Developmental and adjustment issues of gay, lesbian, and bisexual adolescents: a review of the empirical literature

The Development of Proud & Empowered: An Intervention for Promoting LGBTQ Adolescent Mental Health

Sexual and gender minority adolescents (SGMA) experience higher rates of internalizing psychopathology, including depression, anxiety, self-harm, and posttraumatic stress disorder. The primary explanation for these mental health disparities is minority stress theory, which suggests that discrimination, violence, and victimization are key drivers of chronic minority stress and place SGMA at higher risk of mental health concerns. To help address these concerns, the authors undertook a nearly 8-year process of developing Proud & Empowered, a school-based intervention to help SGMA cope with minority stress experiences. This manuscript details the intervention development process, including: (a) identifying the mechanisms of change (Stage 0), (b) building the intervention (Stage 1A, Part 1), (c) acceptability testing and program revision (Stage 1A, Part 2), (d) feasibility and pilot testing (Stage 1B, Part 1), (e) modification of the intervention to improve implementability (Stage 1B, Part 2), and (f) the final intervention.

Adolescent stress experiences over time study (ASETS) protocol: design and methods of a prospective longitudinal study of sexual minority adolescents in the USA

INTRODUCTION

Sexual minority adolescents (SMA) report higher rates of anxiety, self-harm, depression and suicide than heterosexual peers. These disparities appear to persist into adulthood and may worsen for certain subgroups, yet the mechanisms that drive these concerns remain poorly understood. Minority stress theory, the predominant model for understanding these disparities, posits that poorer outcomes are due to the stress of living in a violently homophobic and discriminatory culture. Although numerous studies report associations between minority stress and behavioural health in adolescence, no study has comprehensively examined how minority stress may change throughout the course of adolescence, nor how stress trajectories may predict health outcomes during this critical developmental period.

METHODS AND ANALYSIS

Between 15 May 2018 and 1 April 2019, we recruited a US national sample of diverse SMA (n=2558) age 14-17 through social media and respondent-driven sampling strategies. A subset of participants (n=1076) enrolled in the longitudinal component and will be followed each 6 months until 1 July 2022. Primary outcomes include symptoms of depression, anxiety and post-traumatic stress disorder; suicidality and self-harm and substance use. The key predictor is minority stress, operationalised as the Sexual Minority Adolescent Stress Inventory. We will use parallel cohort-sequential latent growth curve models to test study hypotheses within a developmental framework.

ETHICS AND DISSEMINATION

All participants provided assent to participate, and longitudinal participants provided informed consent at the first follow-up survey after reaching age 18. All study procedures were reviewed and approved by the University of Southern California Social-Behavioral Institutional Review Board, including a waiver of parental permission given the potential for harm due to unintentional 'outing' to a parent during the consent process. The final anonymous data set will be available on request, and research findings will be disseminated through academic channels and products tailored for the lay community.

Development of the Sexual Minority Adolescent Stress Inventory

Although construct measurement is critical to explanatory research and intervention efforts, rigorous measure development remains a notable challenge. For example, though the primary theoretical model for understanding health disparities among sexual minority (e.g., lesbian, gay, bisexual) adolescents is minority stress theory, nearly all published studies of this population rely on minority stress measures with poor psychometric properties and development procedures. In response, we developed the Sexual Minority Adolescent Stress Inventory (SMASI) with N = 346 diverse adolescents ages 14–17, using a comprehensive approach to de novo measure development designed to produce a measure with desirable psychometric properties. After exploratory factor analysis on 102 candidate items informed by a modified Delphi process, we applied item response theory techniques to the remaining 72 items. Discrimination and difficulty parameters and item characteristic curves were estimated overall, within each of 12 initially derived factors, and across demographic subgroups. Two items were removed for excessive discrimination and three were removed following reliability analysis. The measure demonstrated configural and scalar invariance for gender and age; a three-item factor was excluded for demonstrating substantial differences by sexual identity and race/ethnicity. The final 64-item measure comprised 11 subscales and demonstrated excellent overall (α = 0.98), subscale (α range 0.75–0.96), and test–retest (scale r > 0.99; subscale r range 0.89–0.99) reliabilities. Subscales represented a mix of proximal and distal stressors, including domains of internalized homonegativity, identity management, intersectionality, and negative expectancies (proximal) and social marginalization, family rejection, homonegative climate, homonegative communication, negative disclosure experiences, religion, and work domains (distal). Thus, the SMASI development process illustrates a method to incorporate information from multiple sources, including item response theory models, to guide item selection in building a psychometrically sound measure. We posit that similar methods can be used to improve construct measurement across all areas of psychological research, particularly in areas where a strong theoretical framework exists but existing measures are limited.

