Lesbian and bisexual female youths aged 14 to 21: developmental challenges and victimization experiences

The Developmental Collision Hypothesis: An Empirical Test With Three Generations of Sexual Minority Youth

Sexual minority youth experience disproportionate rates of mental health symptomatology relative to their heterosexual peers. Less is known about why these disparities have persisted despite growing public awareness of sexual diversity. The developmental collision hypothesis states that increased cultural visibility of sexual diversity has accelerated the developmental timing of sexual minority identity formation processes such that they collide with early adolescence, a uniquely sensitive period for experiencing identity-based stigma and associated mental health vulnerability. To test this hypothesis, levels and relations between ages of sexual minority identity development milestones, frequency of LGBT-related victimization, and depressive symptoms were examined across three age-matched but cohort-distinct samples of sexual minority adolescents. Data come from three secondary datasets of sexual minority youth who were adolescents in the 1990s, 2000s, and 2010s, respectively: the Challenges and Coping Study, the Victimization and Mental Health among High Risk Youths Study, and the Risk and Protective Factors for Suicide among Sexual Minority Youth Study (n = 1312; Mage = 17.34, SD = 1.30; 52% female). Adolescents from more recent cohorts reported earlier mean ages of several milestones but similar frequencies of LGBT-related victimization relative to those from less recent cohorts. Path analysis models showed that earlier milestones were associated indirectly with more depressive symptoms through LGBT-related victimization. Notably, earlier ages of self-identification and disclosure of a sexual minority identity were also directly related to less depressive symptoms. Few generational differences in relations between constructs emerged. Findings garner initial support for the developmental collision hypothesis and suggest that LGBT-related victimization, rather than earlier milestones themselves, increases mental health vulnerability.

"If You're Not Yourself, Who are You Going to be?" an Exploration of Gender and Sexuality Diverse Pupils Experiences of Visibility Management in School: A Systematic Literature Review

Like all young people (YP), those who are gender and sexuality diverse (GSD) spend their youth exploring and discovering their identities; but unlike their peers, they must consider whether, how, and when to disclose their GSD identity to others in a dynamic process of visibility management (VM). At school, GSD YP actively test social reactions, interpret attitudes, and assess safety, ultimately seeking belonging as their authentic selves. Our systematic review explored findings from 16 qualitative studies capturing GSD YPs experiences of managing visibility in schools internationally. Data were thematically synthesized, and seven themes were constructed. The process of visibility management is fluid, a negotiation with social norms that GSD YP's very existence transgresses. YP search for, and through activism actively shape, accepting environments in which they can safely be their authentic selves. GSD YP are actively asking school staff for help in creating open communities where all YP can find a place to belong, to fight to be visible. We offer some suggestions for how we might begin.

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.

The social determinants of mental health and disorder: evidence, prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

Sexual Orientation Identity Development Milestones Among Lesbian, Gay, Bisexual, and Queer People: A Systematic Review and Meta-Analysis

This paper is a systematic review and meta-analysis on sexual orientation identity development milestones among people who are lesbian, gay, bisexual, or another sexual minority identity (LGB+). Common milestones measured in the 30 studies reviewed were becoming aware of queer attractions, questioning one's sexual orientation, self-identifying as LGB+, coming out to others, engaging in sexual activity, and initiating a romantic relationship. Milestones occurred in different sequences, although attraction was almost always first, often followed by self-identification and/or sexual activity; coming out and initiating a romantic relationship often followed these milestones. Meta-analysis results showed that the mean effect sizes and 95% confidence intervals varied by milestone: attraction [M _age=12.7 (10.1, 15.3)], questioning one's orientation [M _age=13.2 [12.8, 13.6]), self-identifying [M _age=17.8 (11.6, 24.0)], sexual activity [M _age=18.1 (17.6, 18.6)], coming out [M _age=19.6 (17.2, 22.0)], and romantic relationship [M _age=20.9 (13.2, 28.6)]. Nonetheless, results also showed substantial heterogeneity in the mean effect sizes. Additional meta-analyses showed that milestone timing varied by sex, sexual orientation, race/ethnicity, and birth cohort. Although patterns were found in LGB+ identity development, there was considerable diversity in milestone trajectories.

Parental Responses to Coming out by Lesbian, Gay, Bisexual, Queer, Pansexual, or Two-Spirited People across Three Age Cohorts

OBJECTIVE

The study aimed to better understand the complexities of parental responses to coming out in the narratives from Lesbian, Gay, Bisexual, Queer, Pansexual, or Two-Spirited (LGBQ+) individuals, and to examine whether those from recent cohorts experience a different parental response than those in older cohorts.

