Rejected by Family for Being Gay or Lesbian: Portrayals, Perceptions, and Resilience

Definitions and Measurement Tools for Assessing Parental Reactions to LGB People Coming Out: A Critical Review

Parental responses to young people's coming out as lesbian, gay or bisexual (LGB) are a crucial experience in identity formation and subsequent mental health outcomes. However, how parents react to coming out varies and remains relatively imprecise in the literature. The aim of the present critical review was to explore and discuss the different definitions and measurement tools used in studies assessing perceived parental reactions to the coming out of LGB people aged 18 years and over. Following PRISMA guidelines, a review of 14 selected articles was carried out to examine the different tools used. Then, based on this selection of articles, a review of the different proposed definitions of parental reactions was carried out. Analysis revealed that the Perceived Parental Reactions Scale emerged as the most widely used and most appropriate international scale for capturing the diversity of perceived parental reactions. Then, parental responses were often addressed in a dichotomous manner, focusing primarily on acceptance or rejection. Future studies will need to consider a more nuanced approach to understanding parental reactions to coming out.

Exploring Socio-Political Factors and Quality of Life Among LGBT Individuals in India

The quality of life of queer individuals in India is a result of a complex sociopolitical climate which is what this study aims to explore through qualitative methodology. Previous research has explored the social factors that impact the wellbeing of LGBT individuals in western countries, while the impact of politics on the wellbeing of marginalized groups is still largely unexplored. Through thematic analysis, this study found that family support and peer networks are the two most important social structures that determine the quality of life of LGBT emerging adults in India, whereas the impact of politics on wellbeing depends on the level of political awareness of the participants and their socio-political privilege in terms of caste, class and gender. However, there were significant differences in the relevant factors that affect the quality of life for cisgender and transgender participants which leaves room for further research. The findings indicate intra-community conflicts and changing dynamics within the community, and there needs to be extensive research on understanding the intersectionality of different identities within the community and their impact on the lives of queer individuals.

Measuring the prevalence and impact of adverse childhood experiences in the lives of LGBTQ individuals: A much-needed expansion

BACKGROUND

Numerous studies indicate that LGBTQ people have extensive experiences with adverse childhood experiences (ACEs), more so than their heterosexual and cisgender counterparts. Research also shows that LGBTQ youth endure traumatic experiences with victimization, including bullying, harassment, and violence, based on their non-hetero-cis-normative genders and/or sexual identities. Yet, most ACE measurement strategies fail to: (1) explicitly link the risk of ACE exposure to the discrimination and stigmatization of LGBTQ people, and (2) account for the breadth of potential ACE exposure in LGBTQ populations.

OBJECTIVE

In the current article, we develop and present a more comprehensive ACE measurement strategy for understanding the cumulative and deleterious impacts of ACEs in the lives of LGBTQ individuals.

METHODS

Here, we offer three expansions to the current ACE framework: (1) the inclusion of an LGBTQ-specific ACE in addition to the standard ACE measures, (2) the addition of LGBTQ qualifiers for current ACE items (when applicable), and (3) the expansion of ACE measures to capture the unique ACE experiences of LGBTQ individuals in family life, schools, and faith communities.

CONCLUSIONS

The implementation of a more comprehensive ACE measurement strategy will assist scholars and policymakers in better understanding the impacts of ACEs in the lives of LGBTQ individuals. In all, ACE measurement strategies that capture the breath of exposure of ACEs in the lives of LGBTQ individuals will assist in ACE screening, public health policy, and clinical intervention efforts.

Help-seeking preferences in Australian mental health website visitors: A latent profile analysis

OBJECTIVE

Psychological distress and suicide rates are climbing in Australia despite substantial mental health programme investment in recent decades. Understanding where individuals prefer to seek support in the event of a personal or emotional crisis may help target mental health resources to where they are most needed. This study aimed to explore individual differences in help-seeking preferences that may be leveraged for early intervention and mental health service design.

METHOD

Latent profile analysis was used to explore the help-seeking preferences of 1561 Australian online help-seekers who elected to complete a psychological distress screening on a popular mental health website, Beyond Blue.

RESULTS

Four latent profiles of help-seeker emerged that illustrate distinct preference channels for support: help-negaters, professional help-seekers, family help-seekers and help-affirmatives. Help-negaters were the least likely to consider seeking help from any source, recorded the highest levels of psychological distress and suicidal ideation, and were more likely to be younger. Help-affirmatives were the most likely to seek help from any source, particularly from religious leaders, and were more likely to speak a language other than English at home.

