Homoerotic development during childhood and adolescence

Sexual Identity Fluidity and Depressive Symptoms: Findings From a National Longitudinal Study of Sexual Minority Adolescents

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.

Sexual identity fluidity, identity management stress, and depression among sexual minority adolescents

Introduction

Sexual identity is mutable and evolving, particularly during adolescence. Sexual identity fluidity could be stressful for some adolescents and may differ by birth-sex. Evidence suggests chronic stress can lead to negative mental health outcomes. However, it is unknown if these two processes (stress and depression) differ by sexual identity fluidity.

Methods

This paper studied time-sequential associations between identity management stress and depression over time by sexual identity fluidity, in a national longitudinal data from sexual minority adolescents (SMA) aged 14-17 years using a multigroup autoregressive cross-lagged model (n = 1077).

Results

In the sample, 40% of SMA reported at least one change in sexual identity over 18-month period. Greater number of cisgender females reported sexual identity fluidity compared to their male counterparts (46.9% vs. 26.6%). A temporal cross-lagged effect was reported between depression and identity management stress among cisgender females who reported fluidity in sexual identity; and no cross-lagged effect was reported among those females who did not report fluidity. However, among cisgender male sample depression predicted subsequent identity management stress, irrespective of their change sexual identity fluidity status.

Conclusion

Public health programs and practice must be responsive to the sexual identity fluidity processes among adolescents, with particular attention to minority stress and depression. In addition, our results indicate that sexual identity development and fluidity processes differ between cisgender females and males; and the nuances associated with these processes of change need further investigation.

Sexual Orientation Change among Adolescents and Young Adults: A Systematic Review

This article reviews research on changes in self-reported sexual orientation labels and associated health outcomes among adolescents and young adults. Using seven electronic databases and supplementary methods, we identified 30 studies for inclusion in the review, published between 2000 and 2020. This review aimed to summarize the approaches to measuring sexual orientation change; the prevalence, patterns, and directionality of changes in sexual identity; and how changes in sexual orientation relate to health outcomes among adolescents and youth adults. The reviewed studies lacked agreement in operationalization and assessment of sexual orientation changes. Prevalence of change in self-reported sexual orientation differed by birth sex, whereby cisgender female participants were more likely to report a change than male participants. In addition, adolescents and youth identifying with a nonheterosexual orientation or sexual minority at baseline were more likely to report a change in sexual orientation. Few studies reported on the impact of changes in sexual orientation on behavioral health outcomes. Adolescents who reported either nonheterosexual orientation at baseline or a shift toward nonheterosexual orientation had a greater likelihood of reporting depressive symptomology, suicidality, and substance use compared to those who did not report a change or reported consistent heterosexuality. Recommendations for future research and implications for practice are discussed.

"Words Aren't Supposed to Hurt, But They Do": Sexual and Gender Minority Youth's Bullying Experiences

Sexual and gender minority youth (SGMY) are more likely to experience bullying and violence compared to the youth who do not identify as SGMY, leading to increased risk of poor mental and physical health outcomes, and poor academic performance. Few studies explore the entire range of bullying experienced by sexual and gender minority youth (SGMY). The purpose of this study was to qualitatively describe the ways in which SGMY experience bullying victimization. We conducted semi-structured interviews with a diverse sample of 20 SGMY aged 14-18 years (median age 16 years) recruited from online social media. The sample included 10 participants who identified as cisgender girls, 4 who identified as cisgender boys, 2 who identified as transgender, and 4 who identified as another gender identity. Ten participants identified as bisexual, six identified as lesbian, and four identified as gay. Findings indicated six common experiences of bullying among the participants: (a) verbal harassment; (b) gender policing; (c) physical violence; (d) sexual harassment; (e) treated as sexual perpetrators and deviants; and (f) and social exclusion. SGMY described how bullying victimization ranged from overt to concealed attitudes and behaviors, and they articulated how several forms of bullying are likely not experienced by heterosexual and cisgender youth. These results support findings from prior qualitative studies and suggest that efforts to address school-based bullying may benefit from a more complete awareness of the range of bullying victimization experienced by SGMY. Development of multi-item scales of bullying that reflect the six common experiences of bullying presented in this study would allow researchers to quantitatively explore the range of bullying behaviors experienced by SGMY, and would aid in the conceptualization and successful implementation of anti-bullying interventions.

