The Relationships between Parenting and Mental Health and Substance Use Outcomes Among Queer Children and Adolescents: A Systematic Review

Background and Purpose: Queer youth (those who identify as lesbian, gay, bisexual pansexual, queer, and other identities) face stigma from heterosexism and various stressors (e.g., harassment, rejection, discrimination) compared to heterosexual youth, contributing to mental and behavioral health disparities. Queer youth have high rates of depression, anxiety, suicidality, and substance use/abuse. Extant research shows that the parents of queer youth play important roles in shaping these outcomes in positive and negative ways (e.g., parental acceptance and affirmation vs. parental rejection); however, this evidence is scattered across various fields and a systematic review to integrate recent evidence on this topic has not been completed. Such information could inform the development of interventions targeting youth, parents, families, and other contexts to address disparities. Given the importance of parents in shaping outcomes for queer youth, we undertook a systematic review to synthesize evidence on the relationships between parenting factors and mental health and substance use outcomes.

Methods: We followed the PRISMA 2020 standards in conducting this systematic review. Studies were included in the review if they collected data from queer youth (ages 12-25), examined the relationship between one or more parenting variables and one or more mental/behavioral health outcome, collected data in the United States, and were completed since January 1, 2011. Searches were performed in 7 databases (APA PsycInfo, CINAHL, ProQuest Dissertations & Theses Global, PubMed, Sociological Abstracts, Social Services Abstracts, and Web of Science) using an expert-informed search string. Following duplicate removal and double-independent screening, 37 studies were included in the review. Relevant data were extracted from the studies, which were then synthesized using narrative thematic synthesis.

Results:

Overall, studies suggest that queer youth with supportive/accepting parents were at lower risk of negative mental health outcomes (i.e., depression, suicidality) and substance use. However, findings were mixed, especially for substance use outcomes with several studies finding no effects. Further, some studies found different effects for fathers and mothers or between sexual identity groups (bisexual vs. gay/lesbian). There is also some evidence that parenting may moderate the links between bullying or victimization and youth mental health outcomes. Importantly, studies were limited in the parenting variables they focused on. Most studies (57%) focused on the effects of general parent social support or overall feelings of parental acceptance or rejection; only 20% of studies examined other aspects of parenting (e.g., parental monitoring, parenting style). Few studies (21%) examined parental acceptance/rejection or parental behaviors (e.g., preparation for bias) specific to sexual orientation. Most studies were cross-sectional (67%), and very few studies examined mediating or moderating processes.

Conclusions and Implications:

Our review suggests that parenting can have important linkages with queer youth mental health and substance use outcomes. Yet, more studies are needed that measure and test a broader range of parenting behaviors, especially those specific to promoting youth positive sexual identity. Moving forward, longitudinal studies that examine more fine-grained processes between parents and queer youth will be important to develop effective interventions that reduce health disparities.