Today's LGBTQ youth come of age at a time of dynamic social and political change with regard to LGBTQ rights and visibility, yet remain vulnerable to compromised mental health. Despite advances in ...individual-level treatment strategies, school-based programs, and state-level policies that address LGBTQ mental health, there remains a critical gap in large-scale evidence-based prevention and intervention programs designed to support the positive development and mental health of LGBTQ youth. To spur advances in research and translation, I pose six considerations for future scholarship and practice. I begin by framing LGBTQ (mental) health disparities in a life course perspective and discuss how research focused on the timing of events could offer insight into the optimum targets and timing of prevention and intervention strategies. Next, I argue the importance of expanding notions of "mental health" to include perspectives of wellbeing, positive youth development, and resilience. I then consider how research might attend to the complexity of LGBTQ youths' lived experience within and across the various contexts they traverse in their day-to-day lives. Similarly, I discuss the importance of exploring heterogeneity in LGBTQ youth experiences and mental health. I also offer suggestions for how community partnerships may be a key resource for developing and evaluating evidence-informed programs and tools designed to foster the positive development and mental health of LGBTQ youth. Finally, I acknowledge the potentials of team science for advancing research and practice for LGBTQ youth health and wellbeing. Throughout, these future directions center the urgent needs of LGBTQ youth.
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BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk ...for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified.
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CMK, FFLJ, NUK, UL, UM, UPUK
Sexual orientation‒related disparities in alcohol use disorder are well-established. Yet, the degree to which sexual orientation differences in alcohol use disorder vary across the life course is ...poorly understood. There is also a limited understanding of how exposure to minority stressors and their relationship with alcohol use disorder vary as a function of age.
Using nationally representative data collected in 2012–2013, authors used sex-stratified time-varying effect models to estimate age-specific prevalence rates of alcohol use disorder among heterosexual and sexual minority adults aged 18–60 years (N=28,090). Among sexual minority adults (n=1,050), authors also assessed age-specific associations between exposure to lesbian, gay, and bisexual‒related discrimination and alcohol use disorder. Analyses were conducted in 2019.
Gay and bisexual male participants aged 18–45 years demonstrated the highest prevalence rates of alcohol use disorder (e.g., >45% at age 25 years), whereas lesbian, gay, and bisexual female participants were most likely to meet the criteria for alcohol use disorder between ages 45 and 55 years. Sexual minority adults who experienced discrimination in the past year had greater odds of alcohol use disorder between ages 23 and 34 years and again from ages 42 to 53 years; the association between discrimination and alcohol use disorder was strongest among sexual minority men.
Sexual orientation–related disparities in alcohol use disorder are dynamic across the life course and point to critical times for screening and intervention. Developmental perspectives of sexual minority health inequities demand focused research attention as findings will help to identify strategies for promoting sexual minority health at distinct points in the life course.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
LGBTQ youth are a population who experience unique stressors. This study investigated their experiences with the COVID-19 pandemic via Q Chat Space—a national online chat-based support program.
...Transcript data from 31 synchronous, text-based chats collected during the onset of state-based “social distancing” ordinances in Spring 2020 were analyzed.
While encountering COVID-19–related stressors likely to be experienced by youth generally, participants' experiences were concomitantly imbued with LGBTQ-specific intrapersonal, interpersonal, and structural challenges. Difficulties included maintaining mental health, being isolated with unsupportive families, and loss of in-person identity-based socialization and support.
Findings highlight the importance of synchronous, text-based online platforms to enable LGBTQ youth to feel safe to seek support while at home. Given the potential for long-term physical distancing, concerted efforts are required to provide necessary resources and support for LGBTQ youth during the COVID-19 pandemic.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Lesbian, gay, bisexual, and queer/questioning youth health disparities are well documented; however, study limitations restrict our understanding of how the temporal interplay among domains of ...sexuality (attraction, behavior, and identity) situate individuals to be more or less at risk for poor mental health and alcohol use across the transition to adulthood. Four waves of data from the National Longitudinal Study of Adolescent to Adult Health (
n
= 12,679; 51.29 % female) were used with repeated measures latent class analysis to estimate sexual trajectory groups designated by prospective reports of romantic attraction, sexual/romantic behavior, and sexual identity from adolescence to adulthood. Five unique trajectories emerged: two heterosexual groups (heterosexual early daters 58.37 % and heterosexual later daters 29.83 %) and three sexual minority groups (heteroflexible 6.44 %, later bisexually identified 3.32 %, and LGB identified 2.03 %). These sexual trajectories differentiate risk for depressive symptomology, suicidal thoughts and behaviors, and alcohol use during adolescence and early adulthood. Groups where individuals first reported same-sex attraction and sexual minority identities in adulthood (heteroflexible and later bisexually identified) had similar levels of depression, suicidality, and greater substance use than those who largely reported same-sex attraction and behavior during adolescence (the LGB identified group). These later recognition groups showed greater risk for poor outcomes in waves where they also first reported these changes in attraction, behaviors, and identities. The emergence of three sexual minority groups reveal within-group differences in sexuality and sexual trajectories and how these experiences relate to risk and timing of risk across the transition to adulthood.
Objective
To examine the availability and facility‐level predictors of LGBT‐specific mental health and substance abuse treatment in the United States.
Data Sources/Study Setting
2016 National Survey ...of Substance Abuse Treatment Services, 2016 National Mental Health Service Survey, and 2015‐2016 Gallup Daily tracking survey.
