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Coulaud PJ, Salway T, Adams N, Ball W, Larmarange J, Kelly-Irving M, Knight R. Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults. J Epidemiol Community Health 2024; 78:556-560. [PMID: 38944417 DOI: 10.1136/jech-2023-221844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024]
Abstract
While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (eg, depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (eg, attractions, identities and behaviour) with various patterns (eg, directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (eg, gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people.
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Affiliation(s)
- Pierre-Julien Coulaud
- École de Santé Publique, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Nick Adams
- School of Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland
| | - William Ball
- School of Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland
| | - Joseph Larmarange
- Centre Population et Développement (UMR 196 Université Paris Cité, IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France
| | - Michelle Kelly-Irving
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Rod Knight
- École de Santé Publique, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
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Evans-Polce RJ, Kcomt L, Veliz P, Boyd CJ, McCabe SE. Associations of sexual identity change and identity-attraction discordance with symptomatic alcohol and other drug use. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1389-1399. [PMID: 38095678 PMCID: PMC11176265 DOI: 10.1007/s00127-023-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/20/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013-2019), and the associations with symptomatic alcohol and other drug use. METHODS Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity-attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex. RESULTS In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity-attraction discordance. CONCLUSION These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period.
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Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA.
| | - Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Research On Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research On Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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Krueger EA, Bishop MD, Mallory AB, Srivastava A, Russell ST. Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use. Am J Psychiatry 2024; 181:753-760. [PMID: 39086296 DOI: 10.1176/appi.ajp.20230458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
OBJECTIVE Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people. METHODS Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health. RESULTS Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=-0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=-0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs. CONCLUSIONS Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.
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Affiliation(s)
- Evan A Krueger
- School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell)
| | - Meg D Bishop
- School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell)
| | - Allen B Mallory
- School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell)
| | - Ankur Srivastava
- School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell)
| | - Stephen T Russell
- School of Social Work, Tulane University, New Orleans (Krueger); School of Public Health, University of Maryland College Park, College Park (Bishop); College of Education and Human Ecology, Ohio State University, Columbus (Mallory); School of Social Work, University of North Carolina, Chapel Hill (Srivastava); School of Human Ecology, University of Texas at Austin (Russell)
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Xu Y, Rahman Q. Sexual Orientation Identity Change, Developmental Trajectories of Depressive Symptoms, and Childhood Abuse From Adolescence to Young Adulthood. J Adolesc Health 2024; 74:523-530. [PMID: 38069933 DOI: 10.1016/j.jadohealth.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE This study tested differences between youths who reported being heterosexual at ages 15.5 and 21, and those who changed from reporting being heterosexual at age 15.5 to nonheterosexual at age 21, in the developmental trajectories of depressive symptoms from age 22-24 years, and whether these longitudinal patterns were explained by childhood and adolescent abuse. METHODS The Avon Longitudinal Study of Parents and Children (ALSPAC) was used (849 male youths and 1,455 female youths). Youths' self-reported sexual orientation was measured at ages 15.5 and 21, and depressive symptoms were measured at ages 22, 23, and 24. Childhood and adolescent abuse between birth and 17 years were reported by youths and their mothers. RESULTS Male and female youths who changed from reporting being heterosexual to nonheterosexual reported significantly more depressive symptoms than their consistently heterosexual counterparts at all 3 ages (except the association for male youths at age 24), with total effects (unstandardized regression coefficients) ranging from 2.00 to 5.27. These associations were weakened but remained statistically significant when childhood and adolescent abuse was controlled for, with direct effects ranging from 1.50 to 4.68. These associations were mediated through childhood and adolescent abuse, with indirect effects ranging from 0.48 to 0.58. Differences between youths who consistently reported being heterosexual and those who changed from reporting being heterosexual to nonheterosexual in depressive symptoms decreased from age 22-24 years, possibly due to the success of identity integration. DISCUSSION Childhood and adolescent abuse may partially explain these developmental disparities.
