Abstract
Introduction
Lesbian, gay, bisexual and queer+ (LGBQ+) youth are more likely to experience depression, anxiety, and suicidal ideation (SI) than their heterosexual peers. These disparities, and increasing rates of poor mental health among LGBQ+ adolescents, make it important to identify protective factors for their mental health. It is unclear how LGBQ+ identity acceptance from others impacts the mental health of LGBQ+ adolescents. This study aims to evaluate whether greater initial (i.e., first learning of identity) and current acceptance of identity from caregivers, close friends, and other peers predict lower depression, anxiety, and SI among LGBQ+ adolescents.
Methods
Participants for this study were recruited from three collaborating sites within 90 days of discharge from acute psychiatric care units following hospitalization for suicide risk. Adolescents (ages 12-18) participated in a baseline assessment in which they completed validated measures of past-week depression symptom severity (PROMIS pediatric depression scale), past-week anxiety symptom severity (PROMIS pediatric anxiety scale), past-week SI severity (Passive and Active Suicide Ideation Scale: PASIS), as well as perceptions of close others' (i.e., caregivers, friends, peers) acceptance of their sexual orientation identity both when the other first learned of the adolescent’s LGBQ+ identity, and currently. Separate multiple linear regression models examined associations between each source (person) and timing (past or current) of acceptance and depression, anxiety and SI severity, controlling for age and whether youth identified as transgender or gender diverse (TGD).
Results
118 adolescents identified as LGBQ+ (55.9% of the full study sample). Higher initial peer acceptance of adolescent sexual orientation was significantly associated with less severe current adolescent anxiety (β=-2.08, p=.001). Conversely, higher current close friend acceptance was associated with more severe adolescent depression (β=2.71, p=.025). Higher current peer acceptance was associated with less severe anxiety at a trend level (β=-1.08, p=.076). All other linear regression models examining associations between initial and current acceptance of adolescents’ sexual orientation and mental health outcomes, controlling for age and TGD identity, were not significant.
CONCLUSIONS: Among LGBQ+ adolescents recently hospitalized for suicide risk, greater initial peer acceptance of sexual orientation was associated with lower current anxiety, with a similar trend emerging for current peer acceptance. This suggests peer acceptance may be particularly relevant to anxiety among high-risk LGBQ+ adolescents. In contrast, current acceptance from close friends was unexpectedly associated with increased depression, warranting further investigation. Acceptance from parents, peers, and friends was not associated with past two-week SI severity. However, caregiver and close friend sexual orientation acceptance was relatively high and showed limited variability in this sample, which may have contributed to null results. Further research should examine additional factors related to both acceptance and LGBQ+ adolescent mental health, such as victimization and the presence of LGBQ+ peers, to further characterize the relationship between variables assessed in this project.