Subtle and Intersectional Minority Stress and Depressive Symptoms Among Sexual and Gender Minority Adolescents of Color: Mediating Role of Self-Esteem and Sense of Mastery

State-level structural racism and adolescent mental health in the United States

We explored state-level indicators of structural racism on internalizing symptoms of depressive affect among US adolescents. We merged 16 indicators of state-level structural racism with 2015-19 Monitoring the Future surveys (n = 41 258) examining associations with loneliness, self-esteem, self-derogation, and depressive symptoms using regression analyses. Students racialized as Black in states with bans on food stamp eligibility and temporary assistance for drug felony conviction had 1.37 times the odds of high depressive symptoms (95% confidence interval [CI], 1.01-1.89) compared to students in states without bans. In contrast, students racialized as White living in states with more severe disenfranchisement of people convicted of felonies had lower odds of high self-derogation (odds ratio [OR], 0.89; 95% CI, 0.78-1.02) and high depressive symptoms (OR, 0.83; 95% CI, 0.70-0.99) compared to states with less severe disenfranchisement. These findings demonstrate the need to address the legacy of structural racism at the state level to reduce mental distress for US youth. This article is part of a Special Collection on Mental Health.

Social-ecological barriers and facilitators to seeking inpatient psychiatric care among transgender and nonbinary people: A qualitative descriptive study

AIM(S)

To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people.

DESIGN

Qualitative interview study.

METHODS

Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study.

RESULTS

Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options.

CONCLUSION

Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care.

IMPLICATIONS

Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care.

IMPACT

The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery.

PATIENT/PUBLIC CONTRIBUTION

Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.

The roles of psychosocial resources in reducing the impact of gendered racism on worry among Black women attending an HBCU

Objective: The study ascertained the effects of Black college women's experiences of gendered racism on worry. Psychosocial resources were examined as factors expected to reduce the impact of gendered racial microaggressions on worry. Participants: The sample comprised 197 Black-identified students enrolled at a southern Historically Black College or University. Methods: A cross-sectional research design was used. After adjusting for covariates, Ordinary Least Squares (OLS) regression models evaluated the associations between gendered racial microaggressions, psychosocial resources, and worry. Results: Frequent experiences of gendered racial microaggressions were associated with heightened worry. The Angry Black Woman stereotype had the most robust relationship with worry. Psychosocial resources, specifically mastery, self-esteem, and resilience, reduced the impact of gendered racial microaggressions on worry. Conclusion: Gendered racism contributes to increased worry, and thus, heightens the risk of experiencing anxiety. High levels of mastery, self-esteem, and resilience reduce the effects of gendered racism on worry.

The pride framework: a sociocultural-developmental approach for understanding LGBTQ+ adolescents' body image and disordered eating

This theoretical review paper offers a sociocultural-developmental framework for understanding LGBTQ+ adolescents' body image concerns and disordered eating risk. The Pride Framework integrates well-established sociocultural theories and extant empirical research, drawing from objectification theory, the tripartite influence model, minority stress theory, and intersectionality theory. The Pride Framework situates sociocultural appearance pressures within the adolescent developmental context, wherein biological, cognitive, and social transitions exacerbate the likelihood of body image disturbances and eating pathology. Various processes are then posited to link these sociocultural-developmental pressures to body image concerns and disordered eating. Crucially, this framework underscores that LGBTQ+ status itself does not pose a risk for body dissatisfaction and eating disorders. Instead, it is the experience of residing in a society that stigmatizes LGBTQ+ identities that increases youth's vulnerabilities. LGBTQ+ health researchers and practitioners are encouraged to engage in collaborative efforts with the aim of fostering acceptance for LGBTQ+ youth. This, in turn, could support normative adolescent identity exploration processes within sociocultural settings that are both affirming and inclusive, potentially mitigating adverse health consequences associated with body image disturbances.

