This study examines the experience of a unique minority stressor, gender identity invalidation (henceforth referred to as invalidation), which is defined as the refusal to accept someone's gender identity as real or valid, among transgender and nonbinary (TNB) individuals. Data are drawn from a large and diverse sample of TNB adults who participated in a quantitative survey concerning transgender identity, minority stress, and mental health ( = 302). Invalidation was assessed using a novel 17-item scale that ascertains the extent to which respondents experienced invalidation across different social contexts. On average, TNB adults in this sample report low levels of invalidation, although a minority experience it at relatively high levels. Experiences of invalidation were significantly higher among nonbinary participants when compared with their binary trans peers. A series of multivariate regression models that control for sociodemographic factors (sex assigned at birth, race/ethnicity, education, age, and income) and well-established indicators of minority stress (felt stigma, enacted stigma) suggest that nonbinary gender identity is independently associated with poor mental health (assessed with the Global Severity Index), and that this association is mediated by invalidation. These findings suggest that invalidation, which is largely unexamined in existing research, merits greater attention as a particularly salient minority stressor influencing mental health among gender diverse populations, nonbinary populations in particular.

Sexual orientation is multidimensional, yet existing studies often only assess one dimension. This study examines multiple dimensions of sexual orientation in a sample of Hispanic adolescents using a latent profile analysis. The study also examines differences in levels of adolescent family functioning (i.e., parent-adolescent communication, parental involvement, family communication) and depressive symptoms by latent profile or subgroup.

Minority stress is the leading explanation for sexual minority women's (SMW) higher rates of, and heavier, alcohol use compared to heterosexual women. Little is known about how both partners' sexual minority stressors impact alcohol consumption in a dyadic context, and even less research has considered these effects at the day-level. This study utilizes dyadic daily diary data to test associations of each partner's sexual minority stress events with drinking outcomes (day-level alcohol use, heavy episodic drinking [HED], and estimated blood alcohol content [eBAC]) among women in same-gender relationships ( 159 couples). Because high-quality relationships may buffer adverse effects of minority stress on alcohol use outcomes, effect modification was also considered. Results differed across alcohol use outcomes. One's own experience of sexual minority stress was associated with one's own greater odds of drinking that day, = 1.33, 95% CI 1.10, 1.61, = .003, whereas one's partner's experience of sexual minority stress was associated with greater odds of same-day HED, = 1.60, 95% CI 1.24, 2.01, < .001 (no significant effects emerged for eBAC). Relationship functioning was associated with lower eBAC only, = -0.01, 95% CI -0.01, -0.00, = .031. No significant effect modification emerged. This initial exploration of how both partners' exposure to sexual minority stressors impact SMW's alcohol use demonstrates nuanced effects across different alcohol outcomes, and is among the first to demonstrate some degree of sexual minority stress contagion on HED.

Minoritized sexual orientation is an established correlate for suicide ideation (SI) and nonsuicidal self-injury (NSSI); however, prospective associations between sexual orientation and SI and NSSI is limited. The current study builds on existing literature by examining sexual orientation as a prospective distal risk factor for SI and NSSI risk among a diverse sample of young women after adjusting for histories of SI and/or NSSI and empirically supported correlates and risk factors. Participants were 135 young adult women (aged 18-24), who were predominately Black with approximately half of the sample experiencing poverty. Participants completed an interview that assessed SI and NSSI at baseline and 6- and 12-month follow-ups. A single item was used to collect participants' self-identified sexual orientation at baseline. Minoritized sexual orientation was strongly associated with NSSI history and future SI and NSSI, adjusting for baseline correlates and predictors of interest. Psychological and physical victimization, race, and poverty were non-significant prospective predictors of SI and NSSI. Race and poverty did not moderate the associations between sexual orientation and follow-up SI and NSSI. These findings suggest young adult women who self-identify as lesbian, gay, bisexual, queer, or questioning (LGBQ) are more likely than those who identify as heterosexual to experience both SI and NSSI in the following year. Sexual orientation should be part of a culturally-informed comprehensive risk assessment. A culturally-informed intersectionality approach may be necessary to identify culturally-specific risk and resiliency factors for SI and NSSI that can guide effective prevention and intervention strategies for LGBQ individuals.

