Abstract
Objective: Sexual minority adolescents (SMA) experience numerous behavioral health disparities, including depression, anxiety, substance use, non-suicidal self-injury, and suicidality. The primary framework to understand these disparities is minority stress theory, which frames this disproportionate burden as the result of discrimination, violence, and victimization in a homophobic culture. Empirical examinations of minority stress among SMA have been limited by lack of diverse samples or validated measures. This study engaged a national community sample of SMA to confirm reliability and validity of the Sexual Minority Adolescent Stress Inventory (SMASI).Method: A national sample of 2,310 SMA aged 14–17 was recruited in the United States through a hybrid social media and respondent-driven sampling approach. Item response theory and confirmatory factor analysis established the psychometric properties of the SMASI in this sample; minority stress was modeled as a latent variable in several regression models to verify criterion and divergent validity.Results: In this national sample (M age = 15.9; 64% female and 60% White), the factor structure of the SMASI and its 11 subscales was confirmed and shown to be invariant by demographic characteristics. Minority stress as measured by the SMASI was significantly associated with all mental and behavioral health outcomes.Conclusions: This study provides evidence that SMASI is a reliable, valid, and important tool for better understanding minority stress and subsequent health and mental health consequences among SMA.
Highlights
Numerous behavioral health disparities exist for sexual minority adolescents (SMA) when compared to their heterosexual peers
Odds ratios corresponding to the association of the latent SMASI variable and each behavioral health outcome. This is one of the largest national studies of minority stress and health among adolescents in the United States with data across all states, a rural sample reflective of the greater U.S census, and a reasonable balance of participants based on cisgender male and female status and racial and ethnic identity
As described in earlier papers on the development of the SMASI, it has been nearly 20 years since the original minority stress theory was formally described by Meyer (2003) and further refined by Hatzenbuehler et al (2009)
Summary
Numerous behavioral health disparities exist for sexual minority adolescents (SMA) when compared to their heterosexual peers. The theory suggests that discrimination, violence, and victimization (i.e., distal stressors) due to a pervasive homophobic culture are internalized (i.e., proximal stress) and the most probable driving mechanisms of mental health disparities among sexual minorities, including SMA (Meyer, 2003; Goldbach and Gibbs, 2017). Hatzenbuehler et al (2009) outlined a psychological mediation framework whereby sexual minorities are exposed to discriminatory experiences in the built environment; these experiences are internalized and cause elevation in emotion dysregulation, social and interpersonal problems, and cognitive processes that confer risk of psychopathology; and these processes lead to poorer behavioral health outcomes. As Hatzenbuehler and Pachankis (2016) rightly noted in their review, stigma occurs at multiple levels for LGBT youth; disrupts cognitive, affective, interpersonal and physiological responses; and can likely only be addressed through multilevel frameworks
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