A multisystem model for understanding stress and adaptation in ethnically and racially diverse youth

Contemporary biological and contextually based theoretical frameworks have conceptualized how stress exposure may influence adaptation in youth. However, nearly all of this scholarship neglects the role of specific contextual features and/or biological processes that are involved in ethnic-racial minority youth's responses and adaptation to sociocultural stressors. Drawing on the theoretical principles of the developmental psychopathology framework and contemporary models of stress and adaptation, this article proposes a new multisystem model that explains how multiple levels and systems within and outside of individual youth influence their sociocultural adaptation. We provide empirical evidence to support components of this multisystem model. We propose that research based on our new theoretical framework will capture the sociocultural experiences of ethnic-racial minority youth by centering processes that are relevant to their lived experiences, coping, and adjustment. In doing so, this model will inform psychosocial interventions focused on promoting healthy adaptation among ethnic and racial diverse youth. Finally, we offer recommendations to guide future research on stress and adaptation among ethnic and racial diverse youth, in particular, and developmental psychopathology more broadly.

The socioecology of sexual minority stigma: Advancing theory on stigma-based mechanisms underlying sexual orientation-based disparities in health

Research in public health and psychology has identified sexual minority stigma-related risk factors that contribute to sexual orientation-based health disparities across settings and societies worldwide. Existing scholarship, however, has predominantly focused on these factors as independent, stand-alone risk factors, neglecting their interconnected nature across different levels. This article theoretically explores how sexual minority stigma may function as a multilevel socioecological system, by building on prevailing theories and emphasizing the interplay between structural, interpersonal, and intrapersonal stigma-related factors. Drawing on the minority stress and socioecological theories, three central tenets are proposed, namely 1) chronosystem with immediate, accumulating, or lasting effects across spatiotemporal contexts, 2) nested multilevel system with cross-level effects, and 3) mechanistic pathways linking stigma exposure to health. By providing a nuanced and comprehensive understanding of how sexual minority stigma may operate as a multilevel socioecological system, this article reflects on the novel implications of this interpretation for future research and aims to guide future conceptualizations and studies, acknowledging the complexity of sexual minority stigma exposure across historical contexts, societies, and the individual life course in shaping physical and mental health of sexual minorities. Limitations of current research and recommendations for future research are being discussed.

Identifying pathways from childhood adversity to suicidal thoughts and behaviors among sexual minority adults: An exploratory mediation analysis

BACKGROUND

The current study uses a nationally representative longitudinal dataset of sexual minority adults in the US to investigate the pathways from adverse childhood experiences (ACEs) to adulthood suicidal thoughts and behaviors.

METHODS

ACEs were measured at year one, potential mediators at year two, and suicidal thoughts and behaviors (suicidal ideation, intent, plan, and attempt) at year three. We conducted an exploratory mediation analysis to identify potential mediating factors linking ACEs to suicidal thoughts and behaviors. Ten candidate mediators were examined: social well-being, felt stigma, experiences of everyday discrimination, social support, psychological distress, alcohol and drug use, importance of sexual identity, community connection, and internalized homophobia.

RESULTS

Participants were 1518 adults who identified as lesbian or gay (n = 833; 55 %), bisexual (n = 493; 33 %), or with other sexual minority identities (n = 181; 12 %) and were on average 36.48 years (SD = 14.7) of age. Psychological distress served as a common mediator between ACEs and suicidal ideation, intent, plan, and attempt. Additionally, experiences of everyday discrimination emerged as a specific mediator leading to suicidal intent, whereas social support uniquely mediated the relation between ACEs and suicide plan.

LIMITATIONS

Potential recall bias due to retrospective reporting of ACEs may be a limitation. Future studies should broaden the measurement scope of ACEs and implement intersectional methods.

CONCLUSION

The current findings underscore the urgent need for targeted interventions that address the specific mental health needs of sexual minority individuals, particularly focusing on mitigating psychological distress, combating systemic discrimination, and enhancing social support.

Out of the Closet, but Not Out of the Woods: The Longitudinal Associations Between Identity Disclosure, Discrimination, and Nonsuicidal Self-Injury Among Sexual Minoritized Young Adults

