minority youth (McInroy et al., 2020). ...
... These findings contradict the scant emerging research on asexual youth, which has found that asexual youth and young adults experience greater depression and anxiety symptoms than gay and lesbian youth and young adults (Borgogna et al., 2019;McInroy et al., 2020). However, the present finding that youth reporting no attractions experienced lower peer victimization than exclusively other-sex-attracted youth partially coheres with findings of an online survey study showing that asexual youth report less discrimination than other sexual minority youth (McInroy et al., 2020). The present finding regarding greater age 12 mother-child discord for youth reporting no attractions compared to exclusively other-sex-attracted youth is novel and requires future study. ...
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Knowing the age at which the sexual orientation disparity in depression and anxiety symptoms first emerges and the early determinants of this disparity can suggest optimal timing and targets of supportive interventions. This prospective cohort study of children ages 3 to 15 (n = 417; 10.6% same-sex-attracted; 47.2% assigned female at birth) and their parents sought to determine the age at which the sexual orientation disparity in depression and anxiety symptoms first emerges and whether peer victimization and poor parental relationships mediate this disparity. Same-sex-attracted youth first demonstrated significantly higher depression symptoms at age 12 and anxiety symptoms at age 15 than exclusively other-sex-attracted youth. Age 12 peer victimization mediated the sexual orientation disparity in age 15 depression symptoms. Age 12 poor mother–child relationship mediated the sexual orientation disparity in age 15 anxiety symptoms. The findings are discussed in terms of implications for developmentally appropriate interventions against social stress during early development.
... 21 In addition, one study of sexual minority youth found that asexual youth experienced higher suicidal ideation than non-asexual peers. 22 There are several factors that place LGB youth at particular risk of experiencing suicidal ideation and suicide attempts, including gender identity. 23 Experiences across the whole LGBT community are often homogenized, with gender often subsumed within sexuality research. ...
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Purpose: This article examines factors associated with suicidal ideation and suicide attempts in the past 12 months among lesbian, gay, bisexual, pansexual, queer, asexual, or other non-heterosexual identifying youth (LGBQA+). Methods: A national Australian cross-sectional online survey was conducted involving 4370 cisgender LGBQA+ participants aged 14-21 years from September to October 2019. Multivariable logistic regression analyses were performed to examine significant factors associated with suicidal ideation and suicide attempts in the past 12 months. Research ethics approval for the WTI4 study was granted by the La Trobe University Human Research Ethics Committee and the ACON Research Ethics Review Committee. Results: Overall, 56.4% of participants reported suicidal ideation and 8.9% a suicide attempt in the past 12 months. Multivariable regression results show that participants aged younger than 18 years, lesbian (compared with gay) identifying, those living in rural or remote locations (compared with inner city), those reporting any verbal, physical, or sexual harassment or assault based on sexual orientation or gender identity, or who had a religious family or household, or had experienced conversion practices in the past 12 months reported higher levels of suicidal ideation or suicide attempts. Those who reported feeling part of their school reported lower levels of suicidal ideation and suicide attempts. Conclusion: High levels of suicidal ideation and suicide attempts among young LGBQA+ people in Australia highlight a need for the ongoing inclusion of LGBQA+ youth as a priority population for suicide prevention. The findings illustrate key factors associated with a greater risk of suicidality among young LGBQA+ people. These findings can be used to inform the provision of tailored support services, including culturally safe suicide prevention programs and efforts to address stigma, discrimination, and conversion practices.
... In this sense, the discrimination suffered by bisexuals, pansexuals, and asexuals can impact their own acceptance and/or concealment of their identity [54,70,71]. This discrimination is also associated with increased depression and anxiety symptomology [55,[72][73][74][75] and worse mental health [76,77], general well-being [72,78], and work experiences [28,69,79]. ...
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Background: Discrimination against sexual and gender minorities in occupational settings has been an important topic of research. However, little is known about this impact in Portuguese-speaking people. Methods: 305 Portuguese and Brazilian participants who identified as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender identities (LGBTQIA+) completed an online survey comprising sociodemographic questions, a set of scales to assess psychological distress, and a set of scales to assess occupational well-being. Results: Participants had higher levels of burnout, depressive symptoms, and anxiety and lower levels of work-related quality of life, engagement, and self-efficacy at work compared to the defined cut-off points for normative populations, with asexual and bisexual people appearing to be the most affected. Significant correlations were found for all variables, and psychological distress was a significant predictor of lower occupational well-being. Conclusions: These findings are useful for understanding the occupational health of LGBTQIA+ people and suggest efforts to improve the climate in the workplace for this population.
... In addition, the results show that the likelihood of being below the cut-off value for clinically significant depression was significantly increased in bisexual individuals and significantly decreased in heterosexual individuals. This finding is in line with previous empirical work [51][52][53]. For example, in a systematic review and meta-analysis on the prevalence of depression and anxiety, higher rates of depression and anxiety were consistently reported among bisexual individuals compared to heterosexual individuals and higher or equivalent rates in comparison to lesbian/gay individuals [54]. ...
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Background Preliminary empirical data indicates a substantial impact of the COVID-19 pandemic on well-being and mental health. Individuals with minoritized sexual and gender identities are at a higher risk of experiencing such negative changes in their well-being. The objective of this study was to compare levels of well-being among cis-heterosexual individuals and individuals with minoritized sexual and gender identities during the COVID-19 pandemic. Methods Using data obtained in a cross-sectional online survey between April 20 to July 20, 2020 (N = 2332), we compared levels of well-being (WHO-5) across subgroups (cis-individuals with minoritized sexual identities, individuals with minoritized gender identities and cis-heterosexual individuals) applying univariate (two-sample t-test) and multivariate analysis (multivariate linear regression). Results Results indicate overall lower levels of well-being as well as lower levels of well-being in minoritized sexual or gender identities compared to cis-heterosexual individuals. Further, multivariate analyses revealed that living in urban communities as well as being in a relationship were positively associated with higher levels of well-being. Furthermore, a moderation analysis showed that being in a relationship reduces the difference between groups in terms of well-being. Conclusion Access to mental healthcare for individuals with minoritized sexual and gender identities as well as access to gender-affirming resources should be strengthened during COVID-19 pandemic. Healthcare services with low barriers of access such as telehealth and online peer support groups should be made available, especially for vulnerable groups.
