Sexual orientation and gender differences in sexual minority identity in China: Extension to asexuality

Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China

OBJECTIVE

LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals' mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery.

METHOD

Chinese young sexual minority men (n = 120; ages 16-30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion.

RESULTS

Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d = -0.50, d = -0.63) and anxiety (d = -0.51, d = -0.49) at 4- and 8-month follow-up, respectively; alcohol use (d = -0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d = 0.42). Greater session completion predicted greater reductions in suicidality and rumination.

CONCLUSIONS

LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.

The Nuances of Intimacy: Asexual Perspectives and Experiences with Dating and Relationships

Asexuality studies are an emerging field in North America and Europe which lack large-scale, qualitative studies. Much existing research focuses on defining and categorizing asexuality, with researchers calling for more focus on the romantic and sexual relationships of asexual people. Drawing from an online survey with 349 participants, this paper describes the perceptions and experiences that asexual people have with dating and relationships. Participants answered 16 open-ended and 9 close-ended questions. After rounds of coding, three themes were selected for examination. These were dating, romantic and/or sexual relationships, and platonic relationships. These results showcase the challenges asexuals face with dating while also demonstrating how asexual people actively dismantle understandings of romantic, sexual, and platonic relationships through their own experiences and perspectives. Overall, this study provides greater legitimacy to the fluidity of asexuality and asexual relationships.

Comparing asexual with heterosexual, bisexual, and gay/lesbian individuals in common mental health problems: A multivariate meta-analysis

We aimed to test whether asexual individuals were at increased risk of higher levels of depressive symptoms, self-harm attempts, and suicide attempts compared with heterosexual, bisexual, or gay/lesbian individuals using multivariate meta-analysis. Seventeen, five, and eight samples were included for depressive symptoms, self-harm attempts, and suicide attempts, respectively, reaching a total sample size of 125,675, 30,116, and 73,366, respectively. Asexual individuals reported higher levels of depressive symptoms than heterosexual individuals (Hedges' g = -0.44, 95%CI = [-0.61, -0.26]) but did not differ from heterosexual individuals in the risk of self-harm (odds ratio = 1.11, 95%CI = [0.88, 1.39]) and suicide attempts (odds ratio = 0.76, 95%CI = [0.56, 1.04]). Asexual individuals were at lower risk of self-harm and suicide attempts than bisexual and gay/lesbian individuals but did not differ from bisexual and gay/lesbian individuals in the levels of depressive symptoms. The greatest risk of higher levels of depressive symptoms was found in bisexual and asexual, followed by gay/lesbian individuals; the greatest risk of self-harm and suicide attempts was found in bisexual, followed by gay/lesbian individuals, and the lowest risk was found in asexual individuals. The magnitude of the disparities in the risk of poorer mental health among heterosexual, bisexual, gay/lesbian, and asexual individuals depended on the type of mental health outcomes.

Monosexism as an Additional Dimension of Minority Stress Affecting Mental Health among Bisexual and Pansexual Individuals in Hong Kong: The Role of Gender and Sexual Identity Integration

Monosexism has been increasingly recognized as a minority stressor uniquely experienced by plurisexual individuals. The present study investigated the effects of monosexist discrimination on mental health and examined the moderating role of gender and sexual identity integration (i.e., negation, authenticity, and disclosure). In a sample of 314 bisexual and pansexual individuals in Hong Kong (73.9% women and 26.1% men), the results showed that monosexist discrimination was associated with higher levels of depression and anxiety symptoms, above and beyond heterosexist discrimination. The association between monosexist discrimination and depression symptoms was stronger among bisexual and pansexual men than women, despite there being no gender differences in vulnerability to monosexist discrimination. Moreover, sexual identity negation, authenticity, and disclosure moderated the associations of monosexist discrimination with depression and anxiety symptoms, such that the associations were not significant among those with more positive integration of sexual identity (i.e., lower levels of sexual identity negation as well as higher levels of sexual identity authenticity and disclosure). This study provides insight into the deleterious impact of monosexism and the protective role of sexual identity integration. Implications for plurisexual-affirming psychological intervention, public policy, and community practice are discussed.

