Is Minority Stress Theory Applicable to Understanding the Experience of Sexual Minority Adolescents?

Background: Significant behavioral health disparities exist for sexual minority adolescents (SMA) when compared to their heterosexual peers, including depression, anxiety, twice the rates of substance use, and five times the rate of suicide attempt. Variance in mental health outcomes among sexual minority adults is generally attributed to a minority stress model, suggesting several domains of chronic stress (e.g. homophobia, disclosure experiences). While evidence for this approach among adults is growing, very few studies have examined the appropriateness of this theory for adolescents, who may report different stress experiences.  For example, fear of disclosure to parents may be notably different for a 15 year old, who may risk homelessness, compared to a 25 year old. The purpose of this study was to investigate the domains of minority stress that SMA report experiencing, and determine how well they align with a set of a priori domains identified through prior research.

Methods: In early 2014, Thirty semi-structured interviews were conducted with SMA (Lesbian, Gay, Bisexual; ages 14 to 17), recruited from 3 community agencies and one school serving a range of racially diverse youth. Participation involved a 90-minute recorded interview utilizing a Life History Calendar (LHC) approach. The chronological structure of the LHC increases participants’ ability to recall both events and associated feelings, and acknowledges the developing aspects of sexual identity formation. Participants were given prompts to reflect on sexual minority milestones (e.g. sexual identity self-labels, disclosures, attraction, sexual behavior etc.) and stressful events within different social contexts. Recordings were transcribed verbatim and entered into QSR NVivo. All transcripts were coded by two members of the research team, went through a consensus process, and were examined using thematic analysis.

Results: Participants were on average 16 years old and 20% Asian, 16% African American, 36% Latino, and 28% White. Participants identified as male (44%), female (40%), and a minority identifying as Transmale or Queer (16%). Participants endorsed a range of sexual orientations: 28% Gay, 24% Lesbian, 32% Bisexual, 16% as other. Coders maintained a high level of inter-rater agreement (91%).  Nine domains of sexual minority stress (i.e. sexual orientation, gender, disclosure, internalized stigma, family, school/peer, racial/ethnic, community, and religious) emerged. These domains included approximately 90 different unique minority stressors (e.g. feeling threatened at school). Almost half of these stressful events emerged from the school and family contexts.

Implications: A minority stress framework accounts for much of varied stress experiences of SMA. However unlike adults, the consequences of disclosure within an adolescent’s family or school context may be more severe. Where adults may have the agency to change their social context, adolescents are embedded within a family and often within a compulsory school. Moreover, due to this, SMA may also be limited in accessing a supportive LGBT community, and have less knowledge about being LGBT and less knowledge of how to understand their identity, both noted as significant stressors.  The findings may inform more culturally tailored interventions and future research on stress and health among this high need population.