Depression and Sexual Orientation During Young Adulthood: Diversity Among Sexual Minority Subgroups and the Role of Gender Nonconformity

Sexual Minority Identity and Risky Alcohol Use: the Moderating Role of Aggressive Behavior

Adolescent alcohol use has significant consequences for concurrent and longitudinal health and wellbeing, with sexual minority youth consistently reporting higher levels of alcohol use than their heterosexual peers. Understanding how individual-difference variables like aggressive behavior are associated with variability in sexual minority adolescents' higher levels of alcohol use offers novel theoretical insight into this vulnerability. The 81,509 participants were drawn from the Profiles of Student life: Attitudes and Behavior Study. They were ages 14-17 years (M = 15.38, SD = 1.09) and 50.1% were cisgender girls. For sexual identity, 88% were heterosexual, 5% were mostly heterosexual, were 4% bisexual, were 1% mostly gay or lesbian, and were 1% being gay or lesbian. Participants reported on alcohol use, aggressive behavior, and sexual identity. Gay/lesbian and mostly gay/lesbian adolescents who reported higher aggressive behavior had higher levels of alcohol use than their heterosexual peers who also reported higher aggressive behavior. The way in which aggressive behavior amplified the link between mostly gay/lesbian and gay/lesbian identities and alcohol use suggests the need for more research examining how this trait may heighten both exposure and reaction to minority stressors among some subgroups of sexual minority youth.

Associations between recalled childhood gender nonconformity and adult sexual dysfunction in Denmark: baseline assessment in the Project SEXUS cohort study

BACKGROUND

Sexual dysfunctions may negatively affect an individual's self-perceived womanhood or manhood, but whether gender nonconformity in childhood or adolescence can influence adult sexual functioning has not been examined so far.

AIM

To explore the possible link between recalled childhood gender nonconformity and sexual dysfunctions in adulthood in a large sample.

METHODS

We analyzed baseline questionnaire data from Project SEXUS, a nationally representative cohort study on sexual health among 15- to 89-year-old Danish citizens. Our sample included sexually active participants aged ≥18 years who were queried about gender nonconformity in childhood or adolescence (N = 21 390). To capture sexual dysfunctions, we assessed (1) difficulties with lubrication, orgasm, vaginal cramps precluding sexual intercourse, and/or genital pain during partnered sexual activity in women and (2) difficulties with erection, premature ejaculation, orgasm, and/or genital pain during partnered sexual activity in men. Furthermore, we assessed whether such difficulties were perceived as problematic. The 6-item Female Sexual Function Index and the 5-item International Index of Erectile Function served as standardized measures. Polytomous logistic regression analyses yielded demographically weighted adjusted odds ratios (aORs) with 95% CIs for associations between childhood gender nonconformity and sexual dysfunctions, controlling for age, sociodemographics, health-related factors, and other potential confounders.

OUTCOMES

Sexual difficulties and dysfunctions, as well as scores on the Female Sexual Function Index and International Index of Erectile Function.

RESULTS

Age-adjusted odds ratios indicated that sexual dysfunctions were significantly more common among childhood gender-nonconforming than conforming participants. After controlling for additional potential confounders, most sexual dysfunctions-notably, vaginal cramps in women (aOR, 2.12; 95% CI, 1.25-3.60) and genital pain dysfunction in men (aOR, 2.99; 95% CI, 1.79-4.99)-remained significantly increased among childhood gender-nonconforming respondents.

CLINICAL IMPLICATIONS

Findings suggest that self-perceived gender nonconformity in childhood or adolescence may negatively affect sexual functioning in adult life. If confirmed by future studies, they may warrant a clinical emphasis on such issues in sexologic treatment and care.

STRENGTHS AND LIMITATIONS

Our study is the first to report associations between childhood gender nonconformity and adult sexual dysfunction, building on data from a large-scale, nationally representative cohort study. The retrospective assessment of childhood gender nonconformity via one item might have neglected significant dimensions of this construct.

CONCLUSION

The present study is the first to show that individuals who recall being gender nonconforming in childhood or adolescence may be at a greater risk of experiencing sexual dysfunctions, particularly sexual pain disorders, as adults.

