Sexual minority mental health: A multidimensional and longitudinal approach


Fish, Jessica N. (2014). Sexual minority mental health: A multidimensional and longitudinal approach.


The association between sexual minority status and poor mental health is well established. However, despite the recent increase in studies investigating health disparities between heterosexual and sexual minority youth and adults, few consider the multidimensional and developmental nature of sexuality when assessing its association with mental health outcomes over various contexts and time. The current study employed the use of complex methodology to assess human sexuality across multiple dimensions (i.e., sex, romantic/sexual attraction, romantic/sexual behavior, and sexual orientation/identity) and developmental stages (i.e., adolescence to adulthood) to assess between and within-group differences on outcomes of depression and suicidality. The influence of interpersonal relationships (parental and peer) and contexts (school and community) on the association between sexual status and mental health outcomes were also examined. In Study 1 latent class analysis was used to identify three groups in adolescence that varied in sexual status. Group comparisons indicated that those who were same- or both-sex attracted reported higher levels of depression and suicide concurrently and at later developmental stages. Proposed risk and protective factors did not fully attenuate differences in outcomes, although the cumulative influence of these effects mitigated differences for depression in early adolescence. Repeated measures latent class analysis on indicators of sexuality from adolescence to adulthood (Study 2) identified five groups that varied in sexual status and sexual maturation and that were differentially related in suicidality and depression over time. Groups identified by sexual minority status characteristics (same- or both- sex attraction or behavior, or nonheterosexual identities) were most at risk across time; however, these groups also demonstrated differences from one another. Longitudinal associations with outcomes identified differential timing of risk, and the analysis of risk and protective factors indicated that youth contexts alter the association between sexual status and mental health outcomes. When assessing the relationship between sexual status groups and trajectories of depression from adolescence to adulthood (Study 3) results indicated four distinct trajectories characterizing chronic low risk, early risk, later risk, and chronic high risk. Findings indicated that groups characterized by sexual minority attraction, behavior, and identity were associated with later and chronic high risk trajectories from adolescence to adulthood when compared to heterosexual groups. Together, results indicate both between- and within-group differences in sexual status and the subsequent association with mental health outcomes. Investigation of risk and protective factors revealed that youth interpersonal relationships and environments act as both mediators and moderators of the relationship between sexual status and mental health, with more robust influences on depression than suicidality and on concurrent rather than longitudinal outcomes. Implications for research, theory, programming, and policy are also discussed. Overall, finding support previous sexual minority health disparities research but highlight the need for within-group studies to assess how differences among sexual minorities and their experiences contribute to mental health outcomes across the lifespan.



Social sciences


Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014

Reference Type



Fish, Jessica N.

Series Author(s)

Pasley, Kay

Year Published


Volume Number





The Florida State University

City of Publication

Ann Arbor





Reference ID