Criterion and Divergent Validity of the Sexual Minority Adolescent Stress Inventory

Sexual minority adolescents (SMA) consistently report health disparities compared to their heterosexual counterparts, yet the underlying mechanisms of these negative health outcomes remain unclear. The predominant explanatory model is the minority stress theory; however, this model was developed largely with adults, and no valid and comprehensive measure of minority stress has been developed for adolescents. The present study validated a newly developed instrument to measure minority stress among racially and ethnically diverse SMA. A sample of 346 SMA aged 14-17 was recruited and surveyed between February 2015 and July 2016. The focal measure of interest was the 64-item, 11-factor Sexual Minority Adolescent Stress Inventory (SMASI) developed in the initial phase of this study. Criterion validation measures included measures of depressive symptoms, suicidality and self-harm, youth problem behaviors, and substance use; the general Adolescent Stress Questionnaire (ASQ) was included as a measure of divergent validity. Analyses included Pearson and tetrachoric correlations to establish criterion and divergent validity and structural equation modeling to assess the explanatory utility of the SMASI relative to the ASQ. SMASI scores were significantly associated with all outcomes but only moderately associated with the ASQ (r = -0.13 to 0.51). Analyses revealed significant associations of a latent minority stress variable with both proximal and distal health outcomes beyond the variation explained by general stress. Results show that the SMASI is the first instrument to validly measure minority stress among SMA.

A developmentally informed adaptation of minority stress for sexual minority adolescents

Sexual minority adolescents (lesbian, gay, bisexual) experience disparities in behavioral health outcomes compared to their heterosexual peers, generally attributed to minority stress. Although evidence of the applicability of the minority stress model among adolescents exists, it is based on a primarily adult literature. Developmental and generational differences demand further examination of minority stress to confirm its applicability. Forty-eight life history interviews with sexual minority adolescents in California (age 14-19; M = 19.27 SD = 1.38; 39.6% cismale, 35.4% cisfemale, 25% other gender) were completed, recorded, transcribed, and analyzed using thematic analysis in QSR NVivo. Following a consensus model, all transcripts were double coded. Results suggest that minority stress is appropriate for use with adolescents; however, further emphasis should be placed on social context, coping resources, and developmental processes regarding identity development. A conceptual model is provided, as are implications for research and practice.

Strategies employed by sexual minority adolescents to cope with minority stress

Sexual minority adolescents (SMA) experience disparities in health and behavioral health outcomes, including high rates of depression, anxiety, self-harm, substance use, HIV risk behavior, suicidal ideation, and suicide attempts. These outcomes are commonly attributed to minority stress. Stress experiences are different for SMA than their adult counterparts. For example, disclosing their sexual orientation may be more likely to result in homelessness because these youth more often live with parents or other family members. Although stress in this population has been explored in previous research, very little is known about how SMA cope. Relying upon an adolescent coping model, this study examined the coping strategies, responses, and resources of SMA related to stress. Forty-eight racially and ethnically diverse SMA (age 14-19) were recruited for 90-minute tape-recorded interviews. The semi-structured interviews were guided by a life history calendar. Recordings were transcribed verbatim and entered into QSR NVivo. All transcripts were coded by two members of the research team and went through a consensus process. Forty-three unique coping statements emerged that fit with the Compas model of adolescent coping. SMA cope with minority stress in similar ways to heterosexual youth coping with general stress, but findings suggest that SMA may also use different kinds of coping resources. Although further research is needed, the present study identified a variety of ways SMA cope with stress and can inform future research on the development interventions.

