Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study.

Sexual minority adolescents are more likely to have mental health problems, adverse social environments, and negative health outcomes compared with their heterosexual counterparts. There is a paucity of up-to-date population-level estimates of the extent of risk across these domains in the UK. We analysed outcomes across mental health, social environment, and health-related domains in sexual minority adolescents compared with their heterosexual counterparts in a large, contemporary national cohort. The Millennium Cohort Study (MCS) is a birth cohort study in the UK following up children born between Sept 1, 2000, and Jan 11, 2002 across England, Wales, Scotland, and Northern Ireland. Children recruited from the MCS have been followed up over six recruitment sweeps to date at ages 9 months, 3 years, 5 years, 7 years, 11 years, and 14 years. We analysed mental health, social, and health-related outcomes in sexual minority versus heterosexual adolescents at age 14 years. Additionally, we estimated the accumulation of multiple adverse outcomes in both groups. The primary aim of the study was to assess whether sexual minority adolescents experienced more adverse outcomes than heterosexual adolescents. Between January, 2015, and April, 2016, 9885 adolescents provided a response about their sexual attraction. 629 (6%) of 9885 adolescents (481 female participants and 148 male participants) were identified as sexual minorities. 9256 (94%) of 9885 participants (4431 female and 4825 male) were attracted to the opposite sex or not attracted to the same sex and identified as heterosexual. Sexual minority adolescents were more likely to experience high depressive symptoms (odds ratio [OR] 5·43, 95% CI 4·32-6·83; p<0·0001), self-harm (5·80, 4·55-7·41; p<0·0001), lower life satisfaction (3·66, 2·92-4·58; p<0·0001), lower self-esteem (β 1·83, 95% CI 1·47-2·19; p<0·0001), and all forms of bullying and victimisation. Sexual minorities were more likely to have tried alcohol (OR 1·85, 95% CI 1·47-2·33; p<0·0001), smoking (2·41, 1·92 -3·03; p<0·0001), and cannabis (3·22, 2·24-4·61; p<0·0001), and also had increased odds of being less physically active (β 0·36, 95% CI 0·25-0·46; p<0·0001), perceiving themselves as overweight (OR 1·73, 95% CI 1·40-2·14; p<0·0001), and dieting to lose weight (1·98, 1·58-2·48; p<0·0001). Sexual minority adolescents had more co-occurring mental health outcomes (mean 1·43 of 3 outcomes, 95% CI 1·34-1·52) compared with heterosexual adolescents (0·40 of 3 outcomes, 0·38-0·41), and more total cumulative difficulties (mean 9·43 of 28 outcomes, 95% CI 9·09-9·76 in sexual minority adolescents vs 6·16 of 28 outcomes, 6·08-6·23 in heterosexual adolescents). Sexual minority adolescents in the UK experience disparities in mental health, social, and health-related outcomes despite living in a time of substantial progress in rights for sexual minorities. These adverse outcomes co-occur, with implications for lifelong health and social outcomes. Health and educational practitioners should be aware of the increased risk for adverse outcomes in sexual minority adolescents. None.

Amos R ，Manalastas EJ ，White R ，Bos H ，Patalay P ... -  《-》

Anxiety disorders, gender nonconformity, bullying and self-esteem in sexual minority adolescents: prospective birth cohort study.

Sexual minority adolescents (i.e. youth not exclusively heterosexual) report more anxiety than heterosexual youth on symptom questionnaires but no research has used standardised diagnostic tools to investigate anxiety disorder risk. This study uses a UK birth cohort to investigate the risk of anxiety disorders in sexual minority and heterosexual youth using a computerised structured clinical interview and explores the influence of gender nonconformity, bullying and self-esteem. Participants were 4,564 adolescents (2,567 girls and 1,996 boys) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Logistic regression analyses were performed to investigate the association between sexual orientation at 15.5 years and the presence of an anxiety disorder at 17.5 years. Covariates including maternal occupation, ethnicity, mother-reported childhood gender nonconformity at 30, 42 and 57 months, child-reported gender nonconformity at 8 years, child-reported bullying between 12 and 16 years and self-esteem at 17.5 years were added sequentially to regression models. Sexual minority adolescents (i.e. those not exclusively heterosexual) had higher early childhood gender nonconformity (CGN), lower self-esteem and reported more bullying than adolescents identifying as 100% heterosexual. Minority sexual orientation at 15.5 years was associated with increased risk of an anxiety disorder at 17.5 years for girls (OR 2.55, CI 1.85-3.52) and boys (OR 2.48, CI 1.40-4.39). Adjusting for ethnicity, maternal occupation, mother-reported and child-reported CGN had minimal impact on this association. Adjusting for bullying between 12 and 16 years and self-esteem at 17.5 years reduced the strength of the associations, although the overall association remained significant for both sexes (girls OR 2.14 and boys OR 1.93). Sexual minority youth are at increased risk of anxiety disorders relative to heterosexual youth at 17.5 years. Bullying between 12-16 years and lower self-esteem may contribute to this risk.

Jones A ，Robinson E ，Oginni O ，Rahman Q ，Rimes KA ... -  《-》

The Relationship Between Sexual History, Bullying Victimization, and Poor Mental Health Outcomes Among Heterosexual and Sexual Minority High School Students: A Feminist Perspective.

Dunn HK ，Clark MA ，Pearlman DN 《-》

Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study.

There are few population-based cohort studies of the emergence, development, and persistence of mental health problems in sexual minorities compared with heterosexuals. We compared trajectories of depressive symptoms in sexual-minority adolescents and heterosexual adolescents from when they were aged 10 years to 21 years, and examined self-harm at ages 16 years and 21 years. The study included 4828 adolescents born between April 1, 1991, and Dec 31, 1992, from the Avon Longitudinal Study of Parents and Children birth cohort (Bristol, UK) who reported their sexual orientation when aged 16 years. Depressive symptoms were assessed with the short Mood and Feelings Questionnaire (sMFQ) at seven timepoints between ages 10 years and 21 years. A self-harm questionnaire was completed at ages 16 years and 21 years. Analyses were linear multilevel models with growth curves (depressive symptoms), logistic multilevel models (self-harm in the previous year at ages 16 years and 21 years), and multinomial regression (lifetime self-harm with and without suicidal intent at age 21 years). At age 10 years, depressive symptoms were higher in sexual minorities (mean sMFQ 4·58 [SD 3·59]) than in heterosexuals (3·79 [3·36]) and increased with age to a larger extent. Depressive symptoms increased at each timepoint by 0·31 sMFQ points in hetereosexuals (95% CI 0·27-0·34), and by 0·49 sMFQ points in sexual minorities (0·40-0·59). Sexual-minority adolescents were more likely than heterosexual adolescents to report self-harm in the previous year at ages 16 years and 21 years (adjusted odds ratio 4·23, 95% CI 2·90-6·16), with no evidence that this estimate decreased with age (p=0·80). When aged 21 years, sexual minorities were 4·53 (95% CI 3·02 to 6·78) times more likely to report lifetime self-harm (ie, on at least one previous occasion) with suicidal intent than heterosexuals. Mental health disparities between heterosexuals and sexual minorities are present early in adolescence and increase throughout the school years, persisting to young adulthood. Prevention of these mental health problems and early intervention must be a priority. Medical Research Council, Wellcome Trust.

Irish M ，Solmi F ，Mars B ，King M ，Lewis G ，Pearson RM ，Pitman A ，Rowe S ，Srinivasan R ，Lewis G ... -  《-》

Growing Up With the Right to Marry: Sexual Attraction, Substance Use, and Well-Being of Dutch Adolescents.

To assess the well-being and substance use of sexual minority adolescents growing up in a tolerant society, we examined differences among same-sex attracted (SSA), those who do not know their attraction yet (not yet attracted [NYA]), and heterosexual Dutch adolescents. Unadjusted and adjusted logistic and linear multilevel analyses were performed using representative data of the 2013 Health Behaviour in School-Aged Children study (N = 5,995; 11-16 years old). The adjusted analyses controlled for sociodemographics (gender, age, education type, ethnicity, urbanicity, and religion). Adjusted results showed that SSA adolescents substantially more often reported alcohol use (adjusted odds ratio [AOR] = 2.01), tobacco smoking (AOR = 2.37), and cannabis smoking (AOR = 3.52) than their heterosexual peers, while NYA participants less often reported alcohol use (AOR = .57) and equal levels of tobacco (AOR = .71) and cannabis smoking (AOR = .87) compared with heterosexual adolescents. SSA adolescents reported lower levels of life satisfaction (b = -1.25) and higher levels of psychosomatic complaints (b = .61) and emotional problems (b = 1.57) than heterosexual adolescents. NYA adolescents reported equal levels of life satisfaction (b = -.18) and psychosomatic complaints (b = .06) as heterosexual adolescents, but higher levels of emotional problems (b = .51). In Dutch society, with over 20 years of inclusive policies for sexual minorities and generally tolerant population attitudes toward sexual minorities, SSA adolescents are still at increased risk of substance use and have lower levels of well-being compared with peers.

Kuyper L ，de Roos S ，Iedema J ，Stevens G ... -  《-》