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Affiliation(s)
- Yin Xu
- Department of Sociology & Psychology, School of Public Administration, Sichuan University, Chengdu, China.
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Srivastava A, Hall WJ, Krueger EA, Goldbach JT. Sexual Identity Fluidity and Depressive Symptoms: Findings From a National Longitudinal Study of Sexual Minority Adolescents. J Adolesc Health 2023; 73:873-879. [PMID: 37530683 PMCID: PMC10592473 DOI: 10.1016/j.jadohealth.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/25/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Sexual minority adolescents (SMAs) consistently report elevated risk of mental health symptoms, including depression. Sexual identities may change over time (referred as sexual identity fluidity), particularly during adolescence. This study examined the effect of sexual identity fluidity on depressive symptoms over time. METHODS National longitudinal data were analyzed from SMAs aged 14-17 years (N = 1,077) in the adolescent stress experiences over time study during an 18-month period. Multigroup time-varying covariate latent growth models were employed to examine the effect of sexual identity fluidity on depressive symptoms. RESULTS In the sample, 40% of SMAs reported at least 1 change in sexual identity during an 18-month period. Cisgender females reported sexual identity fluidity at a higher rate than their male counterparts (46.9% vs. 26.6%, respectively). In our first model (total sample), a change in sexual identity was associated with reporting fewer depressive symptoms (b = -0.591, p = .004). In our multigroup model (by sex assigned at birth), a change in sexual identity was significantly associated with reporting fewer depressive symptoms among cisgender females (b = -0.591, p < .01). However, there was no significant effect found among cisgender males. The models controlled for age and race or ethnicity. DISCUSSION The results add to the limited knowledge on the complex relationship between sexual identity fluidity and mental health risks over time among adolescents. Our results indicate that sexual identity development and change processes differ between cisgender females and males. The nuances associated with these sexual identity processes need further investigation.
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Affiliation(s)
- Ankur Srivastava
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina.
| | - William J Hall
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina
| | - Evan A Krueger
- Tulane University, School of Social Work, Los Angeles, California
| | - Jeremy T Goldbach
- Washington University in St. Louis, Brown School of Social Work, St. Louis, Missouri
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Epstein R, Wang H, Zankich VR. Is everyone a mix of straight and gay? A social pressure theory of sexual orientation, with supporting data from a large global sample. Front Psychol 2023; 14:1187377. [PMID: 37496790 PMCID: PMC10367109 DOI: 10.3389/fpsyg.2023.1187377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/14/2023] [Indexed: 07/28/2023] Open
Abstract
Sigmund Freud, Alfred Kinsey, E.O. Wilson, and others have suggested that social pressure suppresses natural tendencies for humans to express bisexuality, the apparent norm for one of our two closest genetic relatives, the bonobo. An analysis of data obtained from a new online sample of 1,150,938 people in 215 countries and territories (63.9% from the United States, United Kingdom, and Canada) who completed the English version of a validated questionnaire of sexual orientation lends support to this idea. A histogram of scores from 0 (exclusive opposite-sex inclinations) to 18 (exclusive same-sex inclinations) forms a near-normal distribution. Although this distribution was likely caused to some extent by sampling bias, it may also reflect the unusual honesty people show when taking online tests anonymously, as an increasing body of evidence demonstrates. We present a formal mathematical expression of a social pressure theory of sexual orientation, along with empirical evidence and computational explorations that support the theory. We also present an analysis of the new data set. Among other findings: sexual orientation labels corresponded to broad, skewed, overlapping distributions of scores. Self-labeled gays/lesbians and, to a greater extent, self-labeled straights, reported that the larger the mismatch between their sexual orientation label and their actual sexual inclinations, the more distress they felt regarding their sexual orientation, a finding that is predictable from cognitive dissonance theory. Educating the public about the true nature of sexual orientation might quell the often rancorous public debates on this topic, as well as give comfort to a large number of mislabeled people.
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