Substance Use and Mental Health Disparities among Sexual Minority Girls: Results from the Pittsburgh Girls Study

doi:10.1016/j.jpag.2011.06.011

Journal of Pediatric and Adolescent Gynecology

Volume 25, Issue 1, February 2012, Pages 15-18

https://doi.org/10.1016/j.jpag.2011.06.011 Get rights and content

Abstract

Purpose

To examine substance use and mental health disparities between sexual minority girls and heterosexual girls.

Methods

Data from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms.

Results

Compared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms.

Conclusions

Sexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.

Introduction

The adolescent preventive health care visit addresses a broad range of topics and includes identification of health risk behaviors such as substance use and screening for mental health concerns. It can be useful for clinicians who provide adolescent preventive health services to understand which of their patients may be at increased risk for these problems. Two decades of research suggests that, compared with heterosexual youth, sexual minority youth (those who report same-sex sexual attraction, behavior, or gay/lesbian or bisexual identity/orientation) report significant mental health disparities, including depression, suicidality, and substance use.1, 2

When gender differences are explored, mental health disparities in sexual minority youth are even more pronounced among female compared to male patients. For example, sexual minority girls (SMGs) were on average 400% more likely to use drugs and alcohol compared with heterosexual girls, whereas sexual minority boys were on average 180% more likely compared with heterosexual boys.² Other recent studies have also identified gender differences in psychosocial health disparities between sexual minority and heterosexual youth.3, 4 Thus, examining disparities within genders is warranted to help gain a better understanding of the etiology and potential underlying causal mechanisms within gender subgroups. A recent Institute of Medicine report concluded that more research with SMGs is needed to understand the development of these disparities.⁵ The goals of this study were to replicate and extend the results in the current literature by examining substance use and mental health disparities among a sample of urban SMGs.

Section snippets

Methods

The Pittsburgh Girls Study (PGS) is a multiple cohort, multi-informant, prospective study that was designed to investigate the developmental precursors and risk factors of conduct problems and substance use and abuse among urban girls. Participants were recruited from a sample of 103,238 households in the City of Pittsburgh. The original sample comprised 2451 girls (52% African American, 41% European American) who were 5-8 years old at the start of data collection in 2000. Over 8 years, the

Results

Bivariate analyses (chi-square tests) showed that there were no significant group differences regarding the racial background and socioeconomic indicators across groups (see Table 1). Due to the lack of group differences in race and socioeconomic status, the small sample of SMGs, the even smaller subset of African-American (or multiracial) SMGs (n = 18), and the very narrow age range in this subsample of the PGS (all girls were 17 years old), multivariate analyses and subgroup analyses were not

Discussion

A comprehensive preventive visit for an adolescent seeking reproductive health care addresses many topics and includes a discussion of sexual orientation, identification of risk behaviors such as substance use, and screening for mental health issues.¹⁰ A better understanding of the increased vulnerabilities of SMG would be useful to clinicians providing such care. However, to our knowledge, very few studies to date have focused exclusively on SMGs and their risk for mental health problems.

This

Implications for Clinical Practice

Our recent review of several large government health organizations revealed a surprising dearth of information available for health care providers that might help them identify and treat mental health and substance use problems among sexual minority populations.² The Substance Abuse and Mental Health Services Administration was a notable exception.¹⁷ Recent scholarly publications have also offered clinicians useful recommendations tailored specifically to the sexual minority adolescent

Acknowledgments

This manuscript was supported by the following grants from the National Institutes of Health: MH056630, DA012237, and DA030385.

