Mental Health Disorders, Psychological Distress, and Suicidality in a Diverse Sample of Lesbian, Gay, Bisexual, and Transgender Youths

摘要

Objectives. We examined associations of race/ethnicity, gender, and sexual orientation with mental disorders among lesbian, gay, bisexual, and transgender (LGBT) youths. Methods. We assessed mental disorders by administering a structured diagnostic interview to a community sample of 246 LGBT youths aged 16 to 20 years. Participants also completed the Brief Symptom Inventory 18 (BSI 18). Results. One third of participants met criteria for any mental disorder, 17% for conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder. Anorexia and bulimia were rare. Lifetime suicide attempts were frequent (31%) but less so in the prior 12 months (7%). Few racial/ethnic and gender differences were statistically significant. Bisexually identified youths had lower prevalences of every diagnosis. The BSI 18 had high negative predictive power (90%) and low positive predictive power (25%) for major depression. Conclusions. LGBT youths had higher prevalences of mental disorder diagnoses than youths in national samples, but were similar to representative samples of urban, racial/ethnic minority youths. Suicide behaviors were similar to those among representative youth samples in the same geographic area. Questionnaires measuring psychological distress may overestimate depression prevalence among this population. Population-based studies estimate the prevalence of internalizing and externalizing mental health disorders to be higher among lesbian, gay, and bisexual (LGB) adults, although associations by specific subgroup and definitions of sexual orientation have varied across studies. 1 , 2 Less research has been done among LGB youths, but such studies suggest that mental health disparities can emerge or exist during adolescence. 3 – 6 Such studies have played an important role in characterizing and calling attention to the mental health needs of the LGB population across developmental stages. There are several limitations in the current state of knowledge about the mental health of LGB youths. First, previous studies have focused almost exclusively on suicidal intentions and attempts instead of mental health disorders. Many random population surveys of youths in schools and national studies of adolescents have reported associations between aspects of suicidality and LGB identity, 7 – 9 same-gender attractions, 8 , 10 and same-gender behavior. 8 , 11 – 13 Second, studies focused on mental health have primarily relied on symptom or distress scales such as the Brief Symptom Inventory (BSI) or the Center for Epidemiological Studies Depression Scale (CES-D) 5 , 6 , 10 , 14 – 16 instead of using structured diagnostic interviews to examine mental health diagnoses. Such scales may measure general psychological distress rather than depression, and the scales may have low positive predictive values in nonclinical samples. 17 Measures tapping psychological distress could also inflate estimates of depression in stigmatized or victimized communities, thus increasing distress without causing clinical depression. There is only 1 published study that used structured diagnostic interviews in a probability sample that identified LGB youths; the odds of major depression and conduct disorder were approximately 4 times greater among 28 LGB youths than they were among 979 heterosexual youths. 4 Third, population-based samples tend to have very few LGB-identified respondents, which often means that this heterogeneous group must be collapsed together. Because such studies tend to include a higher proportion of bisexual youths than of gay or lesbian youths (on the basis of attraction and behavior indices), combining these groups causes a disproportionate representation of the experiences of bisexual youths. 8 In this population, previous findings have been inconsistent with regard to gender differences in depression symptoms 10 , 18 , 19 and the effect of the interaction between gender and sexual orientation (bisexual vs gay or lesbian) on suicide intentions and attempts. 8 Community-based sampling approaches can complement these population-based studies by exploring differences between LGB persons who were born male versus born female, lesbian or gay versus bisexually identified, and persons of different races/ethnicities. Finally, most studies have not had sufficient numbers of transgender participants to report descriptive statistics on this understudied population. One study of a community sample of 51 male-to-female transgender youths found no evidence of elevation on a depression scale, but the study did find high levels of substance use and victimization. 20 Such findings warrant further attention, despite the difficulty of recruiting transgender youths. Many efforts to explain mental health disparities among LGB and transgender (LGBT) populations have used variants of minor