BACKGROUND

Sexual minorities come out at younger ages today than in past decades, and coming out to parents is a major part of the identification process.

METHOD

Interview excerpts of 155 US lesbian, gay, bisexual, queer, pansexual, or two-spirited (LGBQ+) respondents were analyzed with a qualitative thematic analysis and with basic quantitative methods. The sample consisted of 61 interviewees in a young cohort (ages 18-25), 65 in a middle cohort (ages 35-42), and 29 in an older cohort (ages 52-59), in six ethnic/racial groups.

RESULTS

Themes based on LGBQ+ people's accounts indicated that parental responses varied with the degree of their a priori knowledge of respondents' sexual identities (ranging from suspicion or certainty to surprise). Parental appraisal was either lacking, negative, mixed, or positive with accompanying silent, invalidating, ambivalent, and validating responses, respectively. Validating responses from parents were more often found in the youngest cohort, but invalidating responses were frequent across all cohorts. LGBQ+ people in the oldest cohort were more inclined to accept their parents being noncommunicative about sexuality in general and also about sexual diversity.

CONCLUSION

It is too early to state that coming out to parents has become easier. Harmony in the parent-child relationship after coming out and open communication about sexual identities is regarded as desirable and yet it remains elusive for many LGBQ+ people.

"I feel as if I'm lying to them": Exploring Lesbian Muslims' Experiences of Rejection, Support, and Depression

The current exploratory study utilized a mixed-methods design to study 18 lesbian Muslims' mental health in relation to familial and online social support (M Age = 24, Sd = 9). Due to the threat of familial rejection, the majority of participants (n = 11) selectively disclosed their sexual identity and four participants publicly disclosed. Half of participants scored as mildly to severely depressed on the Beck Depression Inventory (M = 15, Sd = 9). Participants reporting changes in their familial relationships due to their sexual orientation scored as the most highly depressed, F (2, 15) = 4.75, p = .025. Participants' depression scores varied significantly between those that belonged to online support groups addressing religion and sexuality (n = 8, M = 8.712, SD = 6.183) and those that did not (n = 10, M = 20.250, SD = 7.772), t(16) = 3.416, p = .004. Future research would benefit from exploring how therapeutic alliances and family of choice networks can help buffer lesbian Muslims' experiences of familial rejection.

Childhood Familial Victimization: An Exploration of Gender and Sexual Identity Using the Scale of Negative Family Interactions

Familial violence poses a serious public health concern and has therefore received a considerable amount of attention from academics and practitioners alike. Research within this field has found that parent-to-parent and parent-to-child violence often occur simultaneously and are especially prevalent within households that suffer from social and environmental stressors. Sibling violence and its relationship to these other forms of familial violence has received considerably less attention, largely related to the widely held belief that sibling violence is natural, especially for boys. Using the Scale of Negative Family Interactions (SNFI), parent-to-child and sibling-to-sibling violence is investigated. Specifically, the relationship between participants' gender and sexual identities and their reports of familial violence are explored to better understand participants' gendered and sexed experiences. Data suggest that gender and sexual minorities may have a unique experience of familial violence, although further research is needed in this area.

Association of Sexual Orientation Acceptance with Reduced Suicide Attempts Among Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth

Purpose: This study examined the relationship between sexual orientation acceptance from others and suicide attempts among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. Methods: We analyzed data from a 2018 cross-sectional survey of LGBTQ youth between the ages of 13 and 24 years across the United States. Youth reported sexual orientation acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom who they were "out." Adjusted logistic regression analyses were used to examine the association between sexual orientation acceptance and a past-year suicide attempt. Results: All forms of peer and adult acceptance were associated with reduced reports of a past-year suicide attempt, with the strongest associations found for acceptance from parents (adjusted odds ratio [aOR] = 0.52) and straight/heterosexual friends (aOR = 0.54). Youth who reported high levels of acceptance from any adult had nearly 40% (aOR = 0.61) lower odds of a past-year suicide attempt compared with LGBTQ peers with little to no acceptance. Youth with high levels of acceptance from any peer also had significantly lower odds of reporting a past-year suicide attempt (aOR = 0.55). These relationships remained significant even after controlling for the impact of each form of acceptance, suggesting unique associations with suicide risk for both peer and adult acceptance. Conclusion: Interventions aimed at increasing sexual orientation acceptance from supportive adults and peers have strong potential to address the public health burden of LGBTQ youth suicide.

