Sexual Minority Identity Research Articles

"I find value in myself": Queer Asian American men's self-love and resistance in the face of White supremacy.

Queer (i.e., gay, bisexual, or another sexual minority identity) Asian American men experience unique challenges and strengths related to their social identities at the intersection of race and sexual orientation. While a sizable body of research has shown how this population faces racism within the broader queer community, there is little research that specifically examines the strengths of this population, including how they cultivate self-love in the face of White supremacy. Thus, the purpose of this study was to examine how queer Asian American men who endorse self-love regardless of what queer white men think of them cultivate that self-love, as well as to understand the benefits of this self-love. Using a qualitative, grounded theory approach with 20 queer Asian American men who endorsed self-love regardless of what queer White men think of them, results indicated the core category of facilitating forces of self-love. Within this overarching category, results highlighted four key categories: location (i.e., predominantly White area, racially diverse area, and transition from one area to another), social support (i.e., processing experiences and challenging the status quo), self-reflection (i.e., journaling, therapy, and increasing critical consciousness/viewing the self-in-context), and active resistance (i.e., externalizing racism, distancing from Whiteness, seeking representation, engaging in activism or advocacy, and cultivating self-worth). This study highlights the specific mechanisms by which queer Asian American men love themselves regardless of queer white men's views of them, posing larger implications for how marginalized groups can resist and thrive in the face of societal oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-compassion as a mediator of the relationship between social support and identity affirmation in sexual minority adults

ABSTRACT Identity affirmation refers to comfort and pride in sexual minority identity, and consideration of this as a positive facet of one’s identity. Evidence demonstrates that identity affirmation is beneficial for sexual minority individuals, yet little is known about factors predicting identity affirmation. The current research examines social support as a predictor of identity affirmation in lesbian, gay, bisexual, and queer (LGBQ) adults, and tests whether self-compassion mediates this. A sample of 597 LGBQ adults (M age = 40.48 years, SD = 14.62) completed an online anonymous survey assessing demographic characteristics, self-compassion, social support, and identity affirmation. Social support predicted identity affirmation both directly, and indirectly via self-compassion, though sexual identity moderated these effects. Specifically, social support predicted greater identity affirmation via self-compassion among gay, lesbian, and bisexual individuals. However, among queer-identified individuals, there were no direct or indirect effects found. Results suggest that social connection may help to foster identity affirmation by enhancing attitudes of acceptance and kindness towards oneself, at least among gay, lesbian, and bisexual individuals. Findings also suggest there may be unique predictors of identity affirmation for queer-identified individuals, and further research is needed to identify these predictors. Interventions targeting social factors and self-compassion may warrant further investigation to assess whether they can help to cultivate identity affirmation in LGBQ adults.

"I have some people who actually really care:" Young sexual minority women's lived experiences of non-suicidal self-injury disclosure.

Sexual minority youth are more likely to engage in Non-Suicidal Self-Injury (NSSI) than their heterosexual peers, and sexual minority women demonstrate greater risk of NSSI than their sexual minority male counterparts. However, a lack of research exists on NSSI among young sexual minority women, particularly their NSSI disclosure experiences. We used a descriptive-interpretive, qualitative design with semi-structured interviews to examine young sexual minority women's lived experiences disclosing NSSI and of others' responses to these disclosures. The sample included 65 sexual minority women aged 14-30 recruited via paid social media advertising from across the U.S. We performed an inductive thematic analysis of transcripts from 58 participants (89%) who reported a history of NSSI. Participants shared reasons for disclosure (wanting help, communicating distress) or nondisclosure (cultural stigmas), types of disclosure (accidental/involuntary, and direct/voluntary), and recipients of a disclosure (friends, partners, mental health providers, and parents). They also described responses to, and feelings after, NSSI disclosure, revealing two themes: i) Unhelpful/stigmatizing responses (based on fear, anger, and apathy) and ii) Helpful/destigmatizing responses (expressions of concern, emotional support, and alternative coping strategies). Overall, young sexual minority women's disclosure experiences were consistent with those of other populations, highlighting the need to further reduce stigma about NSSI, as well as sexual minority identities, and provide universal education promoting helpful responses to NSSI disclosure.

