Change in Sexual Identity and Depressive Symptoms Among Sexual Minority Adolescents: A Longitudinal Investigation

Introduction: Sexual minority adolescents (SMA) consistently report greater mental health symptoms, including depression, compared to heterosexual youth. In addition, the literature has suggested within-group heterogeneity in depressive symptoms based on sexual identity and birth-sex. Further complicating our understanding of mental health among SMA, is the fact that sexual identities may change over time in particular, during adolescence. Given the importance of identity formation in healthy adolescent development, there is a concerning lack of research on how changes in sexual identities may influence depression among SMA.

Methods: This paper examined changes in sexual minority identity and their association with mental health outcomes, in a national longitudinal data from sexual minority adolescents aged 14–17 years (n = 1077). We ask the following research questions: (1) does prevalence of change in sexual identity differ by birth sex? and (2) if change in sexual identity has an effect on depressive symptoms over time? Multigroup time-varying covariate latent growth models were employed to examine the effect of sexual identity change on depressive symptoms.

Results: In the sample, 40% of SMA reported reported at least one change in sexual identity over 18-month period. In the sample greater number of cisgender females reported change in sexual identity compared to their male counterparts (46.9% versus 26.6%). In our first model (total sample), change in sexual identity was significantly associated with reporting fewer depressive symptoms (b = -0.591, SE = 0.02, p = 0.004). The model controlled for birth sex, race and age. In the next step we examined the difference in the effect of sexual identity change on depressive symptoms by birth sex. Change in sexual identity was significantly associated with reporting fewer depressive symptoms for those identifying as female at birth (b = -0.591, SE = 0.02, p < 0.01). However, there was no significant effect of change in sexual identity on depressive symptoms among those identifying as male at birth (b = -0.718, SE = 0.49, p = 0.15). The models controlled for age and race.

Conclusion: The results from this study, particularly those regarding change in identities, have important public health implications. Findings challenge the traditional methods of gathering and using data on sexual identities and furthers our understanding of sexual identities in non-static ways by examining changes in identities over time. Methodological lessons from the study would be beneficial in informing nationwide longitudinal studies; for example, how national surveys like the Youth Risk Behavior Surveillance System or National Youth Survey may gather data on identities in non-static and multidimensional ways. The results add to the limited knowledge on the complex relationship between sexual identity change and mental health risks over time among adolescents. In addition, our results indicate that sexual identity development and change processes differ between cisgender females and males; and the nuances associated with these processes of change need further investigation.