Sexual Orientation and Gender Identity/Expression in Adolescent Research: Two Decades in Review

There is a long history of research among adolescents who are minoritized and marginalized for their sexual orientation and gender identity/expression (SOGIE). However, it remains unclear how we can best conceptualize and assess SOGIE in adolescence, resulting in different subpopulations and findings across studies. Addressing this issue, we present a narrative literature review of the conceptualization and assessment of SOGIE, and provide recommendations for conceptualizing and operationalizing these concepts. Our review indicated that most research with adolescent populations still almost exclusively assesses isolated dimensions of sexuality and gender (e.g., attraction but not identity). We argue that to make research inclusive and equitable, scholars are required to make clear substantiated decisions and be transparent about the SOGIE dimensions and, thus, subpopulations they represent.

The roles of non-heterosexuality outside of identity and gender non-conformity in Allostatic Load among young adults

Using the National Longitudinal Study of Adolescent to Adult Health, this study contrasted levels of Allostatic Load at the baseline and change observed between the age 20s and 30s, among self-identified Lesbians/Gays/Bisexuals and heterosexuals with non-heterosexual attraction/behavior (discordant heterosexuals), against heterosexuals without (concordant heterosexuals). In addition, the study tested if Allostatic Load differs for each of the sexual orientation group differs jointly or independently of gender non-conformity. The study found no Allostatic Load elevation for self-identified non-heterosexual men and women. For women only, a significantly greater elevation of Allostatic Load is observed among discordant heterosexuals. Independently, Allostatic Load is found higher for females appearing more androgynous. The findings suggest expanding the current scope of sexual minority research to consider the relevance of minority stress to those without a LGB identity, who may be exposed to stress from disparate sources related to their gender identity.

Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: A design-weighted MAIHDA

This study examined how race/ethnicity, sex/gender, and sexual orientation intersect to socially pattern depression among US adults. We used repeated, cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,772) to conduct design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) for two outcomes: past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated group-specific prevalence and excess/reduced prevalence attributable to intersectional effects (i.e., two-way or higher interactions between identity variables). Models revealed heterogeneity between intersectional groups, with prevalence estimates ranging from 3.4-31.4% (past-year) and 6.7-47.4% (lifetime). Model main effects indicated that people who were Multiracial, White, women, gay/lesbian, or bisexual had greater odds of MDE. Additive effects of race/ethnicity, sex/gender, and sexual orientation explained most between-group variance; however, approximately 3% (past-year) and 12% (lifetime) were attributable to intersectional effects, with some groups experiencing excess/reduced prevalence. For both outcomes, sexual orientation main effects (42.9-54.0%) explained a greater proportion of between-group variance relative to race/ethnicity (10.0-17.1%) and sex/gender (7.5-7.9%). Notably, we extend MAIHDA to calculate nationally representative estimates to open future opportunities to quantify intersectionality with complex sample survey data.

Sexual minority youth's mental health and substance use: The roles of victimization, cybervictimization, and non-parental adult support

Victimization is a well-established driver of sexual minority youth's (SMY) mental health and substance use risk. The current study examined and extended this research by exploring how victimization, cybervictimization, and non-parental supportive adults contribute to SMY's vulnerability to poor mental health and substance use. Using data from the first representative sample of Texas youth that measures sexual identity, we analyzed sex-stratified models of the association between sexual identity, mental health, and substance use, and the confounding effects of victimization, cybervictimization, and non-parental adult support. Victimization was more common among SMY and accounted for a greater proportion of sexual identity disparities on mental health and substance use, especially for males. Sexual minority females were more likely to report cybervictimization than heterosexual youth, and cybervictimization was associated with mental health risk. SMY reported fewer available non-parental supportive adults, which was associated with more sadness, suicidality, and polysubstance use. Our study adds to extant evidence that victimization drives SMY's increased susceptibility to mental health and substance use risk. Schools should implement inclusive policies that prohibit bullying based on sexual minority identity and offer professional development opportunities for supporting SMY.

Conflicting signals: Exploring the socioeconomic implications of gender discordant names

We investigate the educational and employment consequences of having a gender discordant name - one that is also given to people of a different gender. People with discordant names may be more likely to experience stigma due to the conflicting signal between their gender and the perceptions of femininity or masculinity associated with their names. Our primary measure of discordance is based on the percentage of men and women with each first name, using a large administrative dataset from Brazil. We find that both men and women with gender discordant names attain significantly less education. Gender discordant names are also negatively and significantly associated with earnings though, after controlling for educational attainment, only people with the most discordant names have significantly lower earnings. These results are corroborated when using crowd-sourced gender perceptions of names in our dataset, which suggests that stereotypes and the judgments of others are a probable mechanism for the observed disparities.

