Association Between LGB Sexual Orientation and Depression Mediated by Negative Social Media Experiences: National Survey Study of US Young Adults

How social is social media for transgender and gender-diverse youth? Association of online social experiences with internalizing mental health problems

Adolescents spend a critical amount of their free time on the Internet and social media. Transgender and gender-diverse (TGD) adolescents, who report elevated rates of mental health issues, especially internalizing problems, have both positive and negative online social experiences (e.g., support and cyberbullying). This can have both beneficial and/or harmful effects on their mental health. Given the lack of research, the present study examined TGD adolescents' online (social) experiences and the association of positive and negative online social experiences with internalizing problems. The sample consisted of n = 165 TGD adolescents (11-18 years) diagnosed with gender dysphoria who attended a Gender Identity Service for children and adolescents (Hamburg GIS) in Germany between January 2020 and December 2022 during the COVID-19 pandemic. Positive (use of online support networks) and negative online social experiences (cyberbullying or other adverse online interactions) were assessed using study-specific items and internalizing problems using the Youth Self-Report. Frequencies of various online (social) experiences were analyzed, and a multiple linear regression analysis was performed to test their association with internalizing problems. In total, 42% of participants reported positive online social experiences (use of online support networks) and 51% of participants reported negative online social experiences (cyberbullying or other adverse online interactions). There was no significant association between negative online social experiences and internalizing problems but between positive online social experiences and more internalizing problems (adjusted R2 = .01). TGD adolescents may seek online support, especially when struggling with mental health problems. Therefore, it is crucial to support youth navigating these online spaces more safely and positively and to empower them to buffer against potentially harmful experiences. Furthermore, strengthening offline relations with peers and family members is pivotal, given their importance for TGD adolescents' mental health.

A chatbot-delivered intervention for optimizing social media use and reducing perceived isolation among rural-living LGBTQ+ youth: Development, acceptability, usability, satisfaction, and utility

Background

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth are at higher risk of isolation and depression than their heterosexual peers. Having access to tailored mental health resources is a documented concern for rural living LGBTQ+ youth. Social media provides access to connections to a broader and like-minded community of peers, but it also is a vehicle for negative interactions. We developed REALbot, an automated, social media-based educational intervention to improve social media efficacy, reduce perceived isolation, and bolster connections for rural living LGBTQ+ youth. This report presents data on the acceptability, feasibility, and utility of REALbot among its target audience of rural living LGBTQ+ youth.

Methods

We conducted a week-long exploratory study with a single non-comparison group of 20 rural-living LGBTQ+ youth aged 14-19 recruited from social media to test our Facebook- and Instagram-delivered chatbot. We assessed pre- and post-test scores of social media self-efficacy, social isolation (4-item Patient-Reported Outcomes Measurement System - PROMIS), and depressive symptoms (Patient Health Questionnaire, Adolescent Version - PHQ-A). At post-test, we assessed acceptability (User Experience Questionnaire - UEQ-S), usability (Chatbot Usability Questionnaire -CUQ and Post-Study Satisfaction and Usability Questionnaire -PSSUQ), and satisfaction with the chatbot (Client Satisfaction Questionnaire - CSQ), along with two open-ended questions on 'likes' and 'dislikes' about the intervention. We compared pre- and post-test scores with standard univariate statistics. Means and standard deviations were calculated for usability, acceptability, and satisfaction. To analyze the responses to post-test open-end questions, we used a content analysis approach.

Results

Acceptability of REALbot was high with UEQ-S 5.3 out of 7 (SD = 1.1) and received high usability scores with CUQ and PSSUQ (mean score (M) = 78.0, SD = 14.5 and M = 86.9, SD = 25.2, respectively), as well as high user satisfaction with CSQ (M = 24.9, SD = 5.4). Themes related to user 'likes' and 'dislikes' were organized in two main categories: usability and content provided. Participants were engaged with the chatbot, sending an average of 49.3 messages (SD = 43.6, median = 30). Pre-/post- changes in scores of perceived isolation, depressive symptoms and social media self-efficacy were not significant (p's > 0.08).

Conclusion

REALbot deployment was found to be feasible and acceptable, with good usability and user satisfaction scores. Participants reported changes from pre- to post-test in most outcomes of interest and effect sizes were small to medium. Additional development and a formal evaluation of feasibility and engagement with behavioral targets is warranted.