Decriminalizing LGBTQ+: Reproducing and resisting mental health inequities

Secure settings are not queer because lesbian, gay, bisexual, transgender, queer, questioning, Two Spirit, and asexual (LGBTQ+) people populate them, and neither are LGBTQ+ people inherently criminal because they are found in those spaces. Queer people bear disproportionate health, mental health, and social inequities that have had, historically and currently, the effect to criminalize them. This review discusses effective language and ideologies when working with LGBTQ+ people in secure settings. Major health, mental health, and social inequities are reviewed, along with the applied framework of minority stress. Then, the process of criminalization is diagrammed across the phases of predetainment, being in the system, and through re-entering the community. Finally, multilevel strategies are offered to decriminalize LGBTQ+ people ideologically and in practice.

Sexual orientation concealment and mental health: A conceptual and meta-analytic review

Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prospective associations among relationship abuse, sexual harassment and bullying in a community sample of sexual minority and exclusively heterosexual youth

INTRODUCTION

Sexual minority youth (SMY) are at significantly greater risk for experiencing adolescent relationship abuse (ARA) than exclusively heterosexual youth, yet little is known about the factors that elevate their risks for such abuse. Peer victimization (i.e., bullying, sexual harassment) has been associated with ARA among heterosexual youth. SMY experience higher rates of peer victimization than heterosexual youth, suggesting that it may be a risk factor for ARA among these youth. Using longitudinal data from a community sample of adolescents recruited from the northeastern US, we examined whether sexual identity was associated prospectively with ARA, and whether that relationship would be indirect, and mediated via bullying and sexual harassment at a 12-month follow-up. We expected to find higher rates of peer victimization and ARA among SMY than heterosexual youth, and we expected that sexual harassment and bullying would predict subsequent relationship abuse.

METHODS

Adolescents (N = 800; 58% female; 81% European-American; 19% SMY) between 13 and 15 years (M = 14.45, SD = 0.85) completed a web survey at baseline, 6-months and 12-months.

RESULTS

Consistent with prior studies, SMY reported higher rates of bullying, sexual harassment, and relationship abuse than heterosexual youth. SMY who reported sexual harassment at baseline were more likely to report relationship abuse over time. Contrary to our expectations, however, bully victimization did not predict subsequent relationship abuse.

CONCLUSIONS

Sexual harassment can be particularly harmful for SMY because it targets gender and sexual identity at a formative developmental period and puts youth at risk for relationship abuse.

"The Worst Part Was Coming Back Home and Feeling Like Crying": Experiences of Lesbian, Gay, Bisexual and Trans Students in Portuguese Schools

Portugal is one of the most egalitarian countries in Europe in terms of lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals' legal rights. However, regarding education Portugal still lacks specific policies, plans and interventions to protect LGBTI students. To assess the perceptions of self-identified LGBTI youth regarding their school context, a total of 663 participants (aged from 15 to 20 years old) filled in an on-line questionnaire about their school climate. One hundred and forty-six of them answered an open-ended question about their personal experiences. A thematic analysis of these answers was conducted, and four main categories were identified: (i) victimization, (ii) coming out experiences, (iii) support networks, and (iv) demands. Most participants reported experiences of discrimination, and several sources of prejudice were identified. Furthermore, participants also recognized a lack of LGBTI information in school curriculum and made several demands. Besides inclusive laws, we suggest that the safety and the well-being of LGBTI youths in Portuguese schools depend upon others measures, such as teacher and school staff training, curricula inclusive of LGBTI diversity, and local strategies, such as Gay-Straight Alliances.

Understanding (and Acting On) 20 Years of Research on Violence and LGBTQ + Communities

Questions related to violence, vulnerability, and sexual and gender minorities continuing to occupy a focal place in U.S. public discourse. We reviewed findings from 20 years of research on that topic to make recommendations for policy, practice, and future research. This article synthesizes findings from 102 peer-reviewed articles as well as a small number of unpublished studies and grey literature. We found no data to support the idea (widespread in popular discourse) that those in the sexual or gender majority require protection from sexual or gender minority individuals. Instead, this wide body of research indicates that sexual and gender minorities are themselves at elevated risk for physical and sexual assault, harassment, bullying, and hate crime victimization throughout childhood, adolescence, and adulthood. Contradicting the image of hate crimes as perpetrated by strangers or acquaintances, we find that bias-related verbal abuse, physical, and sexual assault by close family members contribute heavily to observed victimization rates. Further, despite the perception that society is becoming more welcoming, victimization disparities appear to be stable or widening since the 1990s. More studies with probabilistic sampling approaches, standardized measures, and larger samples of gender minorities are needed. However, widespread victimization of sexual and gender minorities is clearly an urgent issue, demanding attention from clinicians, program developers, and policy makers.

A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth

Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.