Article
A wealth of research documents disparities in workplace outcomes between cisgender heterosexual employees and LGBTQ+ employees. However, few studies have examined how workplace wellbeing may differ among different subgroups within the LGBTQ+ umbrella – that is, the notion of ‘diversity within diversity’. The current study fills this gap in knowledge by theorising and testing differences in workplace wellbeing across nuanced sexual- and gender-identity groups. To accomplish this, we use unique survey data from the 2020 Australian Workplace Equality Index (AWEI) Employee Survey ( n = 5270 respondents and 146 organisations) and random-intercept multilevel regression models. Our results reveal significant differences in workplace wellbeing between different diversity groups. For example, LGBTQ+ employees identifying as gay/lesbian and as cisgender men generally report better outcomes than employees identifying with other minority identities. Overall, our findings call for workplace equity policies that target stigma towards plurisexual, gender non-conforming, and smaller and more invisible diversity groups.
Article
Sexual minorities are at greater risk for mental health difficulties (e.g., depression, suicidal ideations) than their heterosexual peers. Based on the psychological mediation framework (Hatzenbuehler, 2009), this elevated risk is conferred via general psychological processes (e.g., belonging, coping) that are relevant to mental health, regardless of sexual orientation. Although preliminary evidence suggests that individuals who identify as bisexual or asexual may be at particularly heightened risk for mental health difficulties, the majority of the literature has failed to examine nuanced differences within the sexual minority community. In this study, we examined depression, anxiety and happiness as indicators of mental health, and belonging and coping as general psychological processes in 2,424 female and male participants who identified as gay/lesbian, asexual, or bisexual from 28 U.S. colleges and universities. The findings revealed a significant main effect for sexual orientation and a significant main effect for gender in relation to our variables of interest. In terms of sexual orientation, bisexual individuals scored significantly higher on depression and lower on happiness than asexual and gay/lesbian individuals. Gay/lesbian and bisexual individuals scored significantly higher on anxiety and lower on coping than asexual individuals. Asexual individuals reported levels of belonging that were significantly higher than bisexual individuals, and gay/lesbian individuals scored in between those groups. In terms of gender, women had higher levels of depression and anxiety, and lower levels of happiness and coping than men, regardless of sexual orientation. Finally, gender did not moderate the relationship between sexual orientation and the outcome variables. These findings highlight that scholars should not treat the sexual minority community as a monolithic group when considering mental health or general psychological processes. The evidence for group differences in both mental health and general psychological processes should inform individual-level interventions and resources.
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While often included in the spectrum of sexual minority identities, asexuality receives comparatively little attention. Awareness and understanding remains limited, and knowledge has been generated primarily from adult populations. This paper employs a sample of 711 self-identified asexual youth (aged 14–24, M = 17.43 years) who identified as members of the LGBTQ+ community to consider the implications of a number of different areas for service provision. Two-thirds (66.8%) of participants identified as gender minorities within the spectrum of transgender and non-binary identities. Findings include aspects of participants’ LGBTQ+ developmental processes, including that only 14.3% had disclosed their LGBTQ+ status to everyone in their lives. However, just 2.4% had disclosed to no one. Their attraction and sexual activity were also explored, with 27.1% having never experienced any kind of romantic or sexual attraction and 20.6% having ever been sexually active. Findings regarding participants’ accessing of LGBTQ+ health information and engagement in a range of offline and online LGBTQ+ community activities are also provided. Participants acquired more health information online than offline—including sexual health information. Recommendations for service provision, particularly implications for sexual health and Internet-based services, are discussed.
Article
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Sexual and gender minority youth (SGMY) disproportionately experience risks including discrimination and victimization, as well as psycho-social and behavioral concerns. There remains a relative lack of attention to factors promoting their positive development – particularly via online modalities. Research on their supportive use of technologies in specific contexts is necessary to explain the positive outcomes of contemporary SGMY despite their experiences of excessive risk. This article employs uses and gratifications theory to investigate online fandom communities as a source of social support for SGMY, as well as the potential of these online communities to contribute to their resilience and positive adjustment. A sample (n = 3665) of SGMY aged 14–29 ( x¯ = 17.77) was drawn from a mixed methods online survey. Results indicate participation in online fandom communities may increase connectedness, provide opportunities for support and mentorship, facilitate navigation of challenges towards positive adjustment, and encourage feelings of strength. Implications for research and professional practice are emphasized.
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Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. Conclusions: AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. International registered report identifier (irrid): DERR1-10.2196/13462.
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Background: Sexual and Gender Minority Youth (SGMY) (ages 14 – 29) face increased risks to their well-being compared to their cisgender, heterosexual peers—including rejection by family¬¬, exclusion from society, depression, substance use, elevated suicidality and harassment. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive Behavioural Therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help improve mood and increase coping by teaching youth how to identify, challenge and change maladaptive thoughts, beliefs and behaviours. Based on promising pilot study results, AFFIRM is a CBT-informed group intervention that is being tested in a pragmatic trial to assess its implementation potential. Objectives: This project is intended to scale-up implementation and delivery of AFFIRM, an eight-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. This project aims to decrease sexual risk-taking, poor mental health and internalized homophobia, and increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyering at community agencies and organizations, as well as online advertising. Potential participants are assessed for suitability for the group intervention via online screening, and are allocated in a 2:1 fashion to the AFFIRM intervention or a waitlisted control in a stepped wedge waitlist crossover design. The intervention groups are hosted by Collaborating Community Agency Sites (CCASs) (e.g., community health centres and family health teams) across Ontario, Canada. Participants are assessed at pre-wait (if applicable), pre-intervention, post-intervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. All data collection occurs online, either independently or at CCASs via tablet. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing, with a target sample of 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t-tests, and repeated measures linear mixed modeling (LMM) using SPSS to test for differences pre and post intervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions, univariate, and multivariate normality of all variables will be assessed. Conclusions: AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY, but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact.
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Empirical findings indicate that sexual and gender minorities report notably poorer outcomes on measures of mental health when compared with cisgender/heterosexual individuals. Although several studies have examined these issues, few have taken the time to examine differences between cisgender/heterosexual and specific lesbian, gay, bisexual, transgender, and queer identities. This is especially important as an increasing number of new gender and sexual identities emerge, yet limitations in statistical power often preclude such analyses. Thus, the following study addressed this gap by examining data from a large sample of college students from the national Health Minds Study (n = 43,632). Results indicated that college students with transgender and gender nonconforming identities reported significantly higher rates of depression and anxiety symptoms compared with students with cisgender identities, with large effect sizes. Disparities were also significant across sexual minority participants, with the smallest effect sizes being between heterosexual and gay/lesbian individuals, and the largest effect sizes between heterosexual and pansexual participants for depression, and heterosexual and demisexual participants for anxiety. We also found evidence of an interaction of gender and sexual identity impacting mental health such that those with minority statuses in both identity groups had significantly worse outcomes compared to those with only one minority identity. Our results indicate that individuals in the emerging sexual and gender minority categories (pansexual, demisexual, asexual, queer, questioning, and transgender/gender nonconforming) report significantly higher rates of depression and anxiety when compared with cisgender/heterosexual individuals, and even significantly more than those who identify as gay/lesbian. Implications for mental health providers and researchers are discussed.
