4 - (IOP 26) Multilevel Sexual Stigma and Anxiety and Depressive Symptoms Among Sexual Minority Adolescents

Sexual stigma, the negative beliefs, stereotypes, and discrimination directed toward sexual minority people, remains a pervasive concern. In this preregistered study, we examined how sexual stigma at three levels—intrapersonal (internalized heterosexism), interpersonal (heterosexist bullying and parental/caregiver rejection), and structural (state policies devaluing sexual minority people)—was associated with sexual minority youths’ anxiety and depressive symptoms. Specifically, we examined (1) bivariate associations between sexual stigma and anxiety and depressive symptoms and (2) additive and multiplicative effects of sexual stigma on anxiety and depressive symptoms to understand how multiple experiences of sexual stigma combine to predict mental health difficulties.

Data were from a national sample of sexual and gender minority youth (N = 11,858; Mage = 15.89 years, SD = 1.46). All had a sexual minority identity, with the most common identities being gay/lesbian (30%), bisexual (29%), and pansexual (15%). Approximately half (53%) identified as transgender or gender nonconforming, and the majority identified as White (70%).

Results from four bivariate linear-mixed-effects models indicated that more internalized heterosexism (b = 0.36, p < .001), heterosexist bullying (b = 0.21, p < .001), heterosexist parental/caregiver rejection (b = 0.26, p < .001), and state-structural sexual stigma (b = 0.05, p = 0.04) were significantly associated with more anxiety and depressive symptoms. Regarding additive effects, results from a multivariable linear-mixed effects model demonstrated that internalized heterosexism (b = 0.27, p < .001), heterosexist bullying (b = 0.16, p < .001), and heterosexist parental/caregiver rejection (b = 0.15, p < .001) were independently significantly associated with anxiety and depressive symptoms, but state-structural sexual stigma was not (b = 0.01, p = 0.68). Regarding multiplicative effects, of the six two-way interactions tested, only one was significant (internalized heterosexism x heterosexist bullying; b = -0.03, p < .009) and the pattern was not consistent with a multiplicative (worsening) effect. Results are independent of covariates including demographics, receiving counseling services in the past year, and outness to peers and/or caregivers.

Together, these findings replicate previous work demonstrating associations between individual forms of sexual stigma and mental health difficulties among sexual minority youth. Moreover, this study provides novel insights that multiple experiences of sexual stigma combine to predict anxiety and depressive symptoms. Specifically, we found evidence for additive effects of intrapersonal sexual stigma (internalized heterosexism) and two forms of interpersonal sexual stigma (heterosexist bullying and heterosexist parental/caregiver rejection), though there was no evidence for multiplicative effects. Findings underscore the importance of considering multiple levels of sexual stigma to understand influences on sexual minority youths’ mental health difficulties and the need to address these influences when working with these youth clinically.