How Family Impacts Self-Esteem, Anxiety and Depression for Sexual Minority Youth

Purpose: Research and practice with sexual minority youth has focused on risk behaviors and compromised emotional health due to the heightened risk for major depression, generalized anxiety disorders, conduct disorders, substance abuse and dependence, multiple disorders, and poor general health maintenance (e.g., Safren & Heimberg, 1999). Much less attention has been given to family contexts. However, the majority of sexual minority adolescents report problems in getting along with their family (53%; Mercier & Berger, 1989), which has been associated with riskier sexual activity (e.g., higher frequency of unprotected anal sex; Mutchler, 2000). The present study bridges the gap between understanding family relationships and its effects on emotional health outcomes for sexual minority adolescents. Specifically: 1) Do emotional health outcomes, measured as self-esteem, anxiety, and depression, differ by sexual attractions?; 2) Do family relationships differ by sexual attractions?; 3) Do family relationships shape emotional health outcomes?; 4) Do family relationships mediate the association between sexual attractions and emotional health outcomes?

Method: The data are from the National Longitudinal Study of Adolescent Health (Add Health, Wave I, 1995), a nationally representative survey of students in the 7th through 12th grade. Participants were discriminated by those who reported: exclusively same-sex attractions (n = 22 boys, 53 girls), exclusively other sex attractions (n = 3664 boys, 3885 girls), and romantic attractions to both sexes (n = 239 boys, 152 girls). This provides an opportunity to examine variability within sexual orientation groups. Family relationships were assessed by: Joint activities with parents (5 items), parental caring (1 item), relationship with parent (3 items), family attention/fun/understanding (3 items), negative maternal attitude (2 items, parent report). Emotional health outcomes included: self-esteem (9 items), anxiety (7 items), depression (11 items).

Results: Regression models were conducted for each health outcome for boys and girls separately, and for maternal and paternal relationships separately, controlling for ethnicity, parental education, welfare status, family structure, respondent's age, and pubertal development. Accordingly: 1) Anxiety and depression were particularly heightened for same-sex attracted boys; greater anxiety and lower self esteem were associated with both sex attracted girls. Same-sex attracted girls had the highest levels of depression. 2) Sexual minority girls, particularly same-sex attracted, had compromised family relationships (i.e., parent/child activities, affective relationship with mother/father). Further, negative maternal attitude varied by girls' sexual attractions. Sexual minority boys, especially same-sex attracted, also reported less closeness and caring from their mothers. 3) Mother-child relationships and positive family interactions were strong predictors of emotional health outcomes for all youth. Joint activities and maternal caring were less important. 4) Compromised self-esteem, high anxiety, and depression for same-sex attracted youth were significantly mediated by family relationships.

Conclusions and Implications: For same-sex attracted youth, the family context influences the degree to which compromised emotional health outcomes are experienced. However, for youth that are attracted to both sexes, family relationships alone are insufficient for explaining their compromised emotional health. Further research is needed that examines differences between gay, lesbian, and bisexual youth during adolescence, rather than considering sexual minorities as one sample.