Sources of Social Support and Mental Health Among LGB Youth

Disparities in psychosocial adjustment have been identified for lesbian, gay, and bisexual (LGB) youth, yet research that explores multiple sources of social support among subgroups of LGB youth is sparse. Social support theory is used as a framework to analyze the ways that different sources of support might promote better psychosocial adjustment for LGB youth. Data from a diverse sample among LGB youth (N = 835) were used to understand how social support from a close friend, teachers, classmates, and parents might be differently associated with depression and self-esteem. We found that parent support and its importance to the participant were consistently related to higher self-esteem and lower depression for all youth, except for lesbians for whom no forms of social support were associated with self-esteem. Teacher and classmate support influenced some subgroups more than others. These results provide parents, clinicians, and schools a roadmap to assist youth navigate supports.

Measuring Adult Children's Perceptions of Their Parents' Acceptance and Rejection of Their Sexual Orientation: Initial Development of the Parental Acceptance and Rejection of Sexual Orientation Scale (PARSOS)

The Parental Acceptance and Rejection of Sexual Orientation Scale was administered to 256 self-identified lesbian, gay, bisexual, or queer adults who had been out of the closet to their parents for at least 1 year. Principal component analysis revealed a clear two-component solution: parental acceptance and parental rejection. Findings showed that perceived maternal sexual orientation-specific acceptance was higher, and perceived maternal sexual orientation-specific rejection was lower, for gay/bisexual sons compared to their lesbian/bisexual daughters. Results of regression analyses suggest that both perceived sexual orientation specific acceptance and rejection predicted adult children's psychological symptoms after accounting for perceived global parental acceptance and rejection and the child's gender. The scale's utility for research and practice are noted.

Chasing the rainbow: lesbian, gay, bisexual, transgender and queer youth and pride semiotics

While the pride rainbow has been part of political and social intervention for decades, few have researched how lesbian, gay, bisexual, transgender and queer young people perceive and use the symbol. How do lesbian, gay, bisexual, transgender and queer youth who experience greater feelings of isolation and discrimination than heterosexual youth recognise and deploy the symbol? As part of a larger study on supportive lesbian, gay, bisexual, transgender and queer youth environments, we conducted 66 go-along interviews with lesbian, gay, bisexual, transgender and queer youth people from Massachusetts, Minnesota and British Columbia. During interviews, young people identified visible symbols of support, including recognition and the use of the pride rainbow. A semiotic analysis reveals that young people use the rainbow to construct meanings related to affiliation and positive feelings about themselves, different communities and their futures. Constructed and shared meanings help make the symbol a useful tool for navigating social and physical surroundings. As part of this process, however, young people also recognize that there are limits to the symbolism; it is useful for navigation but its display does not always guarantee supportive places and people. Thus, the pride rainbow connotes safety and support, but using it as a tool for navigation is a learned activity that requires caution.

Mindfulness as a Coping Strategy for Bias-Based School Victimization among Latina/o Sexual Minority Youth

This study examined whether mindfulness strategies (e.g., acting non-judgmentally with awareness and attention to present events) were effective in mitigating the associations among school-based victimization related to ethnicity and sexual orientation, well-being (i.e., depressive symptoms and self-esteem), and grade-point average (GPA). The U.S.-based sample included 236 Latina/o sexual minority students, ranging in age from 14 to 24 years (47% were enrolled in secondary schools, 53% in postsecondary schools). Results from structural equation modeling revealed that ethnicity-based school victimization was negatively associated with GPA but not well-being. However, sexual orientation-based victimization was not associated with well-being or GPA. Mindfulness was positively associated with well-being but not GPA. High levels of mindfulness coping were protective when the stressor was sexual orientation-based victimization but not ethnicity-based school victimization. These findings contribute to a growing literature documenting the unique school barriers experienced by Latina/o sexual minority youth and highlight the promising utility of mindfulness-based intervention strategies for coping with minority stress.

Ecological Covariates of Subtle and Blatant Heterosexist Discrimination Among LGBQ College Students

Sexual minority college students report experiencing interpersonal heterosexism, ranging from subtle insults to blatant physical violence. Such negative experiences can complicate developmental tasks common to adolescence and emerging adulthood. Studies examining the nature of heterosexism on college campuses have focused on blatant manifestations, yet subtle forms are more prevalent. Guided by ecological theory, we investigate the microsystem (e.g., perceived social support from friends, ambient heterosexism on campus), mesosystem (e.g., interaction between social support and ambient heterosexism), and macrosystem level (e.g., knowledge of gay-straight alliances on campus) covariates of interpersonal microaggressions, avoidance behaviors, verbal threats, and physical threats. Participants consisted of 530 self-identified LGBQ college students from 37 states. Regression results suggest that at the microsystem level, ambient heterosexism was positively associated with interpersonal microaggressions, avoidance behaviors, and verbal threats. At the mesosystem level, perceptions of LGBQ student support within one's institution moderated the effects of ambient heterosexism on three types of interpersonal heterosexism. At the macrosystem level, students who reported knowing that their campus had a sexual-orientation inclusive anti-discrimination policy reported encountering fewer verbal threats. Directions for future research and implications for campus programming are discussed.

