Gender Minority Adolescents Research Articles

Discrimination, critical consciousness, and mental health in American youth of color.

To resist and cope with oppression, youth of color may use the process of critical consciousness which involves understanding racial injustices (critical reflection), developing motivation to fight these injustices (critical motivation), and taking action to enact sociopolitical change (critical action). However, little is known about how each dimension of critical consciousness affects mental health in adolescents of color. In a sample of 367 ethnically and racially diverse American adolescents of color (age range = 13-17; 68.9% girls, 28.6% boys, and 2.5% gender minority; 84.4% US-born), we conducted multivariate regressions in Mplus to examine the cross-sectional links between each critical consciousness dimension (reflection, motivation, and action) and mental health outcomes (anxiety, depression, and stress) over and above the impact of everyday discrimination. We also investigated the interaction between critical consciousness and discrimination in predicting mental health outcomes. Controlling for age, gender, nativity, and social class, we found that discrimination and critical action were both positively associated with anxiety, depression, and stress. For our covariates, girls and gender minority adolescents reported worse outcomes. No interactions were significant. Overall, critical action, while necessary to enact societal change, may have a complex relationship with youth's depression, anxiety, and psychological stress symptoms and warrants careful exploration. Future research should focus on understanding the longitudinal mechanisms of critical action and how we can maximize the benefits by protecting youth from those negative effects.

Structural homophobia and suicidal ideation and behavior among sexual and gender minority adolescents.

Structural homophobia and suicidal ideation and behavior among sexual and gender minority adolescents.

Supplemental Material for Structural Homophobia and Suicidal Ideation and Behavior Among Sexual and Gender Minority Adolescents

Supplemental Material for Structural Homophobia and Suicidal Ideation and Behavior Among Sexual and Gender Minority Adolescents

“It Doesn’t Feel Easy at All”: Stressors and Supports of Parenting Sexual and Gender Minority Adolescents in the US Southeast

Parents/caregivers of sexual and gender minority (SGM) adolescents play a vital role in supporting their children, yet limited research considers the perspectives of these parents. We conducted semi-structured interviews and focus groups via Zoom with 16 parents of 17 SGM adolescents aged 13–17 residing in Alabama, Georgia, and Tennessee. Parents reported that their SGM adolescents were, on average, 15 years old, most were assigned female sex at birth, identified as transgender, non-binary, or gender-nonconforming, and had received mental healthcare treatment for serious mental health difficulties. A flexible thematic analysis approach identified themes structured around the social-ecological model. Parents described stressors at the structural level (e.g., ramifications of anti-SGM legislation), interpersonal level (e.g., breaking ties with unsupportive religious communities), and intrapersonal level (e.g., exhaustion with being forced into an advocacy position). Parents also reported several sources of support that cut across the three socio-ecological levels and helped them to overcome barriers, challenges, and stressors. This study underscores the difficulties confronted by parents of SGM adolescents in the US Southeast, particularly within an increasingly hostile socio-political climate. Findings highlight the necessity for resources tailored to parents of SGM adolescents to help them navigate multi-level stressors.

Attitudes Toward Using and Willingness to Use a Hypothetical Online Sex Communication Intervention for Parents of Sexual and Gender Minority Adolescents.

Although parents of sexual and gender minority (SGM) adolescents play a critical role in communicating about sexual health to their children, most parents have reported that they are unknowledgeable and uncomfortable talking about sexual health to their SGM adolescent. Because of the limited availability of sex education programs for parents of SGM adolescents, the study aimed to (1) describe the attitudes toward using and willingness to use a hypothetical online sex communication intervention for parents of SGM adolescents and (2) examine factors associated with willingness to use such an intervention. Parents of SGM adolescents from across the United States (N = 385) completed an online survey from March 10-16, 2023. Most participants were open to participating in a hypothetical online sex communication program and had positive attitudes toward it. Logistic regression results showed that participants who overall agreed a hypothetical online parent-based sex education intervention would be helpful and of interest had higher odds of being overall willing to participate in such a hypothetical intervention. Additionally, participants with higher income levels were also more likely to be willing to participate in a hypothetical program. Results from this exploratory study suggest that most parents of SGM adolescents have positive attitudes toward a hypothetical online parent-based sex education program and are willing to participate in it, highlighting a need to develop sex education programs tailored to the needs and preferences of parents of SGM adolescents. Additionally, equitable access to such programs is necessary especially regarding income level.

Intersectional Oppression-Based Stress, Drinking to Cope Motives, and Alcohol Use and Hazardous Drinking Among Sexual and Gender Minority Adolescents Who Are Black, Indigenous, and People of Color.

