Research and Academic
Messaging Guide
(Revised September 2010, Dave Reynolds, MPH, & Sean Iwamoto, MD
Candidate)
0
In an editorial synthesis of the research to date on suicide among sexual minority youth,
noted researcher Gary Remafedi writes:
The evidence is sufficiently compelling to warrant the education of mental health
professionals as well as the development of prevention interventions for [these] youths.
It is time to put controversy aside and be about the business of saving lives.
Archives of General Psychiatry 1999;56(10):885-886
Table of Contents
Research on Suicide among LGBT Youth........……………………………………….…..…2
Research on LGBTQ Youth and Social Service Provision……….……….………………..7
Research on Mental Health among LGBTQ Youth……….……........................................8
Research on Substance Abuse among LGBTQ Youth……………………,……………...10
Research on Child Abuse among LGBTQ Youth ……..…………………………………..12
Research on Violence towards LGBTQ Youth……………………………………………..13
Research on Bullying and School Victimization among LGBTQ Youth…………..……..14
Research on Risk Behaviors among LGBTQ Youth…………………..….…………….…16
Research on Body Image and Eating Disorders among LGBTQ Youth…………………17
Research on Coming Out and Identity Formation among LGBTQ Youth…………........18
Research on Public and School Policies and their Correlates on LGBTQ Youth……....21
1
The following are population-based
and controlled studies are the
strongest methodologically:



28.1% of GB youth report having
made a suicide attempt; they are
3.61 times more likely to report
suicidal intent than their
heterosexual peers (Remafedi G,
French S, et al, “The relationship
between suicide risk and sexual
orientation: results of a
population-based study,” AJPH
1998;88(1):57-60)
LGB students are nearly 50%
more likely to report having
seriously considered suicide
during the last year, and they are
twice as likely to report having
made a suicide attempt. Further,
eight times as many LGB youth
are have attempted suicide four or
more times than their
heterosexual peers and are four
times as likely to have had an
attempt requiring medical
attention. This same study found
an increased risk for violent
experiences and substance abuse
among LGB youth (Faulkner AH,
Cranston K, “Correlates of samesex sexual behavior in a random
sample of Massachusetts high
school student,” AJPH
1998;88(2):262-266)
Men reporting same-sex sexual
behavior after age 18 are 6.5
times as likely as their co-twins to
have attempted suicide (Herrell R,
Goldberg J, et al, “Sexual
orientation and suicidality: a cotwin control study in adult men,”
Arch Gen Psychiatry
1999;56(10):867-874)
Research on Suicide among LGBTQ Youth

Suicide is the third leading cause of death among young
people ages 15 to 24 and accounts for 12.0% of the deaths
every year in that age group (CDC, “Suicide: Facts at a
Glance,” Summer 2009, [Online:
http://www.cdc.gov/violenceprevention/pdf/SuicideDataSheet-a.pdf])

Men at all ages are nearly 4 times more likely to attempt
and complete suicide than women and account for 79.0%
of all suicides in the United States (CDC, “Suicide: Facts at
a Glance,” Summer 2009, [Online:
http://www.cdc.gov/violenceprevention/pdf/SuicideDataSheet-a.pdf])

A meta-analysis of research involving heterosexual and
non-heterosexual people ages 12 and over revealed a 2-fold
increased in suicide attempts in LGB people [pooled risk
ratio for lifetime risk 2.47 (CI 1.87, 3.28), and an
especially high lifetime prevalence of suicide attempt in
gay and bisexual men (RR 4.28, CI 2.32, 7.88) (King M,
Semiyen J, et al, “A systematic review of mental disorder,
suicide, and deliberate self harm in lesbian, gay, and
bisexual people,” BMC Psychiatry 2008;8:70) –
LITERATURE REVIEW

Among sexual minority youth, 42% have sometimes or
often thought of suicide; 33% same-sex feelings and
preceded disclosure of sexual orientation to others. 1/4 said
a family member had made a suicide attempt, and nearly
3/4 said a close friend had attempted suicide (D’Augelli
AR, Hershberger SL, Pilkington NW, “Suicidality patterns
and sexual orientation-related factors among lesbian, gay,
and bisexual youths,” Suicide and Life Threatening Behav
2001;31(3):250-265)

More than 1/3 of LGB youth report having made a suicide
attempt (D’Augelli AR, “Mental health problems among
lesbian, gay, and bisexual youths ages 14 to 21,” Clin
Child Psych and Psych 2002;7(3):439-462)

1/3 of LGB youth report having made a suicide attempt;
though only half of those attempts were judged to be
serious based on lethality. Half of all attempts were related
to sexual orientation. Early openness about sexual
2
orientation, being discouraged by parents and
experiencing psychological abuse, as well as parents
considering behavior to be gender atypical were
associated with gay-related suicide attempts, particularly
in young men (D’Augelli AR, Grossman AH, et al,
“Predicting the suicide attempts of lesbian, gay, and
bisexual youth,” Suicide and Life Threatening Behav
2005;35(6):646-660)
Methodologically-stronger studies
(contd)

GLB youth are 3.41 times more
likely to report a suicide attempt.
Among these youth, young
women are more than 4 times as
likely to report a suicide attempt,
while young men are nearly 4
times as likely to report an
attempt. Being of Latino heritage
or having experienced violence or
victimization more than doubles
the chance of making a suicide
attempt. Drug use is also an
independent predictor of making a
suicide attempt (Garofalo R, Wolf
RC, et al, “Sexual orientation and
risk of suicide attempts among a
respresentative same of youth,”
Arc Peds & Adole Med
1999;153(5):487-493)
 GLB youth who self-identify in
high school are more likely than
their peers to have been
victimized and threatened
(including property damage), and
to have engaged in a variety of
risk behaviors including suicidal
ideation and attempts, multiple
substance use (see that section for
additional odds ratios), and
sexual risk behaviors. In
addition, these youth are nearly
twice as likely, when compared
with heterosexual peers, to report
engaging in multiple risk
behaviors and initiating risk
behaviors at an earlier age than
are their heterosexual peers
(Garofalo R, Wolf RC, et al, “The
association between health risk
behaviors and sexual orientation
among a school-based sample of
adolescents,” Peds 1998;101:895902)

LGB youth report higher rates of suicidal ideation and
suicide attempts than do their heterosexual counterparts
(Silenzio VM, Pena JB, et al, “Sexual orientation and risk
factors for suicidal ideation and suicide attempts among
adolescents and young adults,” AJPH 2007;97(11):20172019)

Sexual minority youth are more likely than their peers to
think about and attempt suicide. The strong effect of
sexual orientation on suicidal thoughts is mediated by
critical youth suicide risk factors, including depression,
hopelessness, alcohol abuse, recent suicide attempts by a
peer or a family member, and experiences of victimization
(Russell ST, Joyner K, “Adolescent sexual orientation and
suicide risk: evidence from a national study,” AJPH
2001;91(8):1276-1281)

In a review of research to date, it is concluded that the
following are risk factors for suicide among LGBTQ
youth: gender non-conformity, early awareness of sexual
orientation, stress, violence, lack of support, school dropout, family problems, acquaintances’ suicide attempts,
homelessness, substance abuse and other psychiatric
issues (Remafedi G, “Sexual orientation and youth
suicide,” JAMA 1999;282(13):1291-1292)

