Effects of victimization on mental health and substance use trajectories in young sexual minority men

Outness, Acceptance, and Victimization: A Longitudinal Study of Depressive Symptoms and Suicidality of Lesbian, Gay, and Bisexual and Transgender and Gender Diverse Youth

PURPOSE

LGBTQ+ youth are at higher risk for poorer mental health. Studies are typically cross-sectional and categorize cisgender lesbian, gay, and bisexual (LGB) and transgender and gender diverse (TGD) youth as a combined group (i.e., LGBTQ+). There is a need for longitudinal studies that examine differences between LGB and TGD youth for a better understanding of their mental health needs.

METHODS

Data come from a 4-wave longitudinal community-based study collected between 2011 and 2015. Hierarchical Linear Models examined trajectories of depressive symptoms and suicidality, comparing LGB and TGD youth. Between-person and within-person associations were examined, accounting for cumulative experiences of victimization, outness to family, and family acceptance in association with depressive symptoms and suicidality.

RESULTS

The study included a diverse sample of 543 LGB and 118 TGD youth. Although TGD youth had, overall, higher levels of depression and suicidality, both LGB and TGD youth experienced improvement in mental health. Youth who were more out and accepted in family were less depressed and suicidal than youth who were less out and accepted in family. Within individuals, when youth become more out and accepted in family, they concurrently reported less depressive symptoms. The accumulation of victimization experiences was associated with higher levels of depression and suicidality, and more depression for youth across time.

DISCUSSION

TGD youth face higher stigmatization than LGB youth, contributing to poorer mental health and disparities. Findings suggest that both LGB and TGD youth develop resilience despite victimization, and many find support within their families to cope with stigma.

Mapping the role of sexuality in adolescent mental health and substance use

Individuals who belong to a sexual minority are at greater risk of adverse health and social outcomes. These effects are observed during adolescence when many mental health problems, such as depression, first emerge. Here, we used a network analytic approach to better understand the role that sexual minority status plays in the association between depression, interpersonal difficulties and substance use in a large sample of mid-adolescents. In doing so, we used data from 8017 fourteen year olds from the UK's Millennium Cohort Study, of which 490 self-identified as belonging to a sexual minority. We found that sexual minority status was highly central in the network and connected to multiple adverse outcomes, sometimes directly and sometimes indirectly. The largest single association was between sexual minority status and depression, and this link mediated multiple negative associations with being in a sexual minority. The shortest path to drinking, poor social support and closeness with parents and victimization occurred via depression. The shortest path to smoking and drug use occurred via conduct problems. We also identified three distinct profiles of adverse outcomes among those belonging to a sexual minority, highlighting the heterogeneous nature of this group.

Substance Use and Misuse among Sexual and Gender Minority Communities Living in Former Soviet Union Countries: A Scoping Review

Objectives

We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations.

Methods

Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature.

Results

Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances.

Conclusion

We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.

Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis

Background

Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior).

Methods

We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria.

Results

A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]).

Conclusion

Implications for clinical practice, policy, and future research are discussed.

The Sexual Orientation Microaggression Inventory Short Form (SOMI-SF): Validation in Three Samples of Racially/Ethnically Diverse Sexual Minority Youth

Introduction

The Sexual Orientation Microaggression Inventory (SOMI) has been used to measure sexual orientation-based microaggression experiences. However, at 19 items, the SOMI may be difficult to fit into survey batteries where microaggressions are not the primary predictor or the time researchers have with each participant is very limited.

Methods

We sought to identify an eight-item short form of the SOMI (SOMI-SF) in a sample of sexual minority (SM) youth (N = 879) and confirm the validity and reliability of the SOMI-SF by administering both versions to separate cohorts of male-assigned (N = 533) and female-assigned (N = 430) at birth SM youth. Data was collected from April 2018 to May 2020.

Results

We found high reliability (α > 0.80) and validity (significant association with SM victimization, depression symptoms, anxiety symptoms, and internalized stigma) in all three samples for the SOMI-SF.

Conclusions

For researchers looking to conserve time and limit burden, the SOMI-SF is a high quality option for measuring sexual orientation microaggressions.

Policy Implications

The greater ease of administering the SOMI-SF means that sexual orientation microaggressions can be measured in a greater number of contexts. With a growing literature linking these experiences to poorer health outcomes for SM populations, measuring these experiences quickly and accurately can improve our understanding of the mechanisms creating those links and impact policy necessary to alleviate them.

