Mental Health Issues in Sexual and Gender Minority Youth (page 2)
Research initiated nearly thirty years ago suggests that sexual minority youth are more likely than their nonminority peers to experience difficulties with depression and suicide, lower self-esteem, difficulties in academic functioning, and substance abuse (Russell, 2006; Williams et al., 2005). Unfortunately, this focus on negative symptoms or “pathology” led researchers to ignore other research topics, such as those related to resilience and resourcefulness in this population. Some researchers (e.g., Cole, Denny, Eyler, & Samons, 2000) are now more interested in exploring how external pressures associated with homophobia, biphobia, and transphobia symptoms may lead to depression, substance abuse, dropping out of school, homelessness, and increased risk for HIV and sexually transmitted diseases.
The first empirical study of sexual minority youth was published by Roesler and Deisher in 1972 in the Journal of the American Medical Association (noted by Savin-Williams, 2005). The 1980s were a time of intense research productivity, particularly in the areas of same-sex sexual identity development, suicide, and HIV. The bulk of the research incorporated convenience samples of sexual minority youth who sought mental health services or who attended social, recreational, or educational programs specifically for sexual minorities (Savin-Williams, 2005).
Most studies employed retrospective or cross-sectional designs and lacked uniform and well-defined questions. Sexual orientation was assessed using single items such as the following: “Are you gay, lesbian, bisexual, heterosexual?” “Have you had sex with males, females, or both?” (D’Augelli, Grossman, Salter et al., 2005). Because of the negative stigma associated with homosexuality, researchers were hard-pressed to capture youth who covertly thought of themselves as gay or lesbian but were not open with others about their identities (Anhalt & Morris, 2003). Ethnic minorities were typically underrepresented in these samples (Diamond, 2006). Bisexual youth were usually omitted from consideration or grouped together with gay- and lesbian-identified participants and mislabeled as such (Russell & Seif, 2002). The research on gender minority children and adolescents was largely based on the autobiographical accounts of gender minority adults and the case reports of practitioners who worked in clinical settings with gender minority youth, many of whom were diagnosed with gender identity disorder (GID). Many researchers also relied on the retrospective recall of adults, many of whom were affiliated with gay or transgender organizations.
Recent advances in research design and methodology have permitted investigators to develop more-sophisticated research agendas. Some of these include the use of multiple recruitment strategies like the Internet to reach stigmatized populations (Cochran & Mays, 2006; Savin-Williams, 2005). Others use alternative measures of sexual orientation, including questions to assess same-sex sexual behaviors and attractions (Savin-Williams, 2005). Still others use existing data sets on comprehensive national health issues (Cochran & Mays, 2006).
Sexual Minority Youth
Suicide among sexual minorities has been a hotly debated and well-researched issue. In 1989, the U.S. Department of Health and Human Services (DHHS) released a report in response to what was perceived to be an epidemic of suicides in children and adolescents. The report indicated that gay and lesbian youth were two to three times more likely than their peers to attempt and succeed in committing suicide (Gibson, 1989). In a later response to the report, the Secretary of the DHHS, Dr. Louis W. Sullivan, repudiated this section of the report, stating “I am strongly committed to advancing traditional family values.... In my opinion, the views expressed in the paper run contrary to that aim” (Sullivan, 1989).
Despite the controversy over this report, a limited number of states (e.g., Massachusetts, Vermont, and Washington) began including sexual minority youth as part of the Youth-Risk Behavior Surveillance Surveys administered in public and private secondary schools. Thus far, results of these surveys have been remarkably consistent with the information reported by Gibson in 1989 (Morrison & L’Heureux, 2001).
In 2005, D’Augelli, Grossman, Salter et al. attempted to address methodological problems associated with prior research by distinguishing among three groups. First, they looked at sexual minority youth who had never attempted suicide, then those who reported suicide attempts related to their sexual orientation, and finally those whose suicide attempts were unrelated to sexual orientation.
D’Augelli and his colleagues also addressed the effect of several risk factors associated with suicide, including age of self-recognition and self-disclosure, victimization experiences, and childhood history of gender nonconformity. Significant determining factors among those who attempted suicide were greater psychological abuse from parents and more childhood gender-atypical behavior, especially for males. Similar results were reported by Friedman et al. (2007). Using data from the Urban Men’s Study, Friedman et al. reported that early gay-related harassment was related to depression, attempted suicide, and HIV seropositivity in adulthood.
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