11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments

Abstract Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health. Key messages • Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals. • Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.

Stressors and symptoms explaining sexual orientation inequalities in mental health services usage: A longitudinal study with young adults

Abstract Background Sexual minority (i.e., lesbian, gay, and bisexual [LGB], and other non-heterosexual) individuals are more likely to use mental health services than heterosexuals; however, evidence is scarce about factors contributing to this difference. Methods This study uses longitudinal data from a population-based sample of young adults (aged 18- 36) in Sweden (N = 1,137). We use mediation analysis to examine whether common mental health symptoms (i.e., depressive, anxiety and social anxiety symptoms, suicidality, and alcohol use) mediate sexual orientation differences in mental health services use; and to understand whether adding general stressors (i.e., low social support, loneliness, and perceived stress) to these models increases the total effect explained. Afterwards, we use logistic regression models to understand how minority-specific stressors (e.g., family reaction and dimensions of sexual minority identity) predict mental health service use among sexual minority individuals (N = 498), adjusting for common mental health symptoms. Results Common mental health symptoms only partially mediate the associations and the direct effect for sexual orientation remain significant (β = 0.11, p < 0.01). Adding general stressors to these models only slightly increase the total effect explained and the direct effect remained significant (β = 0.11, p < 0.01). Among sexual minority individuals, after adjusting for common mental health symptoms, a difficult process of coming out (β = 0.12, p < 0.05) and negative family reaction towards one’s sexual orientation (β = 0.15, p < 0.05) predicted use of mental health services. Conclusions Overall, these results show that minority-specific stressors contribute to help-seeking behaviours among sexual minority individuals, regardless of psychiatric morbidity, highlighting the potential role of mental health services empowering sexual minority individuals to cope with minority stress.

Experiences of LGBTQ+ graduate students in research-focused doctoral programs: a scoping review

Students of sexual and gender minority (SGM) identities have long been underserved in higher education, and the limited research thus far has focused on undergraduates. There is a large gap in understanding the outcomes and experiences of LGBTQ+ graduate students, particularly in STEM. We undertook the first scoping review to examine the available literature on LGBTQ+ student experiences in research-focused doctoral programs. A scoping review methodology was utilized to compile a broad set of publications for a narrative review of emergent themes. A comprehensive search of 5 bibliographic databases yielded 1,971 unique studies, which were screened by two independent reviewers for data on LGBTQ+ doctoral students in non-clinical fields. Eighty-two publications were included in the analysis, over half of which were published in the past 5 years. Thirteen themes emerged from analyzing the included publications. LGBTQ+ ientities can continue evolving during graduate school, and some students incorporated SGM identities in their research (“mesearch”). Though students expected academia to be welcoming, many encountered repeated anti-LGBTQ+ bias that impacted their perceived safety for coming out. Nearly half of the studies mentioned intersectionality with other marginalized identities, including race/ethnicity, religion, disability, and others. Based on the information presented, we outline recommendations for practitioners to improve doctoral education, such as preparing teaching assistants to manage discriminatory classroom conduct.

Associations Between Sexual Orientation Dimensions and Cardiometabolic Diseases: Data From the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III).