Sexual minority men (SMM) in the US are twice as likely to experience mental health challenges, including depressive symptoms, compared with their heterosexual counterparts. Having a like-mentor, or a sexual minority mentor, is associated with improved mental well-being among SMM mentees. However, few studies have explored the potential benefits to mentors. Using confirmatory factor analysis, we calculated a perceptions of mentoring score that encompasses experiences and beliefs regarding mentoring of SMM from the Healthy Aging Substudy of the Multicenter AIDS Cohort Study. We used a generalized estimating equations model to assess associations between perceptions of mentoring and clinically significant depressive symptoms adjusted for key covariates; models were also stratified by HIV serostatus. Among 1,246 men aged 40+ years, the strongest agreement was with the statement "I have encouraged people to be proud of their sexual orientation," for which 770 individuals (72%) indicated "Agree" or "Strongly Agree." Each unit increase in the mean perceptions of mentoring score was associated with 8% decreased odds of having clinically significant depressive symptoms (adjusted odds ratio: 0.92; 95% CI: 0.85-0.99). We show that SMM reported like-mentoring experiences and had positive mentoring beliefs, and that these were associated with a decreased odds of having depressive symptoms. Encouraging SMM to serve as like-mentors could be a way to counter depressive symptoms among this key population. There is a need for increased research regarding how mentoring programs can best be designed to benefit sexual minority mentees and mentors.

Sexual minoritized individuals engage in non-suicidal self-injury (NSSI) at higher rates than their heterosexual peers. Disclosing one's sexual minoritized identity can put one at risk for experiencing discrimination, which is linked to greater engagement in NSSI. However, discrimination has yet to be tested as a mechanism linking sexual identity disclosure to NSSI. Understanding how sexual identity disclosure impacts NSSI has the potential to inform interventions to reduce sexual orientation disparities in NSSI. To address this gap, the current study examined sexual orientation-based discrimination as a mediator of the longitudinal association between sexual identity disclosure and NSSI among 792 sexual minoritized young adults. Higher levels of disclosure at baseline were associated with greater likelihood of NSSI at two-month follow-up via greater discrimination at one-month follow-up, even after controlling for baseline levels of depression and demographic characteristics. The indirect effect became non-significant after controlling for previous levels of discrimination and NSSI. Findings provide partial support for the hypothesis that identity disclosure may precede exposure to discrimination and, in turn, engagement in NSSI. However, identity disclosure does not appear to predict acute increases in discrimination. Future research is encouraged to examine these prospective associations with longer intervals between assessments, as the indirect effect of identity disclosure on NSSI via discrimination may continue to accumulate over time. Findings highlight the need to reduce discrimination following sexual identity disclosure through the implementation of equitable and affirmative practices in school, healthcare, and other settings to improve the well-being of sexual minoritized young adults.

Interpersonal management of homophobic stigma (e.g., selectively constructing one's social network; confronting stigma) is an understudied area of resilience among sexual minority people. Among a sample of cisgender sexual minority men (SMM; = 798) in midlife and older adulthood, we assessed the psychometric properties and characterized the sociodemographic differences of our newly developed, theory-informed homophobia management scale. Data come from the Healthy Aging substudy of the Multicenter AIDS Cohort Study, which is a prospective longitudinal study implemented to evaluate the natural trajectories of HIV risk and treatment among sexual minority men. Guided by the proactive coping processes model, the Healthy Aging team proposed eight items to measure homophobia management, which were included at four waves of survey data collection completed at semiannual study visits. Using factor analyses and linear regressions, we assessed our scale's construct validity, convergent validity, and internal consistency, and characterized scores by age, race/ethnicity, sexual orientation, and HIV status. Factor analyses yielded a six-item scale with adequate construct validity and acceptable internal consistency (Cronbach's alpha = .69). Our final scale exhibited convergent validity given its statistically significant inverse association with internalized homophobia and positive association with psychological connections to the gay community. Bivariate differences in homophobia management emerged by age, race/ethnicity, and sexual orientation but were not statistically significant in multivariable analyses. Our study provides a validated, unidimensional scale to assess homophobia management among SMM in midlife and older adulthood. We provide recommendations to improve the implementation of our scale in future surveillance.

Adolescent (cisgender) sexual minority males (ASMM) face multiple mental health disparities. Yet surprisingly little is known about use of mental health care among ASMM. The current study examined mental health care use among ASMM, both lifetime use and during the COVID-19 pandemic. ASMM (=154, ages 14-17 years) enrolled in Spring 2020 for a pilot randomized controlled trial of an online sexual health intervention. Participants were assessed at baseline and 3-month follow-up. Participants reported lifetime (at baseline) and recent (at follow-up) mental health care use. Anxiety and depressive symptoms were assessed at both timepoints. Differences in care use by sociodemographics, healthcare access, and mental health symptoms were established. More than half of participants reported clinically significant anxiety and depressive symptoms at baseline and at follow-up. Of those youth, fifty-three percent reported lifetime mental health care use, while only 28% reported recent care at follow-up. Being out to an accepting guardian (aOR=4.0, 95% CI: 1.9-8.4), having a primary care physician (aOR=2.6, 95% CI: 1.0-6.7), and having clinically significant symptoms (aOR=3.1, 95% CI: 1.5-6.5) were each independently associated with a greater odds of having received lifetime mental health care. Findings indicate that many ASMM in the sample received mental health care in their lifetimes. However, more participants endorsed clinically significant anxiety/depressive symptoms than received care at both timepoints. This disparity was even more pronounced approximately five months into the COVID-19 pandemic. Research and practice efforts must reduce care barriers and augment facilitators for all ASMM, with particular urgency during COVID-19 and its aftermath.