Sexual minoritized individuals engage in non-suicidal self-injury (NSSI) at higher rates than their heterosexual peers. Disclosing one's sexual minoritized identity can put one at risk for experiencing discrimination, which is linked to greater engagement in NSSI. However, discrimination has yet to be tested as a mechanism linking sexual identity disclosure to NSSI. Understanding how sexual identity disclosure impacts NSSI has the potential to inform interventions to reduce sexual orientation disparities in NSSI. To address this gap, the current study examined sexual orientation-based discrimination as a mediator of the longitudinal association between sexual identity disclosure and NSSI among 792 sexual minoritized young adults. Higher levels of disclosure at baseline were associated with greater likelihood of NSSI at two-month follow-up via greater discrimination at one-month follow-up, even after controlling for baseline levels of depression and demographic characteristics. The indirect effect became non-significant after controlling for previous levels of discrimination and NSSI. Findings provide partial support for the hypothesis that identity disclosure may precede exposure to discrimination and, in turn, engagement in NSSI. However, identity disclosure does not appear to predict acute increases in discrimination. Future research is encouraged to examine these prospective associations with longer intervals between assessments, as the indirect effect of identity disclosure on NSSI via discrimination may continue to accumulate over time. Findings highlight the need to reduce discrimination following sexual identity disclosure through the implementation of equitable and affirmative practices in school, healthcare, and other settings to improve the well-being of sexual minoritized young adults.

Microaggressions Toward Sexual and Gender Minority Emerging Adults: An Updated Systematic Review of Psychological Correlates and Outcomes and the Role of Intersectionality

Purpose: Quantitative data on the psychological effects of microaggressions toward sexual and gender minority individuals have grown substantially. Sexual orientation-based and transgender and gender-diverse (trans+) identity-based microaggressions have been thematically identified in prior research. In addition, combined lesbian, gay, bisexual, transgender and gender-diverse, queer/questioning, and other non-heterosexual (LGBTQ) microaggressions can be examined intersectionally with other marginalized identities. This systematic review synthesizes research on the relationships among these microaggressions and psychological correlates and outcomes. Methods: Forty-five quantitative studies examining sexual orientation-, trans+ identity-, or intersectional identity-based microaggressions and various psychological outcomes were identified from systematic searches of PsycINFO, PsycARTICLES, MEDLINE, and PubMed databases. Data regarding microaggressions were extracted, synthesized, and grouped by mental health outcome or correlate. Results: Sexual orientation-based microaggressions were risk factors for depression, anxiety, and internalized stigma and were positively associated with psychological distress, traumatic stress symptoms, alcohol use and abuse, cannabis use and problems, suicidal ideation, and suicide attempt. Trans+ identity-based microaggressions were positively associated with depression, suicide attempt, and cannabis use. LGBTQ intersectional identity-based microaggressions concerning race/ethnicity were associated with depression, anxiety, and suicidal ideation. Research on other intersectional identity-based microaggressions is scarce. Conclusion: These findings emphasize the psychological harm inflicted by various microaggressions on LGBTQ late adolescents and early adults. Future work should focus on microaggressions toward individuals with trans+ and intersectional identities and protective factors for these experiences. This review also highlights the distinct need for community-based research on implementing microintervention strategies in family, school, and work environments to mitigate the harmful effects of these microaggressions.

Sexual harassment, sexual assault, violence, self-esteem, and the role of LGBTQ-specific parental support in a sample of Latinx sexual and gender minority youth

INTRODUCTION

Oftentimes as result of racism, cissexism, and heterosexism, many Latinx and sexual and gender minority (SGM) youth are victims of sexual harassment, sexual assault, and violence. These experiences of victimization are in part related to increased negative mental health outcomes such as decreased self-esteem. Some research links LGBTQ-specific parental support to mental health outcomes among Latinx SGM youth, yet, no research has explored the role of LGBTQ-specific parental support with self-esteem among Latinx SGM youth.

METHODS

In a sample of 1,012 Latinx SGM youth (ages 13-17), we assessed: (a) associations between sexual harassment, sexual assault, and violence and self-esteem, (b) association between LGBTQ-specific parental support and self-esteem, and (c) whether LGBTQ-specific parental support moderated the relation between sexual harassment, sexual assault, and violence and self-esteem. Main effect and moderation analyses examined interactions between LGBTQ-specific parental support with sexual harassment, sexual assault, and violence on self-esteem.

RESULTS

Latinx SGM youth experienced low levels of LGBTQ-specific parental support and various degrees of sexual harassment, sexual assault, and violence. Also, transgender and nonbinary/genderqueer Latinx youth experienced lower self-esteem than their Latinx cisgender counterparts. Increased LGBTQ-specific parental support was related to increased self-esteem. We also identified a significant interaction between sexual harassment, sexual assault, and violence and LGBTQ-specific parental support, such that parental support was more protective at low levels rather than high levels of sexual harassment, sexual assault, and violence among Latinx SGM youth.