Childhood Experiences and Mental Health of Sexual Minority Adults: Examining Three Models

Three models of recalled childhood gender nonconformity (GNC) and maltreatment are proposed to explain disparities in current psychological distress and lifetime suicidality among sexual minority individuals, using a United States probability sample of cisgender lesbian/gay (n = 701), bisexual (n = 606), and other (e.g., queer, n = 182) adults. Indirect effects indicated that lesbian/gay individuals were more likely than bisexual individuals to experience maltreatment and suicidal ideation as childhood GNC increased. Other indirect effects found that bisexual individuals reported more psychological distress and greater likelihood of lifetime suicidal ideation and attempts than lesbian/gay individuals as maltreatment increased. The direct effects of sexual orientation were stronger than the indirect effects via maltreatment or GNC, with bisexual individuals reporting more maltreatment, distress, and suicidality than lesbian/gay individuals. Significant findings for individuals with other identities were similar to those of bisexual individuals. Adjusted findings were comparable for women and men. The findings indicated that sexual minority individuals reported experiences consistent with sexual minority stress during early developmental periods, before being aware of their sexual orientation. It is necessary to understand the early lived experiences of sexual minority individuals, differences between lesbian/gay and bisexual individuals in those experiences, and their implications for adaptation.

Exploring different profiles of gender (non)conformity in women and their relationship with sexual orientation and mental health

We examined whether sexual orientation and the Conformity to Feminine Norms (CFN) were predictors of three mental health outcomes: depression, anxiety, and self-esteem. The sample comprised 690 women with different sexual orientations (heterosexual, lesbian and bisexual). Our results suggested that there were five CFN profiles related to sexual orientation, but only the former was a significant predictor of the three mental health outcomes and that women might experience different forms of CFN which in turn can differentially influence women's mental health.

Early Timing and Determinants of the Sexual Orientation Disparity in Internalizing Psychopathology: A Prospective Cohort Study from Ages 3 to 15

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.

Sexual orientation and gender identity disparities in co-occurring depressive symptoms and probable substance use disorders in a national cohort of young adults

This study examined sexual orientation and gender identity differences in co-occurring depressive symptoms and substance use disorders (SUDs) among young adults in the Growing Up Today Study national cohort (n = 12,347; ages 20-35; 93% non-Hispanic white). Self-administered questionnaires assessed recent co-occurring depressive symptoms and probable nicotine dependence, alcohol use disorder, and drug use disorder. Multinomial logistic regressions with generalized estimating equations quantified differences in prevalences of depressive symptoms only, SUDs only, and co-occurrence, among sexual minorities (mostly heterosexual; lesbian, gay, and bisexual [LGB]) compared to completely heterosexual participants, and gender minorities compared to cisgender participants. Analyses stratified by sex assigned at birth revealed sexual minorities evidenced greater odds of co-occurrence than their completely heterosexual counterparts (assigned female AORs: 3.11-9.80, ps < 0.0001; assigned male AORs: 2.90-4.87, ps < 0.001). Sexual orientation differences in co-occurrence were pronounced among LGB participants assigned female at birth who evidenced nearly 10 times the odds of co-occurring depressive symptoms with nicotine dependence and drug use disorders than did heterosexual participants assigned female at birth. Relationships between gender identity and co-occurrence were generally weaker, possibly due to low power. Gender minorities assigned male at birth, however, evidenced greater odds of co-occurring depressive symptoms and alcohol use disorders (AOR 2.75, p = 0.013) than their cisgender counterparts. This study adds to the limited research quantifying sexual orientation or gender identity differences in recent co-occurring depressive symptoms and SUDs among young adults and suggests sexual and gender minority young adults should be prioritized in prevention and treatment of co-occurring depression and SUDs.

Heteronormativity in the Lives of Lesbian, Gay, Bisexual, and Queer Young People

Heteronormativity, as defined in queer theory, is the presumption and privileging of heterosexuality. Research on how young people make sense of and narrate heteronormativity in their own lives is needed to inform theories of heteronormativity. Using queer and intersectional frameworks, we conducted semi-structured interviews with 14 sexual and gender minority young people (ages 18 to 24), analyzed using thematic analysis, to examine how young adults make sense of heteronormativity. Participants discussed how gender expression informed both sexuality and sexual attraction. Participants prioritized biological parenthood over other family constructions but rarely discussed marriage. Gender, sexuality, and race contributed important contexts for how participants described heteronormativity in their lives and should be the focus of future research. Finally, binaries of gender, sexuality, and family intersected in participants' lives and their narrative constructions.

