Relationships between Disordered Eating and Family, School, and Community Contexts Among LGBTQ+ Youth in Kansas

Background. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth experience disparate mental health concerns, including depression, suicidality, anxiety, and eating disorders (ED) when compared with cisgender, heterosexual youth (Fish et al., 2019; Marshall et al., 2011; Watson et al., 2017). Extant research often attuned to minority stress theory demonstrates that these disparities are explained, in part, by high levels of anti-LGBTQ+ stigma, discrimination, and victimization (Brewster et al., 2019; Hatzenbuehler, 2011; Ryan et al., 2010). However, few studies have examined the relationship between ED and stigma and/or support in LGBTQ+ youth’s families, schools, and communities. As key contexts of youth development and health, these social environments warrant further consideration in ED research among LGBTQ+ youth, particularly in U.S. states and regions with high rates of victimization and stigma, such as the Midwest and South (Kosciw et al., 2016). Additionally, given the co-occurrence of ED with other serious mental health concerns (Gadalla et al., 2007) and the serious physical health risks associated with ED (de la Rie et al., 2005), additional ED research is warranted. Therefore, this study examined 1) rates of co-occurrence of ED and other physical and behavioral health conditions and 2) the relationship between ED and hostility in LGBTQ+ youth’s families, schools, and communities among a sample of LGBTQ+ youth in Kansas.

Methods. In collaboration with statewide community organizations, we employed an online needs assessment survey with LGBTQ+ youth ages 13-18 living in Kansas (N=129). Measures included demographic variables, the SCOFF questionnaire to assess for eating disorder symptoms (Morgan et al., 2000), presence of a physical health diagnosis, the Patient Health Questionnaire for Anxiety and Depression (Kroenke et al., 2009), and measures of family, school, and community climate. Frequencies of co-occurring conditions and hostile climates were generated, employing established cut-off points, when appropriate. Logistic regression was employed to determine the level of increase in adjusted odds of ED for each additional hostile environment experienced by the respondent.

Results. A third of the sample reported ED symptoms consistent with an ED diagnosis (n=44; 34.1%); among those participants, high levels of depression (68.2%), anxiety (86.4%), and presence of a physical health diagnosis (81.6%) were noted. Additionally, among those who screened positive for an ED, 20.6%, 11.8%, and 25.7% endorsed a hostile family, school, and community climate, respectively. For each additional setting (e.g. family, school, community) that a respondent identified as hostile (Family, School, Community), participants were 2.3 times more likely to screen for having an ED (AOR=2.3, SE=.96, p<.05), even after controlling for demographic factors.

Conclusions. These findings illustrate the high level of ED symptoms among LGBTQ+ youth in Kansas, high rates of co-occurring disorders, and a relationship between ED symptoms and growing up in hostile social environments. Implications from this research include the importance of identifying strategies to reduce hostility and promote support in LGBTQ+ youth’s families, schools, and communities and training mental and physical health providers on identifying and treating ED symptoms and co-occurring disorders, and providing LGBTQ+-affirming care.