Close to 10% of adolescents aged 14-18 make a suicide attempt each year (AFSP, 2018). Many factors are associated with suicidality, including depression, age, and sexual minority status (Guan, Fox, & Prinstein, 2012). Self-injurious thoughts and behaviors (SITB), including suicidal ideation (SI) and nonsuicidal self-injury (NSSI), are associated with attempts, especially when they co-occur (Klonsky et al., 2013), but research suggests that NSSI more strongly predicts suicide attempts, making it a phenomenon of particular concern. The Minority Stress Model (Meyer, 2003) posits that individuals from minority groups disproportionately experience stressors, which increase their risk for psychological distress. Indeed, higher rates of suicide, as well as SI and NSSI are observed within the LGBTQ community compared to national norms (Fox et al., 2018). However, most studies investigating SITB utilize clinical samples and little is known about rates of SITB in community samples. This study aims to describe rates of SI and NSSI among a community sample of adolescent females and whether these rates differ according to sexual minority vs. heterosexual status. Furthermore, we aim to determine how factors related to psychological distress (i.e., depression) might exacerbate the association between LGB status and SITB. The current study used data from a population-based sample of girls (the Pittsburgh Girls Study) to examine whether rates of SI and NSSI are higher among adolescents who identify as LGB. A sample of 1,825 girls had complete data, of whom 189 (10.4%) identified as a sexual minority at age 18. Past year NSSI was assessed with a single question. Past year SI and depressive symptoms were assessed with the Adolescent/Adult Symptom Inventory-4 (Gadow & Sprafkin, 1997; Gadow, Sprafkin & Weiss, 2004) at age 18. Endorsement of SI or NSSI at any point between ages 14-18 years was summed and coded as one variable (yes =1, no =0) and mean depressive severity scores between age 14-18 years was calculated. Results indicated that rates of SI and NSSI were significantly higher in the sexual minority than the heterosexual group (49.2% vs 21.1%, X2 (1) = 73.18, p < 0.01 respectively for SI; and 22.7% vs 7.1%, X2 (1) = 52.50, p < 0.01 respectively for NSSI). In addition, individuals identifying as sexual minority reported more severe depressive symptoms (M=8.44, SD=3.81 vs M=6.55, SD=3.55, t = 6.78, p < 0.01). Stepwise logistic regression revealed unique main effects of LGB status (OR = 1.939, p < 0.01), SI (OR = 9.132, p < 0.01), and depressive symptoms (OR = 1.164, p < 0.01) conferring risk for NSSI. Interaction terms between LGB status and both SI and depressive severity revealed no effect on risk for NSSI. These findings confirm the elevated risk for SI, NSSI, and depressive symptoms among sexual minority adolescents in a community sample. However, the results did not indicate that SI and depressive symptoms among LGB adolescents increased their risk of NSSI, indicating a need for further research elucidating why sexual minority adolescents may be at heightened risk for NSSI.

Background
Research has consistently demonstrated elevated rates of violence victimization among LGBTQ samples (McKay, Lindquist, & Misra, 2017). Furthermore, a history of victimization has been linked to mental health outcomes, such as suicidality and substance abuse, among certain LGBTQ subgroups (e.g., Hughes et al., 2010; Testa et al., 2012). However, little research exists on the effects of multiple types of victimization (i.e., polyvictimization) on both mental and physical health for LGBTQ individuals. The present study sought to take a person-centered approach by identifying meaningful groups of LGBTQ individuals, based on their polyvictimization profiles. Next, the study examined whether these unique profiles differentially predicted mental and physical health outcomes. We hypothesized that participants who had experienced numerous types of victimization would endorse higher rates of both mental and physical health conditions.
Methods
The current sample was derived from a larger health needs assessment of LGBTQ individuals living in the Central Savannah River Area (CSRA; Stepleman et al., 2018). The current study used a subsample of 385 LGBTQ participants who had full data on the primary study variables. To assess polyvictimization, we conducted a latent class analysis (LCA) on a total of 7 items assessing interpersonal violence, intimate partner violence, and violence based on gender/sexual minority status. Chronic health conditions were assessed using items from the 2010 Seattle LGBT Commission Report of Needs Assessment Survey (Boog, Cridland, Villanueva, Juarez-Diaz, & Ballezza, 2011). Chi-square analyses were conducted to assess associations between polyvictimization class and experiences of chronic health conditions.
Results
An LCA on victimization items suggested that a 3-class model best fit the data. Within this model, low trauma (71.4%), interpersonal violence (15.1%), and high trauma (13.5%) groups were identified. Chi-square analysis found no significant associations between chronic physical health conditions and polyvictimization class.
There were significant associations between polyvictimization class and alcohol abuse (X2 (2, N = 337) = 10.016, p = .007), anxiety (X2 (2, N = 347) = 23.164, p