Gender Expression and Its Correlates in a Nationally Representative Sample of the U.S. Adult Population: Findings from the National Survey of Sexual Health and Behavior

We explored the associations of gender expression with childhood gender expression, sexual identity, and demographic characteristics in a representative sample of the U.S. population aged 18 to 65 years (N = 1277), using data from the 2015 National Survey of Sexual Health and Behavior. As expected, gay men were less gender conforming than heterosexual men. However, among women, persons with a bisexual identity were less gender conforming compared to heterosexual and lesbian persons. In multivariate analyses, childhood gender expression trumped the role of sexual identity. In terms of demographic characteristics, gender conformity seemed to be more present among persons with positions with less social status in terms of age, race/ethnicity, education, income, and relationship status. Finally, we found among both men and women, that a large proportion saw themselves as more masculine or feminine than men and women on average, respectively, suggesting that accentuating one's gender conformity has a psychological function.

Stability versus Fluidity of Adolescent Romantic and Sexual Attraction and the Role of Religiosity: A Longitudinal Assessment in Two Independent Samples of Croatian Adolescents

The manner in which individuals report their sexual attraction, self-label their sexual identity, or behave in sexual situations can vary over time, and particularly, adolescents may change their reported sexual attraction or sexual orientation identity over the course of their development. It is important to better understand the social factors that may influence these changes, such as one's religiosity. The present study thus aimed to assess the fluidity of adolescent romantic and sexual attraction over time and to explore the role of religiosity in this dynamic using two independent panel samples of Croatian high school students (N = 849 and N = 995). Response items for sexual and romantic attraction were categorized based on the Kinsey scale, and religiosity was assessed with a standard one-item indicator. Results demonstrated that changes in attraction were substantially more prevalent among non-exclusively heterosexual participants compared to exclusively heterosexual participants in both panels. Although more female than male adolescents reported non-heterosexual attraction, gender differences in attraction fluidity were inconsistent. Religiosity was associated with initial sexual attraction (more religious individuals were more likely to report exclusively heterosexual attraction), but not with changes in romantic and sexual attraction over time. Given that the understanding of adolescent sexual development can play an important role in reducing their vulnerability to sexual risk taking, stigmatization, and abuse, this study's findings have relevance for teachers, parents, and counselors working with adolescents, and in particular for sexual minority youth.

Interest, Personality, and Sexual Traits That Distinguish Heterosexual, Bisexual, and Homosexual Individuals: Are There Two Dimensions That Underlie Variations in Sexual Orientation?

A diverse U.S. sample comprising 1437 men and 1474 women was assessed on sexual orientation, masculinity-femininity of occupational preferences (MF-Occ), self-ascribed masculinity-femininity (Self-MF), Big Five personality traits, sex drive, and sociosexuality (positive attitudes toward uncommitted sex). Discriminant analyses explored which traits best distinguished self-identified heterosexual, bisexual, and homosexual individuals within each sex. These analyses correctly classified the sexual orientation of 55% of men and 60% of women, which was substantially better than a chance rate (33%) of assigning participants to one of three groups. For men, MF-Occ and Self-MF distinguished heterosexual, bisexual, and gay men, with heterosexual men most gender typical, gay men most gender atypical, and bisexual men intermediate. Independently, higher sex drive, sociosexuality, and neuroticism and lower conscientiousness distinguished bisexual men from other groups. For women, gender-related interests and Self-MF distinguished lesbians from other groups, with lesbians most gender atypical. Independently, higher sociosexuality, sex drive, and Self-MF distinguished non-heterosexual from heterosexual women. These findings suggest that variations in self-reported sexual orientation may be conceptualized in terms of two broad underlying individual difference dimensions, which differ somewhat for men and women: one linked to gender typicality versus gender atypicality and the other linked to sex drive, sociosexuality, and various personality traits.