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Cited by (49)

Mental health condition indicators and e-cigarette use among sexual minority youth
2022, Journal of Affective Disorders
Citation Excerpt :
Young sexual minorities have reported higher rates of suicidality and depressive symptoms versus heterosexual youth (Marshal et al., 2011), as well as higher levels of victimization (Burton et al., 2013). And compared with heterosexual girls, sexual minority girls have reported higher rates of suicidal ideation and self-harm and higher than average symptoms of depression, anxiety, bipolar disorder, and obsessive-compulsive disorder (Marshal et al., 2012). Along with mental health disparities, sexual minorities disproportionately experience substance-related problems relative to heterosexuals.
Sexual minorities face mental health disparities compared to heterosexual people. There is limited research on the possible connections between mental health and e-cigarette use among sexual minority youth. This study examines anxiety, depression, and e-cigarette use for sexual minority youth only and between sexual minorities versus straight youth.
Study data were drawn from the 2021 National Youth Tobacco Survey (n = 16,065). Prevalence of self-reported anxiety and depression by sexual minority status was calculated, and the univariate analysis was assessed using Rao-Scott Chi-Square tests. Multivariable logistic regression models were used to evaluate the association of current e-cigarette use with self-reported anxiety and depression among sexual minority youth. The study also examined current e-cigarette use between sexual minorities versus straight students for those with or without anxiety and depression, and stratified analyses were performed by sex.
Analysis showed a substantially higher prevalence of all self-reported mental health problems among sexual minorities than straight students. Sexual minority males with anxiety (aOR 1.91, 95 % CI, 1.22–3.00), depression (aOR 2.08, 95 % CI, 1.27–3.40), moderate depression and anxiety (aOR 1.85, 95 % CI, 1.16–2.97), and severe depression and anxiety (aOR 2.03, 95 % CI, 1.16–3.56) were more likely to be current e-cigarette users than their straight peers with similar mental health conditions.
Self-reported measures and the analysis design precludes making causal inferences.
Sexual minority males with mental health conditions may be particularly vulnerable to e-cigarette use and may require special efforts toward prevention and cessation.
Investigating Protective Factors Associated With Mental Health Outcomes in Sexual Minority Youth
2022, Journal of Adolescent Health
The aim of this study is to identify and evaluate the efficacy of adolescent protective factors against mental health (MH) outcomes in young adulthood of sexual minority identifying youth (SMY).
Using data from the National Longitudinal Study of Adolescent to Adult Health, we identified potential protective factors (e.g., individual factors like self-esteem, family factors like family communication, and community factors like caring teachers) at baseline (1994) when the sample was school-aged for SMY. SMY included those who identified their sexual identity as mostly heterosexual, bisexual, mostly homosexual, or 100% homosexual. MH outcomes (depression, anxiety, or suicidality) were assessed at 14-year follow-up.
Approximately 14,800 youth completed baseline and follow-up surveys, where 13.5% identified as SMY. Of SMY, 57% had a MH outcome compared to 37% of non-SMY (p < .05). Not all factors were protective for SMY. At the individual level, emotional well-being (adjusted odds ratio [AOR] .56, 95% confidence interval [CI] .41–.78) and self-esteem (AOR .79, 95% CI .66–.95) were found to be protective for MH outcomes in regression models. At the family level, family connectedness (AOR .82, 95% CI .71–.95) was found to be protective. At the community level, school connectedness (AOR .78, 95% CI .66–.92) and caring teachers (AOR .76, 95% CI .58–.99) were found to be protective for SMY.
Factors at the individual, family, and community (e.g., caring teachers) levels appear to be protective against MH outcomes unique to SMY. Developing interventions focused on protective factors have potential to prevent health disparities.
Psychosocial correlates of body esteem and disordered eating among sexual minority adolescent girls
2021, Body Image
Citation Excerpt :
Yet, existing literature on minority stress theory posits that people who identify as SM experience unique external stressors, such as sexual orientation-based discrimination and victimization, leading to higher rates of physical and mental health concerns among SM populations (Calzo, Blashill, Brown, & Argena, 2017; Meyer, 1995, 2003). Compared to heterosexual youth, SM youth consistently report higher levels of mental health concerns, including depression, suicidality, and substance use, and these disparities are even more pronounced among SM girls (Marshal et al., 2008, 2011, 2012). Some existing work related to the experiences of SM girls demonstrates disparities in body image-related concerns and DE, compared to heterosexual girls.
