Mental Health of Sexual Minority and Transgender Youth

Mental Health of Sexual Minority and Transgender Youth

• Sexual minority youth (lesbian, gay, bisexual) experience significantly higher rates of depressive disorders, suicidal thoughts, non-suicidal self-injury (NSSI), anxiety disorders, substance use disorders, eating disorders, and post-traumatic stress disorder (PTSD) compared to cisgender peers. Transgender youth experience similar high rates of these mental health issues, and a substantially higher rate of autism spectrum disorder (ASD) compared to the general population (10% vs 2-3%). Physical safety is linked to identifying and expressing their gender.
• Data from BC Adolescent Health Surveys show some improvement in mental health markers for lesbian, gay, and bisexual youth over time, but rates remain high. Suicide attempts have decreased from 30% in 2008 to 17% in 2018. Similarly, binge drinking in a month has also decreased from 68% to 40% during this period.

Minority Stress Framework

• Sexual minority and transgender youth face unique stressors stemming from their identity, in addition to general stressors.
• Distal stressors—discrimination, stigma, and victimization (e.g., verbal or physical abuse, family rejection, unsafe environments) often lead to unstable situations and unsafe environments.
• Proximal stressors—result in internalized negative messages, expectations of rejection, and concealment of identity. Transgender youth also face a unique layer: body identity mismatch with puberty, inaccurate perceptions of their gender identity, and policies that impact their rights.

Unique Factors for Sexual Minority and Transgender Youth

• Youth in minority groups do not inherently belong to that community, which can delay supportive experiences and social connection.
• Prejudice and discrimination persist despite social and policy changes. Existing changes in policies and practices usually benefit adults and not youth.

Coming Out

• Coming out as LGBTIQ+ is stressful, particularly in early adolescence, as it occurs while youth are still influenced by family or educational requirements.
• This disclosure period also coincides with peer relationships and peer status, making youth vulnerable to family rejection and homelessness.
• The fear of rejection from peers and adults can create hypervigilance regarding their interactions and presentation.

Bisexual Youth Mental Health

• Bisexual youth face an even higher risk of poor mental health compared to lesbian and gay youth, stemming from a dual form of stigma (heterosexist and homosexist bias) that makes them feel like they don't belong.

Protective Factors

• Strong social support networks (from peers, adults, and supportive communities) are critical in mitigating the negative impacts of minority stressors. For example, parents accepting a child's chosen name or buying clothes consistent with their gender identity can be protective. Inclusive school environments, policies preventing bullying are also key.

Developmental Collision Hypothesis (DCH)

• The DCH explores the link between earlier disclosure of sexual minority identity and poorer mental health, considering that this disclosure can occur during a period of vulnerability to negative reactions from peers and adults.
• Research shows that earlier disclosure may be associated with fewer depressive symptoms, but it may also be associated with higher rates of victimization and more depressive symptoms.
• The consequences of victimization from disclosure outweigh the protective effect of earlier disclosure, a finding consistent across multiple generations.

Disclosure and Depressive Symptoms (DCH)

• Studies show that earlier disclosure of sexual minority identity correlates with fewer depressive symptoms. A critical factor mediating this relationship is the extent of LGBT-related victimization. Earlier disclosure that is not met with negative reaction or victimization may actually be protective, as experiences aligned with one's identity could boost feelings of coherence and create access to social support.

Diagnosis with Negative Developmental Impact: Autism Spectrum Disorder (ASD)

• Social Communication and Interaction Deficits: Challenges understanding social cues, forming relationships, communicating nonverbally, and understanding emotions.
• Restricted and Repetitive Behaviors (RRBs): Rigidity in routines, narrow interests, intense focus and sensory sensitivities that limit adaptation to new situations.
• Cognitive and Language Differences: Difficulty with executive function, delayed speech, and self-injurious behaviors (which interfere with learning and communication). These challenges significantly impair a child’s social, emotional, and cognitive development.

Prevalence of Diagnoses (General)

• Less common diagnoses (lower prevalence): Conversion disorder (COS), selective mutism, bipolar disorder, ASD, Eating disorders, Disruptive Mood Dysregulation Disorder (DMDD)

• Moderate prevalence: Depression, Fetal Alcohol Spectrum Disorder (FASD), PTSD, Conduct disorder (CD), substance use disorders, Attention-Deficit/Hyperactivity Disorder (ADHD), Specific learning disorder (SLD)

• More common: Anxiety disorders (e.g., phobias, social anxiety, separation anxiety), Oppositional Defiant Disorder (ODD)

• Biological factors are more prominent in diagnosis such as ASD, COS, bipolar and ADHD

• Environmental factors are more prominent in diagnosis such as anxiety, eating disorders and PTSD