Purpose: This study examined the associations between intersectional oppression-based stress and recent alcohol use and hazardous drinking among sexual and gender minority (SGM; e.g., queer or transgender) adolescents who were Black, Indigenous, and People of Color (BIPOC), also known as queer and transgender BIPOC (QTBIPOC) adolescents, and the mediating role of coping motives (i.e., drinking to cope) on these associations. Methods: Data were from a subsample of QTBIPOC adolescents who used alcohol in the past year (n = 1365) from a national U.S. sample of SGM adolescents aged 13-18 years. Results: Intersectional oppression-based stressors were associated with greater odds of recent alcohol use and hazardous drinking, as well as greater coping motives. Coping motives mediated the associations between intersectional-based stressors and both recent alcohol use and hazardous drinking among the aggregate sample of QTBIPOC adolescents, as well as among some subgroups of BIPOC adolescents. Conclusions: The results of this study highlight that intersectional oppression-based stressors are prevalent among QTBIPOC adolescents and serve as a risk factor for alcohol use and hazardous drinking. Multilevel interventions are needed to target and dismantle intersectional oppressions to address alcohol inequities impacting QTBIPOC adolescents. Drinking to cope motives mediated the associations between intersectional oppression-based stress and drinking outcomes, underscoring another important mechanism to target within a context of oppression in drinking interventions.

Discontinuation of Gender-Affirming Medical Treatments: Prevalence and Associated Features in a Nonprobabilistic Sample of Transgender and Gender-Diverse Adolescents and Young Adults in Canada and the United States

PurposeThis study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America. MethodsThis exploratory study used data from an online survey of sexual and gender minority adolescents and young adults aged 15–29 years living in Canada or the United States of America (March–August 2022). The analytic sample was constituted by participants who responded to questions regarding starting and stopping GAMT, as well as reasons for stopping. Correlates of discontinuing GAMT were assessed using univariate logistic regression. ResultsThe mean age of the analytic sample (N = 3,937) was 21.1 years. Participants were predominantly nonbinary (54.2%) and assigned female at birth (80.8%). 75.5% lived in Canada and 24.5% in the United States of America. Among those who had started GAMT, 121 of 720 (16.8%) reported having ever discontinued treatment. Forty five of 121 (37.2%) who ceased GAMT reported “Yes, but I wish I hadn't.” The most frequently endorsed reasons for discontinuing GAMT were health reasons (37.3%), a change in gender identity (32.0%), and cost (16.0%). Greater age; nonbinary identity, ‘other’ gender identity; diagnosis of or self-identifying as living with schizophrenia; residing in the United States of America (relative to Canada); and endorsing a current Christian identity were associated with discontinuation. Ninety seven of 121 (80.2%) who discontinued GAMT reported a current transgender or gender-diverse identity. DiscussionGiven the dearth of information about the subpopulation who discontinue GAMT, this study advances candidate factors to inform future longitudinal research to better understand the multiple reasons and contexts for stopping GAMT.

The effects of family support and smartphone-derived homestay on daily mood and depression among sexual and gender minority adolescents.

Sexual and gender minority (SGM) adolescents are at elevated risk for depression. This risk is especially pronounced among adolescents whose home environment is unsupportive or nonaffirming, as these adolescents may face familial rejection due to their identity. Therefore, it is critical to better understand the mechanisms underlying this risk by probing temporally sensitive associations between negative mood and time spent in potentially hostile home environments. The current study included adolescents (N = 141; 43% SGM; 13-18 years old), oversampled for depression history, who completed clinical interviews assessing lifetime psychiatric history and depression severity as well as self-report measures of social support. Participants also installed an app on their personal smartphones, which assessed their daily mood and geolocation-determined mobility patterns over a 6-month follow-up period. Over the 6-month follow-up period, SGM adolescents reported elevated depression severity and lower daily mood relative to non-SGM youth. Interestingly, SGM adolescents who reported low family support experienced lower daily mood than non-SGM adolescents, particularly on days when they spent more time at home. Current findings reinforce evidence for disparities in depression severity among SGM adolescents and highlight family support as a key factor. Specifically, more time spent in home environments with low family support was associated with worse mood among SGM adolescents. These results underscore the need for clinical interventions to support SGM youth, particularly interventions that focus on familial relationships and social support within the home environment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for The Effects of Family Support and Smartphone-Derived Homestay on Daily Mood and Depression Among Sexual and Gender Minority Adolescents

Supplemental Material for The Effects of Family Support and Smartphone-Derived Homestay on Daily Mood and Depression Among Sexual and Gender Minority Adolescents

Queer and transgender joy: A daily diary qualitative study of positive identity factors among sexual and gender minority adolescents.

Queer and transgender joy: A daily diary qualitative study of positive identity factors among sexual and gender minority adolescents.