Adolescent substance use at the intersections of foster care, sexual orientation and gender identity, racial/ethnic identity, and sex assigned at birth

BACKGROUND

Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth are overrepresented in foster care and report greater substance use during adolescence.

OBJECTIVE

Using an intersectional lens, the current study investigates differences in foster care placement and variation in substance use at the intersections of foster care and sexual orientation, gender identity, racial/ethnic identities, and sex assigned at birth.

PARTICIPANTS AND SETTINGS

A sample of 121,910 LGBTQ youth (grades 6-12) completed either the Minnesota Student Survey in 2019, the California Healthy Kids Survey from 2017 to 2019, or the 2017 LGBTQ National Teen Study.

METHODS

Youth reported their substance use in the past 30 days (alcohol, binge drinking, cigarette, marijuana), social positions (sexual orientation, gender identity, racial/ethnic identities, sex assigned at birth), living arrangement (foster care or not), and grade in school. Logistic regression was used to examine the main and interaction effects of foster care and social positions on youth substance use.

RESULTS

Results indicated significant differences in substance use at the intersection of foster care placement and youth social positions. Significant two-way interactions for foster care placement and social positions emerged predicting alcohol, binge drinking, and marijuana use.

CONCLUSIONS

Findings show that LGBTQ youth in foster care are at higher risk for substance use than those not in foster care. Particular support is needed for lesbian, gay, and questioning youth, transgender youth, LGBTQ youth assigned male at birth, and Asian or Pacific Islander LGBTQ youth in foster care.

A Review of Disparities in Cannabis Use and Cannabis Use Disorder Affecting Sexual and Gender Minority Populations and Evidence for Contributing Factors

Purpose of Review

Sexual and gender minorities (SGM) appear to be at elevated risk for cannabis use (CU) and cannabis use disorder (CUD) compared to cisgender heterosexuals. However, risk factors remain understudied among SGM. This review aims to summarize evidence for disparities in CU and CUD affecting SGM and factors contributing to these disparities.

Recent Findings

We found strong evidence that sexual minorities are at elevated risk for CU and CUD is elevated for sexual minority women. Evidence supports a concurrent association between minority stress and CUD symptoms. There is robust support for coping motives as a mechanism linking minority stress to subsequent CU and CUD. Studies also point to CU norms and contexts as potential risk factors.

Summary

SGM are at high risk for CU and CUD, and minority stress, CU norms, and contextual factors are implicated. Additional research is needed on CU among gender minorities, prospective effects of risk factors, and interventions for SGM.

Intersectional Minority Stress and Intimate Partner Violence: The Effects of Enacted Stigma on Racial Minority Youth Assigned Female at Birth

Many sexual minority youth of color experience enacted stigma based on each of their minority identities. We examined whether experiences of racist discrimination and heterosexist microaggressions were associated with intimate partner violence (IPV) among female-assigned at birth (FAB) sexual minority youth of color. Data were drawn from a larger study of FAB sexual and gender minority youth (FAB400; N = 488). We selected racial/ethnic minority participants who reported a sexual minority identity and reported a romantic relationship in the previous 6 months (N = 249). Negative binomial models were used to test for associations between enacted stigma (racial discrimination and heterosexist microaggressions) and IPV (psychological, physical, sexual, and sexual minority-specific) perpetration and victimization. When considered separately, both forms of enacted stigma was positively associated with perpetration and victimization across all four types of IPV. In multivariate models, racial discrimination and heterosexist microaggressions both had unique, additive effects on psychological IPV perpetration and physical- and sexual minority-specific IPV victimization. Only racial discrimination was uniquely associated with physical perpetration and psychological victimization. Only heterosexist microaggression was uniquely associated with sexual minority-specific perpetration and sexual IPV perpetration and victimization. Findings illustrate how enacted stigma based on each minority identity intersect to raise risk for IPV among sexual minority youth of color.