CONCLUSIONS

Findings add to a growing body of research about the importance of LGBTQ-specific parental support for Latinx SGM youth, and the need to examine culturally appropriate approaches to understand parent-child relationship among these communities.

Interpersonal protective factors for LGBTQ+ youth at multiple intersecting social identities and positions

Interpersonal supports are protective against multiple negative health outcomes for youth such as emotional distress and substance use. However, finding interpersonal support may be difficult for youth exposed to intersecting racism, heterosexism, and cisgenderism, who may feel they are "outsiders within" their multiple communities. This study explores disparities in interpersonal supports for youth at different sociodemographic intersections. The 2019 Minnesota Student Survey includes data from 80,456 high school students, including measures of four interpersonal supports: feeling cared about by parents, other adult relatives, friends, and community adults. Exhaustive Chi-square Automatic Interaction Detection analysis was used to examine all interactions among four social identities/positions (racialized/ethnic identity, sexual identity, gender identity, sex assigned at birth) to identify groups who report different rates of caring from each source (Bonferroni adjusted p<.05). In the overall sample, 69.24% perceived the highest level of caring ("very much") from parents, 50.09% from other adult relatives, 39.94% from friends, and 15.03% from community adults. Models identified considerable differences in each source of support. For example, more than 72% of straight, cisgender youth reported their parents cared about them very much, but youth who identified as LGBQ and TGD or gender-questioning were much less likely to report high parent caring (less than 36%) across multiple racialized/ethnic identities and regardless of sex assigned at birth. Findings highlight the importance of better understanding the ways interpersonal support might differ across groups, and underscore a need for intersectionality-tailored interventions to develop protective interpersonal supports for LGBTQ+ youth, rather than one-size-fits-all approaches.

Emerging Risk of Adolescent Depression and Suicide Detected Through Pediatric Primary Care Screening

OBJECTIVE

The goal of the current study was to document patterns of stability and change in adolescent depression and suicide risk detected via universal depression screening in pediatric primary care and to determine who may go on to experience emerging risk.

METHODS

Retrospective electronic health record information (sociodemographic data and depression screening results for 2 timepoints) was extracted for adolescents aged 12-17 who attended well-visits between November 15, 2017, and February 1, 2020, in a large pediatric primary care network. A total of 27,335 adolescents with 2 completed depression screeners were included in the current study.

RESULTS

While most adolescents remained at low risk for depression and suicide across the 2 timepoints, others experienced emerging risk (i.e., low risk at time 1 but elevated risk at time 2), decreasing risk (i.e., high risk at time 1 but low risk at time 2) or stable high risk for depression or suicide. Odds of experiencing emerging depression and suicide risk were higher among adolescents who were female (compared to males), Black (compared to White), and had Medicaid insurance (compared to private insurance). Odds of experiencing emerging depression risk were also higher among older adolescents (compared to younger adolescents) as well as adolescents who identified as Hispanic/Latino (compared to non-Hispanic/Latino).

CONCLUSIONS

Findings can inform symptom monitoring and opportunities for prevention in primary care.

Sleep and Socioemotional Outcomes Among Sexual and Gender Minority Adolescents: A Longitudinal Study

Sexual and gender minority adolescents face specific stressors associated with their minority status, leading to compromised socioemotional outcomes and sleep. Sleep patterns have, in turn, been found to predict socioemotional outcomes. As such, we aimed to investigate whether healthy sleep patterns prospectively predicted socioemotional outcomes, and whether associations varied as a function of sexual and gender minority status. We conducted a secondary data analysis among adolescents at age 14 to 17, from a nationally representative prospective cohort in the United Kingdom (N = 8923, mean age = 13.8), with 7021 cisgender heterosexual, 1801 sexual minority, and 101 gender minority adolescents. Indicators of socioemotional outcomes included self-esteem, emotional well-being, peer relationships, and relationship with parents. The results showed that gender minority adolescents reported the worst sleep patterns and socioemotional outcomes, followed by sexual minority and cisgender heterosexual adolescents. Results from multi-group path analyses showed that emotional well-being, self-esteem, and peer relationships at age 17 were prospectively predicted by sleep patterns and the associations were moderated by sexual and gender minority status. Influence of sleep patterns, particularly sleep initiation problems and frequent awakening, on socioemotional outcomes was greater among gender minority adolescents, when compared to cisgender heterosexual adolescents. In conclusion, positive socioemotional outcomes were predicted by healthy sleep patterns. The potential role of sleep health in optimizing socioemotional outcomes among sexual and gender minority adolescents might warrant further investigation in prevention or intervention studies.