Research has shown that 50% of lesbians have had
thoughts about suicide at some time, and 18% have
attempted suicide (Bradford JB, Ryan C, Rothblum ED,
“National Lesbian Health Care Survey: implications for
mental health care,” J Consult and Clin Psych
1994;62(2):228-242)
3
 2.2% of men reported same-sex sexual partners. These
men evidenced greater lifetime prevalence rates of
suicide symptoms than men reporting only female
partners. (Cochran SD, Mays VM, “Lifetime prevalence
of suicide symptoms and affective disorders among men
reporting same-sex sexual partners: results from
NHANES III,” AJPH 2000;90(4):573-578


Gay and lesbian youth have support networks with an
average of eight people—most still feel they do not have
enough friends and report feeling lonely. These two
feelings correlated positively with suicidal ideation and
attempts, as well as with drug use (Grossman AH, Kerner
MS, “Support networks of gay male and lesbian youth,”
1998;3(1):27-46)
21% of gay and bisexual-identified men as well as menwho-have-sex-with-men report having made a suicide
plan; 12% report having made a suicide attempt (almost
half were multiple attempters). Most who attempted
suicide made their first attempt before age 25. The
average age for initial attempts has declined in recent
years. Some risk factors were specific to being gay or
bisexual in a hostile environment (Paul JP, Catania J, et
al, “Suicide attempts among gay and bisexual men:
lifetime prevalence and antecedents,” AJPH
2002;92(8):1338-1345)
Methodologically-stronger studies
(contd)
 Young adults who report any samesex sexual contact (regardless of selfidentified sexual orientation) are at
an increased risk for anxiety, mood
and substance use disorders, and for
suicidal thoughts and plans (Gilman
SE, Cochran SD, et al, “Risk of
psychiatric disorders among
individuals reporting same-sex sexual
partners in the National Comorbidity
Survey,” AJPH 2001;91(6):933-939)
 The number of male sexual partners
reported by sexually active male
adolescents correlates with a higher
frequency of victimization, use of
violence, and drug use at school.
Frequency of suicide attempts and
fighting outside of school are also
correlated with the number of samesex sexual partners. (J Peds
1998(1)132:13-8)
Selected findings from Youth Risk Behavior Surveillance (YRBS):

LGB youth are 4 times more likely to attempt suicide than their heterosexual
peers (Massachusetts YRBS 2007)

11% of young women identify as LBQ; and among all LGBQ youth, 1/4 report
having made a suicide attempt (Vermont YRBS 2009)

Youth who report any same-sex sexual contact (regardless of self-identified
sexual orientation) are nearly twice as likely to have experienced depression in the
last year. 25% of these youth reported having attempted suicide in the past year,
and 15% of these youth required medical attention for that attempt—a rate more
than six times higher than their heterosexual counterparts. These youth also
report lower levels of support from family and teachers, and more than 1/3 report
feeling unsafe at school (Wisconsin YRBS 2007)
4
Studies that do not use a
representative sample (not as
methodologically strong):


1/3 of gay and lesbian youth
attempt suicide while ½ has
seriously ideated; the majority of
attempts occurred before the age of
17. 75% of the ideators/attempters
in this study cited sexual
orientation as the reason for their
ideation or attempt. More than
50% of the youth who cited sexual
orientation as their most pressing
issue had (1) a substance abuse
issues, (2) a history of physical or
emotional abuse or (3) experienced
family rejection (Hammelman TL,
“Gay and lesbian youth:
contributing factors to serious
attempts or considerations of
suicide,” J Gay & Lesbian Mental
Health 1993;2(1):77-89)
42% of LGB youth report having
made a suicide attempt. 60% had
thoughts of suicide which
correlated with anxiety,
depression, and self-esteem issues.
Attempters significantly differ
from nonattempters on several
milestones of sexual orientation
development, social aspects of
sexual orientation, parents'
knowledge of sexual orientation,
and mental health problems. 40%
of gay and bisexual men will lose a
friend in the coming out process
(D’Augelli AR, Hershberger SL,
“Lesbian, gay, and bisexual youth
in community settings: personal
challenges and mental health
problems,” Am J Community
Psychol 1993;21(4):421-448)

Self-identified gay male youth are among those most
at risk for making a suicide attempt. Youth who
engage in same-sex behavior and youth with same-sex
orientations are also at risk compared to heterosexual
youth, but their risk appears to be lower than selfidentified LGB youth (Russell ST, “Sexual minority
youth and suicide risk,” Am Behav Scientist
2003;46(9):1241-1257)

Among gay male youths, gender-role nonconformity
is associated with suicidality, and bullying mediates
this relationship (Friedman MS, Koeske GF, et al,
“The impact of gender-role nonconforming behavior,
bullying, and social support on suicidality among gay
male youth,” J Adole Health 2006;38(5):621-623)

Bisexual men and women are more likely to report
feeling sad and having contemplated suicide within
the last year than their heterosexual peers (Conron KJ,
Mimiaga MJ, Landers SJ, “A population-based study
of sexual orientation identity and gender differences
in adult health,” AJPH 2010; e-published, waiting on
print)

Nearly half of young transgender people have
seriously thought about taking their lives and one
quarter report having made a suicide attempt. Factors
significantly related to having made a suicide attempt
included suicidal ideation related to transgender
identity; experiences of past parental verbal and
physical abuse; and lower body esteem, especially
weight satisfaction and thoughts of how others
evaluate their bodies (Grossman AH, D’Augelli AR,
“Transgender youth and life threatening behaviors,”
Suicide and Life Threatening Behav 2007;37(5):527537)
5
Studies using non-representative
samples (contd)

Questioning, unsure, or youth who are less certain of their
sexual orientation report even higher levels of substance
abuse and depressed/suicidal thoughts than their
heterosexual or openly LGBT-identified peers (Poteat
VP, Aragon SR, et al, “Psychosocial concerns of sexual
minority youth: Complexity and caution in group
differences,” J Consult and Clin Psych 2009;77(1):196201)

Among Latinos and Asian-Americans, gay and bisexual
men are more likely than heterosexual men to report a
recent suicide attempt (Cochran SD, Mays VM, et al,
“Mental health and substance use disorders among Latino
and Asian American lesbian, gay, and bisexual adults,” J
Consult and Clin Psych 2007;75(5)785-794)

Youth who disclose their sexual orientation report more
verbal and physical abuse by family members and
acknowledge more suicidality than those who have not
"come out" to their families (D’Augelli AR, Hershberger
SL, Pilkington NW, “Lesbian, gay, and bisexual youths
and their families: Disclosure of sexual orientation and its
consequences,” Am J Orthopsychiatry 1998;68:361-371)

Compared with LGB youth with no history of suicide
attempts, attempters report having told more people about
their sexual orientation, having lost more friends because
of those disclosures, and having experienced more
victimization related to sexual orientation. Suicide
attempters report more self-esteem issues and
acknowledge more mental health problems. The loss of
friends due to youth’s sexual orientation and current
suicidal ideation are the strongest predictors of making an
attempt (Hershberger SL, Pilkington NW, D’Augelli AR,
“Predictors of suicide attempts among gay, lesbian, and
bisexual youth,” J Adole Res 1997;12(4):477-497)