Reflecting resiliency: openness about sexual orientation and/or gender identity and its relationship to well-being and educational outcomes for LGBT students

For lesbian, gay, bisexual, and transgender (LGBT) youth, coming out (i.e., disclosure of LGBT identity to others) can be a key developmental milestone, one that is associated with better psychological well-being. However, this greater visibility may come with increased risk of peer victimization. Being out, therefore, may reflect resilience and may unfold differently depending on ecological context as some spaces may be more or less supportive of LGBT youth than others. This article explores a model of risk and resilience for outness among LGBT youth, including whether it varies by community context. We tested our hypothesized model with a national dataset of 7,816 LGBT secondary school students using multi-group structural equation modeling. Consistent with our hypotheses, outness was related to higher victimization but also to higher self-esteem and lower depression. Greater victimization was related to negative academic outcomes directly and indirectly via diminished well-being. The increases in victimization associated with outness were larger for rural youth, and benefits to well-being partly compensated for their lower well-being overall. This article suggests that being out reflects resilience in the face of higher risk of victimization, in addition to promoting well-being in other ways. Nonetheless, contextual factors influence how this model operates among LGBT youth.

Sexual harassment among adolescents of different sexual orientations and gender identities

This article examines (a) variation in rates of sexual harassment across mode (e.g., in-person, online) and type of harassment, (b) the impact of sexual harassment (i.e., distressing vs. non-distressing), and (c) how sexual harassment is similarly and differently experienced across sexual orientation and gender identity groups. Data were collected as part of the Teen Health and Technology online survey of 5,907 13 to 18 year-old Internet users in the United States. Past year sexual harassment was reported by 23-72% of youth, depending upon sexual orientation, with the highest rates reported by lesbian/queer girls (72%), bisexual girls (66%), and gay/queer boys (66%). When examined by gender identity, transgender youth reported the highest rates of sexual harassment - 81%. Overall, the most common modes for sexual harassment were in-person followed by online. Distress in the form of interference with school, family, and/or friends; creating a hostile environment; or being very/extremely upset was reported by about half of the sexually harassed bisexual girls and lesbian/queer girls, 65% of the gender non-conforming/other gender youth, and 63% of the transgender youth. Youth with high social support and self-esteem were less likely to report sexual harassment. Findings point to the great importance of sexual harassment prevention for all adolescents, with particular emphasis on the unique needs and experiences of youth of different sexual orientations and gender identities. Socio-emotional programs that emphasize self-esteem building could be particularly beneficial for reducing the likelihood of victimization and lessen the impact when it occurs.

Peer harassment and risky behavior among sexual minority girls and boys

The role of peer harassment in the association between sexual minority status and adolescent risky behavior was examined for 15-year-olds in the NICHD Study of Early Child Care and Youth Development (n = 957). The findings, although exploratory, suggest the importance of gender. For girls, peer harassment was best viewed as a moderator of the link between sexual minority status and increased risky behavior. It intensified an existing association, reflecting the gendered nature of the impact of sexual minority status on the adolescent social context. For boys, peer harassment was primarily a mediator, such that sexual minority status was associated with more risky behavior via elevated harassment, although sexual minority status itself was associated with lower risky behavior overall.

Spectrums of love: examining the relationship between romantic motivations and sexual risk among young gay and bisexual men

We examined the association between HIV/AIDS risk behaviors and romantic feelings among single, young gay and bisexual men (YGBM). Romantic feelings may have positive (romantic ideation) and negative (romantic obsession) connotations. Consequently, we hypothesized that YGBM would report greater risks if they reported having obsessive thoughts about their relationship desires; conversely, we hypothesized that YGBM who envision a romantic relationship would report fewer unprotected partners. Using cross-sectional data from a study examining YGBM's online dating experiences (N = 376; ages 18-24), we found a positive association between romantic obsession and number of partners for unprotected receptive (URAI) and insertive (UIAI) anal intercourse. Conversely, we found a negative association between romantic ideation and number of partners for URAI and UIAI. Is love risky or protective? Our results indicate support for both perspectives. We discuss the implications of our findings, highlighting the importance of addressing romantic pursuits into existing HIV prevention interventions for YGBM.

Victimization experiences of lesbian, gay, and bisexual individuals: a meta-analysis

This meta-analysis quantitatively compiled the results of studies from 1992 to 2009 to determine the prevalence and types of victimization experienced by lesbian, gay, and bisexual (LGB) individuals. Based on the results of three searches, 386 studies were retrieved and coded. Comparisons were made across all LGB individuals (138 studies), between LGB and heterosexual individuals (65 studies), and between LGB females and males (53 studies), with over 500,000 participants. Multiple types of victimization were coded, including discrimination, physical assault, and school victimization. Findings revealed that for LGB individuals, reports of victimization experiences were substantial (e.g., 55% experienced verbal harassment, and 41% experienced discrimination) and some types have increased since a 1992 review, while others have decreased. LGB individuals experienced greater rates of victimization than heterosexual individuals (range: d = .04-.58). LGB males experienced some types of victimization more than LGB females (e.g., weapon assault and being robbed) but, overall, the gender differences were small. It can be concluded that LGB individuals still experience a substantial amount of victimization. Implications for research methods are discussed, including recommendations for sampling and measurement of victimization. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Sex Research for the following free supplemental resource(s): Supplementary Tables. These tables are referred to in the text of this article as "Table S1," "Table S2," etc.].