CONCLUSION

Many individuals experiencing mental health concerns will prefer to seek support from family or community contacts rather than professionals, and some will not seek help at all. Diversity in help-seeking preferences should be considered when designing mental health services, outreach and psychoeducation materials.

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.

Attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents

This pilot open trial examined the efficacy of attachment-based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post-treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers' acceptance of their young adult's same-sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents' levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT-SGM, a manualized, affirmative, experiential, family-based treatment, may be effective in reducing long-standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults' relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

Sexual minority young adults' perspectives on how minority stress and other factors negatively affect self-esteem: a qualitative interview study

Sexual minority young adults (lesbian, gay and bisexual), are at increased risk of experiencing mental health problems than their heterosexual peers. On average they also have lower self-esteem which may contribute to the development or maintenance of mental illnesses. Interventions to improve self-esteem could improve well-being and reduce mental ill-health risk in sexual minority young adults. It is important to understand the processes that contribute to lower self-esteem in this population. The present study aimed to explore these processes. Semi-structured qualitative interviews were conducted with a sample of 20 sexual minority young adults (age 16-24 years) with a range of self-esteem levels. Using thematic analysis, three overarching areas were idenitified: 'Negative social evaluations and reduced belonging', 'Striving and failing to meet standards', and 'Negative sexual orientation processes'. These findings have theoretical implications for minority stress models of mental health inequalities, highlighting the potential interaction between minority-specific and more general risk factors for mental health problems. Findings also have clinical implications for the development of tailored interventions to help improve low self-esteem in sexual minority young adults.

Sleep problems among sexual minorities: a longitudinal study on the influence of the family of origin and chosen family

BACKGROUND

There is growing evidence that lesbian, gay, and bisexual (LGB) adults experience more sleep problems than the general population. As LGB individuals experience a significantly greater risk of family rejection and low family support, our study investigates the role of family support as a potential determinant of LGB sleep problems over a prolonged period, and whether friend support (i.e. chosen family) can mitigate the effect of low family support. Given the importance of sleep on mental and physical health, study results may help shed light on persistent health disparities across sexual orientations.

METHODS

Our sample included 1703 LGB individuals from the UK Household Longitudinal Study (UKHLS). Mixed-effect logistic regressions were used to estimate the effect of family and friend support on the development of sleep problems after 24 months while controlling for potential confounders. A modified Pittsburgh Sleep Quality Index was used to measure 1) presence of any sleep problems, 2) short sleep duration, and 3) poor sleep quality.

RESULTS

Family support at baseline was independently associated with all sleep problems in our study after 24-months: 1 SD increase in family support was associated with a 0.94 times lower risk of sleep problems (95% C.I = 0.90-0.98), a 0.88 times lower risk of short sleep duration (95% C.I = 0.81-0.95), and a 0.92 times lower risk of sleep quality (95% C.I = 0.93-0.98). Support from one's chosen family (proxied by friend support) did not mitigate the effects of low family support on sleep problems.

CONCLUSIONS

Our study found a consistent effect of family support across all sleep outcomes along with evidence of a persistent effect after 24 months. Our findings point to the importance of targeting family support in designing interventions aimed at reducing LGB sleep problems.

Family support modifies the effect of changes to same-sex marriage legislation on LGB mental health: evidence from a UK cohort study

Background

Many lesbian, gay and bisexual (LGB) individuals continue to experience unique challenges, such as the lack of family support and access to same-sex marriage. This study examines the effect of the introduction of same-sex marriage in the UK (2013–14) on mental health functioning among sexual minorities, and investigates whether low family support may hamper the positive effects of marriage equality legislation among LGB individuals.

Methods

This analysis included LGB participants (n = 2172) from the UK household longitudinal study waves 3–7, comprising two waves before and two waves after marriage equality legislation passed in England, Wales and Scotland. Individual-level mental health functioning was measured using the mental component score (MCS-12) of the Short Form-12 survey. Fixed-effect panel linear models examined the effect of marriage equality on MCS-12 across varying family support levels. Analyses included adjustment for covariates and survey weights.

Results

Legalization of same-sex marriage was independently associated with an increase of 1.17 [95% confidence interval (CI): 0.28–2.05] MCS-12 in men and 1.13 (95% CI: 0.47–2.27) MCS-12 in women. For men, each additional standard deviation of family support modified the effect of legalization on mental health functioning by +0.70 (95% CI: 0.22–1.18) MCS-12 score. No interaction was found in women.

Conclusions

Our findings provide evidence that same-sex marriage will likely improve LGB mental health functioning, and these effects may be generalizable to other European countries. Since male sexual minorities with low family support benefited the least, additional interventions aimed at improving family support and acceptance of this group is required to help reduce mental health disparities.

