Minority Stress and Health: Implications for Cisgender and Gender Non-Conforming Sexual Minority Youth Accessing Crisis Services

Background and Purpose: Behavioral health disparities exist for gender and sexual minority youth when compared to their cisgender heterosexual peers. For example, sexual minority youth are more likely to report higher rates of substance use, sexual risk taking (such as condomless sex and sex under the influence of alcohol or drugs), pregnancy involvement, homelessness, and suicidal ideation and attempt. Minority stress theory has been widely used to explain the health disparities found among both sexual minority and gender minority youth; however, minority stress research is often limited by lumping these groups together or ignoring gender minority identity. Furthermore, research suggests that increasing number of sexual minority youth are identifying with gender non-conforming (GNC) identities.

Methods: This study examined minority stress and behavioral health outcomes among cis-gender and GNC sexual minority adolescents. The data come from a national sample of youth (aged 12–24) referred from a LGBTQ youth-focused suicide prevention crisis service provider during an 18-month period. Multivariable logistic and linear regression analyses were conducted to assess the association between minority stress and behavioral health outcomes of suicide attempt, PTSD, and depressive symptomology for cis-gendered and gender non-conforming sexual minority adolescents, adjusting for demographic characteristics, burdensomeness, and thwarted-belongingness.

 Results: Over one-quarter (29%) of sexual minority youth identified with GNC identities (e.g., transgender, nonbinary, genderqueer). GNC youth reported higher odds of lifetime suicide attempt (OR=2.33) and greater likelihood of endorsing a future suicide attempt as likely (OR=2.26), after accounting for age, race, burdensomeness and thwarted-belongingness, as compared to non-GNC youth. GNC sexual minority youth reported more symptoms of PTSD (β=0.12, t=5.3, p <.001) and depression (β=1.1, t=2.9, p <.001) after accounting for lifetime minority stress experiences and sexual orientation. In addition, lifetime sexual minority stress was a significant predictor of both PTSD (β=.23, t=5.9, p <.001) and depressive symptomology (β=.12, t=5.3, p <.001) in the sample.

 Conclusions and Implications: Sexual minority youth in our sample presented a range of gender identities (transman, transwoman, nonbinary, genderqueer). GNC sexual minority youth reported more suicidality and symptoms of mental health disorders that their peers. Social workers and crisis services organizations working to reduce suicidality among LGBTQ youth may want to be sensitive to the additional stressors and comorbid behavioral health disparities associated with multiple minority experiences. Helping professionals should assess gender identity without assumptions, to avoid exacerbating what may be a source of stress for GNC young people. Emerging research notes that acknowledging the true gender identity of GNC youth may go far in mitigating otherwise negative health outcomes.