Sexual minorities consistently demonstrate health disparities in psychological and physical health, but few studies have examined protective factors occurring in daily life that may help to alleviate some of these larger disparities. Prior research has shown that intrinsic goals, such as helping others and accepting oneself, are positively associated with psychological well-being and fewer physical symptoms while extrinsic goals, like pursuing wealth and body image, are negatively related. However, most of this research was conducted in heterosexual samples and has not been sufficiently extended to lesbians, gay men, and bisexual (LGB) individuals. This study aimed to understand factors that may protect LGB individuals against experiencing increased rates of psychological and physical symptoms on a daily basis using an experience sampling design. Primarily, we investigated how values, or the goals people are concerned with in their everyday life, are associated with their psychological and physical health that day. In addition to goals, our secondary aim was to examine how autonomy support impacts daily goal pursuits, health, and well-being. As autonomy support conveys acceptance, it may be particularly important to LGB individuals as they have an identity that is devalued and stigmatized in society. Little research has investigated the association between autonomy support, psychological well-being, and physical symptoms in LGB individuals. Furthermore, the link between autonomy support and goals has not been examined in an LGB sample. Data from 71 LGB individuals from the United States was collected at baseline, and up to three times per day for a two-week period. Results supported hypotheses as expected. Implications of such results for LGB individuals include areas of functioning that can be emphasized in therapy through individual, family, or group therapy to help encourage well-being for LGB individuals which result in a healthy LGB community as a whole. This is particularly relevant in our culture today where sexual minority and gender minority individuals are experiencing increased rates of prejudice and discrimination.

Limited systematic data exists on how to improve the high rates of depression and suicidality amongst Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) adults. Our presentation has two components. First, we describe our Patient-Centered Outcomes Research Institute (PCORI) -funded, community-academic partnered, randomized, comparative effectiveness study, Resilience Against Depression Disparities (RADD). Second, we summarize characteristics of adult individuals screened and enrolled into our study. RADD seeks to understand how to improve depression outcomes amongst LGBTQ+, low-income, racial and ethnic minority adults in Los Angeles and New Orleans. RADD compares whether a Resiliency Class, a 7-session cognitive behavioral therapy (CBT) informed Resiliency Class (RC) delivered by community health educators improves depressive symptoms over and above a depression quality improvement training at the agency-level across healthcare and social/community services (Resources for Services [RS]) for randomized, enrolled depressed adults. RADD utilizes a community partnered participatory research (CPPR) model to partner with LGBTQ+ focused community organizations (e.g. clinics, faith-based organizations, social services). RADD uses a Comparative Effectiveness Research (CER) design and the Socio-Ecological Model (SEM) to compare two interventions: one at the agency level (RS) and another at the individual level (RS+RC). RS is a model that provides training for clinically and non-clinically trained organization staff (i.e. therapists, community outreach workers, clergy) on how to deliver depression care within agencies. The RS model is meant to enhance communication and care management between community agencies so that overall depression services and outcomes are improved among depressed patients. RC is a CBT-based class that provides tools to participants to help manage depressive symptoms in a framework that addresses specific needs of the LGBTQ+ community. Classes meet for seven sessions and are taught by non-licensed LGBTQ+ health educators in trusted community settings. Participants are depressed adults from LGBTQ+ focused programs. Inclusion criteria are: age≥18 years, 8-item Patient Health Questionnaire (PHQ-8) ≥10 (severe depression), providing contact information. Exclusion criteria include: not speaking English or Spanish or too impaired to complete screening. Primary outcomes are: depressive symptoms (PHQ-8 score); mental health quality of life (12-item mental composite score ≤ 40), mental wellness, and physical health quality of life (12-item physical composite score) are secondary. We screened n=1859 adults, for n=392 enrolled, and offered 6- and 12-month follow-up. At baseline, 44% of participants self-identified as Gay or Lesbian, 12% Bisexual, and 4% Queer or Questioning; 39% were Latino, 28% African-American, 25% White; 17% were Spanish-speaking, and 25% were foreign-born. 17% of participants were homeless or living in an emergency shelter or supported housing. In addition, our presentation will describe how RADD utilized CPPR principles in participant engagement, post-funding design changes, study implementation, and identify lessons learned to improve relevance for local communities.

