Configurations of Gender and Sexual Identities Predicting Patterns of Co-Occurring Health Risks Among Sexual Minority Youth Using a Latent Class Analysis Approach

Background and Purpose: Behavioral health disparities exist for gender nonconforming (GNC; gender identity does not correspond to birth sex; e.g., transgender, gender nonbinary, genderqueer) and sexual minority youth; however, there is limited knowledge on disparities among youth who identify with both sexual and gender minority identities. Further, evidence based indicated prevention programs for GNC youth are nonexistent.

Methods: This study utilized a diverse sample of GNC and cisgender sexual minority youth seeking crisis services to examine co-occurrence of behavioral health risks. Surveys were administered with youth (aged 12–24, N = 592) recruited from an LGBTQ youth-focused suicide prevention service provider. Latent class analysis was conducted on reports of suicidality, substance use, depression, and posttraumatic stress disorder. Two multinomial logistic regression models were conducted to examine how gender and sexual identity configurations (with cisgender gay or lesbian as the referent) and gender and sexual identity separately (independent effect) predicted class membership.

Results: Analyses resulted in a four-class solution: High All (17.6%), High Substance Use and Moderate Mental Health (10.6%), Low All (20.1%), and High Suicide and High Mental Health (51.7%). In our multinomial logistic regression Model 1 (independent effect of gender and sexual identity), youth who identified as GNC had 2.11 higher odds of being in the High Suicide and High Mental Health class compared to the Low All class; however, sexual identity was not a significant predictor. In Model 2 (configurations of gender and sexual identities), individuals identifying as GNC gay or lesbian or GNC pansexual had 1.95 and 2.57 higher odds, respectively, of being in the High Suicide and High Mental Health class compared to the Low All class.

Conclusions and Implications: Our study suggests not only gender identity, but also the combination of sexual and gender identities predicts health risks. In addition, many programs and practices directed toward sexual minority youth may not necessarily address issues of GNC youth. Our findings suggest that service providers working with sexual minority youth should also be trained to provide GNC-specific services and recognize that youth may identify as both gender and sexual minorities. Implications for indicated prevention approaches are described.