Pleasure, Power, or Both? Heteronormativity, Stigma, and the Intersections of BDSM and Anoreceptive Heterosexual Males

Despite the direct connection between anal sex and pleasure, the majority of academic literature frames anal sex in terms of homophobia and/or disease. In the large body of literature on anal sex, only two academic articles have been published on anoreceptive heterosexual males (ARHMs), despite evidence of this type of sexuality dating back to Ancient Egypt and Greece. A review of the literature suggests that the lack of empirical research on ARHMs is due to compulsory heteronormativity, which can instill sexual shame in those with nonconforming sexual preferences. Some ARHMs are BDSM-oriented, and given that BDSM behavior and identity are also stigmatized, BDSM-oriented ARHMs have an additional concealable status that is subject to prejudice. Skills such as higher level communication and self-reflection often inform BDSM interactions and relationship structures, therefore, BDSM-oriented ARHMs may have more opportunity to develop skills to offset shame and stigma, and may take pride as well as pleasure in subverting traditionally heteronormative anoreception roles.

Languishing in the crossroad? A scoping review of intersectional inequalities in mental health

The concept of intersectionality has gradually been introduced to health inequality research, adding depth and breadth to the way inequalities in health are approached. We conducted a scoping review with the purpose to systematically map, describe and analyze the literature about intersectional inequalities in mental health. For eligibility, the study had to analyze and report inequality defined by combinations of socioeconomic position, gender, race/ethnicity, sexual orientation or religion. The mental health outcome had to be measured as self-reported symptoms assessed through validated scales, or disorders assessed through diagnostic interviews. The search strategy was applied in two databases and the screening process yielded 20 studies. The interaction of intersectional positions showed no consistent patterns in mental health across studies, but both synergistic and antagonistic effects were observed. In most studies an absolute measure of inequality was used and few studies analyzed factors potentially explaining the intersectional inequalities. Taken together, the findings of this review highlight the value of assessing intersectional inequalities across population groups for priority setting and action on mental health inequalities.

Gender, Race, and Minority Stress Among Sexual Minority Women: An Intersectional Approach

Previous research examining the relationship between gender-role presentation and minority stress has largely focused on the negative effects of gender nonconformity. Some research suggests, however, that gender-role nonconformity may be protective against minority stress via participation in sexual minority in-group norms, which may include rejecting traditional gender-role norms and gender presentation. Historically, the meaning and value of masculinity and femininity within sexual minority communities has varied by race/ethnicity. As such, race/ethnicity may moderate the links between gender and minority stressors. This study used a diverse sample of sexual minority women (SMW) (N = 612) and separate indicators of masculinity and femininity to examine the effects of gender role on distal (victimization and discrimination) and proximal (internalized homophobia and stigma consciousness) measures of minority stress. We used multivariate generalized linear models to determine whether the effects of masculinity and femininity on the minority stress outcomes were moderated by race/ethnicity. We found that in many cases the relationships between masculinity and femininity and minority stress varied across racial/ethnic groups, and in fact, worked in opposite directions for White SMW compared to Black and Latina SMW. For example, our results showed that masculinity was associated with lower levels of victimization, discrimination, and stigma consciousness among Black and Latina SMW, but higher levels among White SMW. Results from this study suggest that these differences have important implications for exposure to minority stress.

The Gendered Self of Chinese Lesbians: Self-Esteem as a Mediator Between Gender Roles and Depression

Sexual minority women are at an elevated risk for depression compared to heterosexual women, yet less is known about how gender roles affect the mental health of sexual minority women. Existing studies examining the role of self-esteem in the relationship between gender roles and depression are scarce and have predominantly focused on heterosexual populations. Using a cross-sectional survey of Chinese lesbians in Hong Kong (N = 438), the study tested the direct and indirect effects of different types of gender roles (masculine, feminine, and androgynous) on depression through the mediating factor of self-esteem. We found that masculinity and androgyny were positively associated with self-esteem, while femininity was negatively associated with self-esteem. More importantly, self-esteem fully mediated the inverse relationship between masculinity and depression and that between androgyny and depression. The positive relationship between femininity and depression was also fully mediated by self-esteem. By examining different types of gender roles and incorporating gender roles, self-esteem, and depression into a unified framework, the research highlighted the particularly protective effect of androgyny, which had the strongest positive direct effect on self-esteem and indirect effect on depression through the mediation of self-esteem compared to the effects of other types of gender roles. Our results illuminate the importance of understanding how individual differences in gender roles relate to the mental health of sexual minority women in future research and interventions. Implications for interventions that help Chinese lesbians cope with gender expectations and improve their mental health are discussed.