Background: It is well-known that LGBTQ individuals tend to experience poorer health than their non-LGBTQ counterparts across a variety of domains. These health disparities are in part the result of stigma, prejudice, and discrimination to which LGBTQ individuals are regularly subjected, which lead to stress and ultimately health problems. Moreover, sexual minority individuals who have experienced prejudice related to their LGB status have been found three times more likely to experience physical health problems following an acute incident of prejudice than LGB individuals not reporting such events (Frost, Lehavot, & Meyer, 2015). Further, research indicates that community-level prejudicial attitudes against sexual minorities are predictive of poorer health and higher mortality risk for sexual minorities, indicating that the health of LGBTQ individuals may be affected by general awareness of anti-LGBTQ attitudes from others living in their community (Hatzenbuehler et al., 2014). The purpose of the current study was to investigate how the variables of minority stress, physical health, and perceptions of safety living as an LGBTQ individual may be related for sexual and gender minority individuals in a small, Southern city.
Methods: Data were collected online from 436 individuals in the Central Savannah River Area (CSRA) who identified themselves as sexual and/or gender minorities. Data were primarily collected at local Pride events. Participants completed an online survey that measured various aspects of physical and mental health, experiences with discrimination and violence related to being LGBTQ, and how safe they feel being LGBTQ in the CSRA. The PROCESS Macro for SPSS was used to perform statistical analyses (Hayes, 2017).
Results: For cisgender sexual minority women participants (N=156), feeling unsafe living as an LGBQ individual in the CSRA fully mediated the relationship between experiencing interpersonal violence as a result of being a sexual minority (distal minority stress) and poor physical health (measured as the number of poor health days in the last month). In other words, experiencing physical assault due to being LGBQ predicted poorer physical health, but only for women who reported feeling less safe living in the CSRA. This pattern was not found for cisgender sexual minority men (N=190) or for transgender participants (N=89).
Discussion: Results indicate that feeling unsafe as a sexual minority in the CSRA may lead women who have experienced sexual identity-related violence to experience poorer health. Previous research has shown that concealing one’s sexual identity has also been shown to negatively impact the health of sexual minority individuals (Cole et al., 1996). Thus, interventions aimed at improving the health of sexual minority women in areas where prejudice is more common would be most effective if aimed at reducing heterosexism and increasing LGBTQ inclusivity at a community level in addition to current interventions directly targeting sexual minority women. Our results show that helping sexual minority women to feel more welcome and safer in their communities in order to be more “out” about their sexual identity could potentially have profound effects on overall physical health.
 

 

Background:Research on individuals with non-heterosexual orientations (sexual minority, including lesbian, gay, and bisexual) have found an association between minority stressors such as internalized heterosexism (IH) and higher risks of depression and anxiety. However, most studies have used single-item or standardized assessment tools instead of clinical diagnostic processes for mental disorder measurements. It is therefore difficult to ascertain the clinical significance of the effect of minority stressors. Furthermore, evidence from non-Western settings has been scarce. This study aims to investigate whether IH is associated with a higher risk of having a diagnosis of depression or anxiety disorder among sexual minority individuals in Taiwan.
Methods: Online advertisements were placed through sexual minority-friendly non-governmental organisations to recruit a purposive sample of 120 sexual minority adults living in Taiwan (50 gay, 50 lesbian, 20 bisexual). Sexual orientation was measured using the Kinsey’s Scale; IH was measured by extracted subscales from the Internalized homonegativity Inventory (IHNI) and the Lesbian Internalized Homophobia Scale (LIHS); Primary outcome was defined by having either a Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) diagnosed by a psychiatrist using the Mini-International Neuropsychiatric Interview (MINI). Crude odds ratio (OR) and OR adjusted for employment status were reported from logistic regression models.
Results: The sample had a mean age of 26.6 years; 90.8% had a college degree. 14 individuals only had MDD diagnosis (11.7%), 5 only had GAD diagnosis (4.2%), and 5 had both (4.2%). A higher level of IH was associated with a higher risk of having either an MDD or a GAD diagnosis with a small effect size and an equivocal strength (unadjusted OR=1.038, 95% CI=0.996, 1.083). The adjustment for employment status further diminished the size and strength of the effect (adjusted OR=1.033, 95% CI=0.990, 1.079).
Discussion: This study found little evidence supporting our hypothesis of an association between a higher level of IH and the risk of clinically detectable depression or anxiety disorder. Contrasting our results with findings of significant associations from studies using non-diagnostic assessment tools, it is suggested that the effect of IH of causing mental ill-health may be more prominent at subclinical than at clinical level. Our results should not be taken to undermine the importance of minority stress in sexual minority mental health. Rather, that the mental health effects of IH tend to evade clinical tests highlights the crucial roles of community mental health interventions and preventive strategies. Finally, this study suffered from purposive sampling and cross-sectional design. Longitudinal studies with larger samples are needed to validate these results.