Clinical outcomes for sexual and gender minority adolescents in a dialectical behaviour therapy programme.

Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people. This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK). Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms. SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions. These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting.

Effects of sexual and gender minority stress on depressive symptoms among adolescents of color in the United States.

There is a need for more research on minority stress theory (MST) with sexual and gender minority (SGM) adolescents of color, because of their disproportionate risk for depression. We recruited 1,627 SGM adolescents of color in the United States to complete measures assessing lesbian, gay, bisexual, transgender, and queer (LGBTQ) climate, LGBTQ microaggressions within one's ethnoracial community, internalized LGBTQ stigma, stress management ability, and depressive symptoms. Using structural equation modeling, a hybrid measurement-structural model was tested, indicating good model fit. Multiple significant indirect pathways linking LGBTQ climate and depressive symptoms emerged. A less positive LGBTQ climate was associated with more microaggression-related stress, more internalized LGBTQ stigma, and worse stress management ability, all of which were associated with greater depressive symptoms. A serial mediation with more microaggression-related stress being associated with greater internalized LGBTQ stigma approached significance. Our findings generally support MST processes in terms of depressive symptoms in SGM adolescents of color, suggesting that psychosocial interventions targeting these processes may have meaningful implications for the mental health of this vulnerable group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impacts of sociodemographic factors, identities and neighbourhood safety on the relationship between urban green space and adolescent mental well-being: Findings from Tāmaki Makaurau Auckland, Aotearoa New Zealand

This study explored the relationship between green space accessibility (GSA) in residential area and adolescents’ mental well-being, and whether the relationship was moderated by sociodemographic factors (sex, ethnicity, neighbourhood deprivation), identities (gender and sexuality minority, disability) and perceived neighbourhood safety simultaneously. Data from 3813 adolescents who lived in Tāmaki Makaurau Auckland, Aotearoa New Zealand were obtained from the Youth19 Rangatahi Smart Survey. A Gaussian-based two-step floating catchment area method was employed to measure the spatial accessibility to green space at the neighbourhood level. The World Health Organization-5 Well-being Index was used to assess emotional well-being (EW), and the Reynolds Adolescent Depression Scale-short form was employed to measure depressive symptoms (DS). Through moderation analyses, results showed that perceived neighbourhood safety plays a vital role in the GSA – mental well-being association, with a negative trend in adolescents who reported being less safe in neighbourhoods. Adverse associations of GSA were found in gender and sexuality minority, disabled, Asian and Pacific adolescents, under the condition of not feeling safe in neighbourhoods all the time. The results showed marginalised adolescents tended to feel less safe in neighbourhoods, have lower EW and a higher level of DS. Additionally, the results from bivariate correlations showed there were inequalities in GSA for adolescents who lived in most deprived neighbourhoods and adolescents of Māori ethnicity. This study provides novel evidence of the importance of safe and inclusive green space for effectively promoting mental health and mitigating health inequalities of adolescents in urban areas.

Sleep and Socioemotional Outcomes Among Sexual and Gender Minority Adolescents: A Longitudinal Study

Sexual and gender minority adolescents face specific stressors associated with their minority status, leading to compromised socioemotional outcomes and sleep. Sleep patterns have, in turn, been found to predict socioemotional outcomes. As such, we aimed to investigate whether healthy sleep patterns prospectively predicted socioemotional outcomes, and whether associations varied as a function of sexual and gender minority status. We conducted a secondary data analysis among adolescents at age 14 to 17, from a nationally representative prospective cohort in the United Kingdom (N = 8923, mean age = 13.8), with 7021 cisgender heterosexual, 1801 sexual minority, and 101 gender minority adolescents. Indicators of socioemotional outcomes included self-esteem, emotional well-being, peer relationships, and relationship with parents. The results showed that gender minority adolescents reported the worst sleep patterns and socioemotional outcomes, followed by sexual minority and cisgender heterosexual adolescents. Results from multi-group path analyses showed that emotional well-being, self-esteem, and peer relationships at age 17 were prospectively predicted by sleep patterns and the associations were moderated by sexual and gender minority status. Influence of sleep patterns, particularly sleep initiation problems and frequent awakening, on socioemotional outcomes was greater among gender minority adolescents, when compared to cisgender heterosexual adolescents. In conclusion, positive socioemotional outcomes were predicted by healthy sleep patterns. The potential role of sleep health in optimizing socioemotional outcomes among sexual and gender minority adolescents might warrant further investigation in prevention or intervention studies.