Among LGB youth, past suicide attempters were found to
have higher levels of depressive symptoms, anxious
symptoms, and conduct problems at a later time than
youths who neither attempted nor ideated. This suggests
that LGB youth who attempt suicide continue to have
elevated levels of psychological distress long after their
attempt and it highlights the importance of social
relationships in the youths' psychological distress
6
 Approximately 30% of lesbians
drink alcohol more than once a
week with 6% reporting daily
use. About three fourths have
received counseling at some time,
and half have done so for reasons
of sadness and depression
(Bradford J, Ryan C, Rothblum
ED, “National Lesbian Health
Care Survey: implications for
mental health care,” J Consult
and Clin Psych 1994;62(2):228242)
 39% of GB males (ages 14-19)
who presented at a social service
agency in New York City for
LGBT youth reported having
made a suicide attempt. More
than half of the attempters had
tried more than once, and suicide
attempters were more likely to
have dropped out of school, been
thrown out of their homes, and
have friends and family who
attempted suicide (RotheramBorus MJ, Hunter J, Rosario M,
“Suicidal behavior and gayrelated stress among gay and
bisexual male adolescents,” J
Adole Research 1994;9(4):498508)
 26% of LGB youth who have not
attempted suicide have had
ideations (Proctor CD, Groze
VK, “Risk factors for suicide
among gay, lesbian, and bisexual
youths,” Social Work
1994;39(5):504-513)
(Rosario M, Schrimshaw EW, Hunter J, “Psychological
distress following suicidality among gay, lesbian, and
bisexual youths: Role of social relationships,” J Youth &
Adole 2005;34(2):149-161)


Among sexual minority male youth, compared to those
without a history of at least one suicide attempt,
attempters experience higher levels of both generic life
stressors (low self-esteem, substance use, victimization)
and gay-related stressors, particularly those directly
related to visible (femininity) and behavioral (gay sex)
aspects of their sexual identity (Savin-Williams RC,
Ream GL, “Suicide attempts among sexual-minority male
youth,” J Clin Child and Adole Psych 2003;32(4):509522)
62% of homeless LGB youth will attempt suicide at least
one—compared with 29% of their homeless heterosexual
peers (Van Leeuwen JM, et al, “Lesbian, gay, and
bisexual homeless youth: an eight-city public health
perspective,” Child Welfare 2006;85(2):151-170)
Studies using non-representative
samples (contd)
 Environmental factors associated
with sexual orientation, which
can be targeted and changed
through prevention and
intervention efforts, play a major
role in predicting distress in this
population (Safren SA, Heimberg
RG, “Depression, hopelessness,
suicidality, and related factors in
sexual minority and heterosexual
adolescents,” J Consult and Clin
Psych 1999;67(6):859-866)
 Gay and bisexual youth are an
increased risk for both
homelessness and suicide (Kruks
G, “Gay and lesbian
homeless/street youth: special
issues and concerns,” J Adolec
Health 1991;12(7):515-518)
Research on LGBTQ Youth and Social Service Provision

To assess an LGB young person’s risk for suicide, one
should look at the individual’s risk factors (demographic
and situational variables), as well as the immediate
environments that surround the young person (microsystem) and the social conditions under
which the immediate environment operates (macrosystem) (Morrison LL, L’Heureux J,
“Suicide and gay/lesbian/bisexual youth: implications for clinicians,” J Adole 2001;24:3949)

Young lesbians are at an increased risk for mental health issues, depression, suicide attempts,
deliberate self-harm, alcohol abuse, rejection and isolation—particularly as they are coming
to terms with their sexual orientation. To address this, the Lesbian Youth Support
Information Service (LYSIS) offered support in four ways: correspondence counseling,
telephone counseling, peer support and information (Bridget J, Lucille S, “Lesbian youth
support information service (LYSIS): Developing a distance support agency for young
lesbians,” J Comm & Applied Soc Psych 1996;6(5):355-364)

Among sexual minority youth receiving social services, risk factors related to suicidality
included: homelessness, methamphetamine use, hopelessness, and in-school victimization.
GSAs in schools may serve as a protective resource for sexual minority youth (Walls EN,
7
Freedenthal S, Wisneski H, “Suicidal ideation and attempts among sexual minority youth
receiving social services,” Soc Work 2008;53(1):21-29)

Facilities whose primary focus is a mix of substance abuse and mental health services are
more likely to offer special groups and culturally competent services to LGBT people, as are
private, for-profit facilities (Department of Health and Human Services – SAMHSA 2010)

Being in custody of social services is associated with a significant increase in likelihood of
suicide attempts for heterosexual youth. It does not, however, significantly change the
already increased risk of a suicide attempt for sexual minority youth (Walls NE, Potter C,
Van Leeuwen J, “Where risks and protective factors operate differently: Homeless sexual
minority youth and suicide attempts,” Child & Adole Soc Work J 2009;26(3):235-257)

Among all youth, significant decreases in suicidality and improvements in mental state
during the course of the call are associated with calling a crisis helpline (King R, Nurcombe
B, et al, “Telephone counseling for adolescent suicide prevention: changes in suicidality and
mental state from beginning to end of counseling session,” Suicide and Life Threatening
Behav 2003;33(4):400-411)

The two most commonly cited reasons for not using crisis helplines by youth are not thinking
their problem is serious enough and believing they can solve the problems themselves.
Feelings of self-reliance and shame also predicted nonuse of crisis helplines (Gould MS,
Greenberg T, et al, “Teenagers’ attitudes about seeking help from telephone crisis services
(hotlines),” Suicide and Life Threatening Behav 2006;36(6):601-613)