BACKGROUND: Social expectations of heteronormativity often lead to adverse health outcomes in adolescent men who have sex with men (AMSM). Research with non-Hispanic adults has shown that endorsement of traditional gender roles can lead to internalized gay stigma (IGS) and is associated with negative emotional health outcomes, such as depression. Although attitudes towards homosexuality have improved, IGS remains prevalent across age groups and races. This study looked at the role of sexual practices with men and women as potentially influential over depression and IGS in Latino adolescents (LAMSM).

METHODS: As part of a larger study, we surveyed 597 AMSM ages 13-18, of which 208 identified as Latino. Specifically, questions were asked to assess IGS, depression, and sexual practices (i.e., engaging in mutual masturbation with men and women, kissing men and women).

RESULTS: Participants reported a low degree of IGS (M=2.05, SD=0.74, 1-4) and depression (M=2.53, SD=0.99, 1-5). About 73% of participants had at least engaged with two male partners in mutual masturbation; about 20% reported at least engaging with one or more female partners in mutual masturbation. While IGS was positively related with depression across the sample (β=.17, p=.001), no differences were found between Latino and non-Latino participants regarding any of the psychological or sexual variables.
Key differences emerged unique to the 208 LAMSM and which moderated the significant relationship between IGS and depression. Engaging in mutual masturbation with other men exacerbated the depression associated with IGS (β=.26, p=.03). At the same time, engaging in mutual masturbation with women reduced the depression associated with IS (β=-.24, p=.03). A similar effect was found for LAMSM who engaged in more kissing with women, where kissing decreased depression among those reporting higher IS (β=-.30, p=.001); kissing more men only approached significance as an exacerbating factor of depression (β=.21, p=.09).

DISCUSSION: While IGS was positively related with depression across the sample, LAMSM presented a unique relationship between IGS, depression, and sexual practices. For LAMSM with high levels of IGS, a higher number of male partners was positively associated with higher levels of depression, while higher numbers of female partners became a protective factor for it.
Given that IGS is the result of social exchanges, its moderating effect on depression for LAMSM could be due in part to the expectations of heteronormativity present in American and Latino cultures. In particular, men who do not meet the expectations of hypermasculinity by engaging in sexual practices with other men may be keenly aware of how such behaviors go against cultural expectations. Alternatively, engaging in sexual activity with women may be affirming expectations of hypermasculinity and counteract depression. For LAMSM with high levels of IGS, behavioral bisexuality seems to act as a protective factor against depression.
Although lower levels of depression for LAMSM with higher levels of IGS is a positive outcome, studies have shown that concealment of sexual orientation and gender identity can have adverse outcomes. Further research is necessary to determine the long-term effects of non-disclosure and whether having sexual partners continues being a protective factor for depression for Latino populations.

Background: On average, men who have sex with men report elevated rates of childhood sexual and physical abuse. This high risk of trauma exposure continues into adulthood and manifests through exposure to interpersonal violence, hate crimes, and ongoing psychosocial stress and socioeconomic strain. While characterization of trauma exposure and its impact on mental health outcomes among this population is extensive in Western countries, comparable data are often lacking in low-and middle-income countries like Vietnam, where the burden of mental disorders is concentrated. This study aimed to address these gaps in the literature by examining childhood exposure subtypes, as measured by the Childhood Trauma Questionnaire, and their relationship to depression and anxiety among young men who have sex (YMSM) living in Hanoi, Vietnam. Methods: From March to October 2018, we used venue-based sampling to enroll 200 participants into the study. Results: In this sample of YMSM (aged 18-29), sexual abuse (49.2%) was the most common subtype followed by emotional abuse (46.7%), emotional neglect (46.2%), physical abuse (43.2%), and physical neglect (39.2%). Approximately one-third of the sample met the cut-off for moderate-to-severe depression, while 20.6%, for moderate-to-severe anxiety. Multiple linear regression suggested that controlling for age and socioeconomic and migrant status, only emotional abuse was significantly associated with depression and anxiety symptom severity. Discussion: These findings underscore the ongoing impact of childhood trauma exposure on mental health outcomes among this population and suggest the need for further research on how these ongoing dynamics shape HIV risk behaviors.