Unaccompanied unstable housing among racially, ethnically, sexually, and gender diverse youth: Intersecting identities bearing the greatest burden

Disparities in youth homelessness by racial/ethnic, sexual, and gender identities are well documented, though this literature lacks specificity regarding intersectional social identities of youth who are most likely to experience homelessness. Population-based cross-sectional data on youth from the 2019 Minnesota Student Survey (N = 80,456) were used to examine the relationship between parent caring and intersections of minoritized identities that experience the highest prevalence of two distinct types of unaccompanied unstable housing with expanded categories of sexual and gender identities. Exhaustive chi-square automatic interaction detection models revealed that low parent caring was the most common predictor of unaccompanied homelessness and running away, but there was important variation among youth of color at the intersection of sexual and gender identities. The findings reveal a more complex story of disparities in unaccompanied unstable housing among youth with multiple marginalized social identities and highlight the need to create culturally informed prevention and intervention strategies for parents of LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and questioning) youth of color. The implications for prevention and intervention among subgroups with the highest prevalence are discussed in the context of interlocking systems of power and oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotional Distress Disparities Across Multiple Intersecting Social Positions: The Role of Bias-Based Bullying

OBJECTIVES

To apply an intersectional lens to disparities in emotional distress among youth, including multiple social positions and experiences with bias-based bullying.

METHODS

Data are from the 2019 Minnesota Student Survey (n = 80 456). Social positions (race and ethnicity, sexual orientation, gender) and 2 forms of bias-based bullying (racist, homophobic or transphobic) were entered into decision tree models for depression, anxiety, self-injury, suicidal ideation, and suicide attempts. Groups with the highest prevalence are described. Rates of emotional distress among youth with matching social positions but no bias-based bullying are described for comparison.

RESULTS

LGBQ identities (90%) and transgender, gender diverse, and questioning identities (54%) were common among the highest-prevalence groups for emotional distress, often concurrently; racial and ethnic identities rarely emerged. Bias-based bullying characterized 82% of the highest-prevalence groups. In comparable groups without bias-based bullying, emotional distress rates were 20% to 60% lower (average 38.8%).

CONCLUSIONS

Findings highlight bias-based bullying as an important point for the intervention and mitigation of mental health disparities, particularly among lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning adolescents. Results point to the importance of addressing bias-based bullying in schools and supporting lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning students at the systemic level as a way of preventing emotional distress.

Gender identity and expression in relation to depression and anxiety in racial and ethnic minority youth: Evaluations of intersectionality in a population-based study

INTRODUCTION

Transgender and gender non-conforming (TGNC) youth experience higher rates of depression and anxiety. Risk for these outcomes in racial and ethnic minority populations remains unclear. This study aimed to examine disparities in depression and anxiety at the intersection of race and ethnicity and TGNC status in a population-based sample.

METHODS

Data were from the 2019 Minnesota Student Survey. Students (n = 119,648) completed questions about their race, ethnicity, gender identity and expression, depression, and anxiety.

RESULTS

Within racial and ethnic groups, TGNC youth generally had greater risk for depression and anxiety. Significant associations for gender minority identity ranged from ORDepression = 2.25 for Black youth who do not identify as male to ORDepression = 5.08 for non-minority ethnicity youth who do not identify as female. For perceived gender expression in cisgender youth, significant associations ranged from ORDepression = 1.17 for Black youth assigned female at birth and ORAnxiety = 1.17 for other-minority ethnicity youth assigned female at birth to ORDepression = 1.46 for non-minority ethnicity youth assigned female at birth and ORAnxiety = 1.46 for American Indian/Alaskan Native youth assigned male at birth. Within-TGNC-youth comparisons yielded a few racial/ethnic differences relative to White peers. Significant differences ranged from ORAnxiety = 0.53 to ORAnxiety = 1.41 for cisgender females.