Gender Variance and the Autism Spectrum: An Examination of Children Ages 6-12 Years

Gender variance (GV) and autism spectrum disorder (ASD) frequently co-occur in clinical populations. We investigated GV in association with ASD characteristics in nonclinical children and in children with developmental/mental health diagnoses. In 6-12-year-olds (N = 2445; 51% birth-assigned boys), the Gender Identity Questionnaire for Children measured GV and the Children's Social Behavior Questionnaire measured six subdomains of ASD characteristics. Among nonclinical children, GV was associated with parent-reported difficulties orienting socially and stereotyped behaviors. GV was also associated with parent-reported clinical diagnoses of ASD, sensory processing disorder, and oppositional defiant disorder. These findings suggest associations between specific ASD characteristics and GV in nonclinical children. Also, childhood GV should be further examined in a range of clinical populations, including ASD individuals.

Survey of Heteronormative Attitudes and Tolerance Toward Gender Non-conformity in Mountain West Undergraduate Students

INTRODUCTION

Heteronormative attitudes are prevalent in the United States and may contribute to discrimination against individuals who do not conform to traditional gender roles. Understanding the attitudes of undergraduate students is of particular interest as they may represent emergent societal views toward gender non-conformity.

MATERIALS AND METHODS

We conducted an online survey of Mountain West college students between the ages of 18-24 years to assess perceptions of personal gender conformity using the Traditional Masculinity-Femininity Scale (TMF), endorsement of heteronormative beliefs using the Heteronormative Attitudes and Beliefs Scale (HABS), and explicit tolerance of gender non-conformity on a seven-point Likert Scale.

RESULTS

The sample (n = 502) was 84% female and 78% white. Approximately 21% of respondents identified as a sexual minority and 36% identified as liberal or somewhat liberal (27% were conservative). The mean score on the TMF was 5.23 (95% CI: 5.15-5.32), indicating moderate levels of personal gender conformity. The mean HABS score was 3.31 (95% CI: 3.19-3.43), indicating relatively low endorsement of heteronormative attitudes. TMF and HABS scores were both highest in heterosexual males. Most respondents (73%) were taught traditional gender roles in their childhood home, and 89% had heard negative opinions about non-conformity. The majority (80.6%) of respondents reported that they know someone who displays non-conforming characteristics and 61% said that they associate gender non-conformity with homosexuality. Approximately, 7% reported they had bullied others for not conforming to their gender. Among heterosexuals, 13.6% reported they had been bullied for gender non-conformity as did 42.7% of LGBTQ-identified individuals. Nearly 1-in-4 (23.6%) believed that male cross-dressing is wrong. Nearly 1-in-5 (17.2%) agreed with the statement that those who dress or act like the opposite sex were more likely to be abused or neglected during their development.

CONCLUSION

Students reported relatively low endorsement of heteronormative attitudes and moderate levels of acceptance toward gender non-conforming persons. The sample may reflect shifting attitudes when compared with outside data sets.

Psychological Distress Transmission in Same-sex and Different-sex Marriages

Ample work stresses the interdependence of spouses' psychological distress and that women are more influenced by their spouse's distress than men. Yet previous studies have focused primarily on heterosexual couples, raising questions about whether and how this gendered pattern might unfold for men and women in same-sex marriages. We analyze 10 days of diary data from a purposive sample of men and women in same-sex and different-sex marriages ( n = 756 individuals from 378 couples) to examine psychological distress transmission between spouses and how this process may differ for men and women in same-sex and different-sex marriages. We find that women are more strongly influenced by their partners' distress than men, regardless of whether they are married to a man or a woman, and that this relationship is particularly strong for women with male spouses.

Is developmental change in gender-typed behavior associated with adult sexual orientation?

The goal of this article was to examine gender-typed behavior longitudinally and to consider its relationship with sexual orientation in adulthood. Data were from 10,624 respondents who completed Wave 1 (adolescence), Wave 3 (emerging adulthood), and Wave 4 (early adulthood) of the National Longitudinal Study of Adolescent to Adult Health. First, we described the distributions of gender-typed behavior by adult sexual orientation at each of the three developmental stages. Next, we performed multilevel mixed regression models to assess longitudinal variation in gender-typed behavior from adolescence to adulthood within sexual orientation groups. Results showed that gender-typed behavior varied both within and between sexual orientation groups, as well as over time. For males, the differences in gender-typed behavior among the sexual orientation groups were relatively consistent at each stage, whereas differences in gender-typed behavior among sexual orientation groups varied more at each stage among females. Longitudinal models exhibited curvilinear patterns, such that gender-typed behavior strengthened from adolescence to early adulthood but peaked in emerging adulthood. To our knowledge, this is the first study to use population representative data to study gender-typed behavior both prospectively and at multiple time points from adolescence to adulthood, and to consider how such behavior is related to adult sexual orientation. This research contributes to a growing body of prospective literature on the link between gendered behavior and sexual orientation and provides further justification for more age- and cohort-specific measures of gender-typed behavior in future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Healthcare Work in Marriage: How Gay, Lesbian, and Heterosexual Spouses Encourage and Coerce Medical Care