The present study examined whether body esteem mediates the associations between psychosocial factors, including peer victimization and parent–adolescent relationship quality, and multiple categories of disordered eating (DE) within a diverse sample of adolescent sexual minority (SM) girls. Participants were 528 girls, aged 14–18 years, recruited as part of a larger online study on LGBTQ + adolescent health. Participants anonymously completed self-report measures of parent–adolescent relationship quality, sexual orientation-based victimization, body esteem, and DE behaviors, including binge eating, purging, and caloric restriction. Parent–adolescent relationship quality was positively associated with SM adolescent girls’ body esteem, and some aspects of body esteem subsequently mediated the associations between parent–adolescent relationship quality and DE behaviors. Experiences of sexual orientation-related victimization were also positively related to endorsement of caloric restriction. However, no significant indirect effects were observed between sexual orientation-related victimization and DE via body esteem. These results suggest parents could influence their SM daughters’ DE behaviors via body esteem, and SM girls may be engaging in caloric restriction if they experience victimization, regardless of their body esteem.
Exploring childhood temperament as a moderator of the association between adolescent sexual minority status and internalizing and externalizing behavior problems
2020, Journal of Adolescence
Citation Excerpt :
Starting with the main effects, in the total model, same-sex attraction was associated with youth reported mental health problems, but not parent-reported mental health problems. The association between sexual minority status and mental health during adolescence are well established (Lucassen et al., 2017; Marshal et al., 2011, 2012). Youth report may be particularly important for assessing both externalizing and internalizing behaviors during adolescence, as youth have more access to their own internal states as well as a more complete awareness of the behaviors in which they are engaging than their parents (Dirks et al., 2012; van der Ende et al., 2020).
Sexual minority youth experience worse mental health compared to their heterosexual peers, reflecting the consequences of sexual minority-based stigma. Previous research has focused on contextual variation to understand variability within this vulnerability. Childhood temperament factors such as negative affect, effortful control and surgency/extraversion are important for understanding differential susceptibility to environmental stressors. The objective of the current study was to understand how childhood temperament factors, measured prior to the most difficult developmental period for sexual minority youth, moderated the association between sexual minority status and internalizing and externalizing behavior problems.
Youth reporting same-sex attraction in an ongoing longitudinal project on the development of conduct problems in Quebec, Canada were matched with heterosexual peers, for an analytic sample of 280 youth (62% girls). Structural equation models were used to examine (1) the association between youth-reported same-sex attraction (ages 13–16) and parent and youth-reported internalizing and externalizing problems a year later at ages 14–17, and (2) the moderating role of temperament (ages 6–9) in this association between sexual minority status and internalizing and externalizing problems.
Same-sex attraction was associated with higher levels of youth-reported internalizing and externalizing behavior problems. Surgency/extraversion moderated the association between sexual minority status and youth-reported internalizing and externalizing problems.
These findings suggest that temperament linked to individual visibility may be important for understanding variation in self-reported mental health among sexual minority youth, and supports the use of developmental constructs like temperament to better understand vulnerability to psychosocial difficulties within this population.
A scoping review of sexual minority women's health in Latin America and the Caribbean
2019, International Journal of Nursing Studies
Despite research documenting significant health disparities among sexual minority women (lesbian, bisexual, and other non-heterosexual women) in high-income countries, few studies of sexual minority women’s health have been conducted in low- and middle-income countries. The purpose of this scoping review was to examine the empirical literature related to the health disparities and health needs of sexual minority women in Latin America and the Caribbean (LAC), and to identify research gaps and priorities.
A scoping review methodology was used.
We conducted a comprehensive search of seven electronic databases. The search strategy combined keywords in three areas: sexual minority women, health, and LAC. English, Spanish, and Portuguese language studies published through 2017 in peer-reviewed journals were included.
A total 1471 articles were retrieved. An additional 5 articles were identified following descendancy search; 3 of these met inclusion criteria. After removal of duplicates and title and abstract screening, we screened the full text of 37 articles, of which 22 (representing 18 distinct studies) met inclusion criteria. At least two authors independently reviewed and abstracted data from all articles.