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This article explores two cases at the intersection of emerging studies of transgender experience: heterosexualities and asexualities. Drawing on data from a mixed-methodological survey, we analyze the ways 57 asexual transgender people and 42 heterosexual transgender people occupying varied gender, race, class, age, and religious identities (1) make sense of gender and (2) experience coming out as transgender. Our analyses reveal some ways cisnormativity impacts transgender people across sexual identities, and the theoretical potential of incorporating transgender people into studies focused on asexualities and heterosexualities. In conclusion, we outline implications for understanding (1) transgender experiences with cisnormativity across sexual and other social locations and (2) possibilities for expanding studies of heterosexualities and asexualities beyond cisgender experiences.
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Previous studies have identified myriad negative consequences of internalized homophobia, or self-directed antigay prejudice, but few can speak to its developmental antecedents. This work explored whether parenting styles might affect the development of internalized homophobia and negative psychological health outcomes in sexual minority individuals. Specifically, we expected that perceiving parents as autonomy supportive during childhood would link to lower internalized homophobia and better psychological health, and that lower levels of shame would help to explain this effect. We tested this in a cross-sectional survey with 484 lesbian, gay, and bisexual (LGB) adults. Results supported the hypothesized model: Those who described their parents as being more autonomy supportive during childhood reported lower internalized homophobia, anxiety, and depression, and greater self-esteem. These relations were mediated by a tendency to experience shame, whereby autonomy support from mothers (but not fathers) related to lower shame, which in turn linked to lower internalized homophobia and better psychological health. This work underscores the importance of autonomy-supportive interventions with families, as it suggests that autonomy-supportive parents may promote resilience against the development of internalized homophobia, a potent risk factor for mental health problems and self-harm.
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Lesbian, gay, and bisexual (LGB) individuals report higher levels of problematic alcohol and substance use than their heterosexual peers. This disparity is linked to the experience of LGB-specific stressors, termed minority stress. Additionally, bisexual individuals show increased rates of psychopathology, including problematic alcohol and substance use, above and beyond lesbian and gay individuals. However, not everyone experiencing minority stress reports increased rates of alcohol and substance misuse. Emotion regulation (ER), which plays a critical role in psychopathology in general, is theorized to modulate the link between minority stress and psychopathology. However, it remains largely unknown whether ER plays a role in linking instances of minority stress with substance and alcohol use outcomes. To address the gap, the current study assessed 305 LGB individuals' instances of minority stress, ER, and substance and alcohol use outcomes. We assessed the role of ER in problematic alcohol and substance use among LGB individuals using moderated mediation, where sexual minority status was entered as the moderator, and ER difficulties was entered as the mediator. The results indicated significant indirect effects of minority stress, through ER difficulties, on both problematic alcohol and substance use. However, there was no significant interaction with sexual orientation status, suggesting that ER may be important for all LGB individuals in predicting problematic alcohol and substance use. These results highlight the important role that ER plays between instances of minority stress and substance and alcohol use in LGB individuals, suggesting that ER skills may serve as a novel target for intervention.
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Background: Sexual and gender minority youth are a population in peril, exemplified by their disproportionate risk of negative experiences and outcomes. Sexual and gender minority youth may be particularly active users of information and communication technologies (ICTs), and it is important to identify the potential contributions of ICTs to their resilience and well-being. Objective: Our aim was to (1) investigate the use of ICTs by sexual and gender minority youth, (2) identify the ways that ICTs influence the resilience and coping of sexual and gender minority youth, focusing on promotion of well-being through self-guided support-seeking (particularly using mobile devices), (3) develop a contextually relevant theoretical conceptualization of resilience incorporating minority stress and ecological approaches, (4) generate best practices and materials that are accessible to multiple interested groups, and (5) identify whether video narratives are a viable alternative to collect qualitative responses in Web-based surveys for youth. Methods: Mixed methods, cross-sectional data (N=6309) were collected via a Web-based survey from across the United States and Canada from March-July 2016. The sample was generated using a multipronged, targeted recruitment approach using Web-based strategies and consists of self-identified English-speaking sexual and gender minority youth aged 14-29 with technological literacy sufficient to complete the Web-based survey. The survey was divided into eight sections: (1) essential demographics, (2) ICT usage, (3) health and mental health, (4) coping and resilience, (5) sexual and gender minority youth identities and engagement, (6) fandom communities, (7) nonessential demographics, and (8) a video submission (optional, n=108). The option of a 3-5 minute video submission represents a new research innovation in Web-based survey research. Results: Data collection is complete (N=6309), and analyses are ongoing. Proposed analyses include (1) structural equation modeling of quantitative data, (2) grounded theory analysis of qualitative data, and (3) an integrative, mixed methods analysis using a data transformation design. Theoretical and methodological triangulation of analyses integrates an interwoven pattern of results into a comprehensive picture of a phenomenon. Results will be reported in 2017 and 2018. Conclusions: This research study will provide critical insights into the emerging use of ICTs by sexual and gender minority youth and identify intervention strategies to improve their well-being and reduce risks encountered by this vulnerable population. Implications for practice, research, and knowledge translation are provided. Full text available here: http://www.researchprotocols.org/2017/9/e189/
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Objective: Research has suggested that sexual minority young people are more likely to have depressive symptoms or depressive disorder, but to date most studies in the field have relied on convenience-based samples. This study overcomes this limitation by systematically reviewing the literature from population-based studies and conducting a meta-analysis to identify whether depressive disorder and depressive symptoms are elevated in sexual minority youth. Method: A systematic review and meta-analysis were conducted and informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to determine if rates of depressive symptoms or depressive disorder differ for sexual minority youth, relative to heterosexual adolescents. MEDLINE, PsycINFO, EMBASE and ERIC databases were searched. Studies reporting depressive symptom data or the prevalence of depressive disorder in population-based samples of adolescents, which included sexual minority youth and heterosexual young people, were included in the review. A meta-analysis was conducted to examine differences between groups. Results: Twenty-three articles met the inclusion criteria. The proportion of sexual minority youth in the studies ranged from 2.3% to 12%. Sexual minority youth reported higher rates of depressive symptoms and depressive disorder (odds ratio = 2.94, p < 0.001 and standardized mean difference, d = 0.39, p < 0.001) in comparison to heterosexual young people. Female sexual minority youth were more likely to report depressive symptoms when compared to male sexual minority youth (standardized mean difference, d = 0.34, p < 0.001). Limitations included variations in how sexuality was operationalized and how depressive symptoms or depressive disorder was measured. Conclusions: There is robust evidence that rates of depressive disorder and depressive symptoms are elevated in sexual minority youth in comparison to heterosexual young people. Despite the elevated risk of depressive symptoms or depressive disorder for sexual minority youth, the treatment for this group of young people has received little attention.