In a study that explored online social networks as a venue for prevention research targeting
young LGB individuals, results of a hypothetical intervention among a mapped network of
100,014 young LGB suggested that varying the number of peers that can be recruited is more
important than just increasing the number of randomly-selected individuals who start the
intervention. (Silenzio VM, Duberstein PR, et al, “Connecting the invisible dots: reaching
lesbian, gay, and bisexual adolescents and young adults at risk for suicide through online
social networks,” Soc Sci Med 2009;69(3):469-474)
Research on Mental Health among LGBTQ Youth
 A meta-analysis of research involving heterosexual and non-heterosexual people ages 12 and
over revealed a 1.5-times higher risk for depression and anxiety disorders (over a period of
12 months or a lifetime) among LGB people (RR range 1.51-4.00). (King M, Semiyen J, et
al, “A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay,
and bisexual people,” BMC Psychiatry 2008;8:70) – LITERATURE REVIEW
8
 Youth who are attracted to the same sex experience larger increases in depressive symptoms
across time than those attracted to members of the opposite sex (Joyner K, Udry JR, “You
don’t bring me anything but down: adolescent romance and depression,” J Health and Soc
Behav 2000;41(4):369-391)
 Youth who report early awareness of sexual orientation,
disclosure to family/peers, and peer rejection and
victimization based on sexual orientation may be at risk for
mental health problems (Hershberger SL, Pilkington NW,
D’Augelli AR, “Predictors of suicide attempts among gay,
lesbian, and bisexual youth,” J Adole Res 1997;12(4):477497)hH
 There is a small, increased risk of recurrent depression among
gay men, with symptom onset occurring, on average, during
early adolescence (Cochran SD, Mays VM, “Lifetime
prevalence of suicide symptoms and affective disorders
among men reporting same-sex sexual partners: results from
NHANES III,” AJPH 2000; 90(4):573-578)
 Young gay men report a greater fear of negative evaluation
and social interaction anxiety and lower self-esteem than
younger heterosexual men. Young gay men who are less
open about their sexual orientation and those who are less
comfortable with being gay are more likely to experience
anxiety in social interactions. Self-esteem levels overall are
lower in young gay men when compared with their
heterosexual peers, and 75% report having changed their
behavior out of fear of being identified as gay or harassed or
attacked due to their sexual orientation (Pachankis JE,
Goldfried MR, “Social anxiety in young gay men,” J Anxiety
Disord 2006;20:996-1015)
 LGB persons have a higher prevalence of mental disorders
than heterosexual persons (Meyer IH, “Prejudice, social
stress, and mental health in lesbian, gay, and bisexual
populations: conceptual issues and research evidence,” Psych
Bull 2003;129(5):674-697) LITERATURE REVIEW
 Sexual minority men who have high levels of minority stress
are 2 to 3 times as likely to suffer from high levels of distress
(Meyer IH, “Minority stress and mental health in gay men,” J
Health and Soc Behav 1995;36(1):38-56)
9
Methodologically-stronger
Study:
 Community surveys to
separately assess the mental
health of young and middleaged homosexual and bisexual
groups (rather than as a
combined group) compared
with heterosexuals revealed
that the bisexual group had
highest measures of anxiety,
depression and negative affect
compared with homosexuals
than heterosexuals. Bisexuals
also had more current adverse
life events, greater childhood
adversity, less positive support
from family, more negative
support from friends and a
higher frequency of financial
problems. Homosexuals
reported greater childhood
adversity and less positive
support from family compared
to heterosexuals (Jorm AF,
Korten AE, et al, “Sexual
orientation and mental health:
results from a community
survey of young and middleaged adults,” Br J Psychiatry
2002;180:423-427)
 Among gay male youth, self-esteem is a predictor of moderate strength for emotional
distress; however it proves to be a particularly strong predictor of emotional distress among
young lesbians (Grossman AH, Kerner MS, “Self-esteem and supportiveness as predictors of
emotional distress in gay male and lesbian youth,” J of Homosexuality 1998;25(2):25-39)
 Questioning, unsure, or youth who are less certain of their sexual orientation report even
higher levels of substance abuse and depressed thoughts than their heterosexual or openly
LGBT-identified peers (Poteat VP, Aragon SR, et al, “Psychosocial concerns of sexual
minority youth: Complexity and caution in group differences,” J Consult and Clin Psych
2009;77(1):196-201)
 Sexual minority adolescents report more externalizing, potentially risky behaviors and
depression symptoms than heterosexual youth (Williams T, Connolly J , et al, “Peer
victimization, social support, and psychosocial adjustment of sexual minority adolescents,” J
Youth and Adole 2005;34(5):471-482)
 Latina and Asian-American lesbians and bisexual women are more likely than heterosexual
women to have lifetime histories of depressive disorders putting them at an elevated risk.
However, the level of morbidity among Latino and Asian-American sexual minority women
appears similar to or lower than that observed in population-based studies of LGB adults
(Cochran SD, Mays VM, et al, “Mental health and substance use disorders among Latino and
Asian American lesbian, gay, and bisexual adults,” J Consult and Clin Psych 2007;75(5)785794)
 Among African-American gay and bisexual men, failing to recognize or acknowledge
discrimination can have negative health consequences for some individuals from
marginalized groups (Huebner DM, Davis MC, “Perceived antigay discrimination and
physical health outcomes,” Health Psychol 2007;26(5):627-634)
Research on Substance Abuse among LGBTQ Youth
 The odds of substance abuse are 190% higher for LGB youth than for their heterosexual
peers, with bisexual youth and lesbians being at an even higher risk—340% and 400%
respectively (Marshal MP, Friedman MS, et al, “Sexual orientation and adolescent substance
use: a meta-analysis and methodological review,” Addiction 2008;103(4):546-556) –
LITERATURE REVIEW
 A meta-analysis of research involving heterosexual and non-heterosexual people ages 12 and
over revealed that lesbian and bisexual women were particularly at risk of substance
dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87,
6.53; any substance use disorder RR 3.42, CI 1.97, 5.92). (King M, Semiyen J, et al, “A
systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and
bisexual people,” BMC Psychiatry 2008;8:70) – LITERATURE REVIEW
10
 LGB youth are more than 6 times as likely to report cocaine
use before the age of 13 than their heterosexual peers. They
are nearly twice as likely to have initiated earlier sexual
contact and have used alcohol and marijuana than their
heterosexual peers. They are also at an elevated risk for more
frequent crack cocaine use, inhalant use, and an increased
number of sexual partners. Increased smokeless tobacco use
in the past 30 days and an increased number of sexual
partners in the previous 3 months were associated with LGB
orientation (Garofalo R, Wolf RC, et al, “The association
between health risk behaviors and sexual orientation among a
school-based sample of adolescents,” Peds 1998;101:895902)
 Compared with their heterosexual peers, youth reporting any
minority sexual orientation report having initiated alcohol use
at younger ages. Bisexual females exhibited the highest
relative risk for alcohol abuse. Younger age at alcohol use
initiation among sexual minority youth significantly
contributes to their elevated risk of binge drinking. Findings
suggest that disparities in alcohol use among youth with a
minority sexual orientation emerge in early adolescence and
persist into young adulthood (Corliss HL, Rosario M, et al,
“Sexual orientation disparities in longitudinal alcohol use
patterns among adolescents: findings from the Growing Up
Today Study,” Arch Ped & Adole Med 2008;162(11):10711078)
 Among sexual minority youth, as involvement in gay-related
activities increases, alcohol and marijuana use has been found
to initially increase, but then decline as involvement in gayrelated activities continues to increase (Rosario M,
Schrimshaw EW, Hunter J, “Predictors of substance use over
time among gay, lesbian, and bisexual youths: an examination
of three hypotheses,” Addictive Behav 2004;29(8):16231631)
 Bisexual-identified and youth with both-sex attractions are at
a somewhat higher risk for substance use and abuse than are
heterosexual youths—highlighting the importance of
distinguishing between youth with only same-sex attractions
and those with both-sex attractions (Russell ST, Driscoll AK,
Truong N, “Adolescent same-sex romantic attractions and
relationships: implications for substance use and abuse,”
AJPH 2002;92:198–202)
11
Methodologically-stronger
Studies:
 Lesbian and bisexual women
aged 20 to 34 years reported
higher weekly alcohol
consumption and less
abstinence from drinking
compared with heterosexual
women and older lesbians and
bisexual women. Of note,
lesbians and bisexual women
younger than 50 were more
likely than heterosexual
women to smoke cigarettes and
drink heavily (Gruskin EP,
Hart S, et al, “Patterns of
cigarette smoking and alcohol
use among lesbians and
bisexual women enrolled in a
large health maintenance
organization,” Am J Public
Health 2001;91(6):976-979)
 A national population-based
survey to assess alcohol-related
problems among homosexual,
bisexual, and heterosexual
people demonstrated few
significant differences between
men of different sexual
orientation (only notably
higher report of drunkenness
among gay men). Both lesbian
and bisexual women had lower
abstention rates and
significantly greater odds of
reporting alcohol-related social
consequences, alcohol
dependence and past helpseeking for an alcohol problem
(Drabble L, Midanik LT,
Trocki K, “Reports of alcohol
consumption and alcoholrelated problems among
homosexual, bisexual and
heterosexual respondents:
Results from the 2000 national
alcohol survey,” J Stud
Alcohol 2005;66(1):111-120)

