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Anhalt, K., & Morris, T. L. (1999). Developmental and adjustment issues of gay, lesbian and bisexual adolescents: A review of the empirical literature. Clinical Child and Family Psychology Review, 1, 215-230.
Various studies have reported adjustment problems experienced by gay, lesbian, and bisexual (GLB) adolescents. A primary purpose of this paper is to critically review this literature. Difficulties that have been studied include past suicide attempts, substance use and abuse, conduct problems, and academic concerns. For example, a considerable number of GLB youth report a history of suicide attempts, with prevalence rates ranging from 11 to 42%. However, among other methodological concerns, studies in this area have not used a comparison sample of heterosexual youths. Characteristics of development particular to GLB adolescents are described, the empirical research on adjustment issues is reviewed, and potential risk and protective factors for GLB youths are discussed.

Bradford, J., Ryan, C., & Rothblum, E. D. (1994). National Lesbian Health Care Survey: Implications for mental health care. Journal of Consulting and Clinical Psychology, 62, 228-242.
Presents demographic, lifestyle, and mental health information about 1,925 lesbians from all 50 states who participated as respondents in the National Lesbian Health Care Survey (1984-1985), the most comprehensive study on US lesbians to date. Over half the sample had had thoughts about suicide at some time, and 18% had attempted suicide. 37% had been physically abused as a child or adult, 32% had been raped or sexually attacked, and 19% had been involved in incestuous relationships while growing up. Almost one third used tobacco on a daily basis, and about 30% drank alcohol more than once a week, 6% daily. About three fourths had received counseling at some time, and half had done so for reasons of sadness and depression. Lesbians in the survey also were socially connected and had a variety of social supports, mostly within the lesbian community. However, few had come out to all family members and coworkers. Level of openness about lesbianism was associated with less fear of exposure and with more choices about mental health counseling.

Cochran, S. D. (2001). Emerging issues in research on lesbians' and gay men's mental health: Does sexual orientation really matter? American Psychologist, 56, 931-947.
Theoretical writings and research suggest that the onset, course, treatment, and prevention of mental disorders among lesbians and gay men differ in important ways from those of other individuals. Recent improvements in studies of sexual orientation and mental health morbidity have enabled researchers to find some elevated risk for stress-sensitive disorders that is generally attributed to the harmful effects of anti-homosexual bias. Lesbians and gay men who seek mental health services must find culturally competent care within systems that may not fully address their concerns. The affirmative therapies offer a model for intervention, but their efficacy and effectiveness need to be empirically documented. Although methodological obstacles are substantial, failure to consider research questions in this domain overlooks the welfare of individuals who may represent a sizable minority of those accessing mental health services annually.

Cochran, S. D., Keenan, C., Schober, C., & Mays, V. M. (2000). Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U. S. population. Journal of Consulting and Clinical Psychology, 68, 1062-1071.
Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.

Cochran, S. D., & Mays, V. M. (1994). Depressive distress among homosexually active African American men and women. American Journal of Psychiatry, 151, 524-529.
Examined rates of depressive distress and suicidal thoughts among 829 African American men (aged 18-70 yrs) and 603 African American women (aged 18-60 yrs) who were homosexually active and who might be especially at risk for psychiatric morbidity due to multiple stigmatized social statuses. Ss completed self-administered questionnaires, including the Center for Epidemiologic Studies Depression Scale. Results indicate that homosexually active Black women were as distressed as HIV-infected gay Black men. Men with symptomatic HIV disease were significantly more distressed than men who were HIV infected but asymptomatic, who were HIV-antibody negative, or whose HIV status was unknown. Both men and women reported distress levels in excess of those previously reported in studies (e.g., J. H. Boyd et al) of Blacks or primarily White gay men.

Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of psychiatric disorders, psychological distress, and treatment utilization among lesbian, gay, and bisexual individuals in a sample of the U. S. population. Journal of Consulting and Clinical Psychology, 71, 53-61.
Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.

D'Augelli, A. R. (2002). Mental health problems among lesbian, gay, and bisexual youth ages 14 to 21. Clinical Child Psychology and Psychiatry, 7, 433-456.
The mental health problems of lesbian, gay, and bisexual youths were studied using a sample of 542 youths from community settings. Information about the development of sexual orientation, problems related to sexual orientation, parents' reactions, and victimization based on sexual orientation was related to mental health symptoms and suicidality. Lesbian, gay, and bisexual youths were found to demonstrate more symptoms than a comparison group of adolescents. Over one-third of the sample reported a past suicide attempt. More symptoms were related to parents not knowing about youths' sexual orientation or with both parents having negative reactions to youths' sexual orientation. More than three-quarters had been verbally abused because of their sexual orientation, and 15 percent reported physical attacks. More than one-third said they had lost friends because of their sexual orientation. Youths who had experienced more victimization and who had lost friends reported more mental health symptoms. Mental health professionals are urged to attend to the distinct problems of these youths, especially dealing with conflicts with families and peers.

Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual men: Findings from three U.S. cities. American Journal of Public Health, 91, 927-932.
Assessed the relation between experiences of social discrimination (homophobia, racism, and financial hardship) and symptoms of psychologic distress (anxiety, depression, and suicidal ideation) among 912 self-identified gay and bisexual Latino men (mean age 31.2 yrs). Data were collected from interviews. The results show high prevalence rates of psychologic symptoms of distress during the 6 mo before the interview, including suicidal ideation, anxiety, and depressed mood. Experiences of social discrimination were strong predictors of psychologic symptoms. It is concluded that the mental health difficulties experienced by many gay and bisexual Latino men are directly related to a social context of oppression that leads to social alienation, low self-esteem, and symptoms of psychologic distress.
Hershberger, S. L., & D'Augelli, A. R. (1995). The impact of victimization on the mental health and suicidality of lesbian, gay, bisexual youths. Developmental Psychology, 31, 65-74.
Lesbian, gay, and bisexual youths (aged 15-21 yrs) were studied to determine the impact of verbal abuse, threat of attacks, and assault on their mental health, including suicide. Family support and self-acceptance were hypothesized to act as mediators of the victimization and mental health-suicide relation. Structural equation modeling revealed that in addition to a direct effect of victimization on mental health, family support and self-acceptance in concert mediated the victimization and mental health relation. Victimization was not directly related to suicide. Victimization interacted with family support to influence mental health, but only for low levels of victimization.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

Pachankis, J. E., & Goldfried, M. R. (2006). Social anxiety in young gay men. Journal of Anxiety Disorders, 20, 996–1015.
Based on the assumption that sexual minority individuals are particularly sensitive to the possible rejection of others, the present study examined the occurrence and correlates of social anxiety symptomatology in gay and heterosexual men. Eighty-seven heterosexual and 87 gay undergraduate men between the ages of 18 and 24 completed common measures of social anxiety, self-esteem, boyhood gender conformity, and a modified S-R Inventory of Anxiousness. Results reveal that gay men reported greater fear of negative evaluation and social interaction anxiety and lower self-esteem than heterosexual men. Gay men who are less open about their sexual orientation and those who are less comfortable with being gay were more likely to experience anxiety in social interactions. The modified S-R Inventory of Anxiousness was useful in revealing that relatively innocuous situations for heterosexual men can be anxiety-provoking for gay men. The hypothesis that gay men who were gender nonconforming as children would report a higher degree of social interaction anxiety was not supported. Results are discussed in terms of the socialization experiences of gay men and are explicated using a minority stress framework. Implications are offered for the treatment of social anxiety in this population.

Pilkington, N. W., & D'Augelli, A. R. (1995). Victimization of lesbian, gay, and bisexual youth in community settings. Journal of Community Psychology, 23, 34-56.
Surveyed 194 lesbian, gay, and bisexual youth (aged 15-21 yrs) about victimization due to their sexual orientation. The 3 areas assessed included the prevalence of different kinds of victimization, ranging from verbal abuse to armed assault; the specific social contexts in which anti-lesbian/gay victimization occurred, including family, school, work, and the broader community; and correlates of anti-lesbian/gay victimization, including age-related sexual orientation milestones, concealability of sexual orientation, sex, race/ethnicity, and safety fears. Most respondents had experienced some form of victimization, with no social environment being free from risk of harm. Particularly vulnerable for abuse were youth who self-labeled or self-disclosed at an earlier age and those whose sexual orientation was less concealed or concealable.

Safren, S. A., & Heimberg, R. G. (1999). Depression, hopelessness, suicidality and related factors in sexual minority and heterosexual adolescents. Journal of Consulting and Clinical Psychology, 67, 859-886.
In the present study, the researchers examined factors related to depression, hopelessness, and suicidality in gay, lesbian, and bisexual adolescents, compared with demographically similar heterosexual adolescents. Sexual minority adolescents reported greater depression, hopelessness, and past and present suicidality than did heterosexual adolescents. However, when controlling for other psychological predictors of present distress, significant differences between the 2 samples disappeared. For past suicidality scores, the effects of sexual orientation were reduced, but still significant, when accounting for the other predictor variables. These results suggest that environmental factors associated with sexual orientation, which can be targeted and changed through prevention and intervention efforts, play a major role in predicting distress in this population.

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