Marriage benefits health in part because spouses promote one another's well-being, yet how spouses facilitate formal healthcare (e.g., doctor's visits, emergency care) via what we call healthcare work is unknown. Moreover, like other aspects of the marital-health link, healthcare work dynamics likely vary by gender and couple type. To explore this possibility, we use in-depth interviews with 90 midlife gay, lesbian, and heterosexual spouses to examine how spouses perform healthcare work. Our results show that in heterosexual marriage, women perform the bulk of healthcare work and typically do so in coercive ways. A minority of heterosexual men provide instrumental healthcare work for their wives. Gay and lesbian spouses appear to commonly use both coercive and supportive healthcare work strategies to effectively promote healthcare use. Our findings demonstrate the ways spouses are central to supporting and coercing one another to obtain medical care and how these patterns are gendered.

Cardiovascular Disease Disparities in Sexual Minority Adults: An Examination of the Behavioral Risk Factor Surveillance System (2014-2016)

PURPOSE

Investigate sexual orientation differences in cardiovascular disease risk and cardiovascular disease.

DESIGN

Cross-sectional.

SETTING

The 2014 to 2016 Behavioral Risk Factor Surveillance System.

PARTICIPANTS

A total of 395 154 participants.

MEASURES

The exposure measure was sexual orientation. Self-report of cardiovascular disease risk factors and cardiovascular disease was assessed.

ANALYSIS

Sex-stratified logistic regression analyses to examine sexual orientation differences in cardiovascular disease risk and cardiovascular disease (heterosexuals = reference group).

RESULTS

Sexual minority men reported higher rates of mental distress (gay adjusted odds ratio [AOR]: 1.59; bisexual AOR: 1.88) and lifetime depression (gay AOR: 2.48; bisexual: AOR 2.67). Gay men reported higher rates of current smoking (AOR: 1.28), but lower rates of obesity (AOR: 0.82) compared to heterosexual men. Sexual minority women reported higher rates of several cardiovascular risk factors including mental distress (lesbian AOR: 1.37; bisexual AOR: 2.33), lifetime depression (lesbian AOR: 1.96; bisexual AOR: 3.26), current smoking (lesbian AOR: 1.65; bisexual AOR: 1.29), heavy drinking (lesbian AOR: 2.01; bisexual AOR: 2.04), and obesity (lesbian AOR: 1.50; bisexual AOR: 1.29), but were more likely to exercise than heterosexual women (lesbian AOR: 1.34; bisexual AOR: 1.24). Lesbian women reported lower rates of heart attack (AOR: 0.62), but bisexual women had higher rates of stroke than heterosexual women (AOR: 1.46).

CONCLUSIONS

Findings can inform the development of prevention efforts to reduce cardiovascular disease risk in sexual minorities.

The Impact of Gender Variance on Adolescents' Wellbeing: Does the School Context Matter?

Schools are often heteronormative environments, negatively influencing the wellbeing of LGB students. Less is known about the impact on gender-variant adolescents. Hence, this study investigates the wellbeing of gender-variant students-as evidenced by their gender (a)typicality and pressure for gender conformity- in different school cultures-as evidenced by the level of traditional gender role attitudes and homonegativity. We examine these context-dependent associations in a sample of 4987 Flemish students, who were questioned three times in 2012-2014. Multilevel regression analyses show that both gender-typical and atypical adolescents feel worse in heteronormative than inclusive schools. Furthermore, the social acceptance of boys seems to be more conditional on gender-conformity in heteronormative than inclusive schools. Overall, inclusive schools ensure higher wellbeing for all students (regardless of sex or gender variance), and student-teacher relationships seem central in explaining these school differences. Implications for school policy as well as research considering heteronormativity and gender-variance are discussed.