Bisexual men and women are more likely to abuse drugs, and binge drinking is more
common among bisexual women than heterosexuals ((Conron KJ, Mimiaga MJ, Landers SJ,
“A population-based study of sexual orientation identity and gender differences in adult
health,” AJPH 2010; e-published, waiting on print)
Research on Child Abuse among LGBTQ Youth
 Compared with heterosexual men, gay and bisexual men report higher of childhood
emotional and physical maltreatment (including major physical maltreatment) by their
mother/maternal guardian and major physical maltreatment by their father/paternal
guardian. Lesbians and bisexual women, as compared to heterosexual women, report
higher rates of major physical maltreatment by both their mother/maternal guardian and
their father/ paternal guardian (Corliss HL, Cochran SD, Mays VM, “Reports of parental
maltreatment during childhood in a United States population-based survey of
homosexual, bisexual, and heterosexual adults,” Child Abuse & Neglect
2002;26(11):1165-1178)
 37% of lesbians report having been physically abused as a child or adult; 32% have been
raped/sexually assaulted, and 19% have been involved in incestuous relationships
growing up (Bradford JB, Ryan C, Rothblum ED, “National Lesbian Health Care Survey:
implications for mental health care,” J Consult and Clin Psych 1994;62(2):228-242)
 Lesbians who experienced childhood sexual abuse are at heightened risk of lifetime
alcohol abuse and those who experienced childhood physical abuse are at heightened risk
of lifetime psychological distress relative to lesbians without abuse histories (Hughes TL,
Johnson TP, et al, “Childhood risk factors for alcohol abuse and psychological distress
among adult lesbians,” Child Abuse & Neglect 2007;31(7):769-789)
 1/5 of adult gay and bisexual men report having been the victim of childhood sexual
abuse—primarily by non-family perpetrators. Initial abuse experiences are characterized
by high levels of force (43% involved physical force/weapons), and penetrative sex (46%
reported attempted or actual anal intercourse). These men are more likely to engage in
risky, potentially self-destructive behavior (Paul JP, Catania J, et al, “Understanding
childhood sexual abuse as a predictor of sexual risk-taking among men who have sex
with men: The Urban Men’s Health Study,” Child Abuse & Neglect 2001;25(4):557-584)
 Reports of being the victim of childhood sexual abuse by young lesbians and bisexual
women range from 25% to 50%; 20% of young gay men and 25% of young bisexual men
report being the victim of childhood sexual abuse. Young bisexual men are up to 10
times more likely than their heterosexual peers to report being the victim of childhood
sexual abuse while young bisexual women are nearly 2 times as likely to report that
abuse when compared with heterosexual young women. Gay and bisexual young men
are also at an increased risk for being the victim of physical abuse when compared with
their heterosexual peers (Saewyc EM, Skay CL, et al, “Hazards of stigma: the sexual and
12
physical abuse of gay, lesbian, and bisexual adolescents in the United States and
Canada,” Child Welfare 2006;85(2):195-213) – LITERATURE REVIEW
 Childhood sexual abuse significantly contributes to affective disorders in men-who-havesex-with-men by skewing or undermining critical motivational, coping, and interpersonal
factors that, in turn, affect adult risky behavior—namely sexual behavior (Catania JA,
Paul JP, et al, “Mediators of childhood sexual abuse and high-risk among men-who-havesex-with-men,” Child Abuse Negl 2008;32(10):925-940)
 On average, transgender youth felt, acted, and were told they were “different” for the first
time between 8 and 9 years of age. Many were called sissies and told to change their
behavior by parents; more gender-atypical youth reported increased childhood parental
abuse that was both physical and verbal (Grossman AH, D’Augelli AR, Salter NP,
“Male to female transgender youth: Gender expression milestones, gender atypicality,
and parents’ responses,” Journal of GLBT Fam Stud 2006;2(1):71-92)
Research on Violence towards LGBTQ Youth
 Youth who report same-sex or both-sex romantic attraction are more likely to experience
and/or witness extreme forms of violence than youths who report other-sex attraction.
The higher incidence of violence perpetrated by youths attracted to the same-sex is
explained by their experiences of violence (Russell ST, Franz B, Driscoll AK, “Samesex romantic attraction and experiences of violence in adolescence,” AJPH
2001;91(6):903-906)
 Lesbians and gay men, bisexuals, and heterosexuals who report any same-sex sexual
partners over their lifetime had a greater risk of childhood maltreatment, interpersonal
violence, trauma to a close friend or relative, and unexpected death of someone close than
do heterosexuals with no same-sex attractions or partners. 45% of LGB women and 28%
of GB men have experienced violence or abuse in childhood, compared with 21% of
women and 20% of men in the general population. LGB people are also twice as likely
to report having PTSD—which is largely accounted for by sexual orientation minorities’
greater exposure to violence, exposure to more potentially traumatic events, and earlier
age of trauma exposure (Roberts AL, Austin SB, et al, “Pervasive trauma exposure
among US sexual orientation minority adults and risk of posttraumatic stress disorder,”
AJPH 2010 e-published, waiting on print)
 37% of gay and bisexual men report experiencing anti-gay verbal harassment in the
previous 6 months; 11.2% report discrimination, and 4.8% report physical violence. Men
are more likely to report these experiences if they are younger, are more open in
disclosing their sexual orientation to others, and are HIV positive. Reports of
mistreatment were associated with lower self-esteem and increased suicidal ideation
(Huebner DM, Rebchook GM, Kegeles SM, “Experiences of harassment, discrimination,
and physical violence among young gay and bisexual men,” AJPH 2004;94(7):12001203)
13
 Gay and bisexual men who reach gay/bi-related developmental milestones early are more
likely, compared to others, to experience forced sex and gay-related harassment before
adulthood. They are more likely to be HIV seropositive and experience gay-related
victimization, partner abuse and depression during adulthood. The experience of
homophobic attacks against young gay/bisexual male youth helps to explain heightened
rates of serious health problems among adult gay men (Friedman MS, Marshhuebal MP,
et al, “Gay-related development, early abuse and adult health outcomes among gay
males,” AIDS Behav 2008;12(6):891-902)
 Among gay and bisexual men, perceived discrimination is a significant predictor of
depressive symptoms (even after controlling for hostility and neuroticism) (Huebner DM,
Nemeroff CJ, Davis MC, “Do hostility and neuroticism confound associations between
perceived discrimination and depressive symptoms?” J Soc and Clin Psych
2005;24(5):723-740)
 Compared with heterosexual people, LGB individuals report more frequently both
lifetime and day-to-day experiences with discrimination. Approximately 42% attributed
this to their sexual orientation—in whole or part. Perceived discrimination was positively
associated with both harmful effects on quality of life and indicators of psychiatric
morbidity (Mays VM, Cochran SD, “Mental health correlates of perceived discrimination
among lesbian, gay, and bisexual adults in the United States,” AJPH 2001;91(11):18691876)