Sexual and Gender Minority Patients’ First Pelvic Examination Experiences: What Clinicians Need to Know

This study aims to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB). Using purposive sampling, we recruited SGM AFAB individuals, ages 18 to 24, who had at least one pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had Krippendorff's alpha intercoder reliability score > 0.7. Interviews were analyzed using ATLAS.ti. Thirty participants completed interviews. Fourteen participants identified as bisexual, two gay, one lesbian, three pansexual, eight queer, and two straight/heterosexual. Sixteen participants identified as cisgender, nine genderqueer/gender nonconforming, and five transgender. Factors influencing the first pelvic exam experience were organized as patient or clinician level factors. Patient Level Factors: Gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. Clinician Level Factors: Clinicians' gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam. SGM AFAB individuals identify patient and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.

Wellbeing and healthcare access for sexuality and gender minority secondary school students with long-term health conditions

ObjectiveTo explore the prevalence of long-term health conditions (which includes disorders such as asthma and diabetes, lasting six months or more) among sexuality and gender minority youth (SGMY) within Aotearoa New Zealand, and report on SGMY access to health care services. MethodWe used data from a population-based survey (Youth’19) of 7,059 secondary school students in Aotearoa New Zealand. Multivariable logistic regression models were used to investigate the associations of five sex, gender and sexuality groups: heterosexual cisgender females (n = 3,127, 44.30%); heterosexual cisgender males (n = 2,934, 41.64%); sexuality minority cisgender females (n = 659, 9.34%); sexuality minority cisgender males (n = 216, 3.06%); and gender minority adolescents (n = 123, 1.74%), and the selected outcome variables (i.e., general health, long-term health conditions, difficulties accessing healthcare and talked to a health provider privately). ResultsGender minority adolescents reported the highest odds of having a long-term health condition (adjusted Odds Ratio/aOR = 6.69, 95% Confidence Intervals/CI 3.89–11.42) compared to heterosexual cisgender males. Sexuality minority cisgender females and males also had significantly higher odds of having a long-term health condition compared to heterosexual cisgender males. Gender minority youth reported the highest odds of experiencing difficulties accessing health care (aOR = 3.99, 95% CI 2.50–6.36) compared to heterosexual cisgender males. Sexuality minority cisgender females and males were also significantly more likely to experience difficulties accessing healthcare than heterosexual cisgender males. ConclusionSGMY are more likely to report a long-term health condition compared to their peers and access to health care for SGMY is constrained. Health and social care service providers need to ensure their provisions are safe, accessible, inclusive, and appropriate for SGMY.

Exploring the Relationship between Self-Rated Health and Unmet Cancer Needs among Sexual and Gender Minority Adolescents and Young Adults with Cancer.

This study evaluates the unmet needs of sexual and gender minority (SGM) adolescent and young adult (AYA) cancer survivors by comparing SGM AYA self-rated health (SRH) scores to their non-SGM (i.e., cisgender/heterosexual) counterparts. The Cancer Needs Questionnaire-Young People (CNQ-YP) and self-rated health measures were used to assess unmet needs in AYAs aged 15-39 who had been diagnosed with cancer in the previous ten years (n = 342). Participants were recruited from a National Cancer Institute (NCI) Comprehensive Cancer Center registry using the modified Dillman's method. Self-reported sexual orientation and gender identity (SO/GI) data were collected. Independent t-tests were used to test between-group differences in unmet needs and Pearson's chi-square test was used to determine the difference in SRH scores between SGM and non-SGM AYA cancer survivors. SGM AYA cancer survivors reported greater mean needs than their non-SGM counterparts across all six domains and reported significantly greater needs in the domains of Feelings and Relationships, t(314) = -2.111, p = 0.036, Information and Activities, t(314) = -2.594, p = 0.009, and Education, t(207) = -3.289, p < 0.001. SGM versus non-SGM SRH scores were significantly different, indicating that a higher percentage of SGM AYAs reported poor/fair health compared to those who were non-SGM. Unmet life and activities needs were negatively associated with AYA cancer survivors' SRH, whereas unmet work needs were positively associated with AYA cancer survivors' SRH. An AYA's gender identity (SGM versus non-SGM) was not a moderator. SGM AYAs are an understudied group within an already vulnerable patient population. Unmet psychosocial needs related to one's feelings and relationships, and information and activity needs merit further research to develop tailored interventions that reflect the experiences of SGM AYAs.

A Qualitative Study of First HIV Test Experiences Among Sexual and Gender Minority Adolescents

A Qualitative Study of First HIV Test Experiences Among Sexual and Gender Minority Adolescents

The Role of Family Rejection of Gender Expression on Minority Stress and Mental Health of Sexual and Gender Minority Adolescents

The Role of Family Rejection of Gender Expression on Minority Stress and Mental Health of Sexual and Gender Minority Adolescents

Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study.

Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as "digital natives," since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM's connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps. This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes. We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non-sexual and gender minority adolescents. Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024. This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health. DERR1-10.2196/50984.