A Psychometric Review of Measures Assessing Discrimination Against Sexual Minorities

Discrimination against sexual minorities is widespread and has deleterious consequences on victims' psychological and physical wellbeing. However, a review of the psychometric properties of instruments measuring lesbian, gay, and bisexual (LGB) discrimination has not been conducted. The results of this review, which involved evaluating 162 articles, reveal that most have suboptimal psychometric properties. Specifically, myriad scales possess questionable content validity as (1) items are not created in collaboration with sexual minorities; (2) measures possess a small number of items and, thus, may not sufficiently represent the domain of interest; and (3) scales are "adapted" from measures designed to examine race- and gender-based discrimination. Additional limitations include (1) summed scores are computed, often in the absence of scale score reliability metrics; (2) summed scores operate from the questionable assumption that diverse forms of discrimination are necessarily interrelated; (3) the dimensionality of instruments presumed to consist of subscales is seldom tested; (4) tests of criterion-related validity are routinely omitted; and (5) formal tests of measures' construct validity are seldom provided, necessitating that one infer validity based on the results obtained. The absence of "gold standard" measures, the attendant difficulty in formulating a coherent picture of this body of research, and suggestions for psychometric improvements are noted.

Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth

Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified.

Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the ‘failed’ self

International evidence suggests that young people are less likely to seek help for mental health problems in comparison with adults. This study focused on lesbian, gay, bisexual and trans young people who are a population group with an elevated risk of suicide and self-harm, and little is known about their help-seeking behaviour. Utilising qualitative virtual methods, lesbian, gay, bisexual and trans youth web-based discussions about seeking help for suicidal feelings and self-harming were investigated. Findings from a thematic analysis indicate that these young people wanted assistance but found it difficult to (1) ask for help, (2) articulate emotional distress and (3) ‘tell’ their selves as ‘failed’. This analysis suggests that key to understanding these problems are emotions such as shame which arise from negotiating norms connected to heterosexuality, adolescence and rationality. I argue that these norms act to regulate what emotions it is possible to feel, what emotions it is possible to articulate and what type of young lives that can be told. The future development of health and social care interventions which aim to reduce lesbian, gay, bisexual and trans youth suicide and self-harm need to work with a nuanced understanding of the emotional life of young people if they are to be effective.

How a romantic relationship can protect same-sex attracted youth and young adults from the impact of expected rejection

Same-sex attracted youth's well-being is jeopardized by components of minority stress, but this stress can be buffered by social support. What is unknown is whether a romantic relationship can also serve as a buffer. With an online survey we examined the link between components of minority stress, psychological well-being, and its moderated relation by romantic relationship status among 309 Dutch same-sex attracted youth (16-24 years old, 52.9% female). The results showed that minority stress components (internalized homophobia, expected rejection, and meta-stereotyping) were negatively related to psychological well-being. Moderation analyses revealed that only the impact of "expected rejection" on psychological well-being was buffered for those involved in a romantic relationship. This shows the particular functional link of romantic support in rejection contexts.

Sexual assault, drinking norms, and drinking behavior among a national sample of lesbian and bisexual women

Childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) are strongly associated with women's alcohol use and the rates of both alcohol use and sexual assault history are higher among lesbian and bisexual women than heterosexual women. Although descriptive drinking norms are one of the highest predictors of alcohol use in emerging adults, this is the first study to examine the relationship between sexual assault history, drinking norms, and alcohol use in lesbian and bisexual women. We found that CSA severity was associated with a higher likelihood of experiencing more severe alcohol-involved ASA, more severe physically forced ASA, and was indirectly associated with more drinking behavior and higher drinking norms. Additionally, more severe alcohol-involved ASA was associated with higher drinking norms and more drinking behavior, but physically forced ASA was not. These findings help explain previous contradictory findings and provide information for interventions.

Victimization among female and male sexual minority status groups: evidence from the British Crime Survey 2007-2010

International surveys of victims show crime rates in England and Wales, including hate crimes, are among the highest in Europe. Nevertheless, sexual minority status is a less considered risk factor in general victimization research. This study used sexual minority status and sex to predict victimization across British Crime Surveys from 2007-2010. Logistic regression analyses showed sexual minority status groups were more likely than heterosexuals to be victimized from any and some specific crimes. However, bisexuals rather than lesbians or gay men were more consistently victimized, notably by sexual attacks and within the household. Implications for understanding victimization among these groups are discussed.