Bisexual women are the most likely group to report having been sexually assaulted (Conron
KJ, Mimiaga MJ, Landers SJ, “A population-based study of sexual orientation identity and
gender differences in adult health,” AJPH 2010; e-published, waiting on print)
Research on Bullying and School Victimization among LGBTQ Youth
 LGB youths reporting high levels of at-school victimization report higher levels of
substance use, suicidality, and sexual risk behaviors than heterosexual peers reporting
high levels of at-school victimization (Bontempo DE, D’Augelli AR, “Effects of atschool victimization and sexual orientation on lesbian, gay, or bisexual youths’ health
risk behavior,” J Adole Health 2002;30(5):364-374)
 More than 75% of sexual minority youth report verbal abuse while 15% report physical
abuse. More than 1/3 lost have friends through coming out. Increased victimization and
losing friends both predict negative mental health outcomes (D’Augelli AR, “Mental
health problems among lesbian, gay, and bisexual youths ages 14 to 21,” Clin Child
Psych and Psych 2002;7(3):439-462)
 Among all youth, being threatened at school in the past year, having property stolen at
school and fighting in the past 12 months more than double the odds of attempting
suicide (Epstein J, Spirito A, “Risk factors for suicidality among a nationally
14
representative sample of high school students,” Suicide Life Threat Behav
2009;39(3):241-251)
 Compared with their heterosexual peers, sexual minority youth report more sexual
harassment, more bullying, less closeness with their mothers and less companionship
with best friends. Victimization and school social support mediate the link between
sexual orientation and psychological symptoms (Williams T, Connolly J , et al, Peer
victimization, social support, and psychosocial adjustment of sexual minority
adolescents,” J Youth and Adole 2005;34(5):471-482)
 Most LGB youth have experienced some form of victimization, with no social
environment being free from risk of harm. Particularly vulnerable for abuse are youth
who self-label as LGB or self-disclose at an earlier age and those whose sexual
orientation is less concealed or concealable (Pilkington NW, D’Augelli AR,
“Victimization of lesbian, gay, and bisexual youth in community settings,” Am J Comm
Psych 1995;23(1):34-56)
 Among middle school students, being the target of homophobic victimization
significantly predicts increased anxiety and depression, personal distress, and a lower
sense of school belonging in males with higher levels of withdrawal in females (Poteat
VP, Espelage DL, “Predicting psychosocial consequences of homophobic victimization
in middle school students,” J Early Adole 2007;27(2):175-191)
 More than 50% of LGB youth report verbal abuse in high schools because of sexual
orientation while 11% report being physically assaulted. Youth who are more open about
sexuality or have a history of more gender atypical behavior report being abused more
often. Males are targeted significantly more than females. Current mental health
symptoms (especially PTSD) are associated with having experienced more verbal abuse
in school (D’Augelli AR, Pilkington NW, Hershberger SL, “Incidence and mental health
impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high
school,” School Pscyh Quart 2002;17(2):148-167)
 48% of all young men report being bullied in the past year. Of those bullied, 26% report
that the bullying was related to others calling them gay. Young men who were bullied
because they were called gay experience more psychological distress, greater verbal and
physical bullying, and more negative perceptions of school than those young men bullied
for other reasons (Swearer SM, Turner RK, et al, “’You’re so gay!’: Do different forms
of bullying matter for adolescent males?” School Psych Rev 2008;37(2):160-173)
 80% of LGB youth report verbal victimization, 11% report physical victimization, and
9% sexual victimization—with males reporting significantly more. Victimization begins
on average at age 13—though verbal attacks can begin as early as age 6, physical attacks
at age 8 and sexual assaults at age 9. Youth considered to be gender atypical in
childhood report higher victimization and more current mental health symptoms. PTSD
was found in 9% of LGB youth and is associated with past physical victimization
(D’Augelli AR, Grossman AH, Starks MT, “Childhood gender atypicality, victimization,
15
and PTSD among lesbian, gay, and bisexual youth,” J Interpersonal Violence
2006;21(11):1462-1482)
 A lack of community and empowerment frequently leaves LGBT youth without a sense
of human agency in school—making them feel increasingly vulnerable there. As a
principal means of coping, LGBT youth often escape and avoid stressors by distancing
themselves from school (Grossman AH, Haney AP, et al, “Lesbian, gay, bisexual, and
transgender youth talk about experiencing and coping with school violence: A qualitative
study,” J LGBT Youth 2009;6(1):24-46)
 28% of LGBT youth are forced to drop out of school because of harassment related to
their sexual orientation or gender expression/identity (Hershberger SL, D’Augelli AR,
“The impact of victimization on the mental health and suicidality of lesbian, gay, and
bisexual youths,” Dev Psych1995;31:65-74)
 LGBT youth in rural communities and those with lower adult educational attainment face
particularly hostile school climates. Male students are more likely to be victimized based
on sexual orientation or gender identity as are younger LGBT students when compared
with older LGBT students (Kosciw JG, Greytak EA, Diaz EM, “Who, what, where,
when, why: demographic and ecological factors contributing to hostile school climate for
lesbian, gay, bisexual, and transgender youth,” J Youth Adole 2009;38:976-988)
 Young men generally report more sexual orientation victimization than do young women
among heterosexual and questioning/less certain students. Significant 3-way interactions
between sexual orientation, race, and gender exist for substance use and
depressed/suicidal thoughts (Poteat VP, Aragon SR, et al, “Psychosocial concerns of
sexual minority youth: complexity and caution in group differences,” J Consult and Clin
Psych 2009;77(1):196-201)
 Familial, social, peer and teacher contexts all play a role in school troubles, attitudes and
performance; but teachers play an especially crucial role in mediating school troubles
(Russell ST, Seif HM, Truong NL, “School outcomes of sexual minority youth in the
United States: evidence from a national study,” J Adole 2001;24(1):111-127)
Research on Risk Behaviors among LGBTQ Youth
 With regards to mental health, sexual risk-taking, and general health risks, there is a higher
risk for self-identified LGB youth when compared with their heterosexual peers. This
study did not find an increased risk for substance abuse, homelessness or truancy (Lock J,
Steiner H, “Gay, lesbian, and bisexual youth risks for emotional, physical, and social
problems, results from a community-based survey,” Child and Adole Psych
1999;38(3):297-304)
 The response to LGB adolescents by those in their environments is often associated with
several problematic outcomes, including school-related problems, running away from
home, conflict with the law, substance abuse, prostitution and suicide (Savin-Williams RC,
16
“Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual
youths: associations with school problems, running away, substance abuse, prostitution,
and suicide,” J Consult Clin Psych 1994;62(2):261-269)
 Among sexual minority youth, limited involvement in gay and lesbian activities is
associated with engaging in increased unprotected sex. Negative attitudes toward