The Influence of Social Media Interactions and Behaviors on Depressive Symptoms Among Sexual and Gender Minority Young Adults in the United States: Protocol for a Mixed Methods Longitudinal Study

BACKGROUND

Sexual and gender minority (SGM; ie, lesbian, gay, bisexual, transgender, and otherwise queer) young adults experience disparities in depression and other internalizing psychopathology. Although social media use is widespread and SGM people have more social media accounts and are more socially active on them than non-SGM individuals, few studies have examined the impact of social media on depression in this group.

OBJECTIVE

The PRIDE iM study will be the first longitudinal, mixed methods research conducted to determine the impact of social media interactions and behaviors as pathways to depressive symptoms among SGM young adults living in the United States.

METHODS

PRIDE iM uses a bookends variation of the longitudinal sequential mixed methods design. Participants will be recruited nationally from social media. First, between July 2019 and February 2020, we conducted a qualitative phase (T1) comprising web-based individual interviews (N=58) to inform the building and content of the quantitative survey. Second, from February 2022 to September 2022, we will conduct a series of web-based surveys (N=1000 at baseline) with 4 data points (T2-T5), each one collected every 6 to 8 weeks. Third, from October 2022 to December 2022, we will conduct a second qualitative phase (T6) of web-based interviews using outcome trajectories found in the longitudinal survey analyses to purposively sample survey participants and conduct web-based interviews to contextualize and explain survey findings. Qualitative data from T1 and T6 will be analyzed using a reflexive thematic analysis approach. As we sought to capture change over time in the association between the main predictors (ie, social media interactions and behaviors) and depressive symptoms, we propose analyzing T2 to T5 data using latent growth models with a structural equation modeling framework. Data integration at the method, interpretation, and reporting levels will be achieved through building and connecting and the use of a staged approach and joint displays, respectively. At all stages, we will assess the fit of data integration as recommended by the principles of best practice for mixed methods research in psychology.

RESULTS

Data collection will be completed by December 2022. Qualitative data analyses will be completed by March 2023, and quantitative analyses of the primary outcome of interest will be completed by June 2023.

CONCLUSIONS

PRIDE iM will confirm, reject, or uncover the presence of potential relationships between social media interactions and behaviors and depressive symptoms among SGM people. This study represents fundamental groundwork to develop social media-based interventions that target modifiable interactions and behaviors that are most likely to influence mental health outcomes, thus seizing the opportunity to merge the popularity of this medium among SGM people with evidence-based approaches.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43627.

Social network sites as learning environments and their implications for mental health

Social network sites (SNSs) have become ubiquitous around the globe and interwoven with all aspects of life. In this article, I will argue that the communicative infrastructure of SNSs, i.e., all SNS-elements that allow users to communicate, is a key element for understanding their impact as it creates environments in which users, their behaviors, and social interactions are embedded. These digital environments facilitate and encourage fundamental mechanisms of implicit learning from feedback as well as observation in an unprecedented way. I will discuss how these technology-based learning environments impact the mental health of their users, e.g., by linking negative online feedback to depression and following influencers to disturbed eating. The article ends with a conclusion that emphasizes the advantages of understanding SNSs as environments in order to reflect the complexity, relevance, and ubiquitousness of the phenomenon.

Examining Social Media Experiences and Attitudes Toward Technology-Based Interventions for Reducing Social Isolation Among LGBTQ Youth Living in Rural United States: An Online Qualitative Study

Purpose

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth living in rural areas who feel isolated are at high risk of depression and suicidality. Given the lack of support in their offline communities, many rural-living LGBTQ youth turn to social media for social support. In this qualitative study, we examined rural LGBTQ youth's social media experiences and attitudes toward technology-based interventions for reducing perceived isolation.

Method

In Spring 2020, we conducted online interviews with LGBTQ youth aged 14-19, living in rural areas of the United States, who screened positive for perceived social isolation (n = 20; 11 cisgender sexual minority, 9 transgender). Interviews examined (1) supportive social media experiences, (2) personal strategies to improve social media experiences, and (3) perspective on potential digital intervention delivery modalities. Data were analyzed using thematic analysis.

Findings

Related to supportive content and interactions, themes included (1) positive representation of and connecting with LGBTQ groups on social media are important; (2) content from people with shared experience feels supportive, and (3) lack of feedback to one's experiences is isolating. Regarding personal strategies to improve social media experiences, themes were (1) selecting platforms to connect with different audiences helps make for a more enjoyable social media experience, and (2) several social media platform features can help make for a safer social media experience. Youth discussed advantages and disadvantages of intervention delivery via a mobile app, social media pages or groups, conversational agents (chatbots), and a dedicated website.