A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda

Relatively little is known about how parents influence the health and well-being of lesbian, gay, and bisexual (LGB) adolescents and young adults. This gap has led to a paucity of parent-based interventions for LGB young people. A systematic literature review on parental influences on the health of LGB youth was conducted to better understand how to develop a focused program of applied public health research. Five specific areas of health among LGB young people aged 10-24 years old were examined: (a) sexual behavior; (b) substance use; (c) violence and victimization; (d) mental health; and (e) suicide. A total of 31 quantitative articles were reviewed, the majority of which were cross-sectional and relied on convenience samples. Results indicated a trend to focus on negative, and not positive, parental influences. Other gaps included a dearth of research on sexual behavior, substance use, and violence/victimization; limited research on ethnic minority youth and on parental influences identified as important in the broader prevention science literature; and no studies reporting parent perspectives. The review highlights the need for future research on how parents can be supported to promote the health of LGB youth. Recommendations for strengthening the research base are provided.

Internet use and sexual health of young men who have sex with men: a mixed-methods study

Young gay, bisexual, and other men who have sex with men (MSM) experience sexual health disparities due to a lack of support in settings that traditionally promote positive youth development. The Internet may help to fill this void, but little is known about how it is used for sexual health purposes among young MSM. This mixed-methods study reports quantitative results of a large survey of 18- to 24-year-old MSM in an HIV testing clinic (N = 329) as well as qualitative results from interviews. Level of Internet use was high in this sample and the majority of participants reported using the Internet to find HIV/AIDS information. Black and Latino youth used the Internet less frequently than White youth, and after controlling for age, education, and frequency of Internet use, Black youth were 70% less likely to use the Internet to find HIV/AIDS information. Qualitative analyses identified themes related to the role of the Internet in finding sexual health information, sexual minority identity development, and sexual risk taking behaviors. Participants reported that the Internet filled an important and unmet need for sexual health education. It allowed for connections to the gay community and support during the coming out process, but also exposure to homophobic messages. There was no evidence of increased risk behaviors with partners met online, but at the same time the potential for the use of the Internet to facilitate safer sex communication was largely untapped. Our findings generally present an optimistic picture about the role of the Internet in the development of sexual health among young MSM.

Sexual attraction status and adolescent suicide proneness: the roles of hopelessness, depression, and social support

This study explored the relationship between sexual attraction status (same-sex, both-sex, and opposite-sex) and suicidal behavior in a diverse sample of adolescents (N = 1,533 youth). Adolescents with attractions to both sexes reported greater suicide proneness, recent and lifetime suicidal ideation, and past suicide attempts than those with exclusively opposite-sex attractions; individuals reporting same-sex attractions generally demonstrated moderate elevations on these variables. As hypothesized, both hopelessness and depression mediated the relationship between sexual attraction status and suicide proneness. Social support moderated the mediating effect of depression but not hopelessness in the sexual attraction status-suicide proneness link. Targeting the distress that can be associated with experiencing same-sex or both-sex attractions may enhance suicide prevention efforts, particularly in U.S. youth with reduced social support.

Identity development and exploration among sexual minority adolescents: examination of a multidimensional model

Based on a multidimensional model of sexual identity development, the current study examined self-labeling, romantic, and sexual experiences among middle and late adolescent sexual minorities. Eighty-two youths between the ages of 14 and 21 were recruited from gay, lesbian, bisexual, and transgender (GLBT) community centers and associated Internet groups. Differences between males and females and between middle and late adolescents were first examined. Males reported markedly different patterns of self-labeling and romantic experiences, relative to females, but few age differences emerged. Additionally, patterns of association between self-labeling and sexual or romantic experiences provided support for the multidimensional model of identity development and exploration. Finally, significant associations emerged between relationship experiences and relational competency, such that adolescents who described themselves as isolated from intimate interpersonal relationships reported less relational esteem and more relational depression than those who reported predominantly engaging in same-sex romantic relationships. In addition, alternative styles of engaging in interpersonal relationships (e.g., same-sex intimate friendships, heterosexual dating) also were also associated with increased relational competency.

Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents

BACKGROUND

Sexual minority adolescents appear to be at increased risk for internalizing disorders relative to their heterosexual peers, but there is a paucity of research explaining this elevated risk. Emotion regulation deficits are increasingly understood as important predictors of internalizing psychopathology among general samples of adolescents. The present study sought to examine whether deficits in emotion regulation could account for disparities in internalizing symptoms between sexual minority and heterosexual adolescents.

METHODS

The present study utilized longitudinal data from a racially/ethnically diverse (68% non-Hispanic Black and Hispanic/Latino) community sample of 1,071 middle school students (ages 11-14).

RESULTS

Adolescents who endorsed same-sex attraction evidenced higher rates of internalizing symptoms at both time points. Structural equation modeling indicated that sexual minority adolescents exhibited greater deficits in emotion regulation (rumination and poor emotional awareness) than their heterosexual peers. Emotion regulation deficits in turn mediated the relationship between sexual minority status and symptoms of depression and anxiety.

CONCLUSIONS

The results demonstrate the importance of considering normative psychological processes in the development of internalizing symptomatology among sexual minority adolescents, and suggest emotion regulation deficits as specific targets of prevention and intervention efforts with this population. Future studies are needed to determine whether stigma-related stressors are responsible for emotion regulation deficits among sexual minority youth.

Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses' Health Study II

BACKGROUND

A growing body of research documents multiple health disparities by sexual orientation among women, yet little is known about the possible causes of these disparities. One underlying factor may be heightened risk for abuse victimization in childhood in lesbian and bisexual women.

METHODS

Using survey data from 63,028 women participating in the Nurses' Health Study II, we investigated sexual orientation group differences in emotional, physical, and sexual abuse in childhood and adolescence. Multivariable log-binomial and linear regression models were used to examine orientation group differences in prevalence and severity of abuse, with heterosexual as the referent and controlling for sociodemographics.

RESULTS

Results showed strong evidence of elevated frequency, severity, and persistence of abuse experienced by lesbian and bisexual women. Comparing physical abuse victimization occurring in both childhood and adolescence, lesbian (30%, prevalence ratio [PR] 1.61, 95% confidence interval [CI] 1.40, 1.84) and bisexual (24%, PR 1.26, 95% CI 1.00, 1.60) women were more likely to report victimization than were heterosexual women (19%). Similarly, comparing sexual abuse victimization occurring in both age periods, lesbian (19%, PR 2.16, 95% CI 1.80, 2.60) and bisexual (20%, PR 2.29, 95% CI 1.76, 2.98) women were more likely to report victimization than were heterosexual women (9%).

CONCLUSIONS

This study documents prevalent and persistent abuse disproportionately experienced by lesbian and bisexual women.

Sexual orientation, gender, and alcohol use in a cohort study of U.S. adolescent girls and boys

BACKGROUND

Sexual minority youth may be at elevated risk for alcohol use relative to heterosexual youth, but the reasons underlying higher rates and whether there may be gender differences in risk are not known.

METHODS

Cross-sectional survey data from 9731 early and middle adolescent girls and boys in the Growing Up Today Study in 1999 were examined to assess sexual orientation and gender patterns in alcohol use. Multivariable regression models estimated associations between sexual orientation and alcohol-related behaviors, such as binge drinking and drinking before age 12 years. Models controlled for sociodemographic and psychosocial factors, with heterosexuals as the reference.

RESULTS

Girls who described themselves as "mostly heterosexual" and lesbian/bisexual girls were at elevated risk compared to heterosexual girls on almost all alcohol-related behaviors and exposures. "Mostly heterosexual" boys were also at elevated risk. No significant differences in alcohol-related behaviors were observed between gay/bisexual and heterosexual boys. Gender-by-sexual orientation interactions were statistically significant for LGB but not other orientations, indicating that lesbian/bisexual girls experienced elevated risk above and beyond that of gay/bisexual boys relative to same-gender heterosexual peers.

CONCLUSIONS

In early and middle adolescence, sexual minority girls and "mostly heterosexual" boys experienced consistent patterns of elevated risk for alcohol use.