homosexuality are related directly to more unprotected sex, and they are related indirectly
to more unprotected sex by means of emotional distress (Rosario M, Hunter J, et al, “The
coming-out process and its adaptational and health-related associations among gay, lesbian,
and bisexual youths: Stipulation and exploration of a model,” Am J Comm Psych
2001;29(1):133-160)
 Bisexual adolescents report levels of protective factors against suicide (including family
connectedness, school connectedness, and religious involvement) lower than or similar to
those of adolescents with same-gender partners. Bisexual adolescents have lower levels of
most protective factors than did heterosexual adolescents, which may help explain their
higher prevalence of risky behavior (Saewyc EM, Homma Y, et al, “Protective factors in
the lives of bisexual adolescents in North America,” AJPH 2009;99(1):110-117)
 Among sexual minorities, more negative attitudes toward homosexuality, more substance
abuse symptoms, and poorer intentions for safer sex are directly associated with engaging
in increased risky behaviors, namely a greater likelihood of unprotected anal sex, over
time. Lower self-esteem, more anxious symptoms, and childhood sexual abuse are related
to more risky behavior and substance abuse symptoms (Rosario M, Schrimshaw EW,
Hunter J, “A model of sexual risk behaviors among young gay and bisexual men:
Longitudinal associations of mental health, substance abuse, sexual abuse, and the comingout process,” AIDS Ed and Preven 2006;18(5):444-460)
 Engaging in survival sex is associated with an increased risk for suicide attempts for both
heterosexual and sexual minority youth (Walls NE, Potter C, Van Leeuwen J, “Where risks
and protective factors operate differently: Homeless sexual minority youth and suicide
attempts,” Child & Adole Soc Work J 2009;26(3):235-257)
 Worries about sexual orientation, a familial history of either sexual abuse or deliberate selfharm (DSH), anxiety, and self-esteem issues are all associated with young people engaging
in repeated DSH (O’Connor RC, Rassmussen S, Hawton K, “Predicting deliberate selfharm in adolescents: a six month prospective study,” Suicide and Life Threatening Behav
2009;39(4):364-375)
Research on body image and eating disorders among LGBTQ Youth
 Among gay men, there is a heightened concern for physical attractiveness that results in
high levels of body satisfaction; this leads to an increased risk for eating disorders when
compared with their heterosexual counterparts. Lesbians are not at an increased risk for
eating disorders when compared with their heterosexual counterparts (Siever MD,
17
“Sexual orientation and gender as factors in socioculturally aquired vulnerability to body
dissatisfaction and eating disorders,” J Consult and Clin Psych 1994;62(2):252-260)
 Compared with heterosexual boys, gay/bisexual boys were more concerned with trying to
look like men in the media (p < .05) and more likely to binge (odds ratio 15.2; 95%
confidence interval = 3.3-69). Compared with heterosexual girls, lesbian/bisexual girls
were happier with their bodies (p < .05) and less concerned with trying to look like
women in the media (p < .05). (Austin SB, Ziyadeh N, et al, “Sexual orientation, weight
concerns, and eating-disordered behaviors in adolescent girls and boys,” J Am Acad
Child Adolesc Psychiatry 2004;43(9):1115-1123)
 Among females and compared with heterosexuals, “mostly heterosexuals,” bisexuals, and
lesbians were more likely to report binge eating, but only “mostly heterosexuals” and
bisexuals were also more likely to report purging. Among males, all three sexual
orientation subgroups [“mostly heterosexual,” bisexual, and gay] were more likely than
heterosexual males to report both binge eating and purging. Within each orientation
subgroup, females generally reported higher prevalence of purging and binge eating than
did males. (Austin SB, Ziyadeh NJ, et al, “Sexual orientation disparities in purging and
binge eating from early to late adolescence,” J Adolesc Health 2009;45(3):238-245)
Research on Coming Out and Identity Formation among LGBTQ Youth
 LGB youth who come from highly rejecting families are more than 8 times as likely to
have attempted suicide than LGB peers who reported no or low levels of family rejection.
Additionally, they are 6 times more likely to report high levels of depression, more than 3
times more likely to use illegal drugs, and as well as 3 times more likely to report having
engaged in unprotected sexual intercourse, when compared with peers from families that
reported no or low levels of family rejection. Latino men reported the highest number of
negative family reactions to their sexual orientation in adolescence (Ryan C, Huebner D, et
al, “Family rejection as a predictor of negative health outcomes in white and Latino
lesbian, gay, and bisexual young adults,” Peds 2009;123(1):346-352)
 Youth who self-identify as LGB or who are unsure of their sexual identity are at an
increased risk for suicide attempts; however those youth who report same-sex attractions or
experiences but self-identify as heterosexual are at no greater risk for suicide than the
population at large. The majority of youth who had same-sex attractions or experiences
self-identified as heterosexual, highlighting the importance of assessing both identity and
behavior aspects of sexual orientation when conducting research among youth. This
research highlights that it is the interface between LGB individuals and society that causes
LGB youth the most distress (Zhao Y, Montoro R, et al, “Suicidal ideation and attempt
among adolescents reporting “usure” sexual identity or heterosexual identity plus same-sex
attraction or behavior: forgotten groups,” J Am Acad Child Adolesc Psychiatry
2010;49(2):104-113)
18
 Among LGB youth, rejecting reactions to disclosure of their sexual orientation have a
direct association with increased substance use and abuse, including in the long-term
(Rosario M, Schrimshaw EW, Hunter J, “Disclosure of sexual orientation and subsequent
substance use and abuse among lesbian, gay, and bisexual youths: Critical role of
disclosure reactions,” Pysch of Addictive Behav 2009;23(1):175-184)
 In one study, ¾ of sexual minority youth have told at least one parent, more frequently the
mother than the father. Those who had disclosed reported verbal and physical abuse by
family members and acknowledged more suicidality than did those who had not "come
out" to their families (D’Augelli AR, Hershberger SL, Pilkington NW, “Lesiban, gay, and
bisexual youths and their families: Disclosure of sexual orientation and its consequences,”
Am J Orthopsychiatry 1998;68:361-371)
 Among LGB youth, more negative mental health symptoms are associated with parents not
knowing their sexual orientation or with both having a negative reaction. More than 1/3 of
sexual minority youth lose friends through coming out. Increased victimization and losing
friends both predicted negative mental health outcomes (D’Augelli AR, “Mental health
problems among lesbian, gay, and bisexual youths ages 14 to 21,” Clin Child Psychology
and Psychiatry 2002;7(3):439-462)
 50% of gay and lesbian youth report that their parents rejected them because of their sexual
orientation. 26% are forced to leave home because of conflicts related to sexual identity
(Remafedi G, “Male homosexuality: the adolescent’s perspective,” Peds 1987;79(3):326330)
 LGBT youth generally cannot rely on their families to provide them with the skills or
validation needed to negotiate hostile societal waters (Morrow DF, “Social work with gay
and lesbian adolescents,” Soc Work 1993;38(6):655-660)
 Gay and lesbian youth tend to be further along in the identity integration process (e.g.,