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Lesbian, gay, and bisexual (LGB) emerging adults often seek support from their peers if they lack support from their family of origin. We predicted that peer social support would moderate the link between negative family relationships and psychosocial adjustment, such that in the context of family rejection, experiencing more peer support would predict lower levels of anxiety, depression, and internalized homonegativity (IH) and higher self-esteem. Sixty-two (27 females) LGB individuals (ages 17–27, M = 21.34 years, SD = 2.65) reported on their families’ attitudes toward homosexuality, experiences of family victimization, peer social support, anxiety and depression symptoms, IH, and self-esteem. Results showed that peer social support moderated the link between negative family attitudes and anxiety and also moderated the link between family victimization and depression. The moderating effects suggest that having a supportive peer group may protect against mental health problems for LGB emerging adults who lack support from their family of origin.
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This article explores the relationship between contemporary asexual lives and compulsory sexuality, or the privileging of sexuality and the marginalizing of non-sexuality. Drawing on thirty in-depth interviews, I identify four ways the asexually-identified individuals in this study saw themselves as affected by compulsory sexuality: pathologization, isolation, unwanted sex and relationship conflict, and the denial of epistemic authority. I also identify five ways these asexually-identified individuals disrupted compulsory sexuality: adopting a language of difference and capacity to describe asexuality; deemphasizing the importance of sexuality in human life; developing new types of non-sexual relationships; constituting asexuality as a sexual orientation or identity; and engaging in community building and outreach. I argue that some of these practices offer only a limited disruption of compulsory sexuality, but some of these practices pose a radical challenge to sexual norms by calling into question the widespread assumption that sexuality is a necessary part of human flourishing.
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Purpose: Sexual minority (lesbian, gay, bisexual) populations have a higher prevalence of mental health and substance use disorders compared to their heterosexual counterparts. Such disparities have been attributed, in part, to minority stressors, including distal stressors such as discrimination. However, few studies have examined associations between discrimination, mental health, and substance use disorders by gender among sexual minority populations. Methods: We analyzed data from 577 adult men and women who self-identified as lesbian, gay, or bisexual and participated in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Six questions assessed discrimination due to sexual orientation. Weighted multivariable logistic regression examined associations between experiences of sexual orientation discrimination and both mental health and substance use disorders. Analyses were conducted separately for sexual minority men and women, adjusting for sociodemographic covariates. Results: Sexual minority men who ever experienced discrimination (57.4%) reported higher odds of any lifetime drug use disorder and cannabis use disorder compared to sexual minority men who never experienced discrimination. Sexual minority women who ever experienced discrimination (42.9%) reported higher odds of any lifetime mood disorder and any lifetime anxiety disorder compared to sexual minority women who never experienced discrimination. Conclusion: The findings suggest that discrimination is differentially associated with internalizing (mental health) and externalizing (substance use) disorders for sexual minority men and women. These findings indicate a need to consider how homophobia and heteronormative discrimination may contribute to distinct health outcomes for lesbian and bisexual women compared with gay and bisexual men.
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Online research methodologies may serve as an important mechanism for population-focused data collection in social work research. Online surveys have become increasingly prevalent in research inquiries with young people and have been acknowledged for their potential in investigating understudied and marginalized populations and subpopulations, permitting increased access to communities that tend to be less visible—and thus often less studied—in offline contexts. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people are a socially stigmatized, yet digitally active, youth population whose participation in online surveys has been previously addressed in the literature. Many of the opportunities and challenges of online survey research identified with LGBTQ youths may be highly relevant to other populations of marginalized and hard-to-access young people, who are likely present in significant numbers in the online environment (for example, ethnoracialized youths and low-income youths). In this article, the utility of online survey methods with marginalized young people is discussed, and recommendations for social work research are provided.
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Although LGBQ students experience blatant forms of heterosexism on college campuses, subtle manifestations, such as sexual orientation microaggressions are more common. Similar to overt heterosexism, sexual orientation microaggressions may threaten LGBQ students' academic development and psychological wellbeing. Limited research exists in this area, in part due to lack of a psychometrically sound instrument measuring the prevalence of LGBQ microaggressions on college campuses. To address this gap, we created and tested the LGBQ Microaggressions on College Campuses Scale. Two correlated subscales were generated: Interpersonal LGBQ Microaggressions and Environmental LGBQ Microaggressions. The results indicated that the subscales demonstrate strong reliability and validity.
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Internalized heterosexism refers to the development of a negative view of one’s own and others’ sexual minority identities as a product of living within a heterosexist society. Various negative mental health outcomes have been associated with internalized heterosexism (IH), such as anxiety, depression, and suicidality. However, little is known about the actual processes through which these outcomes take place. The current study examined the role of self-criticism (a psychological process) and lack of connectedness with other sexual minorities (a social process) in explaining the relation between IH and psychological distress. Data were collected via an online survey (N = 436) and analyzed using structural equation modeling. Results supported previous research, showing a significant direct positive relationship between IH and psychological distress. In addition, higher self-criticism (β = .28, p < .001; 95% CI: .22, .36) and lower connectedness with sexual minorities (β = .10, p < .01; 95% CI: .04, .16) partially explained the shared variance between IH and psychological distress. The final model that included both mediators of the relation between IH and psychological distress accounted for a significant amount of the variance in psychological distress (64.3%) and fit the data well. Both self-criticism and connectedness to a sexual minority community are mechanisms that could be targeted within therapy when working to improve the mental health of clients with high IH and specific therapeutic suggestions are presented.
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Research on the sexual health of trans women (male-to-female spectrum transgender people), has focused primarily on sexual response and satisfaction after initiating hormone treatment or undergoing genital surgery, or on HIV-related sexual risk among trans women sexually active with cisgender (cis, i.e., non-trans) men. Given that these situations are not representative of the majority of trans women at most points in the lifecourse, a broader discussion is needed to provide sex educators, therapists, clinicians, and researchers, as well as trans women and their partners, with information needed to promote sexual health. Drawing on the theoretical constructs of cisnormativity and cissexism, as well as previously published and new data from Trans PULSE, a community-based study of trans health in Ontario, we discuss the social context and sexual realities of trans women's lives.
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In this review article, human asexuality, a relatively understudied phenomenon, is discussed. Specifically, definitions and conceptualizations of asexuality (e.g., is it a unique category of sexual orientation?), biological and historical contexts, identity issues, discrimination against asexual people relative to other minorities, origins, and variations, including gender differences, are reviewed. Whether asexuality should be construed as a disorder is also discussed. The study of asexuality allows for a better understanding of an underrecognized sexual minority but also affords a unique opportunity to examine and better understand human sexuality.