Sexual orientation can be measured across identity, attraction, and behavior. Sexual minorities are at increased risk of cardiovascular disease (CVD) and diabetes; however, it is not known whether cardiometabolic disease risk varies across these dimensions. We analyzed cross-sectional data from 36,309 adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Participants were categorized as heterosexual (reference), lesbian/gay, or bisexual across identity, attraction, and behavior using structured clinical interview data. Prevalent CVD (myocardial infarction, stroke, angina, or arteriosclerosis) and diabetes were assessed by self-report. Demographics (age, sex, race/ethnicity, education, and income) adjusted logistic regression models revealed bisexual behavior (i.e., people reporting sexual activity with both man- and woman-identifying individuals), but not lesbian/gay behavior (i.e., people reporting sexual activity exclusively with same-sex individuals), was associated with an increased odds of prevalent CVD (OR = 1.44, 95% CI = 1.08-1.91, p = .013) and prevalent diabetes (OR = 1.39, 95% CI = 1.09-1.77, p = .007). Contrastingly, sexual minority identity (i.e., self-concept) and attraction (i.e., one's sexual/romantic feelings) were not associated with prevalent CVD or diabetes. Our results in a nationally representative sample indicate that the sexual orientation dimension of behavior is linked with prevalent CVD and diabetes. This finding suggests that assessing multiple sexual orientation dimensions may aid in identifying sexual minority subgroups in greatest need of cardiometabolic disease prevention efforts. Although mechanisms such as stigma and minority stress have been proposed, future studies are required to elucidate mechanisms underlying the bisexual behavior-cardiometabolic disease relationship.

A Systematic Review and Narrative Synthesis of Factors Affecting Pre-exposure Prophylaxis Willingness Among Black Women for HIV Prevention.

Pre-exposure prophylaxis (PrEP) can significantly reduce human immunodeficiency virus (HIV) transmission among Black women in the United States (U.S.), a group disproportionately affected by HIV. However, PrEP uptake in this HIV-vulnerable population is low. This review analyzes the factors influencing Black women's PrEP willingness using the Behavioral Model for Vulnerable Populations (BMVP). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework, we conducted a systematic literature search and selected 24 peer-reviewed studies on PrEP willingness. Narrative synthesis revealed a heterogeneous landscape of the determinants affecting PrEP willingness among Black women, categorized into three main domains. Predisposing demographic and social factors included younger age, unmarried status, higher education, sexual or gender minority identity, trust in healthcare providers, and perceived HIV risk. Predisposing behavioral factors included condomless sex, multiple partners, and engagement in sex work. Socioeconomic status, health insurance, healthcare access, support systems, and structural challenges were identified as enabling factors influencing Black women's PrEP willingness. Finally, the perceived need domain and health-related factors influencing the perceived need for PrEP included a history of sexually transmitted infections (STI), intimate partner violence (IPV), and birth control interference. This study emphasizes the complexity of the barriers and facilitators of PrEP uptake and, thus, the need for tailored interventions and health strategies to promote its use. Addressing the interconnected individual, interpersonal, and structural determinants of PrEP access is crucial for improving PrEP willingness and thereby advancing health equity in this population.

The Developmental Collision Hypothesis: An Empirical Test With Three Generations of Sexual Minority Youth.

Sexual minority youth experience disproportionate rates of mental health symptomatology relative to their heterosexual peers. Less is known about why these disparities have persisted despite growing public awareness of sexual diversity. The developmental collision hypothesis states that increased cultural visibility of sexual diversity has accelerated the developmental timing of sexual minority identity formation processes such that they collide with early adolescence, a uniquely sensitive period for experiencing identity-based stigma and associated mental health vulnerability. To test this hypothesis, levels and relations between ages of sexual minority identity development milestones, frequency of LGBT-related victimization, and depressive symptoms were examined across three age-matched but cohort-distinct samples of sexual minority adolescents. Data come from three secondary datasets of sexual minority youth who were adolescents in the 1990s, 2000s, and 2010s, respectively: the Challenges and Coping Study, the Victimization and Mental Health among High Risk Youths Study, and the Risk and Protective Factors for Suicide among Sexual Minority Youth Study (n = 1312; Mage = 17.34, SD = 1.30; 52% female). Adolescents from more recent cohorts reported earlier mean ages of several milestones but similar frequencies of LGBT-related victimization relative to those from less recent cohorts. Path analysis models showed that earlier milestones were associated indirectly with more depressive symptoms through LGBT-related victimization. Notably, earlier ages of self-identification and disclosure of a sexual minority identity were also directly related to less depressive symptoms. Few generational differences in relations between constructs emerged. Findings garner initial support for the developmental collision hypothesis and suggest that LGBT-related victimization, rather than earlier milestones themselves, increases mental health vulnerability.