Cultural context matters: Testing the minority stress model among Chinese sexual minority men

Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men (n = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Modelo Relacional da Antiafeminação em Homens Não-Heterossexuais: Estudo Exploratório

Homens gays e bissexuais afeminados são alvo de dupla estigmatização por conta da antiafeminação e da homofobia da sociedade mesmo entre a comunidade não-heterossexual. O objetivo deste estudo foi investigar, de forma exploratória, a estrutura relacional da antiafeminação por meio de uma análise de rede. Realizou-se um levantamento on-line com 1.123 homens não-heterossexuais brasileiros, maiores de 18 anos e com média de idade de 26,85 anos (DP = 8,51). O modelo relacional da antiafeminação produzido neste estudo encontrou associações com a homofobia internalizada (rp = 0,32) e a predileção por parceiros mais másculos (rp = 0,45). Além disso, foi possível identificar relação indireta com abertura da orientação sexual, que ocorre por meio da homofobia internalizada. Este estudo, além de ser o primeiro a desenvolver uma análise de rede sobre a antiafeminação, contribui para o entendimento do fenômeno no contexto brasileiro, fornecendo perspectivas para o aprofundamento de pesquisas no campo.

Cultural context matters: Testing the minority stress model among Chinese sexual minority men

Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men (n = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Rejection Sensitivity Model as a Framework for Understanding Sexual Minority Mental Health

Sexual minorities are disproportionately affected by mental health problems (e.g., depression, anxiety, substance use disorders, suicidality). Minority stress theory and the psychological mediation framework have become the predominant conceptual models used to explain these disparities, and they have led to substantial advances in research on stigma-related stress and mental health. However, the field's reliance on these models has limited the extent to which other theories have been considered as potential frameworks for further advancing our understanding of sexual minority mental health. In this article, I discuss how the rejection sensitivity (RS) model can be used to complement and extend minority stress theory and the psychological mediation framework by: (1) emphasizing the role of perception in stigma-related experiences; (2) acknowledging the unique consequences of different anticipatory emotions; (3) describing additional mechanisms linking proximal minority stressors to mental health; and (4) further specifying the temporal order of these processes. I conclude by discussing the importance of attending to developmental processes in research on sexual orientation-related RS and describing important directions for future research.

Victimization and substance use among adolescents in residential child care

BACKGROUND

Adolescents in Residential Child Care (RCC) report high levels of victimization. This has been linked to mental health problems and a higher risk of substance use and substance use problems. The present study aimed to evaluate the specific impact of different forms of victimization on alcohol and cannabis use problems among adolescents in RCC, attending to sex differences.

METHODS

321 adolescents from 38 residential therapeutic care facilities in Spain participated in the study. Thirty-six different forms of victimization were evaluated, as well as alcohol and cannabis use problems. Impact of polyvictimization and specific forms of victimization on alcohol and cannabis use problems and disorders were calculated using Analysis of Variance (ANOVA) and logistic regression models.

RESULTS

Girls in RCC reported significantly more experiences of victimization. Polyvictimization was associated with alcohol use problems but not cannabis use problems. Property, domestic and community victimization showed the highest predictive role regarding alcohol and cannabis use disorders, with significant interactions with sex and migrant family background.

CONCLUSIONS

Adolescents in RCC reported considerably high levels of victimization and alcohol and cannabis use problems. In this population, property victimization, as well as indirect domestic and community victimization were predictors of further substance use problems, with girls being particularly sensitive to victimization. Migrant family backgrounds can also have an influence on the impact of some victimization forms on substance use. Victimization associated to high-risk environments and families could contribute to explain the high levels of substance use problems in this population.

Effects of sexual/gender minority- and race-based enacted stigma on mental health and substance use in female assigned at birth sexual minority youth

OBJECTIVE

People of color who are also sexual and gender minorities (SGM) experience forms of enacted stigma based on both their racial/ethnic identity and their SGM status. We set out to test the effects of enacted stigma specific to race/ethnicity and SGM identity on mental health and substance use problems among female assigned at birth (FAB) SGM of color.

METHOD

Data come from a community-based sample of FAB SGM who also identified as racial/ethnic minorities (N = 352). The effects of racial discrimination, SGM victimization, and sexual orientation microaggressions on depression symptoms, anxiety symptoms, alcohol-related problems, and marijuana-related problems were tested using linear regression and negative binomial models.

RESULTS

Enacted stigma based on both race/ethnicity and SGM status were significant predictors of mental health outcomes and alcohol-related problems within the same model, which suggested that both uniquely contributed to poorer health. There was little support for interactive effects between the multiple forms of enacted stigma. Marijuana-related problems were best explained by enacted stigma based on race/ethnicity only.

CONCLUSIONS

Racially diverse FAB SGM are at unique risk of experiencing multiple forms of discrimination and aggression based on their minority identities that each contribute negatively to their wellbeing. Consideration of the multiple forms of enacted stigma they face is necessary for understanding health disparities in these populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).