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Factors associated with the well-being of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth were qualitatively examined to better understand how these factors are experienced from the youths' perspectives. Largely recruited from LGBTQ youth groups, 68 youth participated in focus groups (n = 63) or individual interviews (n = 5). The sample included 50% male, 47% female, and 3% transgender participants. Researchers used a consensual methods approach to identify negative and positive factors across 8 domains. Negative factors were associated with families, schools, religious institutions, and community or neighborhood; positive factors were associated with the youth's own identity development, peer networks, and involvement in the LGBTQ community. These findings suggest a pervasiveness of negative experiences in multiple contexts, and the importance of fostering a positive LGBTQ identity and supportive peer/community networks. Efforts should work towards reducing and eliminating the prejudicial sentiments often present in the institutions and situations that LGBTQ youth encounter.
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Human asexuality is defined as a lack of sexual attraction to anyone or anything, and preliminary evidence suggests that it may best be defined as a sexual orientation. As asexual individuals may face the same social stigma experienced by gay, lesbian and bisexual persons, it follows that asexual individuals may experience higher rates of psychiatric disturbance that have been observed among these non-heterosexual individuals. This study explored mental health correlates and interpersonal functioning and compared asexual, non-heterosexual and heterosexual individuals on these aspects of mental health. Analyses were limited to Caucasian participants only. There were significant differences among groups on several measures, including depression, anxiety, psychoticism, suicidality and interpersonal problems, and this study provided evidence that asexuality may be associated with higher prevalence of mental health and interpersonal problems. Clinical implications are indicated, in that asexual individuals should be adequately assessed for mental health difficulties and provided with appropriate interventions that are sensitive to their asexual identity.
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Objective Sexual orientation is usually considered to be determined in early life and stable in the course of adulthood. In contrast, some transgender individuals report a change in sexual orientation. A common reason for this phenomenon is not known. Methods We included 115 transsexual persons (70 male-to-female “MtF” and 45 female-to-male “FtM”) patients from our endocrine outpatient clinic, who completed a questionnaire, retrospectively evaluating the history of their gender transition phase. The questionnaire focused on sexual orientation and recalled time points of changes in sexual orientation in the context of transition. Participants were further asked to provide a personal concept for a potential change in sexual orientation. Results In total, 32.9% (n = 23) MtF reported a change in sexual orientation in contrast to 22.2% (n = 10) FtM transsexual persons (p = 0.132). Out of these patients, 39.1% (MtF) and 60% (FtM) reported a change in sexual orientation before having undergone any sex reassignment surgery. FtM that had initially been sexually oriented towards males ( = androphilic), were significantly more likely to report on a change in sexual orientation than gynephilic, analloerotic or bisexual FtM (p = 0.012). Similarly, gynephilic MtF reported a change in sexual orientation more frequently than androphilic, analloerotic or bisexual MtF transsexual persons (p = 0.05). Conclusion In line with earlier reports, we reveal that a change in self-reported sexual orientation is frequent and does not solely occur in the context of particular transition events. Transsexual persons that are attracted by individuals of the opposite biological sex are more likely to change sexual orientation. Qualitative reports suggest that the individual's biography, autogynephilic and autoandrophilic sexual arousal, confusion before and after transitioning, social and self-acceptance, as well as concept of sexual orientation itself may explain this phenomenon.
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Sexual minority youth [SMY] are a population who experience considerable stress related to their sexual identities. Previous investigations have identified individual risk factors that contribute to suicide among SMY, yet little research has focused on cumulative stressors that may exacerbate negative outcomes for multiethnic sexual minority youth [MSMY]. This study used hierarchical logistic regression to explore the relationship between cumulative risks and their relationship to self-reported suicide risk for MSMY. The community-based clinical sample (n = 137) reported high co-occurrence of risks, with an average of 9. Overall, MSMY with a higher number of cumulative risk factors were twice as likely to express self-reported suicide risk. Specifically, experiencing chronic illness and physical or sexual abuse resulted in threefold higher odds of self-reported suicide risk among MSMY. These findings address a gap in the literature about the relationship of cumulative and specific stressors to the self-reported suicide risk for an understudied, vulnerable population.
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Clinicians working with sexual minority youth (SMY) should be knowledgeable about the contemporary language around sexuality and gender used by adolescent clients. Such knowledge contributes to the clinical environment and aids clinicians in developing therapeutic relationships. However, individuals working with SMY should also be aware of the potential impact of social environment and individual context on SMYs language and terminology. This paper discusses the role that socio-demographic and contextual factors may play in access to discourses of sexuality and sexual identity taxonomies for a population of multiethnic sexual minority youth (MSMY) (n = 500) from Miami-Dade County, Florida. The study population is comprised of primarily Black, non-Hispanic (31.4%), and Hispanic (65.4%) SMY; 94.2% identify using traditional sexual identity terminology, including lesbian (38.1%), gay (25.7%), and bisexual (28.1%). The impact on clinical practice and counseling with SMY is discussed throughout.
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Homophobic teasing is often long-term, systematic, and perpetrated by groups of students (Rivers, 2001); it places targets at risk for greater suicidal ideation, depression, and isolation (Elliot & Kilpatrick, 1994). This study fills a gap in the literature by examining buffering influences of positive parental relations and positive school climate on mental health outcomes for high school students who are questioning their sexual orientation. Participants were 13,921 high school students from a Midwestern U.S. public school district. Students completed a survey consisting of a wide range of questions related to their school experiences (bullying, homophobia, school climate), parental support, mood, and drug-alcohol use. Students were categorized into three groups: (a) youth who identified as heterosexual, (b) youth who questioned their sexual orientation, and (c) youth who identified as lesbian, gay, or bisexual (LGB). As hypothesized, sexual minority youth were more likely to report high levels of depression-suicide feelings and alcohol-marijuana use; students who were questioning their sexual orientation reported more teasing, greater drug use, and more feelings of depression and suicide than either heterosexual or LGB students. Sexually questioning students who experienced homophobic teasing were also more likely than LGB students to use drugs-alcohol and rate their school climate as negative. Finally, positive school climate and parental support protected LGB and questioning students against depression and drug use.