Background: Both persons of color (POC) and sexual and gender minorities (SGM) who experience more enacted stigma (i.e., discrimination, overt victimization, or covert acts of aggression) based on their minority identity are more vulnerable to mental health and substance problems. The dual status of being a POC and SGM puts one at risk of experiencing both racial/ethnic and SGM enacted stigma. However, very little research has examined the health consequences of stigma experiences of those who exist at the intersection of both identities. Our aim was to identify if each had additive negative effects on mental health or substance problems or if one form of stigma interacted and exacerbated the other. We hypothesized that female assigned at birth (FAB) SGM of color who experienced the highest levels of both forms of stigma would report higher mental health and substance problems. Methods: Data come from a racial/ethnic minority subsample of FAB SGM (N = 352; mean age = 20.27) drawn from the larger community-based FAB 400 sample (N = 488). The associations of race/ethnicity and SGM enacted stigma with depression symptoms, anxiety symptoms, alcohol problems, and marijuana problems were tested using linear regression and negative binomial models. SGM stigma was measured using the LGBT victimization scale (D'Augelli et al., 1998) and the sexual orientation microaggression inventory (Swann et al., 2016). Race/ethnicity stigma was measured using the perceived ethnic discrimination questionnaire (Brondolo et al., 2005). Mental health problems were measured with the PROMIS depression and anxiety scales (Pilkonis et al., 2011). Alcohol and marijuana problems were measured with the AUDIT (Babor et al., 2001) and CUDIT (Adamson et al., 2010), respectively. Results: Enacted stigma based on both race/ethnicity and SGM status were significant predictors of depression symptoms (SGM enacted stigma: Beta = 1.15, 95% CI = 0.26-2.04; race/ethnicity enacted stigma: Beta = 1.95, 95% CI = 1.08-2.81), anxiety symptoms (SGM enacted stigma: Beta = 0.99, 95% CI = 0.09-1.88; race/ethnicity enacted stigma: Beta = 1.90, 95% CI = 1.03-2.78), and alcohol problems (SGM enacted stigma: IRR = 1.18, 95% CI = 1.01-1.38; race/ethnicity enacted stigma: IRR = 1.18, 95% CI = 1.01-1.37), which suggested that both uniquely contributed to poorer health. There was no support for interactive effects between the multiple forms of stigma. Marijuana problems were best explained by enacted stigma based on race/ethnicity only (IRR = 1.31, 95% CI = 1.14-1.49). Discussion: The present study suggests that experiences of stigma based on SGM and racial/ethnic identity each have unique, additive effects on mental health and substance use problems. The two types of stigma may have cumulative effects that contribute to the mental health and substance use disparities experienced by SGM of color. As such, it highlights the importance of assessing both racial/ethnic and SGM stigma experiences when researching the effects of minority stress on SGM POC. For SGM POC, consideration of all of their minority identities, and the nuances of their experiences, is crucial for understanding the health disparities that they face.

Background: Accumulating evidence indicates that non-monosexual individuals (individuals attracted to more than one gender) are at increased risk for suicidality, mental health problems, poor physical health, and substance use compared to heterosexual and lesbian/gay populations (e.g., Ross, Salway, Tarasoff, MacKay, Hawkins, & Fehr, 2017; Marshal et al., 2008). Research suggests that the stigmatization of non-monosexuality contributes to non-monosexual individuals’ heightened risk (e.g., Dyar & London, 2018a; Mereish, Katz-Wise, & Woulfe, 2017). However, the vast majority of this research has focused on associations between non-monosexual stressors and anxiety/depression, with other health outcomes being largely neglected. To address this gap, the current study examined associations between non-monosexual stresssors and suicidality, physical health, substance use, and mental health among non-monosexual individuals. Methods: In a diverse sample of 360 non-monosexual adolescents and young adults (age 16 to 32) assigned female at birth, we utilized structural equation modeling to examine cross-sectional associations between non-monosexual stressors (discrimination, internalized stigma, and anticipated stigma) and health (physical health, mental health, suicidality, and substance use). This analytic sample is part of a larger longitudinal cohort study of 488 sexual and gender minority individuals assigned female at birth – referred to as FAB400. By using structural equation modeling, we were able to utilize a range of measures to more accurately model the four health domains examined. For example, physical health was modeled using the presence of a range of acute and chronic health conditions; substance use was modeled via alcohol and cannabis use problems, cigarette use, prescription drug misuse, and non-cannabis illicit drug use; suicidality was indicated by suicidal ideation, plans, and attempts; and mental health was indicated by anxious and depressive symptoms. Results: Higher levels of all non-monosexual stressors were associated with more mental and physical health problems. Experiences of non-monosexual discrimination and internalized stigma, but not anticipated stigma, were also associated with more substance use and higher suicidality. To determine whether these associations differed among subgroups of non-monosexual individuals, we conducted invariance testing across race/ethnicity, gender identity, and sexual identity. Results indicated that associations between non-monosexual stressors and health did not differ by race/ethnicity (White, Black, Latinx), gender identity (ciswoman, gender minority), or sexual identity (bisexual, pansexual, queer). Discussion: These findings expand the literature on non-monosexual minority stress by demonstrating that non-monosexual stress is associated with a range of health outcomes beyond anxiety and depression. Many of the indicators of the health outcomes examined in this study have not been previously examined in association with non-monosexual stress (e.g., chronic and acute physical health disorders, suicidality). This indicates that future research should begin to broaden the health outcomes examined in research on the effects of non-monosexual stress. Future longitudinal research is needed to test the directionality of these associations