Sexual identity group differences in child abuse and neglect

Childhood abuse and neglect are pervasive problems among girls and young women that have numerous health consequences. Research suggests that sexual minority women are more likely than heterosexual women to report childhood abuse and neglect, but little is known about which sexual minority women are at greatest risk for these early adverse experiences. Using data from a pooled sample of women in a national probability study and in a large community-based study of sexual minority women designed to replicate the national study's methodology (pooled n = 953), we investigated rates and characteristics of childhood sexual abuse, physical abuse, and neglect among women from five sexual identity groups. As predicted, heterosexual women reported significantly less childhood abuse and neglect than did women who identified as mostly heterosexual, bisexual, mostly lesbian, or lesbian. We found considerable variability across the sexual minority subgroups, including severity of abuse, highlighting the need for research that distinguishes among these groups. To the extent that differences reported by women in the sample reflect the actual prevalence and severity of abuse experiences, sexual identity group differences in childhood abuse have important clinical and public health implications.

Operationalization of three dimensions of sexual orientation in a national survey of late adolescents

This study investigated three dimensions of sexual orientation-identity, attraction, and behavior-in a national survey of late adolescents. Prevalence rates and the diversity of dimensions of sexual orientation when combined were studied. A representative sample of 3,432 Swedish high school seniors completed an anonymous school-based self-report survey about sexuality, Internet use, and health. Four measures of sexual orientation were included-one for sexual identity, two for attraction (emotional or sexual attraction, romantic attraction), and one for sexual behavior. Prevalence rates of sexual minority orientation varied between 4.3% for sexual behavior (males 2.9%, females 5.6%) and 29.4% for emotional or sexual attraction (males 17.7%, females 39.5%). Different measures of sexual orientation were significantly associated with one another. Bisexual or homosexual orientation was reported by 1.5% of the participants in all four measures and by 17.6% in at least one measure. Researchers need to carefully choose, depending on the research questions under investigation, which dimensions of sexual orientation and which measures they wish to include in their survey. Recommendations based on findings from the study are given.

Assessing Developmental Trajectories of Sexual Minority Youth: Discrepant Findings from a Life History Calendar and a Self-Administered Survey

Research suggests that the timing and sequence of sexual identity development milestones impacts myriad health and mental health outcomes for sexual minority youth. Because these milestone events are typically assessed retrospectively, traditional data collection approaches are limited by recall bias and lack of precision in the recording of milestone events, which may conceal the distinctions between events and distort the recording of youths' developmental trajectories. The purpose of this exploratory study was to compare responses to questions about psychosexual milestones elicited by a Life History Calendar and a self-administered survey. Results indicated discrepancies in the reported occurrence and timing of milestone events between the survey and Life History Calendar. Differences in the timing of specific milestone events ranged from two months to 15 years. Implications of these discordant findings for sexual minority youth are discussed.

The influence of general identity disturbance on reports of lifetime substance use disorders and related outcomes among sexual minority adults with a history of substance use

Previous research has shown that sexual minority (i.e., nonheterosexual) individuals report increased problematic substance use involvement, compared with their sexual majority counterparts. We hypothesize that feelings of an unstable sense of self (i.e., identity disturbance) may potentially drive problematic substance use. The purpose of the current study is to examine identity disturbance among sexual minorities as a potential explanatory mechanism of increased sexual minority lifetime rates of substance dependence. Measures of identity disturbance and three indicators of sexual orientation from lifetime female (n = 16,629) and male (n = 13,553) alcohol/illicit drug users in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Findings generally showed that the increased prevalence of alcohol dependence, illicit drug dependence, and combined alcohol/illicit drug dependence as well as a younger age of alcohol use initiation among sexual minority women was associated with elevated levels of identity disturbance. The results were consistent with a mediational role for identity disturbance in explaining the association between sexual minority status and substance dependence and were generally replicated among male sexual minority respondents. The current research suggests that identity disturbance, a predictor of substance use, may contribute to heightened risk for substance dependence among certain subgroups of sexual minority individuals.

Alcohol-Related Problems among Sexual Minority Women

In this article I describe the historical context for research on sexual minority women's drinking, including the age-old tendency to link homosexuality and alcoholism; I summarize gaps and limitations that characterized much of the research on sexual minority women's drinking over the past several decades; and I review recent literature to highlight progress in the field-with a particular focus on my own research related to risk and protective factors for heavy drinking and drinking-related problems among sexual minority women. I conclude with a discussion of barriers to treatment for sexual minority women and recommendations for substance abuse treatment providers.

Victimization and substance use disorders in a national sample of heterosexual and sexual minority women and men

CONTEXT

There is consensus in the research literature that substance use disparities exist among sexual minority women and men; however, few studies have examined risk factors that may contribute to these disparities.