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This article describes a social psychological framework for understanding sexual stigma, and it reports data on sexual minority individuals' stigma-related experiences. The framework distinguishes between stigma's manifestations in society's institutions (heterosexism) and among individuals. The latter include enacted sexual stigma (overt negative actions against sexual minorities, such as hate crimes), felt sexual stigma (expectations about the circumstances in which sexual stigma will be enacted), and internalized sexual stigma (personal acceptance of sexual stigma as part of one's value system and self-concept). Drawing from previous research on internalized sexual stigma among heterosexuals (i.e., sexual prejudice), the article considers possible parallels in how sexual minorities experience internalized sexual stigma (i.e., self-stigma, or negative attitudes toward the self). Data are presented from a community sample of lesbian, gay, and bisexual adults (N = 2,259) to illustrate the model's utility for generating and testing hypotheses concerning self-stigma. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The present study examined the link between sexual orientation and adjustment in a community sample of 97 sexual minority (gay male, lesbian, bisexual, and questioning) high school students, taking into account their experiences of peer victimization and social support within peer and family contexts. Adolescents were identified in a large-scale survey study conducted at 5 high schools. They were matched to a comparison sample of their heterosexual peers. Sexual minority adolescents reported more externalizing behaviors and depression symptoms than heterosexual youth. Compared to their heterosexual peers, sexual minority youth reported more sexual harassment, more bullying, less closeness with their mothers, and less companionship with their best friends. There were no significant differences between gay male, lesbian, bisexual, and questioning adolescents. Overall, both victimization and social support mediated the link between sexual orientation and psychosocial symptoms. Among sexual minority youth, the link between social support and externalizing was mediated by experiences of peer victimization. These findings highlight the contextual risk and protective factors associated with non-heterosexual sexual orientation in accounting for the emotional and behavioral problems in this population.
Article
Suicide continues to be the second-leading cause of death for all youths aged 15–24. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are at a significantly higher risk for suicidal thoughts or behaviors (STB). Establishing and understanding correlates of STB among LGBTQ youth is one important step toward enhancing prevention, intervention, and research efforts. To synthesize current knowledge on suicide among LGBTQ youth, the present meta-analyses offer results from 44 studies over the past 20 years. Two-hundred and thirty-four correlation coefficient effect sizes were calculated and categorized. To be included, the study had to quantitatively examine correlates of STB among LGBTQ youth. A number of social-science databases were used to examine the existing published research. Results illustrated the variability among correlates of STB as well as substantial limitations in the extant literature. There was a heterogeneity of effect sizes, a lack of novel correlates, a focus on risk, a dearth of theoretically driven designs, moderate publication bias, a paucity of developmentally driven analyses, and a dearth of research with transgender youth.
Article
Purpose of review: Suicide is the second leading cause of death in youth aged 10-24 years old globally, but detecting those at risk is challenging. Novel preventive strategies with wide influence across populations are required. Interest in the potential for both detrimental and supportive influences of social media/internet use on suicidal behaviour has been growing; however, the relationship remains unclear. Recent findings: A systematic search of articles from database inception up to 25 January 2019 across five databases: Medline, PsycINFO, EMBASE, HMIC and CINAHL revealed nine independent studies investigating social media/internet use and suicide attempts in young people less than 19 years old (n = 346 416). An independent direct association was found between heavy social media/internet use and increased suicide attempts in seven studies (adjusted ORs ranged from 1.03 to 5.10), although adjusting for cyberbullying victimization and sleep disturbance reduced the strength of this association. Two studies found that some social media/internet use, versus no use, may be associated with fewer suicide attempts. There were no studies investigating the relationship between social media/internet use and completed suicide. Summary: There is an independent association between problematic use of social media/internet and suicide attempts in young people. However, the direction of causality, if any, remains unclear. Further evaluation through longitudinal studies is needed.
Article
Purpose: Transgender and gender-nonconforming (TGNC) adolescents and young adults experience mental health problems, including anxiety and depression, at an elevated rate as compared to their cisgender counterparts. A growing literature suggests that vulnerability to psychiatric problems in TGNC individuals results from social discrimination and minority stress. Methods: The sample consisted of adolescent TGNC patients (N = 109) who completed behavior health screening questionnaires as standard of care at their first clinical visit to an interdisciplinary gender program within a pediatric academic medical center in a metropolitan Midwestern city. Binary logistic regressions were used to assess whether the likelihood that participants met clinical diagnostic criteria for Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) was predicted by gender identity appearance congruence, proximal forms of minority stress (e.g., negative expectations of the future related to gender identity; internalized transphobia) and community connectedness (i.e., resilience) . Results: Overall, 33% (n = 36) of the sample met diagnostic criteria for MDD and 48% (n = 53) met diagnostic criteria for GAD. Those with high levels of internalized transphobia were significantly more likely to meet diagnostic criteria for both MDD and GAD. Those with low levels of gender identity appearance congruence were significantly more likely to meet diagnostic criteria for MDD but not GAD. Conclusion: There are several unique factors that may predict mental illness among TGNC youth. Understanding these factors may offer opportunities for targeted clinical and structural interventions.
Article
Purpose: This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14-18 and 19-25). Methods: A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Results: Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Conclusions: Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable.
Article
Purpose: Lesbian, gay, bisexual, and transgender (LGBT) adolescents are at greater risk for mental health problems than their heterosexual peers, in part due to victimization. Social support, particularly from families, has been identified as an important promotive factor. However, little is known about how LGBT youth experience multiple forms of support or how early support predicts mental health across adolescence and into young adulthood. Methods: In an analytic sample of 232 LGBT youth aged 16-20 years at baseline across 5.5 years, we compared developmental trajectories of psychological distress between three empirically derived social support cluster types at baseline: those who reported uniformly low support, those who reported uniformly high support, and those who reported nonfamily support (i.e., high peer and significant other but low family support). Results: Longitudinal multilevel modeling, controlling for age, victimization, and social support at each wave, indicated key differences between cluster types. Youth in the low and nonfamily support clusters reported greater distress across all time points relative to youth in the high support cluster; however, they also showed a sharper decline in distress. Youth in the nonfamily cluster gained family support across adolescence, such that they resembled youth in the high support cluster by early adulthood. Conclusions: Findings underscore the importance of family support for LGBT youth. Youth who lack family support, but who have other forms of support, report a decrease in psychological distress and an increase in family support across adolescence. Youth who are low in all forms of support continue to exhibit high distress.
Article
This review provides an update on the growing body of research related to the mental health of transgender youth that has emerged since the 2011 publication of the Institute of Medicine report on the health of lesbian, gay, bisexual, and transgender people. The databases PubMed and Ovid Medline were searched for studies that were published from January 2011 to March 2016 in English. The following search terms were used: transgender, gender nonconforming, gender minority, gender queer, and gender dysphoria. Age limits included the terms youth, child, children, teenager*, and adolescen*. The combined search produced 654 articles of potential relevance. The resulting abstracts went through a tiered elimination system, and the remaining 15 articles, which presented quantitative data related to the prevalence of transgender youth and their mental health, were included in the present review. In addition to providing new estimates of the number of young people who identify as transgender (.17%-1.3%), studies since 2011 have shown that transgender youth have higher rates of depression, suicidality and self-harm, and eating disorders when compared with their peers. Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents. Recent research has demonstrated increased rates of psychiatric morbidity among transgender youth compared to their peers. Future work is needed to understand those youth who identify as gender nonbinary, improve methods to capture and understand diverse gender identities and related health disparities, and delineate the social determinants of such disparities.