The lesbian, gay, bisexual and transgender communities' mental health care needs and experiences of mental health services: An integrative review of qualitative studies

WHAT IS KNOWN ON THE SUBJECT?: There is evidence that the LGBT communities experience greater health disparities, particularly in relation to their mental health needs. The LGBT communities are often faced with stigma and discrimination within mental health services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: People within the LGBT communities have identified that their experiences of mental health services reinforce stigma and lack an understanding of their specific needs. Their needs can be addressed by mental health services that challenge heteronormative assumptions and promote self-acceptance and equity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The existing heteronormative culture in mental health nursing practice needs to be challenged. Practice needs to demonstrate self-awareness of personal and societal LGBT biases, prejudices, and stigma. Practice needs to demonstrate knowledge of important LGBT health care and psychosocial issues. Practice needs to reflect LGBT clinical skills grounded in professional ethics, guidelines, and standards of care.

ABSTRACT

INTRODUCTION: The lesbian, gay, bisexual and transgender (LGBT) communities are a minority population that experience a range of health disparities, including mental health. Because these groups have higher rates of mental disorder than the general population it is, therefore, pertinent to identify their specific mental health needs and their experiences when accessing mental health care.

AIM

To identify the mental health needs of the LGBT communities and their experiences of accessing mental health care.

METHODS

An integrative review of qualitative studies was conducted.

RESULTS

A total of fourteen studies were selected for this review. The studies identified that participants' experiences of accessing mental health care were related to (a) experiencing stigma and (b) staff's lack of knowledge and understanding of LGBT people's needs. They identified a need for mental health care that promotes the principles of equity, inclusion and respect for diversity.

DISCUSSION

The LGBT communities while not a homogenous group, face unique challenges when dealing with their mental health needs. Services that promote health equity and self-acceptance are important for this group.

IMPLICATIONS FOR PRACTICE

It is vital that mental health nursing education incorporate models that promote equity, inclusion and respect for diversity regarding this group of people.

Madman in the Closet: "Homosexual Panic" in Nineteenth Century New England

This analysis uses trial records from the 1860s to explore a same-sex male relationship that devolved into panic and murder. The paper's goal is to better understand how, during the middle of the nineteenth century, men who had sexual feeling for other men were forced into spaces that were qualitatively different than our current understanding of "the closet." The paper concludes that what we now call "coming out" was not an option during this era. In telling the story of how Samuel Andrews killed his best friend, Cornelius Holmes, this paper shows that the categories ordinarily presented as symmetrical binary oppositions in contemporary times-homo/heterosexual, closeted/out-did not work for Andrews and Holmes, and probably did not and could not have worked for others living under similar conditions.

The Perceptions of New Zealand Lawyers and Social Workers About Children Being Adopted by Gay Couples and Lesbian Couples

Global trends increasingly appear to be legitimizing same-gender relationships, yet international research shows that despite statutory rights to marry—and by extension, adopt children—same-gender couples continue to experience difficulties when trying to adopt. Primary among these barriers are the persistent heteronormative beliefs, which strongly underpin the unfounded myths about parenting abilities of same-gender couples. Such biased beliefs are perpetuated by some adoption professionals who oppose placing children with lesbian or gay couples. In 2013, New Zealand passed the Marriage Equality Act, making it possible for same-gender couples to legally marry—and by extension, adopt. This provided an opportunity to investigate the perceptions of New Zealand professionals about children being placed with same-gender couples, in a country often perceived to be more tolerant of LGBT people. New Zealand social workers and lawyers (an under-studied group)—the professions most likely involved in adoption—were recruited via professional bodies. Because studying perceptions and beliefs on socially sensitive topics are highly susceptible to social desirability, we designed an instrument utilizing multiple methods to assess and corroborate participants’ views about placing children for adoption with couples of the same gender. Administered online and anonymously, the survey included demographic questions, evaluation of negative-meaning and positive-meaning statements, and used a scenario describing a prospective adoptive couple whose gender was ambiguous, in the context of adopting children of varying needs. Overall, the study found that while New Zealand lawyers and social workers (N = 314) had generally favorable views of gay and lesbian adoption, they still reported a preference to see children adopted by heterosexual couples over same-gender couples, within which lesbian and gay couples were preferred equally. Moreover, being religious and politically conservative were characteristics associated with more negative views toward placing children with same-gender couples. We conclude that, despite winning the rights to marry (and adopt as couples), such legislative wins might be merely the first hurdle to be overcome; normalizing same-gender parenting is what needs to happen next. Our study adds to the research focused on adoption professionals in various countries, with the ultimate aim to inform practices and policies supportive of families headed by same-gender couples and formed through adoption.

