Sexual orientation and mental health in a US cohort of children: a longitudinal mediation study.

BACKGROUND: Sexual minorities, including children, are at increased risk for adverse mental health outcomes compared to their heterosexual peers, but longitudinal studies are needed to determine the factors that explain the associations between sexual minority identification and adverse mental health outcomes during this developmental period. We examined longitudinal associations between sexual orientation and mental health over 2 years in a US cohort of children (aged 9-10 at baseline) and two explanatory factors (increased social problems such as getting teased and decreased perceived school safety). We hypothesized that beginning to identify as gay/bisexual and consistently identifying as gay/bisexual would be associated with increases in internalizing (e.g. depression, anxiety) and externalizing (e.g. aggression) problems compared to consistently identifying as heterosexual, and these associations would be partially explained by increased social problems and decreased perceived school safety. METHODS: We used data from Waves 1-3 of the Adolescent Brain Cognitive Development study. The analytic sample included 5,574 children (46.0% female; 55.1% non-Hispanic White). RESULTS: Beginning to identify as gay/bisexual was associated with increased internalizing/externalizing problems, and consistently identifying as gay/bisexual was associated with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, increased disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety, and increased disparities in externalizing problems were partially explained by increased social problems. CONCLUSIONS: These findings suggest the health disparities affecting sexual minority children include both internalizing and externalizing problems, and social problems and feeling unsafe at school may be contributing factors.

Examining the association of structural stigmas with body image-related outcomes among sexual minority individuals.

Sexual minority individuals display heightened body image disturbance, which is associated with negative health outcomes. Structural stigmas are associated with negative health outcomes among sexual minority individuals, but the association between structural stigmas and body image is not understood. Using a linear regression approach, we examined how U.S. state-level structural racism and structural sexual minority stigma were associated with body image-related outcomes including eating pathology, appearance and/or performance-enhancing drug (APED) misuse, and dysmorphic concern. Participants were 942 cisgender sexual minority individuals ages 18-30, with approximately equal representation among non-Hispanic/Latinx White, Black, Asian, and Hispanic/Latinx individuals. There was not a significant main effect of state-level structural sexual minority stigma on body image-related outcomes. In states with higher structural racism, Hispanic/Latinx participants endorsed higher APED misuse, and this interaction was not significant among non-Hispanic/Latinx White individuals. This pattern was not found among Black or Asian participants, nor was it replicated for dysmorphic concern or eating pathology. Findings suggest that reducing exposure to structural racism could reduce APED misuse among Hispanic/Latinx individuals.

Gender identity-based disparities in self-injurious thoughts and behaviors among pre-teens in the United States.

INTRODUCTION: Transgender individuals are at heightened risk for self-injurious thoughts and behaviors (SITBs). Evidence suggests that middle childhood-aged transgender individuals experience elevated rates of non-suicidal self-injury (NSSI) and passive suicidal ideation (SI), compared to cisgender children. Little is known about gender identity-based disparities in SI more broadly and suicidal behavior (SB) in children aged 9 and 10. The aim of this study was to examine gender identity-based disparities in SITBs among children in middle childhood (pre-teens) in a US-based sample. METHODS: Using data from the 3.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study, logistic regression models, unadjusted and adjusted for covariates, were performed to examine gender identity-based disparities in SITBs. RESULTS: In a model adjusted for birth sex, race/ethnicity, and household income, transgender children were at significantly higher odds for current (adjusted odds ratio [AOR] = 6.34) but not lifetime NSSI compared with cisgender children. Transgender children were at significantly higher odds for current and lifetime SI (AOR = 13.03; AOR = 5.39, respectively) and SB (AOR = 14.21; AOR = 12.64, respectively) compared with cisgender children. CONCLUSIONS: Gender identity-based disparities in SITBs may be present as early as age 9 and 10, demonstrating the need for SITB prevention and intervention efforts specific to transgender children.

Lifecourse-varying structural stigma, minority stress reactions and mental health among sexual minority male migrants.

BACKGROUND: Increasing evidence suggests that structural stigma (e.g. discriminatory laws, policies and population attitudes) can give rise to minority stress reactions (i.e. rejection sensitivity, internalized homophobia and identity concealment) to compromise sexual minorities' mental health. Yet, many sexual minorities encounter divergent structural stigma climates over the life course, with potential implications for their experience of minority stress reactions and mental health. We take advantage of sexual minority male migrants' lifecourse-varying exposures to structural stigma contexts to examine this possibility. METHODS: A sample of 247 sexual minority men who had migrated from 71 countries to the low-structural-stigma context of Sweden completed a survey regarding migration experiences, minority stress reactions and mental health. This survey was linked to objective indices of structural stigma present in these men's countries of origin, diverse in terms of structural stigma. RESULTS: Country-of-origin structural stigma was significantly associated with poor mental health and this association was mediated by rejection sensitivity and internalized homophobia, but only among those who arrived to Sweden at an older age and more recently. CONCLUSIONS: Prolonged exposure to high levels of structural stigma can give rise to stressful cognitive, affective and behavioural coping patterns to jeopardize sexual minority men's mental health; yet, these consequences of structural stigma may wane with increased duration of exposure to more supportive structural contexts.