Article
Objective More than 75,000 articles have been published on internalizing and externalizing problems. To advance clinical and research applications of internalizing/externalizing concepts and data, our objectives were as follows: to provide an overview of recent research on internalizing/externalizing problems assessed at ages 1½ to 18 years; to identify issues raised by methods for assessing such problems; and to develop recommendations for more precise, consistent, informative, and productive assessment of such problems. Method A total of 4,870 peer-reviewed articles published from January 1, 2012 through December 31, 2014 were systematically reviewed and identified by the search terms “internalizing” or “externalizing,” followed by detailed coding of 693 articles that reported use of measures meeting criteria for methodologically sound assessment of internalizing/externalizing problems. Results Many articles reported data based on measures that did not meet criteria for methodologically sound assessment of internalizing/externalizing problems. The 693 articles that used measures meeting criteria for methodological soundness and that qualified for detailed coding reported findings for 649,457 children living in 65 societies on all inhabited continents. Data were obtained from parents, teachers, children, clinicians, caregivers, and others. Samples included general population, clinical, school, at-risk, multicultural, welfare, and various ethnic/racial and socioeconomic groups. Many analytic methods were used to test associations of diverse variables with internalizing/externalizing problems. Conclusion The diverse procedures used to assess internalizing/externalizing problems pose challenges for clinical and research applications. To meet the challenges, recommendations are provided for using assessment instruments supported by published standardization, reliability, validity, and normative data to advance clinical services and research.
Article
This quantitative study examined differences in the coming-out process between self-identified lesbian, gay, and bisexual (LGB) participants in five age cohorts. An Internet survey and convenience sampling strategy was used to recruit 1,131 participants (ages 18 to 85). Participants provided demographic information and information about their home environment growing up, completed the Lesbian, Gay, and Bisexual Identity Scale (LGBIS) (Mohr & Fassinger, 200020. Mohr, J. J., & Fassinger, R. E. (2000). Measuring dimensions of lesbian and gay male experience. Measurement and Evaluation in Counseling and Development, 33(2), 66–90.View all references), and shared ages that they achieved important milestones in the coming-out process. ANCOVA of differences between men and women in the five cohorts on the age that significant milestones were achieved resulted in significant findings for all comparisons (p < .001). In post hoc analysis, 52% of the 450 pairwise comparisons were significant at at least the .05 level. Generally speaking, two significant trends were found in this sample: (a) that the average age of achieving milestones has decreased over time; and (b) that a gender gap in the age of achieving milestones between men and women has disappeared. The current study supports and extends research that suggests a strong connection between social acceptance of LGB people and coming out at younger ages.
Article
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.
Article
Youth Studies: an introduction is a clear, jargon-free and accessible textbook which will be invaluable in helping to explain concepts, theories and trends within youth studies. The concise summaries of key texts and the ideas of important theorists make the book an invaluable resource. The book also raises questions for discussion, with international case studies and up-to-date examples. The book discusses important issues within youth studies, for example: • education and opportunity. • employment and unemployment. • family, friends and living arrangements. • crime and justice. • identities. • health and sexuality. • citizenship and political engagement. Suitable for a wide range of youth-related courses, this textbook provides a theoretical and empirical introduction to youth studies. It will appeal to undergraduate students on international academic and vocational courses, including sociology, politics, criminology, social policy, geography and psychology.
Article
This study utilizes qualitative survey responses with 86 asexual-identified people to explore their experience in clinical settings. Findings indicate that asexuality is experienced as a healthy sexual orientation. Although asexual people often expect bias from practitioners, they also indicated experiences and opportunities for affirming approaches to care. Utilizing multicultural competence situated within a larger affirmative practice framework reveals formative strategies in providing quality care for asexual-identified clients. These strategies for creating safe spaces for asexual-identified clients to disclose and discuss their experiences are discussed. Further, additional areas of inquiry are recommended to expand our knowledge around issues that impact asexual communities.
Article
Research in various populations has shown that, starting early in childhood, individuals often demonstrate resilience in the face of stress and adversity. Against the experience of minority stress, LGBT people mount coping responses and most survive and even thrive despite stress. But research on resilience in LGBT populations has lagged. In this commentary, I address 2 broad issues that I have found wanting of special exploration in LGBT research on resilience: First, I note that resilience, like coping, is inherently related to minority stress in that it is an element of the stress model. Understanding resilience as a partner in the stress to illness causal chain is essential for LGBT health research. Second, I explore individual- versus community-based resilience in the context of minority stress. Although individual and community resilience should be seen as part of a continuum of resilience, it is important to recognize the significance of community resilience in the context of minority stress.
Article
The purpose of this study was to describe baseline characteristics of participants in a prospective observational study of transgender youth (aged 12-24 years) seeking care for gender dysphoria at a large, urban transgender youth clinic. Eligible participants presented consecutively for care at between February 2011 and June 2013 and completed a computer-assisted survey at their initial study visit. Physiologic data were abstracted from medical charts. Data were analyzed by descriptive statistics, with limited comparisons between transmasculine and transfeminine participants. A total of 101 youth were evaluated for physiologic parameters, 96 completed surveys assessing psychosocial parameters. About half (50.5%) of the youth were assigned a male sex at birth. Baseline physiologic values were within normal ranges for assigned sex at birth. Youth recognized gender incongruence at a mean age of 8.3 years (standard deviation = 4.5), yet disclosed to their family much later (mean = 17.1; standard deviation = 4.2). Gender dysphoria was high among all participants. Thirty-five percent of the participants reported depression symptoms in the clinical range. More than half of the youth reported having thought about suicide at least once in their lifetime, and nearly a third had made at least one attempt. Baseline physiologic parameters were within normal ranges for assigned sex at birth. Transgender youth are aware of the incongruence between their internal gender identity and their assigned sex at early ages. Prevalence of depression and suicidality demonstrates that youth may benefit from timely and appropriate intervention. Evaluation of these youth over time will help determine the impact of medical intervention and mental health therapy. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Article
A significant body of research is now emerging on the subjective meaning of asexuality. This study explored how self-identification as asexual is managed, both as a threat to the self-concept and a source of personal meaning. A total of 66 self-identified asexuals were recruited from an asexuality internet community and responded to open-ended questions on an online survey. Of these, 31 participants identified as female, 15 as male, 18 gave a different label such as genderqueer or androgynous, and two did not provide information on gender. A thematic analysis of the transcripts resulted in three themes. Socially, asexuality attracted denial and resistance due to incompatibility with heteronormative societal expectations. Despite the threat to self-integrity arising from asexuality being socially rejected, it was typically assimilated as a valued and meaningful orientation on an intra-personal level, aided by information and support from the online community. A second level of threat to self arose whereby other self-identifications, especially gender, had to be reconciled with a non-sexual persona. The accommodation made to other elements of the self was reflected in complex sub-identities. The findings were interpreted using identity process theory to understand how threats arising from self-identifying as asexual are managed. Although asexuality emerges as an orientation to sexuality that can be reconciled with the self, its invisibility or outright rejection in society constitute an on-going challenge.