Conclusion

Viewing positive representation of and connecting with LGBTQ groups, content from people shared experiences, and utilizing a wide array of platform features to increase the likelihood of positive connections are key to a positive social media experience among this group. Combining delivery modalities is key to engaging rural-living LGBTQ youth in digitally delivered support interventions to reduce perceived isolation. Our results inform future intervention research and conversations about social determinants of health between providers and rural LGBTQ patients.

Multiple Minority Stress and Behavioral Health Among Young Black and Latino Sexual Minority Men

Purpose: Young Black and Latino sexual minority men may experience multiple minority stressors, which may negatively impact behavioral health. To investigate this, longitudinal associations between multiple minority stressors and behavioral health outcomes were examined over a 2-year period. Methods: Data were from the Healthy Young Men's Cohort Study. The present study used five waves of data collected every 6 months from 2016 to 2019. Participants were young Black and/or Latino sexual minority men in Los Angeles, California (n = 448; aged 16-24). Participants self-reported their experiences of racial and homonegative discrimination, internalized homonegativity, alcohol use, and depressive symptoms. Latent growth curve models with time-varying covariates examined contemporaneous associations between minority stressors as well as general life stress and behavioral health measures. Results: After accounting for general life stress and demographic characteristics, racial discrimination was persistently associated with unhealthy alcohol use. Internalized homonegativity was associated with unhealthy alcohol use initially, but this association became non-significant over time. In models predicting depressive symptoms, racial discrimination was a significant predictor at early waves, and homonegative discrimination and internalized homonegativity emerged as significant predictors at later waves. Conclusion: These results help clarify which multiple minority stressors are more prominent in their relationship to young Black and Latino sexual minority men's unhealthy alcohol use and depressive symptoms. Interventions targeting multiple minority stressors may be needed at different times during young adulthood.

Young Sexual Minority Adolescent Experiences of Self-expression and Isolation on Social Media: Cross-sectional Survey Study

BACKGROUND

Early adolescent years are marked by pervasive self- and peer-regulation regarding gender and sexuality norms, which can affect the mental well-being of sexual minority youth. During this developmental period, social media use is also emerging as a dominant mode of communication with peers, allowing for both risk and resilient behaviors that can impact well-being.

OBJECTIVE

This exploratory study aims to examine how sexual minorities in middle school use social media, who they are connected to and for what purposes, and the associations between these behaviors and mental well-being compared with their heterosexual peers.

METHODS

In our cross-sectional survey study of 1033 early adolescents aged between 10 and 16 years (average age 12.7, SD 1.21 years) from 4 middle school sites in the Northeastern United States, we conducted an exploratory study comparing sexual minorities (212/873, 24.3% of sample with known sexual orientation) with their heterosexual peers (n=661), obtaining an 84.46% (1033/1223; total possible) response rate.

RESULTS

Sexual minorities reported having smaller networks on their favorite social media website (β=-.57; P<.001), less often responded positively when friends shared good news (β=-.35; P=.002), and less often tried to make friends feel better when they shared bad news (β=-.30; P=.01). However, sexual minorities more often reported joining a group or web-based community to make themselves feel less alone (β=.28; P=.003), unlike heterosexual youth. Sexual minorities had higher averages of loneliness and social isolation (β=.19; P<.001) than heterosexual students. Sexual minorities were also twice as likely to have tried to harm themselves in the past (β=.81; odds ratio [OR] 2.24, 95% CI 1.64-3.06; P<.001) and were more likely to have symptoms that reached the Center for Epidemiological Studies-Depression definition of depression (β=.15; OR 1.16, 95% CI 1.08-1.25; P<.001). About 39.1% (83/212) of sexual minorities had no one to talk to about their sexual orientation. Sexual minorities were 1.5 times more likely to have joined a social media website their parents would disapprove (β=.41; OR 1.50, 95% CI 1.14-1.97; P=.004) and more likely to report seeing videos related to self-harm (β=.33; OR 1.39, 95% CI 1.06-1.83; P=.02) on the web than heterosexual youth.

CONCLUSIONS

Given previous reports of supportive and safe web-based spaces for sexual minority youth, our findings demonstrated that sexual minority youth prefer to maintain small, close-knit web-based communities (apart from their families) to express themselves, particularly when reaching out to web-based communities to reduce loneliness. Future longitudinal studies could determine any bidirectional influences of mental well-being and social media use in sexual minorities during this difficult developmental period.