Sexual Minority Women in Longitudinal Survey Research: Is Attrition a Problem?

As more longitudinal surveys collect information on sexual orientation, evaluating the quality of these data and understanding how sexual minorities engage with the survey process are increasingly important endeavors. This study constitutes the first systematic analysis of sexual orientation as a predictor of attrition from longitudinal surveys. Drawing upon the minority stress model, we developed testable hypotheses about how sexual identity and sexual identity change relate to panel attrition. These hypotheses were subsequently tested using data from two national cohorts of Australian women from the Australian Longitudinal Study on Women's Health (one born 1973-1978, n = 11,262, and one born 1989-1995, n = 16,689). In the older cohort, sexual minority women were more likely to attrit from the survey than exclusively heterosexual women-largely due to noncontact rather than noncooperation. The associations faded once sociodemographic and health-related covariates were included in the models. Further, higher rates of noncontact were observed among women who changed their sexual identity in a more same-sex-oriented direction, compared to women with a stable sexual identity. None of these associations were apparent in the younger cohort. Taken together, our results suggest that sexual minority status may be a risk factor for panel attrition among older but not younger cohorts of women and that improved efforts to locate and contact participants who are generally vulnerable could increase the retention of sexual minorities in longitudinal studies. Effect sizes were nevertheless small, suggesting that existing research on sexual orientation using longitudinal surveys is unlikely to be biased by non-random attrition of non-heterosexual individuals.

Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT

BACKGROUND

There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW's alcohol intake, wellbeing, and engagement with alcohol treatment.

METHODS

A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic 'thank you' message, and a nested qualitative study to further explore the intervention's feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index - Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability.

DISCUSSION

This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability.

TRIAL REGISTRATION

This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392 ).

The Complexity of Family Reactions to Identity among Homeless and College Lesbian, Gay, Bisexual, Transgender, and Queer Young Adults

Familial responses to lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people's identities range on a spectrum from rejection to acceptance and these reactions strongly impact family relationships and young adult well-being. Less is known, however, about how family members' reactions may differ based on young people's contexts of socioeconomic status. Through a qualitative, life course analysis of in-depth interview data from 46 LGBTQ college students and LGBTQ homeless young adults, our study highlights the diverse, contextual nuances of young people's "linked lives" within their families. We find that the context of socioeconomic status influenced how a young person managed family rejection. Conversely, processes of familial acceptance were also connected to life course transitions that worked in some cases to enhance LGBTQ young adults' family relationships. Finally, the intricacy of familial reactions to a young person's LGBTQ identity transcended socioeconomic contexts as many respondents shared similar experiences of rejection and acceptance. These findings have implications for understanding how young people manage family relationships across different contexts of socioeconomic status and how these experiences can shape their life course trajectories. Results from this study can inform LGBTQ youth service providers by tailoring intervention programs that account for contextual social diversity.

The Impact of Marriage Equality on Sexual Minority Women's Relationships With Their Families of Origin

Support from family of origin is important to the health and wellbeing of sexual minority women (SMW) and structural stigma may impact that support. The recent extension of marriage rights to same-sex couples in all U.S. states provided an opportunity to examine whether this change in law would impact the relationship of SMW with their families of origin regarding their same-sex relationships, including marriage. Interviews with 20 SMW were conducted to learn about their perceptions of how support from families of origin had been impacted by or changed since the U.S. Supreme Court decision (Obergefell v. Hodges, 135 S. Ct. 2584, 2015). Thematic analysis of the narrative responses revealed stories of continued family support; increases in acceptance or support; mixed support/rejection or unclear messages; "don't ask, don't tell" or silence; and continued or increased family rejection. Most participant narratives included more than one theme. Implications for SMW's health and relationships are discussed.

"We are Two of the Lucky Ones": Experiences with Marriage and Wellbeing for Same-Sex Couples

Happy marriages provide protective health benefits, and social support is a key factor in this association. However, previous research indicates one of the greatest differences between same- and different-sex couples is less social support for same-sex couples. Our goal was to examine the extent to which formal markers of couple status (e.g., marriage) impact wellbeing among same-sex married partners. Using a mixed-methods approach, data were collected from 218 primarily White gay and lesbian individuals in the Midwest. Quantitative analysis revealed individuals in a prior formal union with a different-sex partner reported the lowest levels of sexuality specific social support and acceptance. Qualitative analysis revealed four primary impacts of marriage on support from family, friends, and co-workers: no change, increased support, decreased support, and a synthesis of mixed support. Three mechanisms prompting change in the family were identified and are presented.