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Despite some increased visibility in recent years, the asexual community and asexuality generally remain largely unknown. Aiming to demystify asexuality, this paper discusses the context of anti-asexual animosity in which the (largely American) asexual community is situated. Specifically, the asexual community constructed itself in response to hostility, including explicit anti-asexual discrimination, homophobia against asexual people perceived to be lesbian or gay, and the negative impact of (implicit) pathologising low sexual desire. This theoretical paper outlines some of the unique challenges asexual people face negotiating identities and relationships; the collective sense-making strategies they use (generating language and discourse) to do so; and why these things are central to understanding asexual people's experiences. This is accomplished through a purposeful review of literature and a case study of the Asexual Visibility and Education Network as an asexual community space. Understanding the challenges asexual people face and the resources they invoke to overcome them helps applied psychologists develop the cultural competence they need to work effectively with the asexual people they will encounter. Copyright © 2014 John Wiley & Sons, Ltd.
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This paper identifies the term “homophobia” as inaccurate: “Homophobia” is not a phobia. The confusion may result in part from literary uses of “phobia,” which include both anxiety and anger conditions. Clinical observations of clients displaying “homophobia” are discussed. Alternative language is recommended as more accurate and more likely to result in appropriate treatment.
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Although biases against homosexuals (and bisexuals) are well established, potential biases against a largely unrecognized sexual minority group, asexuals, has remained uninvestigated. In two studies (university student and community samples) we examined the extent to which those not desiring sexual activity are viewed negatively by heterosexuals. We provide the first empirical evidence of intergroup bias against asexuals (the so-called “Group X”), a social target evaluated more negatively, viewed as less human, and less valued as contact partners, relative to heterosexuals and other sexual minorities. Heterosexuals were also willing to discriminate against asexuals (matching discrimination against homosexuals). Potential confounds (e.g., bias against singles or unfamiliar groups) were ruled out as explanations. We suggest that the boundaries of theorizing about sexual minority prejudice be broadened to incorporate this new target group at this critical period, when interest in and recognition of asexuality is scientifically and culturally expanding.
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Lesbian, gay, and bisexual (LGB) adolescents report disparate rates of substance use, and often consume more cigarettes, alcohol, marijuana, cocaine, and ecstasy than their heterosexual peers. It is therefore crucial to understand the risk factors for substance use among LGB adolescents, particularly those unique to their minority status. In an effort to organize the current knowledge of minority-related risk factors for substance use among LGB youth, this study presents results from a systematic review and meta-analysis of the published research literature. Results from 12 unique studies of LGB youth indicated that the strongest risk factors for substance use were victimization, lack of supportive environments, psychological stress, internalizing/externalizing problem behavior, negative disclosure reactions, and housing status. Results are discussed in terms of their implications for targeted intervention programs that address minority stress risk factors for substance use among LGB youth.
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Several decades of research tell us that sexual minority youth are among those most at risk for the negative outcomes of frequent concern in the lives of young people: academic failure, emotional distress, compromised relationships, risk behavior, and suicidality. We know much less about resilience, the characteristics and factors that explain or predict the healthy adolescent and adult lives of most sexual minorities. How can we move,“beyond risk” to understanding resilience? I outline a context for the focus on risk in studies of sexual minority youth and then discuss the conceptual distinctions between risk, risk factors, risk outcomes, protective factors, and resilience. I argue that an important area for further research will be to identify risk and protective factors that are unique to sexual minority youth. Recent research on school-based harassment and victimization is used as an example of research on LGBT issues in education that is grounded in the history of risk while offering the potential for significant advances in thinking about resilience.
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Greater understanding of the complex interrelationships among work-relevant constructs has increased the number of constructs on organizational surveys. Good psychometric practice also dictates the use of multiple items per construct. The net result has been longer surveys. Longer surveys take more time to complete, tend to have more missing data, and have higher refusal rates than short surveys. Arguably, then, techniques for reducing the length of scales while maintaining psychometric quality are worthwhile. Little guidance exists on how to reduce the length of a multi-item scale and we argue that the most common technique, maximizing internal consistency, is problematic and should be avoided. We present a set of item "quality indices" to help conceptualize the competing issues that influence item retention decisions. Statistical analysis of an example case using these indices suggested that there are three key aspects of item quality to consider when reducing a scale. We describe software and present statistical analyses that can assist scale developers in using these three aspects of item quality when making scale reduction decisions.
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To examine disparities between sexual minority youth (SMY) and heterosexual youth in rates of suicidality and depression symptoms. Separate meta-analyses were conducted to examine suicidality and depression disparities. Studies were included if the average age of the participants was <18 years, and if suicidality or depression symptoms were compared across SMY and heterosexual youth. SMY reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. Disparities increased with the increase in the severity of suicidality (ideation [OR = 1.96], intent/plans [OR = 2.20], suicide attempts [OR = 3.18], suicide attempts requiring medical attention [OR = 4.17]). Effects did not vary across gender, recruitment source, and sexual orientation definition. Disparities in suicidality and depression may be influenced by negative experiences including discrimination and victimization. Clinicians should assess sexual orientation, analyze psychosocial histories to identify associated risk factors, and promote prevention and intervention opportunities for SMY and their families.
Article
Academic interest in asexual people is new and researchers are beginning to discuss how to proceed methodologically and conceptually with the study of asexuality. This article explores several of the theoretical issues related to the study of asexuality. Researchers have tended to treat asexuality either as a distinct sexual orientation or as a lack of sexual orientation. Difficulties arise when asexual participants are inconsistent in their self-identification as asexual. Distinguishing between sexual and romantic attraction resolves this confusion, while simultaneously calling into question conceptualizations of the asexual population as a single homogenous group. Arguments are considered in favor of exploring diversity within the asexual population, particularly with respect to gender and romantic orientation, proposing that the categorical constructs employed in (a)sexuality research be replaced with continuous ones. Furthermore, given the recently noted bias toward including only self-identified asexuals, as opposed to non-self-identified asexuals or "potential-asexuals," in research about asexuality, the nature and meaning of asexual self-identification are discussed. Particular attention is paid to the theoretical importance of acknowledging asexual self-identification or lack thereof in future research into asexuality. This article discusses what these current theoretical issues mean for the study of asexuality and sexuality more generally, including a brief consideration of ethical implications for research with asexual participants. Finally, directions for future research are suggested.