Study Design
Logistic regression models and average marginal effects were used to identify characteristics of facilities that offer LGBT‐specific programs. Linear regression models were used to estimate the association between the state‐level proportion of LGBT people and the proportion of facilities that offer LGBT‐specific programs.
Data Collection/Extraction Methods
Secondary data analysis. Cases with missing values for any predictor were excluded.
Principle Findings
12.6 percent of mental health and 17.6 percent of substance abuse facilities reported LGBT‐specific programs. Several facility characteristics were statistically associated with the likelihood of mental health and substance abuse facilities providing LGBT‐specific programs, including offering outpatient or residential treatment, private ownership, religious affiliation, and payment type. The proportion of LGBT adults living within each state was statistically associated with state‐level density of LGBT‐specific mental health programs, but not substance abuse programs.
Conclusions
Findings suggest limited availability of culturally competent mental health and substance abuse treatment, despite well‐documented need.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
The purpose of this study was to examine rates of substance use between transgender and nontransgender youth using a representative population-based sample and to examine mediating risk factors.
A ...statewide cross-sectional sample of California middle and high schools collected between 2013 and 2015. This representative sample of students in California included 335 transgender and 31,737 nontransgender youth. Using multivariate linear and logistic regression, we assessed differences between transgender and nontransgender youth in substance use behaviors related to alcohol, cigarette, marijuana, other illicit drugs, polysubstance use, and heavy episodic drinking. Substance use was assessed with lifetime use, age of onset, and past 30-day use for alcohol, cigarettes, and marijuana. Past 30-day use was also assessed for other illicit drugs and polysubstance use. Models were adjusted for demographics and risk factors including victimization, depressive symptoms, and perceived risk of substance use.
The prevalence of substance use was 2.5–4 times higher for transgender youth compared with their nontransgender peers (depending on the substance). Transgender youth were also at greater risk for early age of onset and recent substance use than nontransgender youth. In addition, psychosocial risk factors related to victimization, depressive symptoms, and perceived risk of substance use partially mediated the relationship between gender identity and substance use.
Using data from the first representative study of youth to include a measure of gender identity, we show that transgender youth are at heightened risk for substance use compared with nontransgender peers. Future research is needed to identify the structural and psychosocial mechanisms that drive these disparities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Using data from the first national probability sample of Black, White, and Latinx sexual minority people in the United States, we examined whether and how sexual identity development timing and ...pacing differs across demographic subgroups at the intersections of cohort, sex, sexual identity, and race/ethnicity. Among a sample of 1,491 participants aged 18-60 from 3 distinct birth cohorts, we measured participants' ages of sexual identity development milestones, including first same-sex attraction, first self-realization of a sexual minority identity, first same-sex sexual behavior, first disclosure to a straight friend, and first disclosure to a family member. Participants from more recent cohorts reported earlier and accelerated pacing of milestones relative to those from older cohorts. Subgroups defined by sex and sexual identity varied in milestone timing and pacing, with gay males reporting an earlier onset of some milestones than other subgroups. Those who used newer identity labels (e.g., pansexual, queer) reported younger ages of milestones relative to bisexual participants but similar ages to lesbian and gay participants. Black and Latinx participants reported some milestones at younger ages than White participants. Race-stratified models testing groups at the intersection of cohort, sex, and sexual identity revealed subgroup differences in ages of first disclosure to family, as well as differences in the time between self-realization, same-sex sexual behavior, and disclosure to a straight friend. The results suggest substantial variation in the developmental timing and pacing of milestones across social identities and the need to further examine how milestone timing is related to identity, stress, and health.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Population-level increases in psychopathology and other negative mental health outcomes, including posttraumatic stress, depression, anxiety, and elevated substance use, are directly linked to ...large-scale disasters in the United States. Thus, it is unsurprising that the current coronavirus disease 2019 (COVID-19) pandemic is seriously impacting population-level mental health in the United States, especially among socially disadvantanged, young, and racial and ethnic minority persons. The indirect psychological harms of the COVID-19 pandemic for those who belong to minoritized communities are complicated, exacerbated, and compounded by experiences and stressors specific to their marginalized social identities. In this regard, lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adolescents and young adults have received limited public health attention. This commentary aims to provide a nuanced perspective on the potential indirect mental health effects of the COVID-19 pandemic crisis on LGBTQ young persons. International research suggests that heteronormativity and cisnormativity in practice and policy-level response to large-scale disasters systematically ignores the needs of LGBTQ populations.7 Globally, issues relevant to LGBTQ communities in disaster contexts (eg, discrimination in accessing emergency government services because of LGBTQ status) are largely unreported, and government agencies historically fail to support LGBTQ-affirming interventions during recovery efforts.7 International guidelines and policy frameworks on disaster response and recovery have further failed to consider the needs of LGBTQ populations.7 The dearth of existing research on LGBTQ communities and disaster response in the United States speaks to the invisibility of LGBTQ young persons in the current public health response to the COVID-19 pandemic crisis. Despite limited attention to the mental health needs of LGBTQ young persons during the COVID-19 pandemic, LGBTQ young persons may face unique mental health challenges6,8 driven by the overlapping experience of pandemic-related9-11 and sexual and gender minority–related3,11,12 stressors.
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BFBNIB, INZLJ, NMLJ, NUK, OILJ, PNG, SAZU, UKNU, UL, UM, UPUK, VSZLJ, ZRSKP
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