Background: LGBTQ students are at substantially higher risk of suffering from common mental health problems than cisgender and heterosexual students. However, there is a lack of robust, prospective studies investigating psychological processes contributing to mental health problems in these young adults. Drawing on cognitive behavioural models of distress and Hatzenbuehler’s (2009) psychological mediation framework this longitudinal study simultaneously examined minority stressors and general cognitive and behavioural processes (e.g., beliefs) in order to determine their relative importance in conferring risk for subsequent depression, anxiety and suicidality. It was hypothesised that general and LGBTQ related negative beliefs about the self, others or the future would be associated with distress, and that this relationship would be mediated by unhelpful cognitive and behavioural responses. Methods: This was an online study of 385 participants, which employed a three-wave longitudinal design. Eligibility criteria for the study were (i) self-identifying as a sexual or gender minority (LGBTQ), (ii) being 16 years of age or over, and (iii) being currently enrolled as a student at a UK College or University. Beliefs about the self, others or the future were assessed using questionnaire measures of hopelessness, dysfunctional attitudes, self-esteem, internalised heteronormativity and rejection sensitivity. Cognitive and behavioural responses were assessed using measures of rumination, self-compassion, avoidance and active concealment. Distress was assessed using measures of depression, anxiety and suicidality. Structural equation modelling was used to look at the relationship between negative beliefs at baseline and distress two months later, via cognitive and behavioural response mediators assessed at an intermediate point, one month after baseline. Results: Results supported the hypothesis that general negative beliefs about the self are prospectively associated with anxiety, depression, and suicidality, and that LGBTQ-related negative beliefs are independently associated with these outcomes. A general latent factor of cognitive and behavioural responses, which included general avoidance and rumination, partially mediated the relationship between beliefs at baseline and distress two months later. Similarly, a latent factor including LGBTQ specific rumination and active concealment mediated the relationship between LGBTQ-related beliefs and distress and suicidality. Discussion: To our knowledge this is the first longitudinal study to test a model incorporating general and LGBTQ-specific risk factors and distress in LGBTQ students. Consistent with the psychological mediation framework, negative LGBTQ-related beliefs and cognitive / behavioural responses were associated with subsequent distress. The present findings extend this field by revealing that general negative beliefs about the self, others or the world, were associated with subsequent depression, anxiety and suicidality in LGBTQ students and this association was mediated by unhelpful cognitive or behavioural responses, such as rumination and avoidance. These processes may be promising targets for cost-effective, evidence-based psychological interventions.