Sexual fluidity and BMI, obesity, and physical activity

Analyzing reported changes in sexual identity over time is necessary for understanding young adult health risks. Utilizing waves 3 and 4 of the National Longitudinal Study of Adolescent to Adult Health, this paper studies the relationships between sexual identity changes and BMI, obesity, and physical activity among young adults in the U.S (N = 11,349). The results show that men who report a change toward a more homosexual identity have a significantly lower BMI and participate in more physical activity, while men who report a change toward a more heterosexual identity participate in less physical activity and have a higher BMI compared to those who did not report a change. For women, a change toward a more homosexual identity is significantly associated with more physical activity and lower odds of being obese compared to no change. The results suggest that specific sexual identity changes may also be linked to improvements in health.

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Links between sexual fluidity and weight and physical activity are analyzed.

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Certain sexual identity changes may improve weight and physical activity behavior.

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The direction of sexual identity change matters more for men than for women.

Sexual orientation and its impact on sexual behaviour of young people aged 15-29: a cross-sectional study

AIMS

The aim of this study was to determine whether there was a direct relation between sexual orientation and sexual practices involving penetration; to analyse whether condom use in the first sexual relation was conditioned by sexual orientation; to verify whether consistent condom use in sexual relations was determined by sexual orientation.

BACKGROUND

Recent research suggests that sexual orientation (i.e. heterosexuality, homosexuality or bisexuality) is a determining factor in high-risk sexual behaviour.

DESIGN

A cross-sectional study with purposive sampling.

METHODS

Data were collected between March 2013-April 2014 from 900 participants (524 males and 376 females). All participants were 15-29 years of age. Their mean age was 20·93 years. The participants were given a socio-demographic survey as well as a psychometric test on high-risk sexual behaviour, which had been used in previous studies.

RESULTS

There were no statistically significant differences in relation to sexual orientation and sexual practices involving penetration either in the general model for both sexes or in the models for men and women. It was also found that sexual orientation did not significantly affect condom use in the first sexual relation. Furthermore, consistent condom use had a protector effect in the general model for homosexuals and bisexuals. In the model for men, this was also true for homosexuals and in the model for women, this was the case for bisexuals.

CONCLUSION

Condom use in the first sexual relation was similar in all sexual orientations. However, the sexual orientation of the subject was found to be a determining factor in consistent condom use.

What's Love Got to Do with It? Substance Use and Social Integration for Young People Categorized by Same-Sex Experience and Attractions

The aim of the study was to assess whether social integration and substance use differed between three groups of adolescents that were categorized by a combination of sexual experience and attractions: (a) heterosexual orientation and attraction only, (b) same-sex experiences without same-sex attraction, and (c) same-sex attraction. A school based sample of 5,500 Norwegian 16 to 19 year olds (92% response rate) with good population representativity was analyzed. Same-sex experiences included “necking”/“making out,” petting, intercourse, and oral sex. Compared to heterosexual young people, young people reporting same-sex sexual experiences only were more socially integrated into their peer group and consumed more alcohol. Young people reporting same-sex attraction reported poorer social integration into peer networks and good social support, but a stronger sense of loneliness. Use of illegal drugs other than marijuana was more than three times as prevalent compared to that of heterosexual youths, and the gender differences in substance use were small or the opposite of what was expected.

Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity

Bullying and substance use represent serious public health issues facing adolescents in the United States. Few large-sample national studies have examined differences in these indicators by gender identity. The Teen Health and Technology Study (N = 5,542) sampled adolescents ages 13 to 18 years old online. Weighted multivariable logistic regression models investigated disparities in substance use and tested a gender minority social stress hypothesis, comparing gender minority youth (i.e., who are transgender/gender nonconforming and have a gender different from their sex assigned at birth) and cisgender (i.e., whose gender identity or expression matches theirs assigned at birth). Overall, 11.5% of youth self-identified as gender minority. Gender minority youth had increased odds of past-12-month alcohol use, marijuana use, and nonmarijuana illicit drug use. Gender minority youth disproportionately experienced bullying and harassment in the past 12 months, and this victimization was associated with increased odds of all substance use indicators. Bullying mediated the elevated odds of substance use for gender minority youth compared to cisgender adolescents. Findings support the use of gender minority stress perspectives in designing early interventions aimed at addressing the negative health sequelae of bullying and harassment.

'YES, I AM MORE THAN JUST THAT': GAY/BISEXUAL YOUNG MEN RESIDING IN THE UNITED STATES DISCUSS THE INFLUENCE OF MINORITY STRESS ON THEIR SEXUAL RISK BEHAVIOR PRIOR TO HIV INFECTION

Rates of HIV infection in the United States are markedly over-represented among gay/bisexual young men (GBYM), especially those who are African American and Latino. The degree to which minority stress may explain racial disparities in HIV incidence is understudied in GBYM. This qualitative study examined racial/ethnic-minority and sexual-minority stress and their perceived influence on HIV infection in a sample of GBYM living with HIV. Findings indicated that racial/ethnic-minority stress more often emerged during sexual interactions, while sexual-minority stress was often family-based. Our discussion offers recommendations for primary HIV prevention efforts for GBYM.

Toward a definition of "hypersexuality" in children and adolescents

Recent psychiatric literature has used the term "hypersexuality" to denote pathologically increased sexual behavior in children and adolescents. Various patterns of increased sexuality have been described in youth, including sexuality that is excessive, developmentally precocious, compulsive, aggressive, or otherwise socially inappropriate. Such "hypersexual" behavior in children and adolescents is associated with a variety of factors. Social factors include sexual abuse, physical abuse, life stress, and impaired family relationships. Psychiatric factors include emotional and behavioral problems in general, posttraumatic stress disorder and dissociative symptoms in particular, and possibly bipolar disorder. Despite the importance of increased sexual behavior in youth as a possible sign of these problems, there is currently no uniform definition in psychiatric literature of the term "hypersexuality" applied to children and adolescents. The usefulness of this term depends upon the degree to which it can be defined, measured, and distinguished from non-pathological juvenile sexual behavior. Research instruments are described that may be useful in measuring levels of sexual behavior in children and adolescents. Elements of a definition of juvenile hypersexuality are proposed based upon current knowledge about children and adolescents' sexuality in both normal development and a variety of conditions in which it is increased. Care is warranted in distinguishing between normal and abnormal sexual behavior in youth because of the variety of factors that can affect its measurement.

Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents

Children and adolescents who are growing up gay, lesbian, bisexual, gender nonconforming, or gender discordant experience unique developmental challenges. They are at risk for certain mental health problems, many of which are significantly correlated with stigma and prejudice. Mental health professionals have an important role to play in fostering healthy development in this population. Influences on sexual orientation, gender nonconformity, and gender discordance, and their developmental relationships to each other, are reviewed. Practice principles and related issues of cultural competence, research needs, and ethics are discussed.

Can we change sexual orientation?

The self-reports of individuals who claim that they have changed their sexual orientation are either dismissed as false or relied upon to promote sexual orientation change efforts. However, these reactions do not capture the complexity of the sexual reorientation phenomenon. This article provides an overview regarding the promise and effort of sexual reorientation and how this knowledge may inform our current understanding of human sexuality. Specifically, a brief history is given of the interventions used to change attractions to same-sex adults and the assumptions underlying these efforts. Information will be given regarding which conclusions can be derived from sexual reorientation studies. The limitations of these studies will be explained to strengthen future research. Hypotheses will be presented regarding the motivations and needs of those distressed by a same-sex erotic orientation and the impact that the hope of sexual reorientation may have for family members, religious leaders, and policy makers. A multivariate model of sexuality and sexual orientation, including scales of attraction and aversion, will be proposed based upon current understanding of sexuality and the distinctions found in sexual reorientation research. In the end, a therapeutic framework will be highlighted that may be used (and researched) to help those distressed by their sexual orientation.