AIMS

To compare reports of life-time victimization experiences in a US national sample of adult heterosexual and sexual minority women and men and to examine the relationships between victimization experiences and past-year substance use disorders.

DESIGN, PARTICIPANTS, MEASUREMENTS

The secondary data analyses used 2004-05 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data collected in structured diagnostic face-to-face interviews in the United States. Substance use disorders (SUDs) were defined according to DSM-IV criteria and included past-year alcohol abuse, alcohol dependence, drug abuse and drug dependence. The sample consisted of 34 653 adults aged 20 years and older; approximately 2% of the respondents self-identified as sexual minority (lesbian, gay or bisexual).

FINDINGS

Results showed strong associations between victimization and any past-year SUDs and confirmed findings from several previous studies indicating that, compared with heterosexuals, sexual minority women and men are at heightened risk for life-time victimization. However, prevalence of the seven victimization experiences and the degree of association between individual victimization experiences and SUDs varied substantially across sexual minority subgroups. The childhood victimization variables-especially childhood neglect-showed the strongest and most consistent associations with SUDs. Odds of SUDs were generally higher among both female and male respondents, regardless of sexual identity, who reported multiple (two or more) victimization experiences than among those who reported no life-time victimization, suggesting a possible cumulative effect of multiple victimization experiences.

CONCLUSIONS

Higher rates of life-time victimization, particularly victimization experienced in childhood, may help to explain higher rates of substance use disorders among sexual minorities. However, more research is needed to understand better the complex relationships among sexual orientation, victimization and substance use.

Sexual-Minority College Women's Experiences with Discrimination: Relations with Identity and Collective Action

This study examined sexual-minority women's reports of sexism, heterosexism, and gendered heterosexism (discrimination that is both sexist and heterosexist) as predictors of social identity and collective action during college. A measure of gendered heterosexism was developed that assesses women's experiences with discrimination that is simultaneously sexist and heterosexist in nature. This measure was distinct from measures of sexism and heterosexism and had good internal consistency. The sample included 83 sexual-minority college women (mean age = 19.93 years). Significant differences occurred between groups of women based on their identification as lesbian/queer or bisexual. Lesbian/queer women reported significantly more heterosexist discrimination, social identity, and commitment to sexual orientation activism than did bisexual women. After controlling for reported sexism, heterosexism, and their interaction, reported gendered heterosexism uniquely predicted social sexual-orientation identity, commitment to feminist activism, and commitment to lesbian/gay/bisexual/queer (LGBQ) collective action. Thus, young LGBQ women may experience discrimination that is qualitatively different from sexism, heterosexism, or high levels of both sexism and heterosexism. Results are discussed in terms of the implications of intersectionality on sexual-minority women's experiences and identity development.

"Coming out" stories of gay and lesbian young adults

Gay and lesbian young adults (N = 53) were interviewed about coming out to their parents. Analyses of memory content were conducted. Hypotheses related to disclosure were largely supported. Participants typically first disclosed their sexual orientation to a friend. More participants came out to their mother than their father. When disclosure was made to both parents, mothers were told prior to fathers. Mothers were often told using direct methods, whereas fathers were typically informed using indirect methods. Mothers tended to inquire about their sons' sexuality; mothers inquired less with daughters. Findings are discussed in relation to autobiographical memory, sexuality, and clinical literatures.

Age of minority sexual orientation development and risk of childhood maltreatment and suicide attempts in women

Women with minority sexual orientations (e.g., lesbian, bisexual) are more likely than heterosexual women to report histories of childhood maltreatment and attempted suicide; however, the importance of the timing of minority sexual orientation development in contributing to this increased risk is uncertain. This study investigated relationships between self-reported ages of achieving minority sexual orientation development milestones (first awareness of same-gender attractions, disclosure of a minority sexual orientation to another person, and same-gender sexual contact), and childhood maltreatment and suicide attempt experiences in a sample of 2,001 women recruited from multiple-community sources. Younger age of minority sexual orientation development milestones was positively linked to self-reported recall of childhood maltreatment experiences, and to a childhood suicide attempt. After adjusting for differences in maltreatment, the odds of suicide attempt attributable to younger age of sexual orientation development milestones was reduced by 50 to 65%, suggesting that maltreatment may account for about half of the elevated risk for childhood suicide attempts among women with early minority sexual orientation development. Implications for services, interventions, and further research to address maltreatment disparities for sexual minorities are discussed.