More than half of the studies were conducted in Brazil (n = 9) and Mexico (n = 5). Sexual health was the most studied health issue (n = 11). Sexual minority women were at elevated risk for sexually transmitted infections related to low use of barrier contraceptive methods during sexual encounters with men. Findings suggest that sexual minority women are generally distrustful of healthcare providers and view the healthcare system as heteronormative. Providers are believed to lack the knowledge and skills to provide culturally competent care to sexual minority women. Sexual minority women generally reported low levels of sexual health education and reluctance in seeking preventive screenings due to fear of mistreatment from healthcare providers. Sexual minority women also reported higher rates of poor mental health, disordered eating, and substance use (current tobacco and alcohol use) than heterosexual women. Gender-based violence was identified as a significant concern for sexual minority women in LAC.
Significant knowledge gaps regarding sexual minority women’s health in LAC were identified. Additional investigation of understudied areas where health disparities have been observed in other global regions is needed. Future research should explore how the unique social stressors sexual minority women experience impact their health. Nurses and other healthcare providers in the region need training in providing culturally appropriate care for this population.
Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study
2019, The Lancet Child and Adolescent Health
Citation Excerpt :
Few population-based cohort studies have compared depressive symptoms in sexual-minority adolescents and heterosexual adolescents over time, and fewer still have investigated self-harm. Existing cohort studies mostly use short follow-up periods to mid-adolescence14 and are either small—and thus might lack statistical power15,16—or retrospective, which might introduce information bias.17,18 As far as we are aware, only two large population-based samples have been used to compare depressive symptoms (but not self-harm) in sexual-minority youth and heterosexual youth from adolescence to young adulthood.
There are few population-based cohort studies of the emergence, development, and persistence of mental health problems in sexual minorities compared with heterosexuals. We compared trajectories of depressive symptoms in sexual-minority adolescents and heterosexual adolescents from when they were aged 10 years to 21 years, and examined self-harm at ages 16 years and 21 years.
The study included 4828 adolescents born between April 1, 1991, and Dec 31, 1992, from the Avon Longitudinal Study of Parents and Children birth cohort (Bristol, UK) who reported their sexual orientation when aged 16 years. Depressive symptoms were assessed with the short Mood and Feelings Questionnaire (sMFQ) at seven timepoints between ages 10 years and 21 years. A self-harm questionnaire was completed at ages 16 years and 21 years. Analyses were linear multilevel models with growth curves (depressive symptoms), logistic multilevel models (self-harm in the previous year at ages 16 years and 21 years), and multinomial regression (lifetime self-harm with and without suicidal intent at age 21 years).
At age 10 years, depressive symptoms were higher in sexual minorities (mean sMFQ 4·58 [SD 3·59]) than in heterosexuals (3·79 [3·36]) and increased with age to a larger extent. Depressive symptoms increased at each timepoint by 0·31 sMFQ points in hetereosexuals (95% CI 0·27–0·34), and by 0·49 sMFQ points in sexual minorities (0·40–0·59). Sexual-minority adolescents were more likely than heterosexual adolescents to report self-harm in the previous year at ages 16 years and 21 years (adjusted odds ratio 4·23, 95% CI 2·90–6·16), with no evidence that this estimate decreased with age (p=0·80). When aged 21 years, sexual minorities were 4·53 (95% CI 3·02 to 6·78) times more likely to report lifetime self-harm (ie, on at least one previous occasion) with suicidal intent than heterosexuals.
Mental health disparities between heterosexuals and sexual minorities are present early in adolescence and increase throughout the school years, persisting to young adulthood. Prevention of these mental health problems and early intervention must be a priority.
Medical Research Council, Wellcome Trust.

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: The authors indicate no conflicts of interest.

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Original StudySubstance Use and Mental Health Disparities among Sexual Minority Girls: Results from the Pittsburgh Girls Study

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Implications for Clinical Practice

Acknowledgments

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

Sexual orientation and adolescent substance use: A meta-analysis and methodological review

Addiction

A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals

Am J Public Health

The Pittsburgh Girls Study: overview and initial findings

J Clin Child Adolesc Psychol

Child Symptom Inventories Manual

The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics

J Am Acad Child Adolesc Psychiatry

The International Personality Disorder Examination, IPDE. The WHO/ADAMHA International Pilot Study of Personality Disorders

Arch Gen Psychiatry

Original Study
Substance Use and Mental Health Disparities among Sexual Minority Girls: Results from the Pittsburgh Girls Study