Development of AACAP practice parameters for gender nonconformity and gender discordance in children and adolescents

The American Academy of Child and Adolescent Psychiatry (AACAP) is preparing a publication, Practice Parameter on Gay, Lesbian or Bisexual Sexual Orientation, Gender-Nonconformity, and Gender Discordance in Children and Adolescents. This article discusses the development of the part of the parameter related to gender nonconformity and gender discordance and describes the practice parameter preparation process,rationale, key scientific evidence, and methodology. Also discussed are terminology considerations, related clinical issues and practice skills, and overall organization of information including influences on gender development, gender role behavior, gender nonconformity and gender discordance, and their relationship to the development of sexual orientation.

Stability and change in self-reported sexual orientation identity in young people: application of mobility metrics

This study investigated stability and change in self-reported sexual orientation identity over time in youth. We describe gender- and age-related changes in sexual orientation identity from early adolescence through emerging adulthood in 13,840 youth ages 12-25 employing mobility measure M, a measure we modified from its original application for econometrics. Using prospective data from a large, ongoing cohort of U.S. adolescents, we examined mobility in sexual orientation identity in youth with up to four waves of data. Ten percent of males and 20% of females at some point described themselves as a sexual minority, while 2% of both males and females reported ever being "unsure" of their orientation. Two novel findings emerged regarding gender and mobility: (1) Although mobility scores were quite low for the full cohort, females reported significantly higher mobility than did males. (2) As expected, for sexual minorities, mobility scores were appreciably higher than for the full cohort; however, the gender difference appeared to be eliminated, indicating that changing reported sexual orientation identity throughout adolescence occurred at a similar rate in female and male sexual minorities. In addition, we found that, of those who described themselves as "unsure" of their orientation identity at any point, 66% identified as completely heterosexual at other reports and never went on to describe themselves as a sexual minority. Age was positively associated with endorsing a sexual-minority orientation identity. We discuss substantive and methodological implications of our findings for understanding development of sexual orientation identity in young people.

The health and health care of lesbian, gay, and bisexual adolescents

Adolescents face a variety of challenges in their transition to adulthood; lesbian, gay, and bisexual adolescents face these typical challenges as well as additional challenges that are related to the social stigma of their sexual orientation. For some lesbian, gay, and bisexual adolescents, this stigma may induce psychosocial stress, leading to increased health risk behaviors and poorer health outcomes. In this article, we review data on the health and health care of LGB adolescents. We examine health indicators and health risks for LGB youth, including substance use, eating disorders, suicidality, risky sexual behaviors, violence exposure and victimization, and homelessness. We also examine health care provision and utilization for LGB youth. Lastly, we discuss ways in which researchers and clinicians can improve LGB adolescent health and health care.

Lack of differences between males with or without perceived same sex attraction

Adolescent males are often concerned that they may be homosexual because of a sense of sexual attraction to other males. This not uncommon concern is often expressed to pediatric endocrinologists who come into contact with these boys because of concerns with abnormal pubertal development. To explore the character and prevalence of these types of homosexual concerns we assessed the perceptions of a group of healthy adolescent males using a structured questionnaire. The aim of this study was to determine whether males concerned about homosexual tendencies manifest a unique self-perception profile or interact differently with others. A multi-item questionnaire regarding demographic, behavioral, psychological and sexual characteristics was administered to 52 18-24 year-old males. Overall, there were few differences between males admitting to an adolescent homosexual attraction to males and males without this attraction. Differences between these two groups included more exposure to some kinds of pornography (including male to male imagery), noticeable psychosexual responses to male pornography, internal questioning over homosexual tendencies, comparisons of genitalia and perceptions of body build. There were no differences in demographics, family structure, religious beliefs, socio-economic status, knowledge of puberty, inter-personal relationships or sources of information about sexuality.