Levels and outcomes of 12-step participation among sexual and gender minority subgroups

IntroductionSexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes. MethodsWe used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately. ResultsParticipants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model. ConclusionsThis study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

Mental health help-seeking willingness among U.S. college students: A resilience factor associated with many sexual minority identities

BackgroundFor populations with elevated mental health risks such as college students and minority groups, understanding openness to seeking professional help can inform ways to improve service engagement. This study explores help-seeking willingness among U.S. college students by sexual orientation. MethodsData were drawn from the 2021 National College Health Assessment (N = 64,079). The main outcome of interest was help-seeking willingness (i.e., reported openness to seeking professional mental health help when needed). A secondary outcome was help-seeking history (i.e., past mental health service utilization). Logistic regression analyses were conducted using R version 4.0.5. ResultsIncreased help-seeking willingness was detected among students with a help-seeking history, whether within the past 12 months (OR=7.40, 99%CI: 6.78–9.08) or beyond (OR=2.26, 99%CI: 2.11–2.42). Even after controlling for various covariates including help-seeking history, elevated odds of help-seeking willingness persisted for gay (AOR=2.01, 99%CI: 1.63–2.49), bisexual (AOR=1.35, 99%CI: 1.23–1.49), questioning (AOR=1.22, 99%CI: 1.04–1.45), pansexual (AOR=1.31, 99%CI: 1.06–1.63), and queer (AOR=1.78, 99%CI: 1.35–2.38), relative to heterosexual students. ConclusionsHelp-seeking willingness is a mental health resilience factor unique to several sexual minority groups. Examining what yields greater help-seeking willingness for these sexual minority student groups may inform interventions that enable all college students to seek help when they are in distress.

Validation of the Brief Perceived Sexual Minority Discrimination Questionnaire-Community Version

Sexual minorities—people who identify as lesbian, gay, bisexual, etc.—experience unique forms of discrimination. Yet few validated measures assess sexual minority discrimination, and none allow for comparison with other forms of discrimination. I examined an adaption of the Brief Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CVB) for use with sexual minorities (PSMDQ-CVB). Sexual minority participants complete the PSMDQ-CVB online in addition to measures of harassment, sexual minority identity, and well-being (N = 528). Exploratory factor analysis found that the PSMDQ-CVB's factor structure was inconsistent with the four-factor structure of the original PEDQ-CVB. The 16 items retained had strong internal consistency, and good convergent validity with measures of sexual minority discrimination. The PSMDQ-CVB had good divergent validity with measures of stressful life events, and sexual minority identity, and good predictive validity with well-being measures related to discrimination: symptoms of depression, anxiety, and physical ill-being. Results support the psychometric validity of the PSMDQ-CVB.

Navigating sexual minority identity in sport: a qualitative exploration of sexual minority student-athletes in China

BackgroundSexual minority student-athletes (SMSAs) face discrimination and identity conflicts in intercollegiate sport, impacting their participation and mental health. This study explores the perceptions of Chinese SMSAs regarding their sexual minority identities, aiming to fill the current gap in research related to non-Western countries.MethodsA qualitative methodology was adopted, utilising the Interpretive Phenomenological Analysis (IPA) approach with self-categorization theory as the theoretical framework. Participants were recruited through purposive and snowball sampling, and data were collected via semi-structured interviews, documents, and field notes. Sixteen former and current Chinese SMSAs participated in this study.ResultsThe study reveals four themes: hidden truths, prioritisation of athlete identity, self-stereotyping, and attempt. The results revealed that while SMSAs were common in intercollegiate sport, their identities were often concealed and not openly discussed. The predominant focus on athlete identity in sport overshadowed their sexual minority identities. Additionally, SMSAs developed self-stereotypes that influenced their thoughts and behaviours. The non-heterosexual team atmosphere in women’s teams led to the development of intimate relationships among teammates.ConclusionsThe findings from this study could be incorporated into existing sport policies to ensure the safe participation of SMSAs in Chinese intercollegiate sports. This research offers valuable insights for the development and implementation of inclusive policies. Future research in China could investigate the attitudes of coaches and heterosexual student-athletes toward sexual minority identities to inform targeted interventions.