more certain, comfortable, and accepting of their same-sex sexuality, more involved in gayrelated social activities, more possessing of positive attitudes toward homosexuality, and
more comfortable with others knowing about their sexuality) than youth who transitioned
from a bisexual identity to a gay or lesbian one as well as youth who consistently identified
as bisexual. Female youth are less likely to change sexual identities than males but sexual
identity development continues after the adoption of a gay or lesbian sexual identity
(Rosario M, Schrimshaw EW, et al, “Sexual identity development among gay, lesbian, and
bisexual youths: consistency and change over time,” J Sex Res 2006;43(1):46-58)
 Men who have sex with men (MSM) who still identify as heterosexual are more likely than
their gay-identified counterparts to belong to racial or ethnic minorities, be foreign born,
and have lower educational attainment and incomes (Pathela P, Hajat A, et al,
“Discordance between sexual behavior and self-reported sexual identitiy: a populationbased survey of New York City men,” Ann Internal Med 2006;145(6):416-425)
 A minority of lesbians have come out to all their family members and coworkers. Level of
openness about lesbianism is associated with less fear of exposure and with more choices
19
about mental health counseling (Bradford JB, Ryan C, Rothblum ED, “National Lesbian
Health Care Survey: implications for mental health care,” J Consult and Clin Psych
1994;62(2):228-242) – NOT PUB MED
 Gender and sexual abuse, gay-related stress, social support, negative social relationships,
sexual orientation, sexual identity, and gender predict patterns of sexual identity integration
and changes over time—suggesting that these are both facilitators and barriers to healthy
psychosexual development (Rosario M, Schrimshaw EW, Hunter J, “Predicting different
patterns of sexual identitiy development over time among lesbian, gay, and bisexual
youths: a cluster analytic approach,” Am J Comm Psych 2008;42:266-282)
 Comparisons of lesbian butches, lesbian femmes, and bisexual femmes have found that
lesbian butches and femmes generally do not differ on sexual identity formation, but they
do differ from bisexual femmes. Lesbian butches tend to be more involved in more gay
social activities, are more comfortable with others knowing about their homosexuality, and
are more certain, comfortable, and accepting of their sexual identity than are bisexual
femmes. Sexual identity formation does not differ between butch or femme women, but
differences are linked to sexual identity as lesbian or bisexual but neither sexual identity
nor butch/femme alone may explain sexual identity integration (Rosario M, Schrimshaw
EW, et al, “The coming-out process of young lesbian and bisexual women: are there
butch/femme differences in sexual identity development?” Arch Sex Behav 2009;38(1):3449)
 A significant portion of African American mothers and sisters are aware of the sexual
orientation of gay and lesbian family members, however some level of emotional and/or
physical estrangement from family members is a common experience among African
American gay and lesbian people. (Mays VM, Chatters LM, et al, “African American
families in diversity: gay men and lesbians as participants in family networks,” J Comp
Fam Stud 1998;29(1):73-88) – NOT PUB MED
 African American youth report involvement in fewer gay-related social activities, report
less comfort with others knowing their sexual identity, and disclose that identity to fewer
people than do white youths; and Latino youths disclose to fewer people than do white
youths. Cultural factors do not impede the formation of identity but may delay identity
integration (Rosario M, Schrimshaw EW, Hunter J, “Ethnic/racial differences in the
coming-out process of lesbian, gay, and bisexual youths: a comparison of sexual identity
development over time,” Cul Diversity and Eth Minority Psych 2004;10(3):215-228)
 Parents are seldom the first person a youth tells about same-sex attractions. Mothers are
usually told before fathers; and more mothers know about their children’s same-sex
attractions than do fathers. 50%-60% of LGB young people have disclosed to at least one
sibling (Savin-Williams RC, “The disclosure to families of same-sex attraction by lesbian,
gay, and bisexual youths,” J Res on Adole 1998;8(1):49-68) – NOT PUB MED
 Empirical support for the traditional, stage, “mourning/loss” model of coming out to
parents is limited and does not account for the reality that all parents react differently and
proceed through different stages and events independently of others (Savin-Williams RC,
20
Dube EM, “Parental reactions to their child’s disclosure of a gay/lesbian identity,” Fam
Relations 1998;47(1):1-7) – NOT PUB MED
 Most transgender youth report feeling they were transgender at puberty, and they report
having experienced negative reactions to their gender atypical behaviors, as well as
confusion between their gender identity and sexual orientation. Transgender youth note
four problems related to their vulnerability in health-related areas: the lack of safe
environments, poor access to physical health services, inadequate resources to address their
mental health concerns, and a lack of continuity of caregiving by their families and
communities (Grossman AH, D’Augelli AR, “Transgender youth: invisible and
vulnerable,” J of Homosexuality 2006;51(1):111-128)
Research on Public and School Policies and their Correlates on LGBTQ Youth
 Among LGB persons, there is strong association between living in states without hate
crimes laws that explicitly include sexual orientation and without laws banning sexual
orientation employment discrimination, and an increased risk for generalized anxiety
disorder, PTSD, dysthymia, as well as psychiatric comorbidity (Hatzenbuehler ML, Keyes
KM, Hasin DS, “State-level policies and psychiatric morbidity in lesbian, gay, and bisexual
populations,” AJPH 2009;99(12):2275-2281)
 Sexual minority adolescents who believe they have one school staff member with whom
they could talk about problems are only 1/3 as likely as those without that support to report
being threatened or injured by a weapon at school or report making multiple suicide
attempts in the past year. Lower victimization rates and suicidality among sexual minority
youth has also been linked with peer support groups, the availability of non-academic
counseling, anti-bullying policies, a student judicial court system, staff training on sexual
harassment, and peer-tutoring systems (Goodenow C, Szalacha L, Westheimer K, “School
support groups, other school factors, and the safety of sexual minority adolescents,” Pscyh
in the Schools 2006;43(5):573-589) – NOT PUB MED
 The implementation of a GSA, teacher training, and/or inclusive school policies has a
positive effect on a schools’ sexual diversity climate. LGBT youth are also more likely
than heterosexual youth to make negative assessments of their school’s sexual diversity
climate without these programs (Szalacha LA, “Safer sexual diversity climates: Lessons
learned from an evaluation of Massachusetts Safe Schools Program for gay and lesbian
students,” Am J Ed 2003;110(1):58-88) – NOT PUB MED
 Environmental factors associated with sexual orientation, which can be targeted and
changed through prevention and intervention efforts, play a major role in predicting distress
(including depression, hopelessness, and suicidality) in young GLB people (Safren SA,
Heimberg RG, “Depression, hopelessness, suicidality, and related factors in sexual
minority and heterosexual adolescents,” J Consult and Clin Psych 1999;67(6):859-866)
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