Cross-sectional studies have demonstrated associations between COVID news exposure, anxiety, and depression. However, longitudinal research examining the directionality of these associations is extremely limited. Further, most studies have focused on the general population and neglected sexual and gender minority individuals (SGM), a population disproportionately impacted by the pandemic. To address these limitations, the current study utilized data from a 30-day diary study of SGM assigned female at birth ( = 429). We examined concurrent and prospective associations between COVID news exposure, depressed and anxious affect, COVID distress, substance use, and motives for use. Further, we examined associations between cumulative COVID news exposure across the diary period and prospective changes in anxiety, depression, and COVID distress. When participants were exposed to more COVID news, they experienced more depressed and anxious affect, more COVID distress, less positive affect, and were more likely to use alcohol and cannabis to cope. Further, when participants were exposed to more COVID news, they experienced increases in depressed affect, decreases in positive affect, and increases in the likelihood of using cannabis to cope. Findings also provided evidence of bi-directional prospective associations between COVID news exposure and COVID distress and of a cumulative impact of COVID news exposure on anxiety, depression, and COVID distress. Findings suggest that individuals should balance the need to remain informed about the pandemic and their own mental health when considering how much COVID news to consume.

Transgender and gender diverse (TGD) individuals face high rates of psychological distress, including depression, anxiety, and suicide risk. Further, TGD individuals living outside of urban areas experience additional disparities compared to their urban counterparts. Minority stress theory states that minority stressors (termed marginalization stressors for this paper), such as experiences of discrimination and internalized transphobia, lead to psychological distress. The current study compared marginalization stressors across rural (population less than 2,500), urban cluster (population between 2,500 and 50,000), and urban (population greater than 50,000) samples and tested the degree to which these stressors account for differences across areas of residence.

Bisexual women experience disproportionately poorer health outcomes in comparison to lesbian and gay groups, and the general population, including inequities related to mental and physical health. Although bisexual-specific health inequities are increasingly well-documented, research examining putative causes of such inequities, as well as research that accounts for differences bisexual populations - particularly among racial minorities- remains limited. To address these gaps, this paper reports findings from the Women's Daily Experiences Study (WoDES), a multi-method study that explored the relationship between microaggressions and health outcomes among racially/ethnically diverse cisgender, bisexual women in Chicago. Data from 28-day daily e-diaries ( = 2,104 observations; 99 participants, 57% women of color) were analyzed using multilevel modeling to (1) measure the frequency of microaggressions among bisexual women; (2) examine the influence of sexual orientation, racial, and gender microaggressions on mental and physical health; and (3) investigate how race influences relationships between microaggressions and health. Participants reported an average of 8.1 microaggressions in the previous 28 days, and at least one microaggression was reported for more than 42% of days ( = 802). Microaggressions of any type were associated with increased same-day negative affect and somatic complaints. Latina bisexual women experienced worse health outcomes in comparison to Black bisexual women. This study demonstrated the detrimental impact of microaggressions on the health of bisexual women and highlights the critical need for strategies on broader structural changes that could improve the health and well-being of bisexual women.