Safer Sexting Strategies in Technology-Mediated Sexual Interactions: Findings from a National Study

Abstract Introduction While there is extensive research on safer sex, few studies have investigated safer sexting practices. The main objective of this study is to examine the range of security behaviors that individuals adopt in technology-mediated sexual interactions. Methods Three studies collected data on social safety, concealment strategies, and technical security in technology-mediated sexual interactions from participants aged 14–75 in Austria and Germany in 2020 and 2022 (Ntotal = 13,070). Patterns in the data were identified via descriptive statistics and regression analysis. Results The most common precautions of people who used safer sexting strategies were hiding one’s face (46%), only engaging with digital sex partners that are personally known (41%), and negotiating boundaries of consensual sexting (29%). Binomial regression results show that a sexual minority identity, BDSM preference, frequent contact with sexual communities, and prior experiences of unwanted sexting were associated with adopting a wider variety of safer sexting practices. Conclusions The results suggest that the safety strategies used in technology-mediated sexual interactions vary across social groups. Social context factors such as community involvement are associated with the likelihood of safer sexting. Policy Implications Knowledge about safer sexting helps minimize harm in technology-mediated sexual interactions. Safer sexting messages aimed at reducing risk and shame should be included as part of community-based safer sexting education and should be tailored to specific target groups including LGBTIQA+ individuals. Policymakers should support interventions that enhance those social environmental factors that contribute to building trust and consent in technology-mediated sexual interactions.

Help-Seeking from Victim Services, Personal Networks, and Reporting to Police: Stalking Victim Behaviors from the 2019 NCVS Supplemental Victimization Survey.

Understanding the predictors of stalking victimization, help-seeking behaviors of stalking victims, and their reporting to police can help law enforcement and advocates improve systems and ensure they are accessible and useful to victims. Existing stalking research focuses heavily on campus-based stalking, non-nationally representative populations, and/or dated data collection methods, such as the 2006 National Crime Victimization Survey, Supplemental Victimization Survey (NCVS-SVS), an instrument that has been updated according to current stalking definitions. This study employs the latest 2019 NCVS-SVS to analyze its new stalking screening questions and additional variables. We identified predictors of (a) stalking victimization, (b) help-seeking from victim-serving agencies, (c) help-seeking from personal networks, and (d) reporting to police. Predictors of stalking victimization included younger age, identifying as female, identifying as not heterosexual, household incomes below $50,000, and any college attendance. Victims who knew their offenders (intimate or non-intimate) were more likely than victims of stranger stalking to seek help from victim-serving agencies and personal networks. Younger victims were more likely to seek help from personal networks. None of the variables we examined predicted reporting to police. This study shows the characteristics of stalking victims have stayed consistent over time but highlights an ongoing need for resources for victims of stranger stalking, who may not know about or be able to access stalking services that are offered by intimate partner violence agencies. Future research around stalking victim characteristics should focus on populations that are newly included in national stalking data, such as those who identify as transgender and sexual identity minorities.

