Explaining Health Disparities between Heterosexual and LGB Adolescents by Integrating the Minority Stress and Psychological Mediation Frameworks: Findings from the TRAILS Study

Abstract

Lesbian, gay, and bisexual (LGB) adolescents experience elevated levels of internalizing problems and use more substances than heterosexual adolescents. The minority stress and psychological mediation framework are complementary theoretical frameworks that were developed to explain these disparities. However, limited empirical research has integrated both frameworks to study health disparities between heterosexual and LGB adolescents. This study attempts such an integration, using data from the first five waves (participant age 11-22) of the TRacking Adolescents' Individual Lives Survey (TRAILS), a cohort study of Dutch adolescents (N = 1738; 151 LGB; 54.8% girls). It was tested whether an LGB identity was linked to internalizing problems and substance use through a serial mediation process, in which sexual identity would be associated with peer victimization and negative relationships with parents (first set of mediators, in keeping with the minority stress framework), which in turn would be associated with fear of negative social evaluation and a lack of social support (second set of mediators, in keeping with the psychological mediation framework), and eventually increasing the risk for internalizing problems and elevated levels of substance use. Moreover, it was tested whether the link between minority stress and substance use was mediated by peers' substance use levels, as hypothesized by the psychological mediation framework. Compared to heterosexual participants, LGB participants reported more internalizing problems, smoked more cigarettes, and used more marijuana, but did not consume more alcohol. The relation between sexual identity and internalizing problems was mediated by peer victimization and parental rejection, which is in line with the minority stress framework. No statistically significant support was found for the psychological mediation framework. These findings provide a better understanding of the pathways through which sexual identity disparities in mental wellbeing and substance use come about.

Longitudinal associations of cannabis, depression, and anxiety in heterosexual and LGB adolescents.

“…More specifically, research conducted among adolescents and young adults supports a minority stress framework in describing how minority stressors (e.g., internalized homophobia) predicted both psychological distress and cannabis use, but does not specify directionality between the latter two variables (Goldbach, Schrager, Dunlap, & Holloway, 2015;Kiekens et al, 2020).…”

Youth's experiences with inclusion, isolation, and discrimination in the LGBTQ+ community

“…Additionally, LGBTQ+ youth can feel marginalized and rejected by their parents, due to stigma associated with their sexual orientation and/or gender identity (Higa et al, 2014; McDermott et al, 2018). For instance, Kiekens et al (2020) found that LGB adolescents reported higher rates of parental angry outbursts and rejection compared to straight adolescents. Parental rejection predicted subsequent physical and mental health problems, including smoking, alcohol use and internalizing problems.…”

The Social Cognitions of Victims of Bullying: A Systematic Review

“…First, some studies did not find significant associations between victimization and hostile interpretation tendencies (Leff et al, 2014;Mathieson et al, 2011;Prinstein et al, 2005;Smalley & Banerjee, 2014;Smorti & Ciucci, 2000;van Dijk et al, 2017;Warden & Mackinnon, 2003) or being more upset after hypothetical, ambiguous provocations (McQuade et al, 2019), or only found evidence of this association for Japanese but not for American children (Kawabata et al, 2013). Other studies found no association between victimization and fearing negative evaluation (Kiekens et al, 2020;Pabian, 2019) or expecting and interpreting rejection (Rudolph et al, 2021;Stubbs-Richardson & May, 2020). In addition, one study found no evidence that victims interpret situations more often as emergencies when they were also asked whether they would intervene that particular situation (Jenkins & Nickerson, 2017).…”