The relation of social support, connectedness, and collective self-esteem to the psychological well-being of lesbian, gay, and bisexual youth

The present study extended the research on the mental health of lesbian, gay, and bisexual (LGB) youth by testing the relationship of social support, social connectedness, and collective self-esteem to psychological well-being in a sample of 218 LGB youth. Perceived social support significantly predicted psychological well-being subscales; social connectedness and collective self-esteem contributed significantly to the psychological well-being of the LGB participants when controlling for perceived social support. Age moderated the relations between several of the social and psychological well-being variables. Results of the study suggest that helping professionals working with LGB youth consider assessment of the youth's sense of connectedness to those around him/her and esteem related to LGB group membership in addition to assessing general social support.

Romantic relationships and their social context among gay/bisexual male youth in the Castro District of San Francisco

This article examines the culture of romantic relationships among gay/bisexual male youth in the Castro District of San Francisco. The article seeks to specify the cultural ideology that informs these relationships, drawing upon ethnographic observation, autobiographical accounts, and informant cultural exegesis. The article also seeks to link thinking and experience inside romantic relationships (e.g., bonding, jealousy) to patterns of social behavior associated with romantic relationships (e.g., relationship sequestering, cheating), showing how both are informed by shared assumptions which make these emotions and gestures intelligible to the group. Beliefs about love, compatibility, and monogamy are explored. Reciprocity, including its degradation into negative forms, is examined with focus on the units of value that are exchanged in romantic relationships, in particular sentimental gifts. Gestures of commitment that mark commencement of a romantic relationship as well as extension of the dynamics of a relationship after "breakup" (as in "revenge sex" and "rebound relationships") are examined. Cultural systems that challenge adherence to a romantic ideology, such as a prestige economy associated with sex linked to an ethos of sexual exploration/recreation, are weighed against the pull of romance. "Drama," a hallmark of gay youth, is viewed in the context of romantic culture.

Suicidality among gay, lesbian and bisexual youth: the role of protective factors

PURPOSE

Many reports have indicated that gay, lesbian and bisexual (GLB) youth are particularly vulnerable to poor outcomes, including suicide. Certain protective factors are likely to reduce this risk. The present study examines four protective factors (family connectedness, teacher caring, other adult caring, and school safety) and their association with suicidal ideation and attempts among adolescents with same-gender experience.

METHODS

Data come from the 2004 Minnesota Student Survey of 9th and 12th grade students; 21,927 sexually active youth were grouped according to the gender of their sex partner(s) into GLB and non-GLB groups. Four protective factors and suicidal ideation and attempts were compared across groups. Logistic regression was used to examine the influence of protective factors on suicide, and predicted probabilities of suicidal ideation and attempts were estimated using general linear modeling.

RESULTS

There were 2,255 respondents who reported same-gender experience. Over half of GLB students had thought about suicide and 37.4% reported a suicide attempt. GLB youth reported significantly lower levels of each protective factor than their non-GLB peers. Family connectedness, adult caring, and school safety were significantly protective against suicidal ideation and attempts. Risk associated with a GLB sexual orientation is largely mediated through protective factors.

CONCLUSIONS

Sexual orientation alone accounts for only a small portion of variability in suicidal ideation and attempts. If protective factors were enhanced among GLB youth, suicide in this population is expected to be considerably lower. Protective factors examined here are amenable to change and should be targeted in interventions.

Transgender youth: invisible and vulnerable

This study used three focus groups to explore factors that affect the experiences of youth (ages 15 to 21) who identify as transgender. The focus groups were designed to probe transgender youths' experiences of vulnerability in the areas of health and mental health. This involved their exposure to risks, discrimination, marginalization, and their access to supportive resources. Three themes emerged from an analysis of the groups' conversations. The themes centered on gender identity and gender presentation, sexuality and sexual orientation, and vulnerability and health issues. Most youth reported feeling they were transgender at puberty, and they experienced negative reactions to their gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to their vulnerability in health-related areas: the lack of safe environments, poor access to physical health services, inadequate resources to address their mental health concerns, and a lack of continuity of caregiving by their families and communities.

Sociocultural interpretations of social phobia in a non-heterosexual female

Social Phobia is a prominent anxiety disorder that is not well-understood, especially among socially marginalized, non-heterosexual individuals. A case description of Social Phobia symptoms in a female who is unsure of her sexual identity is presented and analyzed. The diagnostic assumptions of Social Phobia as applied to the case are critically examined. The goal is to highlight unanswered questions regarding social anxiety among non-heterosexuals and to open a discussion of cultural etiological theory. Implications for treating Social Phobia with a cultural component are discussed.