Sexual Orientation Differences in Age of First Treatment for a Mental Health Diagnosis: A Population-Based Study of Childhood and Adolescence

The aim of the current study was to identify the age at which sexual orientation disparity in mental health diagnoses can be first identified, as well as gender and sexual identity subgroup differences in such treatment, in a population-based sample. Young people aged 16 to 25 (N= 10,365) participating in the probability-based Swedish National Public Health Survey in 2018 were included. This sample was linked to physician-assessed mental health care treatment history data starting when all participants were 8 years old using national health care registries. Participants reporting a sexual minority identity in adolescence and young adulthood were more than 3 times as likely to have been treated for an internalizing disorder diagnosis (eg, depression, anxiety) and more than twice as likely to have been treated for a neurodevelopmental disorder diagnosis during childhood than participants reporting a heterosexual identity. Sexual minority participants overall and women in particular were more likely to have been treated for an internalizing disorder diagnosis at an early age compared with heterosexual participants, with this disparity starting at age 13. The sexual orientation disparity in likelihood of treatment for a neurodevelopmental disorder diagnosis was particularly elevated among bisexual/pansexual women with this disparity starting in early/middle adolescence. This population-based study linked to physician-assessed mental health diagnoses during childhood and adolescence identifies the age at which sexual orientation differences in treatment for common mental disorders emerge. The early emergence of this disparity suggests a potential benefit of interventions that facilitate social belonging for all youth.

Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use.

Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people. Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health. Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=-0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=-0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs. Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.

The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study.

Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement. Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in "real-world" settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.

Identifying pathways from childhood adversity to suicidal thoughts and behaviors among sexual minority adults: An exploratory mediation analysis

BackgroundThe current study uses a nationally representative longitudinal dataset of sexual minority adults in the US to investigate the pathways from adverse childhood experiences (ACEs) to adulthood suicidal thoughts and behaviors. MethodsACEs were measured at year one, potential mediators at year two, and suicidal thoughts and behaviors (suicidal ideation, intent, plan, and attempt) at year three. We conducted an exploratory mediation analysis to identify potential mediating factors linking ACEs to suicidal thoughts and behaviors. Ten candidate mediators were examined: social well-being, felt stigma, experiences of everyday discrimination, social support, psychological distress, alcohol and drug use, importance of sexual identity, community connection, and internalized homophobia. ResultsParticipants were 1518 adults who identified as lesbian or gay (n = 833; 55 %), bisexual (n = 493; 33 %), or with other sexual minority identities (n = 181; 12 %) and were on average 36.48 years (SD = 14.7) of age. Psychological distress served as a common mediator between ACEs and suicidal ideation, intent, plan, and attempt. Additionally, experiences of everyday discrimination emerged as a specific mediator leading to suicidal intent, whereas social support uniquely mediated the relation between ACEs and suicide plan. LimitationsPotential recall bias due to retrospective reporting of ACEs may be a limitation. Future studies should broaden the measurement scope of ACEs and implement intersectional methods. ConclusionThe current findings underscore the urgent need for targeted interventions that address the specific mental health needs of sexual minority individuals, particularly focusing on mitigating psychological distress, combating systemic discrimination, and enhancing social support.

Sexual Minority Identity and Risky Alcohol Use: the Moderating Role of Aggressive Behavior.

Adolescent alcohol use has significant consequences for concurrent and longitudinal health and wellbeing, with sexual minority youth consistently reporting higher levels of alcohol use than their heterosexual peers. Understanding how individual-difference variables like aggressive behavior are associated with variability in sexual minority adolescents' higher levels of alcohol use offers novel theoretical insight into this vulnerability. The 81,509 participants were drawn from the Profiles of Student life: Attitudes and Behavior Study. They were ages 14-17 years (M = 15.38, SD = 1.09) and 50.1% were cisgender girls. For sexual identity, 88% were heterosexual, 5% were mostly heterosexual, were 4% bisexual, were 1% mostly gay or lesbian, and were 1% being gay or lesbian. Participants reported on alcohol use, aggressive behavior, and sexual identity. Gay/lesbian and mostly gay/lesbian adolescents who reported higher aggressive behavior had higher levels of alcohol use than their heterosexual peers who also reported higher aggressive behavior. The way in which aggressive behavior amplified the link between mostly gay/lesbian and gay/lesbian identities and alcohol use suggests the need for more research examining how this trait may heighten both exposure and reaction to minority stressors among some subgroups of sexual minority youth.