Sexual and physical abuse: a comparison between lesbians and their heterosexual sisters

The purpose of this study was to investigate similarities and differences in the incidence and patterns of abuse experienced by lesbians and their heterosexual sisters. In a matched sample of 324 lesbian/heterosexual sister pairs, the lesbians reported a greater incidence than their sisters of childhood physical and sexual abuse, as well as adult sexual abuse. Both groups identified male relatives as the most common perpetrator of both childhood physical and sexual abuse. Male relatives were most commonly identified as perpetrators of adult physical abuse and male strangers were most commonly identified as adult sexual abusers. Our results demonstrate that both sexual and physical abuse are common experiences for lesbian and heterosexual women; however, since the context of these experiences is different, each group will have special needs for services and treatment.

Comparing sexual-minority and heterosexual young women's friends and parents as sources of support for sexual issues

The present study provides a comparative analysis of sexual-minority and heterosexual emerging adult women's experiences seeking support for sexual issues from parents and friends. Participants included 229 college women (88 sexual-minority women; 141 heterosexual women), ranging from 18 to 25 years of age, who provided written responses to an inquiry about a time they went to friends and parents for support for a issue related to their sexuality. Responses indicated that the majority of participants had sought support from either a parent or a friend and that mothers and female friends were more likely involved than fathers or male friends, respectively. Sexual issues that participants reported discussing with parents and friends were inductively grouped into five categories: dating and romantic relationships, sexual behavior, sexual health, identity negotiation, and discrimination and violence. Issues that were discussed differed based on sexual orientation identity and the source of support (parent or friend); they did not differ by age. Participants generally perceived parents and friends' responses as helpful, though sexual-minority participants perceived both parents and friends' responses as less helpful than did heterosexual participants. Overall, results suggest both similarities and differences between sexual-minority and heterosexual young women's experiences seeking support for sexual issues from parents and friends.

Age cohort differences in the developmental milestones of gay men

As the social context in which gay men live changes due to greater visibility, greater acceptance, and easier access to gay subculture, gay males may self-identify and take part in gay social activities at earlier ages than in the past. This study examined whether developmental milestones associated with sexual orientation for gay men have changed over the past several decades. A large and diverse sample of 2,402 gay men who responded to a 1994 survey published in a national magazine provided retrospective information on the age at which they reached individual psychological, social, and sexual behavior developmental milestones. We found evidence that individual psychological and sexual behavior milestones (e.g., awareness of attraction to males, having an orgasm with other male) are slowly moving toward earlier chronological ages (by 1 year of age every 8-25 years, p < 0.05), whereas social milestones (e.g., coming out) are moving more rapidly in a similar direction (by 1 year of age every 2-5 years, p < 0.001). The authors perform an innovative sensitivity test to demonstrate the persistence of the finding after correcting for the bias attributable to underrepresentation of those who have not yet self-identified as gay in such samples.

Health concerns of sexual minority adolescent girls

PURPOSE OF REVIEW

The goal of this article is to provide an overview of up-to-date health information about sexual minority female youth so that healthcare practitioners can better serve their healthcare needs.

RECENT FINDINGS

Sexual minority adolescent girls may follow diverse sexual developmental trajectories. Many in this population are quite healthy, but some may be disproportionately vulnerable to health risks, perhaps because of the stigma associated with minority sexuality in society. If sexually active, girls in this population often have sex with boys as well as girls and confront risks attendant with sex with both genders. They may demonstrate fluidity in their sexual identity as they move through adolescence. Data suggest that sexual minority adolescent girls are more likely to smoke cigarettes, drink alcohol, or use illicit drugs compared with girls who are heterosexual. They may be more likely to be victims of violence or victimization or to be depressed or suicidal.

SUMMARY

Sexual minority adolescent girls may be quite resilient, but they face a range of possible adverse health risks. Healthcare practitioners should keep their health issues in mind so they can offer healthcare and counseling that is sensitive, comprehensive, and appropriate.

Predicting the suicide attempts of lesbian, gay, and bisexual youth

In this study predictors of serious suicide attempts among lesbian, gay, and bisexual (LGB) youth were examined. Three groups were compared: youth who reported no attempts, youth who reported attempts unrelated to their sexual orientation, and youth whose attempts were considered related to their sexual orientation. About one third of respondents reported at least one suicide attempt; however, only half of the attempts were judged serious based on potential lethality. About half of all attempts were related to youths' sexual orientation. Factors that differentiated youth reporting suicide attempts and those not reporting attempts were greater childhood parental psychological abuse and more childhood gender-atypical behavior. Gay-related suicide attempts were associated with identifiability as LGB, especially by parents. Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males. Assessment of past parental psychological abuse, parental reactions to childhood gender atypical behavior, youths' openness about sexual orientation with family members, and lifetime gay-related verbal abuse can assist in the prediction of suicide attempts in this population.