Examining the Health and Mental Health Disparities between Sexual Minority Youth and Heterosexual Youth in the United States

Background/Objective: The last two decades have witnessed a proliferation of research focusing on health and mental health disparities between sexual minority and heterosexual youth. In the US, about 11% of youth self-identified as sexual minority in 2015; 2% as lesbian or gay, 6% as bisexual, and 3% as not sure of their sexual identity. In 2017, this proportion rose slightly where almost 15% of youth self-identified as sexual minority; 2.4% as lesbian or gay, 8% as bisexual, and 4.2% as not sure of their sexual identity. Although various studies and systematic reviews have found an association between sexual orientation and health and mental health outcomes, few studies have examined a host of health and mental health outcomes in one study. The objective of this study is to investigate the association between sexual orientation and a broad range of school safety, violence, victimization, mental health, suicidal behaviors, substance use, and protective factors.

Methods: Data for this study came from the Centers for Disease Control and Prevention’s 2017 Youth Risk Behavior Survey (YRBS). The YRBS is a cross-sectional, nationally representative survey of high school students. A sample of 14,547 youth aged 14-18 years (50.1% female) was analyzed using weighted binary logistic regression to determine the association between sexual orientation and 24 dependent variables in the following categories: school safety and violent behaviors (4 variables), victimization (4 variables), mental health (2), suicidal behaviors (3 variable), substance use (7 variables), obesity, and protective factors (3). The study controlled for age, sex, and race/ethnicity.

Results: Of the 14,547 youth examined, 85.4% self-identified as heterosexual, 2.4% as lesbian/gay, 7.9% as bisexual, and 4.2% as unsure. Controlling for age, sex, and race/ethnicity, youth who self-identified as sexual minority (lesbian/gay, bisexual or unsure) were significantly more likely to engage in violent behaviors, be victimized, report poor mental health, engage in suicidal behaviors, engage in substance use, and be obese (adjusted odds ratios ranged from 1.42 to 6.38) compared to youth who self-identified as heterosexual. Youth who self-identified as sexual minority were significantly less likely to describe themselves as mostly A’s or B’s, played on a sports team, or be physically active (adjusted odds ratios ranged from 0.51 to 0.70) compared to youth who self-identified as heterosexual.

Conclusions and Implications: Our findings demonstrate that lesbian/gay, bisexual, and questioning youth are more likely to experience negative health and mental health outcomes such as school safety concerns, violence, victimization, poor mental health, suicidal behaviors, and substance use compared to heterosexual youth. Moreover, lesbian/gay, bisexual, and questioning youth are less likely to draw on protective factors. Further research would benefit from examining reasons why sexual minority youth are at higher risk for negative health and mental health outcomes. Understanding the higher rates at which sexual minority youth are reporting negative health and mental health outcomes and drawing less on protective factors could contribute to research in identifying causes for the disparities. Implications of the findings as they pertain to social work policy and practice are discussed with suggestions for future research.