LIMITATIONS

The cross-sectional data limits our ability to test causation.

CONCLUSIONS

Multiple-minority youth were not universally at increased risk for depression and anxiety, indicating an intersectional framework is important for understanding risk for these outcomes in TGNC youth. Future research identifying potential risk and protective factors is needed to advance screening and treatment strategies for multiple-minority TGNC youth populations.

Substance Misuse among Sexual and Gender Minorities: The Role of Everyday Discrimination and Identity

BACKGROUND

Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity.

METHODS

Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation.

RESULTS

In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities.

CONCLUSIONS

Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance.

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents

Gender minority (GM) youth are at heightened risk for psychopathology, purportedly due to their experiences of GM stressors. However, few studies have examined how GM stressors are associated with depression and anxiety among GM youth. Furthermore, no prior studies have investigated how experiences of GM stressors differ across gender identity and race/ethnicity within a diverse sample of GM youth. A nationwide online cross-sectional survey of 1,943 fourteen- to 18-year-old GM adolescents (66.91% White, 11.73% multiracial, 8.49% Latinx, 7.10% Black, 3.09% Asian, 1.49% American Indian/Alaskan Native) in the United States assessed GM stressors (prejudice events, expectations of rejection, internalized transnegativity, and concealment) and mental health. Structural equation modeling was used to examine how GM stressors and depressive and anxiety symptoms differ across gender identity and race/ethnicity. Higher levels of each GM stressor were related to higher depressive symptoms. Prejudice events, expectations of rejection, and concealment were related to higher anxiety symptoms. Transmasculine and transfeminine youth reported higher levels of GM prejudice events and expectations of rejection, and higher mental health symptoms, than nonbinary youth. Findings were relatively consistent across racial/ethnic identities, with the exception that Black GM adolescents reported fewer GM prejudice events and expectations of rejection and indirectly exhibited lower mental health symptoms as compared to White GM youth. Researchers and clinicians should be attuned to how intersectional identities are related to stress and mental health among diverse GM youth. Recommendations for individual and structural-level interventions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Life Events and Loneliness Among Older Women of Diverse Sexual Identities: Application of the Stress Process Model

Loneliness among older adults has been a topic of interest in recent years. We analyse four waves of data from the Australian Longitudinal Study on Women's Health. We estimate growth models to examine differences in loneliness trajectories from age 50 for women who identify as exclusively heterosexual, plurisexual (bisexual, mainly heterosexual, mainly lesbian) and exclusively lesbian. We find no significant differences in levels of loneliness across sexual identity groups at age 50. We find that while loneliness trajectories of exclusively heterosexual women trend down, levels of loneliness increase with age among plurisexual women. Adverse health events and relationship problems increase loneliness to a greater extent among plurisexual women compared to exclusively heterosexual and exclusively lesbian women. Our results suggest older lesbian women may have accumulated social or personal resources or developed coping mechanisms over the courses of their lives, while plurisexual women remain a vulnerable group.

Minority stress and sleep: How do stress perception and anxiety symptoms act as mediators for sexual minority men?

OBJECTIVES

Sexual minority men experience worse sleep than heterosexuals. Little is known about how minority stress may account for these differences. Therefore, the aims of this study are to (1) understand the relationship between minority stress and sleep disturbance in a sample of sexual minority men, and (2) test whether these relationships are mediated by generalized anxiety symptoms and perception of stress.

METHODS

In 2020, 239 sexual minority men were recruited to complete an online survey. Participants responded to scales assessing minority stress (ie, internalized homophobia, experiences of harassment, microaggressions), perception of stress, generalized anxiety symptoms, and sleep disturbance. Linear regressions were used to test the relationship between minority stress and sleep disturbance and to test generalized anxiety symptoms and perception of stress as mediators.

RESULTS

The final model was significant (F = 16.916, p < .001) and accounted for 43.5% of the variance in sleep disturbance. Generalized anxiety symptoms and perception of stress fully mediated the relationships between minority stress and sleep disturbance.

CONCLUSIONS

Findings from this study suggest the need for psychological intervention to improve sleep for sexual minority men. Future research should test this model longitudinally, and include objective measures of stress. Future interventions could target stress perception using mindfulness or cognitive-based interventions.

