Higher Rates of Depression in Sexual Minority Youth

Batya Swift Yasgur, MA, LSW

April 24, 2018

Adolescents who are gay, lesbian, bisexual, or are questioning their sexual orientation have significantly more depressive symptoms than their heterosexual counterparts, new research shows.

Sexual minority youth reported almost twice as many depressive symptoms than their heterosexual peers during waves 2 and 6 of the study. During the intermediate waves, they reported roughly 50% more symptoms.

Investigators at the National Institutes of Health found that the main drivers of depression were lower family satisfaction, cyberbullying, and unmet medical needs.

"All of these experiences of family dissatisfaction, cyberspace bullying and victimization, and negative experiences in the medical setting explained why sexual minorities had more depressive symptoms," lead author Jeremy Luk, PhD, postdoctoral researcher, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, told Medscape Medical News.

"Adolescence represents an important window for addressing depressive symptoms experienced by these youngsters, which includes increasing screening for depression and identifying barriers for sexual minorities to receive medical care," he said.

The study was published online April 16 in Pediatrics.

Medical Needs Understudied

"Disparities between sexual minority and heterosexual adolescents...in depressive symptoms, major depression, and suicidality are well documented," the authors write.

To optimize preventive strategies, it is important to "identify factors that may explain why these disparities exist," they write.

Although previous research has examined these disparities at specific time points, few studies have "modeled trajectories of depressive symptoms by sexual orientation during the transition from adolescence into young adulthood," the authors state.

Commonly studied contributors to depression include social stress, low parental support, and peer victimization. A "smaller but growing literature" suggests that sexual minority youth report unmet medical needs and that they may be more embarrassed than their heterosexual peers to use mental health services.

"The novelty of our study is that it filled a research gap by looking at multiple factors together instead of one or two factors, and that it is the first study to look at unmet medical needs as a contributor to depressive symptoms among these adolescents," Luk said.

To investigate these varied factors, investigators used data from the NEXT Generation Health Study, an ongoing longitudinal study of a nationally representative sample of 2785 high school students in 22 states.

The study has followed students annually since the 2009-2010 school year.

For the current analyses, the researchers drew data from years 2009 to 2016 for persons from the 11th grade (age 17 years) to 3 years after high school.

Sexual orientation was determined through self-reported attraction either to the same sex or both sexes or through self-reported questioning of sexual orientation.

Those who reported sexual attraction only to the opposite sex were referred to as heterosexual.

During wave 2 of the study, participants were asked about their sexual orientation and their sources of peer support (ie, how many friends they had and whether they had talked to those friends about a problem in the past 7 days).

They were also asked about in-person bullying, either at school or at work, and cyberbullying, as well as whether they thought they should have received medical care but did not during the past 12 months.

During waves 2 to 6, the researchers measured depressive symptoms using mean scores of the 8-item pediatric Patient-Reported Outcomes Measurement Information System scale.

The researchers used latent growth curve models to estimate differences in depressive symptoms with respect to sexual orientation from waves 2 to 6, to conduct mediation analyses of the involvement of the mediators, and to evaluate sex differences.

Better Screening Needed

Sexual minority adolescents experienced considerably higher rates of depression than did their heterosexual peers throughout all five waves of the study.

Of the sexual minority adolescents, 38.5% reported low family satisfaction, compared to 19.3 of the heterosexual adolescents (P = .010).

Sexual minority youngsters also reported cyberbullying victimization (taking place at least two to three times a month) three times more than their heterosexual peers (15.5% vs 5.2%; P =.003).

Notably, almost one third (29.4%) of sexual minority youngsters reported unmet medical needs, in contrast to 18.8% of their heterosexual counterparts (P = .003).

Interestingly, there was considerably less discrepancy between sexual minority and heterosexual youngsters regarding peer support, with almost the same number reporting having no friends (14.1% vs 14.5%; P = .200) as those reporting having one or two friends (31.8% vs 32.2%; P = .200).

More sexual minority youth than heterosexual youth reported having three to four friends (42.5% vs 32.8%; P = .200), although fewer had five to six friends (11.6% vs 20.6%; P = .200).

Cyberbullying victimization and unmet medical needs were found to be significant mediators in the final model, which included the pathway through low family satisfaction.

The moderated path from cyberbullying victimization to depressive symptoms was smaller among male than among female participants.

"The one surprising finding was that we did not find peer support as a significant factor driving depressive symptoms, because we thought minorities would experience lower peer support, but that wasn't the case," Luk commented.

By contrast, the higher rates of depressive symptoms in sexual minorities did not come as a surprise, he said

The authors state that their findings "are important within the context of past research revealing a diminishing gap in depressive symptoms between sexual minority and heterosexual adolescents with age, as well as popular press messages suggesting that depressing symptoms among sexual minority adolescents may decrease with age."

These findings suggest that it is "important for practicing clinicians to engage in better screening for depression and be willing to discuss sexuality and related issues regarding sexual orientation with these youngsters, since many are likely embarrassed to tell the doctor about sexual orientation and potentially related medical needs," Luk said.

Necessary Interventions

Commenting on the study for Medscape Medical News, Gary M. Diamond, PhD, professor, Department of Psychology, Ben-Gurion University, Israel, who was not involved with the study, said that its "major contribution is the large population-based sample."

Moreover, "the study examines the unique effects of family climate and victimization on the trajectory of depression symptoms over the course of adolescence and into young adulthood."

He added, "The good news is that it is possible for intervene in both of these domains.

"I think the take-home message is that there is a need for interventions to help parents work through their own shame and loss and better understand the negative impact that their rejecting behaviors are having on their adolescent and young adult LGBTQ offspring," he said.

Also commenting on the study for Medscape Medical News, Sameer Hinduja, PhD, codirector, Cyberbullying Research Center, and professor of criminology and criminal justice, Florida Atlantic University, Jupiter, who was not involved in the study, called it "rigorous in its methodological approach demonstrating, via quality longitudinal data, that sexual minority youth struggle more with depressive symptomatology and are more likely to be involved in cyberbullying than their heterosexual peers."

Hinduja recommended "more social and community support for those in the sexual minority, because clearly they are still struggling mightily," and suggested "specific programmatic rather than ad hoc and student-led implementations" in every school to "create a culture of tolerance and complete peer respect."

Luk added that identifying and addressing barriers to medical care for sexual minorities is "really important as a systems-based perspective." He recommended that medical care be integrated into the school system and community LGBTQ supportive youth centers so that youth need not depend upon parental involvement to receive the medical care they need.

The project was supported in part by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Heart, Lung, and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute on Drug Abuse; and the Maternal and Child Health Bureau of the Health Resources and Services Administration and funded by the National Institutes of Health. The study authors, Dr Diamond, and Dr Hinjuja have disclosed no relevant financial relationships.

Pediatrics. Published online April 16, 2018. Full text

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