Background: Transgender suicide rates are reportedly on the rise within the United States. Initiatives and policies devoted to comprehensive care of transgender individuals vary throughout the country. The purpose of this study was to assess whether an association existed between gender identity and sexual orientation policies per state and their respective suicide rates. Methods: A retrospective analysis was performed using state data retrieved from the National Equality Map | Transgender Law Center, American Foundation for Suicide Prevention’s “State Fact Sheets”. For the primary and secondary outcomes, independent variables Gender Identity Policy Tallies (GIPT) and Sexual Orientation Policy Tallies (SOPT), respectively, were evaluated by a Mann-Whitney U test being divided into two groups: 1) Favorable and 2) Unfavorable, and their effects on the dependent variable, 2015 Annual Suicide Rates. A policy tally reflects as law or policy that protects or harms Lesbian, Gay, Bisexual, Transgender people. Each state’s tally counts the number of positive laws and policies that help drive equality. Favorable equated to high/medium policy tallies. Unfavorable corresponded to low/negative policy tallies. Data findings from the District of Columbia were not included. Statistical significance for both the primary and secondary outcomes was determined a priori to be an alpha level of p< .05. Results: For the primary outcome, 30 states yielded unfavorable positions on GIPT and 20 states reported favorable stances. For the secondary outcome, 26 states produced unfavorable positions on SOPT and 24 states generated favorable stances. Distributions in the 2015 suicide rates by state were similar across the favorable and unfavorable groups for both GIPT and SOPT. Nevertheless, the median suicide rates in 2015 were statistically significantly higher in the unfavorable (15.44 [GIPT] and 15.44 [SOPT]) versus the favorable (13.44 [GIPT] and 13.94 [SOPT]), U = 171, Z = -2.555, p = .011 [GIPT]; U = 206, Z = -2.058, p = .040 [SOPT]. Discussion: The positions on gender identity and sexual orientation policy tallies demonstrated statistical associations with differences in suicide rates by state. States with more favorable gender identity and sexual orientation policy tallies had significantly lower suicide rates. Our findings are accompanied by scrutiny that extends towards the accuracy of transgender suicides rates as genders assigned at birth typically populate death certificates. Further, some policy makers may view Gender Identity and Sexual Orientation as synonymous considerations. Our results point towards intensifying research in this area moving forward.

Background: Questioning salient parts of one's identities is often a difficult process and, in the case of sexual orientation questioning, can lead to poor mental health outcomes (e.g. depression, anxiety). The aim of this study was to identify teachings about sexuality that contribute to or shield against distress during the process of questioning one's sexual orientation. Heteronormativity teaches all individuals that the only normal way to engage in sexual and romantic relationships is to be heterosexual, often erasing other possibilities. Heteronormative ideals (the idea that one must be heterosexual, heteroromantic, and monogamous) are often imposed from a very young age and are consequently internalized. Uncertainty-Identity Theory states that the most effective way to reduce distressing feelings of self-uncertainty is to join a rigidly defined social group. Methods: We conducted an online survey asking about ideas surrounding sexuality that were taught when growing up, as well as thoughts and feelings experienced when questioning their sexual orientations. We also tested Uncertainty-Identity Theory in the novel context of sexual orientation labels as social group identities. Results: A total of 954 participants completed the survey; of these, 514 identified as non-heterosexual. The prescription of heteronormative ideals was a significant predictor of the distress felt while questioning one’s sexual orientation. Neutrally-presented information about other sexual orientation possibilities did not moderate this relationship as expected, but instead acted as a partial mediator; being exposed to high levels of heteronormativity was associated with lower access to neutrally-presented information, which in turn led to higher questioning-related distress. Perceived authenticity of one’s sexual orientation label accounted for more variance in current identity related distress than did perceived entitativity. Discussion: Internalized heteronormative ideals may contribute to a more distressing sexual orientation questioning process. Access to information about alternative, non-heterosexual identities may not be enough to create an environment safe for questioning one’s sexual orientation when also exposed to heteronormativity. Uncertainty-Identity Theory is not entirely applicable in the context of sexual orientation identity; sexual orientation group entitativity—rigidity of group definition, group homogeneity, shared values—is not a significant predictor of self-uncertainty related distress. Key words: Heteronormativity, sexual orientation, Uncertainty-Identity Theory Public Significance Statement: This study implements new measures relevant to heteronormativity and sexual orientation questioning in addition to con/testing Uncertainty-Identity Theory in a novel context.

Intersecting identities, as many public health scholars and professionals address, have significant impacts on individuals’ experiences in result of multiple interlocking systems of privilege and oppression at the social-structural level. Even though a plethora of research focused on LGTB of color or other minority populations, our understandings of intersecting identities in Asian American health studies are hindered by structural racism and stigma in the dominant society, as well as lack of funding and scientific evidence in public health. This qualitative study seeks to understand the intersecting identities between race/ethnicity and sexual orientation in Asian American individuals in the Midwest, U.S. With their lived experiences of exploring and integrating multiple independent but also interrelated minority identities into a holistic one, 12 Asian American LGB individuals aged between 18 to 35 years completed semi-structural, in-depth interviews. The results revealed that the intergenerational conflicts of homosexuality due to cultural beliefs and family values, those oppressions influence their conversation and relationships with their parents, which led to adverse mental health behavioral health outcomes. Meanwhile, they also described their adverse experiences in dating and gay communities. They are proud of intersecting identities and gradually navigate these identities in different situations. Qualitative thematic analysis generating 4 domains that reflected Asian American LGB individuals on fighting against stereotypes/homophobia, acculturation conflicts, and racial discrimination. Sample themes include: a) Acculturative stress; b) Inter-Cultural Experiences in Dominant American Culture; c) Definition of intersecting identity; and d) Affirming intersecting identity development. Findings advocate for open dialogues of mental health in Asian American communities and underscore the challenges that Asian American LGB individuals encounter in developing a holistic and integrative identity between race/ethnicity, immigrant/refugee status, sexual orientation while others only touted this “model minority” group in good shape. Implication for research and counseling practice with this community are discussed.