Intersectional Minority Stress and Alcohol, Tobacco, and Cannabis Use Among Sexual and Gender Minority Adolescents of Color: Moderating Role of Family Support

Purpose: We examined the associations between intersectional minority stress and substance use among sexual and gender minority (SGM) adolescents of color and the moderating role of family support on these associations. Methods: Data were from a national U.S. sample of SGM adolescents of color (N = 3423). Intersectional minority stress was assessed with the LGBT People of Color Microaggressions Scale. Results: Intersectional minority stress was associated with greater odds of recent and heavy alcohol and recent cannabis use, but not tobacco use. When examining specific domains of intersectional minority stress, racism from SGM communities was associated with greater odds of recent and heavy alcohol, and recent cannabis use, whereas heterosexism from same racial/ethnic communities was associated with greater odds of recent cigarette and cigar use. Family support was associated with lower substance use. Family support was not a significant moderator. Conclusions: Findings underscore the need to examine intersectional stressors that SGM adolescents of color experience and to bolster family supports to prevent substance use. Family support did not buffer the effects of intersectional minority stress on substance use outcomes, suggesting that other strategies, such as other forms of family support (e.g., identity-specific support) and community-level and structural changes that target reducing and dismantling oppression are needed to reduce the deleterious impact of intersectional minority stress.

Perceived racial discrimination and suicidal behaviors among racial and ethnic minority adolescents in the United States: Findings from the 2021 adolescent behaviors and experiences survey

The objectives of this study were to investigate: (1) the prevalence of perceived racial discrimination (PRD) in school, among racial/ethnic minority adolescents, and (2) the association between PRD and suicidal behaviors among racial/ethnic minority adolescents in the United States. Data from a sample of 3241 racial/ethnic minority adolescents (53.7% female) from the 2021 Adolescent Behaviors and Experiences Survey were analyzed using binary logistic regression. Controlling for other factors, racial/ethnic minority adolescents who experienced PRD had 1.57 times higher odds of experiencing suicidal ideation (adjusted odds ratio (AOR) = 1.57, 95% Confidence Intervals (CI) = 1.09-2.25), 1.64 times higher odds of making a suicide plan (AOR = 1.64, 95% CI = 1.09-2.49), and 1.67 times higher odds of attempting suicide (AOR = 1.67, 95% CI = 1.04-2.68) during the past year. Other factors associated with suicidal behaviors included self-identifying as lesbian/gay, bisexual, or other/questioning; experiencing cyberbullying; feeling sad or hopeless; and poor mental health during the pandemic. The findings of this study extend past research and demonstrate that racial/ethnic minority adolescents who experienced PRD were more likely to report suicidal behaviors over and above other well-established risk factors for suicidal behaviors. Future studies that employ longitudinal designs are needed to elucidate mechanisms underlying these associations.

Reactions and Feelings to a Close Relative's Coming Out in a Heterosexual Relationship

Which different feelings and reactions do different family members show if an adult family member who has long been perceived as heterosexual discloses their sexual identity as lesbian, gay, or bisexual (LGB)? Previous studies have investigated reactions of spouses and sometimes children in the United States. This article describes the findings of qualitative interviews and a German-language quantitative survey (N = 188) in which family members were asked about their emotions, experiences during the coming out process, and their use of support options. The samples were recruited via different LGB+ online forums and organizations in Germany, Austria, and Switzerland (age M = 44.08). The results demonstrate that a coming out after years of a heterosexual biography and family life affects adults' parents and siblings in addition to spouses and children. Siblings were perceived as a supportive group of family members showing calm and mostly positive reactions. Parents mainly reported surprise but also showed on the one hand interest in supporting their children in the coming out process; on the other hand, we find also evidence for negative reactions including rejecting behavior. Children's coping and well-being depended on the time that had passed since the coming out and their age at the time of the coming out. Spouses felt shocked, angry, and the ground was pulled from under their feet. Comparing the perspectives of these groups of family members, differences between them, and their specific needs are discussed. Practical implications are derived from the support options mentioned, and range from information from books, the internet to professional advice. Spouses report the need of diverse support options, whereas other family members ask friends and other family members for support. Forums, counseling and the possibility to exchange were perceived as a support but were more accessible for women than for men. They provide the chance for a communicative exchange before the stress becomes too strong.