Applying Minority Stress Theory to the Study of Mental Health Disparities Among Sexual and Gender Minority Youth in Foster Care: A Systematic Review of the Evidence

Background: Extant research demonstrates mental health disparities for sexual and gender minority youth (SGMY) compared to non. SGMY have been found to be over four times more likely than non-SGMY to experience suicidal ideation, even when controlling for demographic and risk factors. Researchers working to understand this striking discrepancy have turned to Minority Stress Theory, which has been widely applied to SGM adults. This theory suggests that three minority stress processes play a role in increasing SGM adults’ rates of psychological symptoms: general stressors, distal stressors (i.e. interpersonal victimization), and proximal stressors (i.e. internalization of negative societal views). Importantly, to date, no systematic review of minority stress theory applied to foster care-involved SGMY has been conducted.

Method: We searched PubMed, the Cochrane Database of Systematic Reviews and Academic Search Complete for studies published from January 1, 2000 through January 30, 2020 in English. Search terms were related to minority stress theory; adolescent/young adult sexual and gender minority psychological comorbidities (i.e. mood disorders, PTSD, suicidality, self-harm); foster-care specific stressors; and resiliency constructs for this population (e.g. SGM-community belonging, familial supports). Systematic review results were synthesized and used to support an explanatory theoretical model of disproportionate psychological comorbidities among SGMY in foster care.

Results: Results corroborate the applicability of minority stress theory for SGMY in foster care. Following minority stress theory framework, general stressors are operationalized as foster-care specific stressors such as high placement instability, or placement in a restrictive care setting (e.g. congregate home) because of the youths’ SGM-status. Distal stress processes include rejection from biological parents, foster parents, and caseworkers, as well as SGM-based victimization and discrimination experiences within child welfare. Proximal stress processes include internalized homo-/bi-/trans-phobia, gender dysphoria, and expected future rejection. Empirically-derived protective factors include SGM-community belonging; self-affirming strategies; affirming mental health practitioners; and affirming biological and chosen familial support systems.

Conclusion/Implications: The present systematic literature review supports the utility of minority stress theory to conceptualize disproportionate psychological comorbidities (anxiety, depression, suicidality and self-harm) among SGMY with foster care histories, and the value of community belonging and connection in the lives of these youths. Future research should empirically test these relationships and consider the relevance of minority stress theory for SGMY subgroups. Specifically, future investigation of system-related stressors, as well as protective factors for direct service, practice, and policy is critical and time sensitive, given the over-representation of SGMY in foster care. Further conceptualization of intersectionality for SGMY of color, and transgender youth in particular will allow vital interventions tailored to their needs.