Lesbian, gay, and bisexual (LGB) individuals experience systemic stress due to their minority status (Meyer, 2003) and many turn to friends, family, and/or partner(s) for support to cope with this stress (Blair & Homberg, 2008). The prevalence of and the extent to which support buffers distress appears to vary by age (Burton, Bonanno, & Hatzenbuehler, 2014; Frost, Meyer & Scwartz, 2016; Graham & Barrow, 2013); however, there has yet to be a systematic investigation of this effect. Given the need of practitioners to effectively work with LGB individuals across the lifespan, research is needed to address this gap. In the present study, we examined three core research questions: (1) Does the amount of social support from family, friends, and partner(s) change across the lifespan? (2) Do these forms of support protect against negative mental health? (3) Do the magnitude of these effects change across the lifespan? To answer these questions, we used archival data from a nationally representative sample of 168 LGB adults (Radler, 2014). Participants were followed for 18 years and data were collected at the beginning (1995), middle (2004), and end of this period (2013). Participant ages ranged from 25 to 75 during the first wave and 43 to 93 during the last wave. We analyzed these data with multilevel longitudinal data analysis. Year was included as a control variable in all analyses to capture effects related to aging independent of effects related to the passage of time, such as greater societal acceptance of LGB people from 1995 to 2013. Results from unconditional growth models showed that total social support remained the same over the lifespan from ages 25 to 93. When examined separately, support from family and friends remained steady, but partner support had a significant curvilinear change. Partner support peaked in early adulthood (20-30), was lowest in mid-life (50-60), and then peaked again in late-life (80-90+). Results from the conditional growth models showed that friend and partner support were associated with less negative affect, and this association was not moderated by age. Alternatively, family support was moderated by age such that low family support predicted worsened negative affect in early adulthood, but this association diminished with age. Our results are consistent with previous literature in highlighting the role of social support in protecting against negative mental health for LGB individuals (Mustanski & Liu, 2013). We found that the amount of support and the protective effect of support largely remained consistent over the lifespan. Thus, although LGB individuals are likely to experience different challenges throughout their lives, the need for support remains unchanged. The exception to this finding is family support. Family support was found to be much more strongly related to improvements in mental health in young adulthood than later in life. This pattern may reflect family of origin issues experienced by many LGB individuals in young adulthood. We encourage practitioners and researchers to be attuned to the changing types and roles of support among LGB individuals over the lifespan.

Background: Transgender and non-binary [trans*] people are disproportionately affected by violence and adverse mental health outcomes, including post-traumatic stress disorder [PTSD] and depression. Polyvictimization, (i.e., experiencing multiple forms of violence throughout the lifespan), has been shown to have a cumulative effect on mental health outcomes among cisgender populations; however, is understudied among trans* communities. The purpose of this study was to examine the relationship between polyvictimization and the mental health outcomes of depression and post-traumatic stress disorder [PTSD] among African American/Black and Latinx/Hispanic trans* people assigned male at birth. Methods: We conducted a secondary data analysis of data collected from 2016-2017 via structured interviews completed by 197 trans* people (147 Black/African American, 54 Hispanic/Latina; residing in Washington, DC, and Baltimore, MD; >18 years old). Polyvictimization was measured using a 15 item inventory spanning three domains of violence: sexual violence, physical violence, and threats of violence. Main outcome measures included the presence of symptoms for (A) lifetime PTSD, via Primary Care PTSD Screener, or (B) past two-week depression, via Patient Health Questionnaire-2 [PHQ2]. Data were analyzed using multiple linear regression and controlled for geographic location and age. Results: Of participants, 91.4% experienced at least one form of either sexual violence, physical violence, or threats of violence, while 86.8% experienced two or more types of in their lifetime (polyvictimization). The regression models including polyvictimization, age, and geographic location explained 30.5% of the variance in depression symptoms reported (F(3, 193)=6.575, p