Sexual Orientation Identity Development Milestones Among Lesbian, Gay, Bisexual, and Queer People: A Systematic Review and Meta-Analysis

Background and Purpose: Sexual orientation identity development refers to changes, processes, and experiences occurring over time involving awareness, exploration, commitment, integration, and communication concerning a person’s identity as a sexual being. Queer people navigate unique milestones due to having a minority and socially stigmatized identity. Since the 1990s, research on queer identity development has focused on milestones that individuals experience as they navigate a LGBQ+ identity, such as becoming aware of non-heterosexual attractions, self-identifying as LGBQ+, and coming out to others. In order to promote healthy and adaptive development among queer people, we must understand the sexual orientation identity development process, which is a central aspect in the lives of queer people. The following research questions drove this systematic review: What are the primary sexual orientation identity development milestones for LGBQ+ people? At what ages do these milestones occur? In what sequences to these milestones occur? Does the chronology of milestones vary by sex, sexual orientation, race/ethnicity, or birth cohort? Methods: The authors followed the PRISMA standards. Studies were included in the review if they collected data from LGBQ+ people about the timing of their identity development milestones, collected data in the United States, and were completed since January 1, 1990. Searches were performed in PsycINFO, Sociological Abstracts, and Google Scholar using an expert-informed search string. Following duplicate removal and double-independent screening, 30 studies were included in the review. Relevant data were extracted from the studies, which was then synthesized using narrative thematic synthesis and meta-analysis. Results: Studies varied regarding which milestones were assessed. Four milestones were measured in the large majority studies: self-identifying as LGBQ+ (n = 28), coming out to others (n = 24), engaging in sexual activity (n = 23), and becoming aware of non-heterosexual attractions (n = 22). Other milestones assessed in some studies included questioning one’s sexual orientation (n = 9), having a romantic relationship (n = 8), experiencing non-heterosexual fantasies (n = 4), and experiencing feelings of differentness (n = 2). Milestones occurred in different sequences, although attraction was usually first, often followed by self-identification and/or sexual activity; coming out and having a romantic relationship often followed these milestones. Meta-analysis results showed that the mean effect sizes and 95% confidence intervals varied by milestone: attraction (M age = 12.7 [10.1, 15.3]), questioning orientation (M age = 13.2 [12.8, 13.6]), self-identifying (M age = 17.8 [11.6, 24.0]), sexual activity (M age = 18.1 [17.6, 18.6]), coming out (M age = 19.6 [17.2, 22.0]), romantic relationship (M age = 20.9 [13.2, 28.6]). Nonetheless, results also showed substantial heterogeneity in the mean effect sizes. Additional meta-analyses showed that milestones ages varied by sex, sexual orientation, race/ethnicity, and birth cohort. Conclusions and Implications: Although patterns were found in queer identity development, there was considerable diversity in developmental pathways. The timing of milestones has implications for developmentally appropriate interventions for queer people who face stigma, confusion, and distress during their identity development. Future research should attend to intersectionality, emerging identities (e.g., queer, pansexual), fluidity, and use more rigorous methods.