More normal than not: a qualitative assessment of the developmental experiences of gay male youth

PURPOSE

To examine gay youth experiences within the context of normal adolescent development.

METHODS

Thematic analyses of interviews with 13 self-identified gay male youth, aged 16-22 years, each reporting minimal sexual identity distress, were completed. Interviews focused on: (a) descriptions of developmental changes perceived to occur for all adolescents, (b) descriptions of the participants' developmental experience, and (c) participants' direct comparisons of their perceptions of gay and nongay developmental experience. Data were analyzed by two investigators who, after initial review of the interview transcripts, developed a unified coding template to permit systematic analysis of the transcripts for recurrent themes.

RESULTS

(a) Few (2 of 13) participants reported overall developmental experience markedly different from nongay peers. (b) Peer interaction was seen as the domain most different from that of nongay peers. (c) Open gay self-identification altered, generally positively, all peer interaction. (d) Increased peer interaction enhanced maturity in other domains. (e) Family dynamics were not substantively altered by open gay self-identification. (f) Middle and high school were identified as relatively hostile environments in which to openly identify as gay, affecting the timing and the extent of self-disclosure. (g) Developmental progress showed asynchrony across developmental domains.

CONCLUSION

General developmental dysfunction is not inevitable for gay adolescents, nor is identifiable personal or family pathology directly related to sexual identity.

New paradigms for research on heterosexual and sexual-minority development

As psychological research on sexual-minority (i.e., nonheterosexual) adolescents has increased over the past 20 years, it has become increasingly segregated from research on mainstream heterosexual youths, as if the knowledge gleaned from each population had nothing to offer our understanding of the other. To the contrary, understanding of both populations would be greatly improved by integrating investigations of sexual-minority issues into mainstream psychological research on adolescents. I outline 4 weaknesses in contemporary research on sexual-minority youth that stem from--and perpetuate--its historical isolation from mainstream developmental research: misspecification of the populations under study, lack of attention to within-group diversity, failure to test alternative explanations for--and moderators of--"sexual-minority effects," and insufficient attention to the underlying processes and mechanisms through which sexual-minority effects operate. Correcting these weaknesses has important implications for future research on how same-sex and other-sex sexuality shape adolescent psychosocial development and clinical child and adolescent problems.

Sexual abuse in lesbian and bisexual young women: associations with emotional/behavioral difficulties, feelings about sexuality, and the "coming out" process

SUMMARY We examined associations between childhood sexual abuse (CSA) and emotional/behavioral difficulties, feelings about one's sexuality, and the "coming out" process in a sample of 227 lesbian and bisexual women, ages 18-23, recruited for an online questionnaire study. Participants with a CSA history ("experiencers") reported significantly more emotional/behavioral difficulties than their nonexperiencer counterparts, suggesting that CSA may be an important contributor to some problems and behaviors currently linked in the literature to sexual orientation. Lesbian and bisexual experiencers varied widely as to whether and how they felt a CSA history affected their feelings about their sexuality or their "coming out" process. We discuss the implications of these findings for counseling, research, and theorizing involving lesbian and bisexual young women.

Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior

PURPOSE

To examine the link between victimization at school and health risk behaviors using representative data comparing lesbian, gay, and bisexual (LGB) youths and heterosexual youths.

METHODS

Data from the 1995 Youth Risk Behavior Survey taken in Massachusetts and Vermont were examined. This sample included 9188 9th through 12th grade students; 315 of these students were identified as LGB. Analyses of variance were used to examine health risk behaviors by sexual orientation by gender by victimization level.

RESULTS

The combined effect of LGB status and high levels of at-school victimization was associated with the highest levels of health risk behaviors. LGB youths reporting high levels of at-school victimization reported higher levels of substance use, suicidality, and sexual risk behaviors than heterosexual peers reporting high levels of at-school victimization. Also, LGB youths reporting low levels of at-school victimization reported levels of substance use, suicidality, and sexual-risk behaviors that were similar to heterosexual peers who reported low at-school victimization.

CONCLUSIONS

The findings provide evidence that differences in health risks among LGB youth are mediated by victimization at school. Such victimization of LGB youth is associated with health risk behaviors.

Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths

Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families' reactions to youths' sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.