Psychological Comorbidities and Social Support Among Sexual and Gender Minority Youth with Foster Care Involvement: Findings from a Community-Based Pilot Study

Background: Growing research evidence supports that SGMY experience greater foster care-related stressors than their non-SGM peers; perhaps contributing to elevated mental health problems. To date, no study has examined the factors unique to the foster care experience that may exacerbate or ameliorate the risk for mood disorders and suicidality for SGMY in the foster care system. The current NIH-funded pilot study investigates rates of psychological comorbidities among SGMY with foster care histories, alongside corollary SGM-specific sources of stress, and social supports that may serve as protective factors.

Methods: Survey interviews were conducted with current and former foster youth who self-identified SGM (N=35). Youth were recruited via caseworkers and supervisors from Cuyahoga County, Ohio, DCFS, and community-based organizations between October 2018 and February 2020. Sample mean-age was 19 years; 57% identified as Black; 17% Multiracial; 14.5% White; and 11.5% other race. 45.7% identified as cisgender; 54.3% transgender. 42.9% identified as lesbian or gay; 37.1% as bisexual or pansexual; and 20% as heterosexual. Tests of association included Kendall’s τ rank correlation coefficient for depression and anxiety scores and Wilcoxon signed rank tests (and Kendall’s τ rank scores for effect sizes) for suicidal behavior outcomes. Open-ended qualitative questions were analyzed thematically using an inductive approach.

Results: 65% met criteria for clinical depression and 79% met criteria for clinical anxiety; 70% reported suicidal ideation and 45% had a past suicide attempt. Results produced relational patterns between interpersonal stressors and mental health outcomes. Partner victimization is correlated with depression (p = .05); suicidal ideation (z = -2.36, p = .02, τ = .43); suicidal planning (z = -2.89, p = .004, τ = .52); suicide attempt (z = 2.65, p = .008, τ = .48); and non-suicidal self-harm (z = -2.85, p = .004, τ = .52). We found a similar pattern between SGM victimization and depression and anxiety, as well as suicidal planning (p < .05). Transgender discrimination, sexual orientation discrimination, and sexual orientation rejection all had positive moderate correlations with anxiety. Sexual orientation-related rejection was also significantly associated with suicidal ideation (z = -2.29, p = .02, τ = .40), and suicidal planning (z = -2.26, p = .02, τ = .39). Social support-related variables were associated with suicidal planning (support: z = -2.18, p = .03, τ = .39; strain: z = 2.23, p = .02, τ = -.35). Qualitative analyses further contextualize these findings.

Conclusion/Implications: SGM-based victimization is a primary concern for this population; and is perpetrated by child-welfare sources (e.g. foster parents, caseworkers, group home staff and other youths in care). Affirming homes are needed to reduce SGM-based victimization in the child welfare system, with implications for reduced mental health problems. All participants reported they were “out” to at least one person identified as a social support, however, strain in these relationships may still contribute to increased mood disorders. Notably, the majority of participants reported biological kin as their primary sources of support, suggesting that building affirming ties with extended birth families is a critical intervention for mental health promotion.