Longitudinal association of homonegative school climate with body dysmorphic disorder among cisgender sexual minority adolescents: Testing mediation through proximal minority stressors.

In a US national cohort study of cisgender sexual minority adolescents (SMAs), we prospectively (1) assessed whether within-person changes in homonegative school climate (i.e., school contextual factors that lead SMAs to feel unsafe or threatened) were associated with risk of probable body dysmorphic disorder (BDD) and (2) tested whether internalized homonegativity and negative expectancies mediated this association. Data came from consecutive time points (18-month, 24-month, 30-month) of the Adolescent Stress Experiences over Time Study (ASETS; N = 758). The Body Dysmorphic Disorder Questionnaire measured probable BDD. Sexual Minority Adolescent Stress Inventory subscales measured past 30-day minority stress experiences. Multilevel models were specified with person mean-centered predictor variables to capture within-person effects. Across one year of follow-up, 26.86% screened positive for probable BDD at least once. Model results indicated significant total (risk ratio [RR]=1.43, 95% credible interval [CI]=1.35-1.52) and direct effects (RR=1.18, 95% CI=1.05-1.34) of homonegative school climate. Internalized homonegativity was independently associated with probable BDD (RR=1.28, 95% CI=1.12-1.46) and mediated 49.7% (95% CI=12.4-82.0) of the total effect. There was limited evidence of mediation via negative expectancies. Implementing SMA-protective school policies and targeting internalized homonegativity in clinical practice may reduce the prevalence and incidence of probable BDD among cisgender SMAs.

Sexual Orientation Change among Adolescents and Young Adults: A Systematic Review.

This article reviews research on changes in self-reported sexual orientation labels and associated health outcomes among adolescents and young adults. Using seven electronic databases and supplementary methods, we identified 30 studies for inclusion in the review, published between 2000 and 2020. This review aimed to summarize the approaches to measuring sexual orientation change; the prevalence, patterns, and directionality of changes in sexual identity; and how changes in sexual orientation relate to health outcomes among adolescents and youth adults. The reviewed studies lacked agreement in operationalization and assessment of sexual orientation changes. Prevalence of change in self-reported sexual orientation differed by birth sex, whereby cisgender female participants were more likely to report a change than male participants. In addition, adolescents and youth identifying with a nonheterosexual orientation or sexual minority at baseline were more likely to report a change in sexual orientation. Few studies reported on the impact of changes in sexual orientation on behavioral health outcomes. Adolescents who reported either nonheterosexual orientation at baseline or a shift toward nonheterosexual orientation had a greater likelihood of reporting depressive symptomology, suicidality, and substance use compared to those who did not report a change or reported consistent heterosexuality. Recommendations for future research and implications for practice are discussed.

Reducing behavioral health symptoms by addressing minority stressors in LGBTQ adolescents: a randomized controlled trial of Proud & Empowered.

BACKGROUND: Minority stress may lead to poorer mental health for sexual and gender minority adolescents, yet no interventions have been tested through an RCT to address these concerns. METHODS: We report on an RCT of an intervention-Proud & Empowered-with four high schools. Measures assess the intervention's impact on mental health symptoms. RESULTS: Compared to the control, participants in the treatment condition reported significant differences in minority stress, anxiety, and depressive symptoms. Moderation analyses showed that the intervention significantly moderated the relationship between minority stress and PTSD (b = -1.28, p = .032), depression (b = -0.79, p = .023), and suicidality (b = 0.14, p = .012) symptoms; those in the intervention condition had mitigated relationships between measures of stress and health outcomes compared to those in the control condition. CONCLUSIONS: Results suggest that Proud & Empowered help reduce mental health symptoms and exposure to minority stressors and build coping strategies. TRIAL REGISTRATION: The intervention was registered on clinicaltrials.gov on August 1, 2019 under Trial # NCT04041414 .