Country-Level Structural Stigma, School-Based and Adulthood Victimization, and Life Satisfaction Among Sexual Minority Adults: A Life Course Approach.

Country-level structural stigma, defined as prejudiced population attitudes and discriminatory legislation and policies, has been suggested to compromise the wellbeing of sexual minority adults. This study explores whether and how structural stigma might be associated with sexual minorities' school-based and adulthood experiences of victimization and adulthood life satisfaction. Using a sample of 55,263 sexual minority individuals (22% female; 53% 18-29 years old; 85% lesbian/gay, 15% bisexual) living across 28 European countries and a country-level index of structural stigma, results show that sexual minorities, especially men, reported school bullying in both higher- and lower-stigma countries. Higher rates of school bullying were found among sexual minorities living in higher-stigma countries when open about their identity at school. Past exposure to school bullying was associated with lower adulthood life satisfaction, an association partially explained by an increased risk of adulthood victimization. These findings suggest that sexual minorities living in higher-stigma countries might benefit from not being open about their sexual identity at school, despite previously established mental health costs of identity concealment, because of the reduced risk of school bullying and adverse adulthood experiences. These results provide one of the first indications that structural stigma is associated with sexual minority adults' wellbeing through both contemporaneous and historical experiences of victimization.

Untethered lives: barriers to societal integration as predictors of the sexual orientation disparity in suicidality.

PURPOSE: Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration-or a lack of meaning, purpose, and belonging as derived from societal norms, goals, and attachment-have been widely theorized as determinants of suicidality for the general population, they have not been comprehensively explored to explain the sexual orientation disparity in suicidality. The aim of this study was to examine differences in suicidal ideation and attempts between LGB and heterosexual individuals in a nationally representative sample, and to examine barriers to societal integration as a potential explanation for any observed disparities over-and-above the influence of established contributors to sexual orientation disparity in suicidality. METHODS: Data come from the cross-sectional Swedish National Public Health Survey, which collected data from unrestricted random samples of individuals (16-84 years of age) living in Sweden, annually from 2010 to 2015 (n = 57,840 individuals [response rates: 48.1-51.3%]; 1281 (2.2%) self-identified as LGB). Analyses examined sexual orientation differences in suicidality (i.e., past-12-month ideation and attempts), and explored the role of barriers to societal integration (i.e., not living with a partner or children, unemployment, and lack of societal trust) in explaining this disparity over-and-above more commonly explored psychological (e.g., depression, substance use) and interpersonal (e.g., discrimination, victimization, lack of social support) suicidality risk factors. RESULTS: Compared to heterosexuals, suicidal ideation and attempts were more common among both gay men/lesbians (adjusted odds ratio [AOR] for suicide ideation: 2.69; 95% confidence intervals [CI]: 2.09, 3.47; AOR for suicide attempts: 5.50; 95% CI: 3.42, 8.83), and bisexuals (AOR for suicide ideation: 3.83; 95% CI: 3.26, 4.51; AOR suicide attempts: 6.78; 95% CI: 4.97, 9.24). Barriers to societal integration mediated the association between sexual orientation and suicidality even in models adjusting for established risk factors for suicidality. CONCLUSION: Our results suggest that previously under-examined factors, namely the disproportionate barriers to societal integration that LGB individuals experience, are important contributors to the substantially elevated risk of suicidality among sexual minorities. Preventive interventions should consider innovative ways to foster societal integration within sexual minority populations and to adjust hetero-centric social institutions to better include sexual minority individuals.

Acceptance of sexual minorities, discrimination, social capital and health and well-being: a cross-European study among members of same-sex and opposite-sex couples.

BACKGROUND: Awareness of health disparities based on sexual orientation has increased in the past decades, and many official public health agencies throughout Europe call for programs addressing the specific needs of lesbian, gay and bisexual (LGB) individuals. However, the acceptance of LGB individuals varies significantly in different countries, which potentially influences health and well-being in this population. We explored differences in self-rated health and subjective well-being between individuals living in same-sex and opposite-sex couples. We also examined the effects of discrimination and country-level variations in LGB acceptance on health and well-being and the potential mediating role of social capital in these associations. METHODS: Using the 2010 European Social Survey (n = 50,781), 315 individuals living with a same-sex partner were matched and compared with an equal number of individuals living in opposite-sex couples. We performed structural equation modeling analyses to estimate path coefficients, mediations and interactions. RESULTS: LGB acceptance was significantly related to better self-rated health and subjective well-being among all individuals, and these associations were partially mediated by individual social capital. No differences in these associations were found between individuals living in same-sex and opposite-sex couples. Sexuality-based discrimination had an additional significantly negative effect on self-related health and subjective well-being. CONCLUSIONS: The findings of this study suggest a negative association between exposure to discrimination based on sexual orientation and both health and well-being of individuals living in same-sex couples. Members of same-sex couples and opposite-sex couples alike may benefit from living in societies with a high level of LGB acceptance to promote better health and well-being.