Prevalence of Depression and Anxiety Among Bisexual People Compared to Gay, Lesbian, and Heterosexual Individuals:A Systematic Review and Meta-Analysis

Over the past decade, evidence has accumulated to suggest that bisexual people experience higher rates of poor mental health outcomes compared to both heterosexual and gay/lesbian individuals. However, no previous meta-analyses have been conducted to establish the magnitude of these disparities. To address this research gap, we conducted a systematic review and meta-analysis of studies that reported bisexual-specific data on standardized measures of depression or anxiety. Of the 1,074 full-text articles reviewed, 1,023 were ineligible, predominantly because they did not report separate data for bisexual people (n = 562 studies). Ultimately, 52 eligible studies could be pooled in the analysis. Results indicate that across both outcomes, there is a consistent pattern of lowest rates of depression and anxiety among heterosexual people, while bisexual people exhibit higher or equivalent rates in comparison to lesbian/gay people. On the basis of empirical and theoretical literature, we propose three interrelated contributors to these disparities: experiences of sexual orientation-based discrimination, bisexual invisibility/erasure, and lack of bisexual-affirmative support. Implications for interventions to improve the health and well-being of bisexual people are proposed.

GENDER CONFORMITY, PERCEPTIONS OF SHARED POWER, AND MARITAL QUALITY IN SAME- AND DIFFERENT-SEX MARRIAGES

Research on gender inequality within different-sex marriages shows that women do more unpaid labor than men, and that the perception of inequality influences perceptions of marital quality. Yet research on same-sex couples suggests the importance of considering how gender is relational. Past studies show that same-sex partners share unpaid labor more equally and perceive greater equity than do different-sex partners, and that lesbian, gay, and bisexual people are less gender conforming than heterosexuals. However, studies have not considered how gender conformity might shape inequalities and marital quality within same- and different-sex unions. In this study, we analyze dyadic data from both spouses in same- and different-sex marriages to explore how sex of spouse and gender conformity influence perceptions of shared power within the relationship, which, in turn, influences marital quality. Results show that greater gender conformity is related to stronger perceptions of shared power in different-sex and male same-sex couples but not in female same-sex couples. Perceptions of shared power are positively associated with marital quality in all union types. Our findings suggest that maintaining hegemonic masculinity and power inequalities may be salient to marriages with men. In female same-sex couples, gender and its relation to power inequalities may carry less meaning.

Disclosure Stress, Social Support, and Depressive Symptoms Among Cisgender Bisexual Youth

Bisexual youth are at elevated risk for depression compared to lesbians and gay men. Research on bisexual stigma suggests these youth are uniquely vulnerable to stress related to sexual identity disclosure. Depression associated with this stress may be buffered by social support from parents and friends. We examined the differential influence of social support from parents and friends (Child and Adolescent Social Support Scale) on the relation between disclosure stress (LGBTQ Coming Out Stress Scale) and depressive symptoms (Beck Depression Inventory) and differences by gender in a sample of cisgender bisexual youth (n = 383) using structural equation modeling. Parental support buffered the association between stressful disclosure to family and depressive symptoms, especially for bisexual men; bisexual women seemed not to benefit from such support when disclosure stress was high. This nuanced examination elucidates the ways family members and clinicians can best support bisexual youth sexual identity disclosure.

Psychosocial Risk and Protective Factors for Depression Among Lesbian, Gay, Bisexual, and Queer Youth: A Systematic Review

Many lesbian, gay, bisexual, or queer (LGBQ) youth suffer from depression. Identifying modifiable risk and protective factors for depression can inform the development of psychosocial interventions. The aim of this review is to evaluate the methodological characteristics and summarize the substantive findings of studies examining psychosocial risk and protective factors for depression among LGBQ youth. Eight bibliographic databases were searched, and 35 studies that met all inclusion criteria were included for review. Results show that prominent risk factors for depression include internalized LGBQ-related oppression, stress from hiding and managing a socially stigmatized identity, maladaptive coping, parental rejection, abuse and other traumatic events, negative interpersonal interactions, negative religious experiences, school bullying victimization, and violence victimization in community settings. Prominent protective factors include a positive LGBQ identity, self-esteem, social support from friends, and family support. LGBQ youth may face an array of threats to their mental health originating from multiple socioecological levels.

Mostly Heterosexual and Lesbian/Gay Young Adults: Differences in Mental Health and Substance Use and the Role of Minority Stress

Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors.