Research on LGBTQ Issues in AJO 

Blosnich, J. R., Cassese, E. C., Friedman, M. R., Coulter, R. W. S., Sang, J. M., Matthews, D. D., & Mair, C. (2018). Religious freedom restoration acts and sexual minority population health in the United States. American Journal of Orthopsychiatry. Advance online publication.

Abstract 

Religious freedom restoration acts (RFRAs) in the United States potentially facilitate discrimination against lesbian, gay, and bisexual individuals (i.e., sexual minorities). In the current investigation, we explored whether a population health metric among sexual minority adults changed over time based on the presence, absence, or introduction of a state RFRA. Data are from 21 of the United States that gathered sexual orientation data from population-based samples of noninstitutionalized adults in the 2015 Behavioral Risk Factor Surveillance System (CDC, 2015, 2016). The analytic sample included 4,911 sexual minority individuals. Time was measured in 4 3-month quarters (i.e., Q1, Q2, Q3, Q4). For each state, the prevalence of sexual minority adults reporting ≥14 unhealthy days/30 days was calculated. Only Indiana (the only state in the sample that passed an RFRA in 2015) exhibited significant increasing proportions over time of sexual minority adults reporting ≥14 unhealthy days (Q1 = 24.5%, Q2 = 34.8%, Q3 = 41.2%, Q4 = 59.5%; β = 0.50, SE = 0.23, p = .037). Post hoc analyses revealed that unhealthy days did not increase for heterosexual adults in Indiana. Indiana’s RFRA could have contributed to the increasing prevalence of unhealthy days among sexual minority adults in that state during 2015. Public health surveillance tools are needed to expedite analyses of the impact of laws on minority population health.

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Hatchel, T., Espelage, D. L., & Huang, Y. (2018). Sexual harassment victimization, school belonging, and depressive symptoms among LGBTQ adolescents: Temporal insights. American Journal of Orthopsychiatry, 88(4), 422-430.

Abstract 

Peer victimization and the associated poor outcomes among lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth have been the focus of countless studies. School climate is a factor that has garnered significant attention. Perceptions of school contexts may even be mechanisms that define how victimization relates to poor outcomes. However, there is a lack of rigorous scholarship that could demonstrate directionality and therefore further augment our understanding of these relations. Specifically, it is not clear if victimization is strictly an antecedent to mental health issues like depressive symptoms. This longitudinal study examined the associations among sexual harassment victimization, school belonging, and depressive symptoms among LGBTQ high school students (n = 404). Self-report measures were completed at 3 time points across 3 school years in 6 Midwest high schools. Structural equation modeling indicated that peer victimization was an antecedent to depressive symptoms, and that school belonging mediated the association. Implications and future directions are discussed. 

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Coulter, R. W. S., Kessel Schneider, S., Beadnell, B., & O'Donnell, L. (2017). Associations of outside- and within-school adult support on suicidality: Moderating effects of sexual orientation. American Journal of Orthopsychiatry, 87(6), 671-679.

Abstract 

This study examined sexual-orientation differences in reports of outside- and within-school adult support, and whether sexual orientation moderates the associations between adult support and suicidality (i.e., thoughts, plans, and attempts). At 26 high schools across MetroWest Boston, 22,834 students completed surveys assessing: sexual orientation (heterosexual, gay/lesbian, bisexual, or questioning); presence of outside- and within-school adult support; and past-year suicidality. Multivariable regression analyses with General Estimating Equations (adjusting for gender, grade, and race/ethnicity) examined sexual-orientation subgroup differences in adult support, and how sexual orientation and adult support were associated with suicidality. Interaction terms tested whether relationships between adult support and suicidality were moderated by sexual orientation. Gay/lesbian, bisexual, and questioning youth were each less likely than heterosexuals to report having outside-school adult support (risk ratios range: 0.85–0.89). Each group also had greater odds than heterosexuals for suicidal thoughts (odds ratios [ORs] range: 1.86–5.33), plans (ORs range: 2.15–5.22), and attempts (ORs range: 1.98–7.90). Averaged across sexual-orientation subgroups, outside-school support was more protective against suicidality (ORs range: 0.34–0.35) than within-school support (ORs range: 0.78–0.82). However, sexual orientation moderated the protective effects of outside-school adult support, with support being less protective for bisexual and questioning youth than for heterosexuals. Adult support, and particularly outside-school adult support, is associated with lower suicidality. However, fewer gay/lesbian, bisexual, and questioning youth can rely on outside-school support and, even if present, it may be less protective against suicidality. Interventions are needed to help adults support gay/lesbian, bisexual, and questioning youth and reduce suicidality disparities.

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Jones, K. N., & Brewster, M. E. (2017). From awareness to action: Examining predictors of lesbian, gay, bisexual, and transgender (LGBT) activism for heterosexual people. American Journal of Orthopsychiatry, 87(6), 680-689.

Abstract 

In recent history, heterosexual allies have played an integral role in promoting change for lesbian, gay, bisexual, and transgender (LGBT) populations in the United States; however, questions have been raised as to what drives heterosexual allies to promote change via activism. To delineate factors important in engagement in activism, 207 self-identified heterosexual allies completed an online survey measuring components associated with LGBT activism using Bandura’s (1986) model of triadic reciprocal determinism: personal factors (ally identity, social justice self-efficacy and outcome expectations, empathetic perspective taking, and gender) and environmental factors (social justice related supports and barriers, positive marginality, and education level) to predict behaviors (LGBT activism). A hierarchical multiple regression analysis revealed a model accounting for 62% of the variance in LGBT activism, with dimensions of ally identification, social justice self-efficacy, outcome expectations, and education level emerging as significant predictors of engagement in activism behaviors. Empathetic perspective taking and social justice related barriers predicted lack of engagement in LGBT activism, however. Supporting the notion that personal and environmental factors simultaneously impact engagement in LGBT activism. 

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Romanelli, M., & Hudson, K. D. (2017). Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. American Journal of Orthopsychiatry, 87(6), 714-728.

Abstract 

Access to effective services is imperative to address the many health and mental health disparities that lesbian, gay, bisexual, and transgender (LGBT) people face. This population, however, remains underserved and often ill-served in health care environments. Furthermore, interactions between system- and individual-level dimensions of access create barriers to service engagement. Within much of the extant literature surrounding health care barriers among LGBT people, the rich narratives and varied experiences of LGBT community members from diverse backgrounds have often been excluded. The current interview-based study was conducted with a sample of 40 self-identified LGBT adults living in New York City. Participants were recruited through flyers distributed to LGBT-specific social and health service organizations. Twenty-nine participants who discussed health care access as a major health concern were included in the current study. Framework analysis revealed barriers stemming from characteristics of services and providers (system-level) and characteristics of care-seekers (individual-level) as major health concerns. The root causes of system-level barriers were all attributed to social-structural factors that worked to exclude and erase LGBT people from the institutions that shape the health and mental health systems. Individual-level barriers were attributed to both individual and social-structural factors, such as health literacy and stigma. Participants linked access barriers to forgone care and to other health and mental health concerns within their communities. We argue that addressing barriers at the individual and sociostructural levels will better serve LGBT communities. 

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Special Section and Commentaries on Transgender Issues:

Scout, NFN. (2016). Transgender health and well-being: Gains and opportunities in policy and law. American Journal of Orthopsychiatry, 86(4), 378-383.

Abstract

This article discusses gains and opportunities in policy and law in the United States related to transgender health and well-being. Topics include (1) how the bathroom myth has been used every time a trans nondiscrimination bill is considered, (2) transgender nondiscrimination laws and policies, (3) the expansion of gender discrimination, (4) strategies for promoting mental health and well-being among trans people, (5) policy developments supporting the mental health and well-being of trans people, and (6) opportunities for action. 

http://psycnet.apa.org/fulltext/2016-32685-004.pdf


Tanis, J. (2016). The power of the 41%: A glimpse into the life of a statistic. American Journal of Orthopsychiatry, 86(4), 373-377.

Abstract

"Forty-one percent?” the man said with anguish on his face as he addressed the author, clutching my handout. “We’re talking about my granddaughter here.” He was referring to the finding from the National Transgender Discrimination Survey (NTDS) that 41% of 6,450 respondents said they had attempted suicide at some point in their lives. The author had passed out the executive summary of the survey’s findings during a panel discussion at a family conference to illustrate the critical importance of acceptance of transgender people. During the question and answer period, this gentleman rose to talk about his beloved 8-year-old granddaughter who was in the process of transitioning socially from male to female in her elementary school. The statistics that the author was citing were not just numbers to him; and he wanted strategies—effective ones—to keep his granddaughter alive and thriving. The author has observed that the statistic about suicide attempts has, in essence, developed a life of its own. It has had several key audiences—academics and researchers, public policymakers, and members of the community, particularly transgender people and our families. This article explores some of the key takeaways from the survey and the ways in which the 41% statistic has affected conversations about the injustices transgender people face and the importance of family and societal acceptance.

http://psycnet.apa.org/fulltext/2016-32685-003.pdf


Jones, N. & Brewster, M. (2016). From Awareness to Action: Examining Predictors of Lesbian, Gay, Bisexual, and Transgender (LGBT) Activism for Heterosexual People. American Journal of Orthopsychiatry

Abstract

In recent history, heterosexual allies have played an integral role in promoting change for lesbiangaybisexual, and transgender (LGBT) populations in the United States; however, questions have been raised as to what drives heterosexual allies to promote change via activism. To delineate factors important in engagement in activism, 207 self-identified heterosexual allies completed an online survey measuring components associated with LGBT activismusing Bandura’s (1986) model of triadic reciprocal determinism: personal factors (ally identity, social justice self-efficacy and outcome expectations, empathetic perspective taking, and gender) and environmental factors (social justice related supports and barriers, positive marginality, and education level) to predict behaviors (LGBT activism). A hierarchical multiple regression analysis revealed a model accounting for 62% of the variance in LGBT activism, with dimensions of ally identification, social justice self-efficacy, outcome expectations, and education level emerging as significant predictors of engagement in activism behaviors. Empathetic perspective taking and social justice related barriers predicted lack of engagement in LGBT activism, however. Supporting the notion that personal and environmental factors simultaneously impact engagement in LGBT activism.

http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2016-51315-001


Rostosky, S.; Black, W.; Riggle, E.; & Rosenkrantz, D. (2015). Positive aspects of being a heterosexual ally to lesbian, gay, bisexual, and transgender (LGBT) people. American Journal of Orthopsychiatry, 85(4):331-338.

Abstract

Research on heterosexual allies has focused on heterosexual identity development models and pathways to allyactivism. The positive aspects or positive experiences of identifying as an ally to lesbiangaybisexual, and transgender (LGBT) identified individuals and communities have received little attention. Using an online survey of participants recruited from LGBT ally related social media, we collected open-ended responses to a question about the positive aspects of self-identifying as a heterosexual allyA final analytic sample of 292 self-identified male and female heterosexual adults (age 18–71, M = 33.47, SD = 13.32) provided responses that generated 8 themes. Positive aspects of being a heterosexual ally were: (a) increased knowledge and awareness, (b) upholding values of justice, (c) beneficial individual relationships, (d) community belonging, (e) educating others, (f) being a role model, (g) using social privilege, and (h) speaking out and taking a stand. The findings suggest that being a heterosexualally is rewarding and may enhance individual well-being. These findings provide information that may contribute to effective ally development efforts.

Fredriksen-Goldsen, K.; Simoni, J.; Kim, H.; Lehavot, K.; Walters, K.; Yang, J.; Hoy-Ellis, C.; & Muraco, A. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6):653-663.

Abstract

National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbiangaybisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the HealthEquity Promotion Model—a framework oriented toward LGBT people reaching their full mental and physical healthpotential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.

Keuroghlian, A.; Shtasel, D.; & Bassuk, E. (2014). Out on the street: A public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. American Journal of Orthopsychiatry, 84(1):66-72.

Abstract

A disproportionate number of lesbiangaybisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violent victimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homelessLGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions.

Additional Research on LGBTQ Issues:

MacKay, J.; Robinson, M.; Pinder, S.; & Ross, L. (2017). A grounded theory of bisexual individuals' experiences of help seeking. American Journal of Orthopsychiatry, 87(1):52-61.

Abstract

Bisexual people constitute the largest sexual minority group in North America and experience significant mental health disparities in relation to heterosexuals, gays, and lesbians. In this article, we will examine the process and experience of help seeking among bisexuals. This was a community-based study that collected qualitative interview data from 41 diverse bisexual people from across Ontario, Canada. We analyzed the interview data using groundedtheory and constructed an understanding of bisexuals’ experiences of help seeking. We have conceptualized an overarching model that illustrates 4 interrelated stages: (a) the consideration of services, (b) the process of finding services, (c) barriers and facilitators to accessing services, and (d) experience of service utilization. This model is nonlinear, in that participants do not necessarily move through stages in sequence. Although many stages are experienced at the individual level, they are simultaneously informed by multiple factors at interpersonal and system levels. Our findings suggest a need for interventions at the policy, service and provider levels to improve accessibility of culturally competent services for this population. Understanding the mental health experiences of bisexual people will allow mental health professionals to build competencies working with this population and thereby contribute to areduction in mental health disparities.

Blosnich, John R.; Nasuti, Laura J.; Mays, Vickie M.; & Cochran, Susan D. (2016). Social support networks among diverse sexual minority populations. American Journal of Orthopsychiatry, 86(1):91-102. 

Abstract

This article reports a study of the function and composition of social support networks among diverse lesbian, gay, and bisexual (LGB) men and women (n = 396) in comparison to their heterosexual peers (n = 128). Data were collected using a structured social support network matrix in a community sample recruited in New York City. Our findings show that gay and bisexual men may rely on “chosen families” more than lesbian and bisexual women. Both heterosexuals and LGBs relied less on family and more on other people (e.g., friends, coworkers) for everyday socialsupport (e.g., recreational and social activities, talking about problems). Providers of everyday social support were most often of the same sexual orientation and race/ethnicity as participants. In seeking major support (e.g., borrowing large sums of money), heterosexual men and women along with lesbian and bisexual women relied primarily on their families, but gay and bisexual men relied primarily on other LGB individuals. Racial/ethnic minorityLGBs relied on LGB similar others at the same rate as did White LGBs but, notably, racial/ethnic minority LGBs reported receiving fewer dimensions of support.


Herek, Gregory M. (2015). Beyond "homophobia": Thinking more clearly about stigma, prejudice, and sexual orientation. American Journal of Orthopsychiatry, 85(5):S29-S37.

Abstract

This article addresses the topic of homophobia. Recent events might make it seem as though it is dying out. Hate crimes based on a person’s sexual orientation or gender presentation can now be prosecuted by the federal government, even when they occur in states lacking their own hate crime laws. Numerous states have changed their laws to permit same-sex couples to marry, some through the passage of legislation and others through ballot measures. Since the U.S. Supreme Court’s 2013 decision overturning part of the Defense of Marriage Act, those marriages have been recognized by the federal government. With the dramatic and relatively rapid turnaround in public opinion, this article focuses on the changes in stigma and issues of sexual prejudice as well.

Bostwick, W.; Boyd, C.; Hughes, T.; West, B.; & McCabe, S. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. American Journal of Orthopsychiatry, 84(1):35-45.

Abstract

Health disparities among sexual minority groups, particularly mental health disparities, are well-documented. Numerous studies have demonstrated heightened prevalence of depressive and anxiety disorders among lesbiangay, and bisexual groups as compared with heterosexuals. Some authors posit that these disparities are the result of the stress that prejudice and perceived discrimination can cause. The current study extends previous research by examining the associations between multiple types of discrimination, based on race or ethnicity, gender, and sexual orientation, and past-year mental health disorders in a national sample of self-identified lesbiangay, and bisexualwomen and men (n = 577). Findings suggest that different types of discrimination may be differentially associated with past-year mental health disorders. Notably, sexual orientation discrimination was associated with higher odds of a past-year disorder only in combination with other types of discrimination. These findings point to the complexity of the relationship between discrimination experiences and mental health, and suggest that further work is needed to better explicate the interplay among multiple marginalized identities, discrimination, and mental health.

Witeck, Bob. (2014). Cultural change in acceptance of LGBT people: Lessons from social marketing. American Journal of Orthopsychiatry, 84(1):19-22.

Abstract

We are in a new era in American history. Showing a remarkable shift in attitudes toward gay, lesbian, bisexual, and transgender (LGBT) people, the United States appears to be embracing a new, more inclusive view of family life. With positive action in two landmark Supreme Court cases and a rapidly growing number of state legislatures, the trends are strong toward full legal recognition of marriages of same-sex partners and parenthood by both partners in committed gay couples rearing children. And, the trend is international. Many people are both astonished and cheered by the accelerating pace of change in acceptance of LGBT people. Surveys now show that about 60% of Americans support marriage equality so that gay couples may wed. Less than a decade ago, that proportion of Americans opposed gay weddings. This article looks at what has changed, and why, as well as how social marketing, among other forces, lifted the curtain on these unmistakable trends.

Rostosky, S. S.; Riggle, E. D.; Horne, S. G.; Denton, F. N.; & Hullemeier, J. D. (2010). Lesbian, gay, and bisexual individuals' psychological reactions to amendments denying access to civil marriage. American Journal of Orthopsychiatry, 80(3):302-310.

Abstract

Political campaigns to deny same‐sex couples the right to civil marriage have been demonstrated to increase minority stress and psychological distress in lesbiangay, and bisexual (LGB) individuals (S. S. Rostosky, E. D. B. Riggle, S. G. Horne, & A. D. Miller, 2009). To further explicate the psychological reactions of LGB individuals to marriage amendment campaigns, a content analysis was conducted of open‐ended responses from 300 participants in a national online survey that was conducted immediately following the November 2006 election. LGB individuals indicated that they felt indignant about discrimination; distressed by the negative rhetoric surrounding the campaigns; fearful and anxious about protecting their relationships and families; blaming of institutionalized religion, ignorance, conservative politicians, and the ineffective political strategies used by LGBT organizers; hopeless and resigned; and, finally, hopeful, optimistic, and determined to keep fighting for justice and equal rights. These 7 themes are illustrated and discussed in light of their implications for conceptualizing and intervening to address discrimination and its negative psychological effects.