Stability and Change in Asexuality: Relationship Between Sexual/Romantic Attraction and Sexual Desire

This study examined the stability and change in asexuality in terms of sexual orientation identity, sexual/romantic attraction, and sexual desire. Data were collected in three waves at 12-month intervals (n = 168). In each wave, the participants completed measures of sexual/romantic orientation identity, sexual/romantic attraction, the Sexual Desire Inventory, and the Asexuality Identification Scale (AIS). Approximately 83% of asexual and gray-asexual individuals maintained their sexual orientation identity between two adjacent waves. The latent growth models indicated an increased tendency for sexual/romantic attraction and solitary sexual desire, while a decreased tendency for AIS over time was established. Only the sexual attraction slope significantly predicted asexual identity, indicating a longitudinal effect of sexual attraction on asexual identification. Initial levels of sexual attraction, and scores on the AIS and dyadic sexual desire (DSD) were associated with stability and changes in asexual identity. Asexual individuals who reported low sexual attraction, low DSD, and high AIS maintained their asexual identity, whereas those who reported high sexual attraction, high DSD, and low AIS were more likely to change their sexual orientation. The current findings indicate the relative stability of asexuality, which supports the notion that asexuality could be deemed a fourth sexual orientation.

Sexual Minority Identity and Mental Health Among Individuals on the Asexuality Spectrum in China: A Longitudinal Study

This study examined the association between sexual minority identity and mental health among Chinese asexual individuals. Data were collected in two waves at 12-months intervals, and 156 participants (27 male and 129 female) completed measures of the Asexuality Identification Scale (AIS) and Depression Anxiety Stress Scales at Times 1 and 2. The adjusted version of the Lesbian, Gay, and Bisexual Identity Scale was assessed at Time 1. Participants self-reported as asexual/gray-sexual and pansexual/demi-sexual, and those having an AIS ≥ 40 were classified as being on the asexuality spectrum. Compared with a control sample of lesbian and gay individuals (521 gay and 216 lesbian individuals), asexual individuals reported poorer mental health. Self-reported non-asexual individuals on the asexuality spectrum had a negative minority identity and poorer mental health than self-reported asexual individuals. Participants who changed their asexual orientation scored higher on internalized asexuality-phobia and identity uncertainty than participants maintaining an asexual orientation. At Time 1, acceptance concern, difficult process, and identity uncertainty were associated with poorer mental health. A difficult process was longitudinally associated with poorer mental health. The findings indicate that minority stress was partially related to asexual people's mental health and, for this reason, more asexuality-specific factors should be explored.

Sexual Minority Stigma and Nonsuicidal Self-Injury Among Sexual Minorities: the Mediating Roles of Sexual Orientation Concealment, Self-Criticism, and Depression

Introduction

Nonsuicidal self-injury (NSSI), a significant predictor of suicide, is more frequent in sexual minorities (e.g., lesbian, gay, and bisexual) than in heterosexuals. The Minority Stress Model proposed that sexual minority stigma (SMS) may lead to maladaptive behaviors, including NSSI. However, the potential mechanism underlying the relationship between SMS and NSSI remains unclear. Therefore, the current study will examine the relationship between SMS and NSSI, and explore the serial mediating roles of sexual orientation concealment (SOC), self-criticism, and depression.

Methods

A total of 666 individuals who self-identified as sexual minorities (64.0% male, M age = 24.49 years, SD = 6.50) completed questionnaires of SMS, SOC, self-criticism, depression, and NSSI, in 2020.

Results

The findings indicated that (1) SMS, SOC, self-criticism, depression, and NSSI were positively correlated; (2) SOC, self-criticism, and depression independently played partial mediating roles between SMS and NSSI; and (3) SOC, self-criticism, and depression played serial mediating roles between SMS and NSSI.

Conclusions

The current study supported the relation between SMS and NSSI among Chinese sexual minorities, and also implied a potential mechanism underlying the relation. Specifically, SMS was related to increased NSSI by higher SOC, self-criticism, and depression. SOC had dual-edged effects on NSSI.

Policy Implications

To reduce NSSI and other psychological problems among sexual minorities, policy makers should take more measures to eliminate SMS. Specifically, policy makers are encouraged to provide more support for changing sexual minorities' living environment, such as repealing bills that could cause SMS and popularizing the knowledge about sexual orientation.