Sexual identity development milestones mark the ages at which sexual minority people first experience key developmental events including same-sex attraction, self-realization of a sexual minority identity, same-sex sexual behavior and romantic relationships, and sexual identity disclosure. Most studies of milestones use variable-centered, rather than person-centered approaches, potentially obscuring diversity in patterns across milestones. Using data from The Generations Study, the first national probability sample of White, Black, and Latinx sexual minority adults in the United States ( = 1,492), we examined variability in milestone timing and patterning using a latent profile analysis approach. We identified four distinct profiles, characterized by variability in milestone mean ages, pacing, and sequences: an early adolescence profile (22.9%), a middle adolescence profile (33.6%), a late adolescence profile (27.6%), and an adulthood profile (15.9%). Profiles were demographically distinct, varying by birth cohort, sexual identity, race/ethnicity, gender identity, and childhood gender nonconformity. Results suggest developmental and demographic diversity in the emergence of sexual identity development across the life course, with implications for sexual minority health and thriving.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals in most countries face strong stigma and often rely on affirmative mental health care to foster coping and resilience. We tested an LGBTQ-affirmative mental health training for psychologists and psychiatrists by comparing in-person versus online modalities and the added benefit of supervision. Participants were randomized to a two-day training either in-person ( = 58) or via live-stream online broadcast ( = 55). Outcomes were assessed at baseline and 5, 10, and 15 months posttraining. Optional monthly online supervision was offered ( = 47) from months 5 to 15. Given the substantial need for LGBTQ-affirmative expertise in high-stigma contexts, the training took place in Romania, a Central-Eastern European country with some of the highest LGBTQ stigma in Europe. Participants ( age = 35.1) were mostly cisgender female (88%) and heterosexual (85%). Trainees, regardless of whether in-person or online, reported significant decreases from baseline to 15-month follow-up in implicit and explicit bias and significant increases in LGBTQ-affirmative clinical skills, beliefs, and behaviors. LGBTQ-affirmative practice intentions and number of LGBTQ clients did not change. Participants who attended at least one supervision session demonstrated greater reductions in explicit bias and increases in LGBTQ-affirmative behaviors from baseline to 15-month follow-up than participants who did not attend supervision. LGBTQ-affirmative mental health training can efficiently and sustainably improve LGBTQ competence and reduce provider bias in high-stigma contexts. Future research can identify additional ways to encourage mental health providers' outreach to LGBTQ clients in need of affirmative care.

While research generally supports that greater outness about one's sexual identity is associated with improved well-being, emerging evidence suggests that outness may have negative consequences for bisexual individuals. Yet, few studies have examined sexual identity as a moderator of the associations between outness and well-being, especially among youth. As such, the role of outness in the mental health of diverse sexual minority youth (including pansexual, queer, questioning, and asexual youth) remains unclear. Thus, we examined how the associations between outness and well-being differed as a function of sexual identity in a sample of sexual minority youth. Using data from the ( = 11,225), we tested sexual identity as a moderator of the associations between outness and well-being (depression and self-esteem). In the full sample, greater outness was significantly associated with lower depression and higher self-esteem. However, these associations were significantly different for gay/lesbian versus questioning youth. Greater outness was associated with lower depression and higher self-esteem for gay/lesbian youth yet was associated with higher depression and was not associated with self-esteem for questioning youth. The association between outness and self-esteem was also significantly different for gay/lesbian versus bisexual youth. Greater outness was associated with higher self-esteem for both groups, but the association was stronger for gay/lesbian youth. These findings suggest that outness may have benefits for gay/lesbian and bisexual youth, yet it may have negative consequences for questioning youth. These findings can inform efforts to promote positive sexual identity development and wellbeing of sexual minority youth.

Involvement in extracurricular groups is associated with positive outcomes for youth. Gender-Sexuality Alliances (GSAs) are school-based clubs that may provide benefits to sexual and gender minority (SGM) youth and their allies, yet little is known about what factors predict member retention. The current study explores individual- and group-level predictors of youth's sustained or discontinued membership in GSAs during a school year. Participants were 410 youth ( = 15.56; 83% sexual minority; 57% cisgender female; 70% White) and 50 advisors in 32 GSAs purposively sampled across Massachusetts who completed surveys at the beginning and end of the school year. Sexual minority youth and youth who took on more leadership roles at the beginning of the year were less likely to have left their GSA by the end of the school year. Youth who perceived higher levels of social support from their GSA trended less likely to leave their GSA as well, although the association was not significant. Youth who engaged in more advocacy were more likely to have left. Youth in GSAs with greater structure to their meetings were less likely to discontinue their membership; specifically, having a meeting agenda was uniquely predictive of member retention. Implications for GSA inclusivity and practices to promote retention within GSAs and similar social justice-oriented clubs are discussed.

Sexual minority individuals assigned female at birth (SM-AFAB) are at increased risk for problematic alcohol use compared to heterosexual women. Despite evidence that drinking locations and companions play an important role in problematic alcohol use among heterosexuals, few studies have examined these social contexts of alcohol use among SM-AFAB. To address this gap, the current study examined two aspects of social contexts in which SM-AFAB drink (locations and companions). We utilized two waves of data (six-months between waves) from an analytic sample of 392 SM-AFAB ages 17-33 from a larger longitudinal study. The goals were: (1) to identify classes of SM-AFAB based on the contexts in which they drank; (2) to examine the associations between drinking contexts, minority stressors, and problematic alcohol use; and (3) to examine changes in drinking contexts over time. Using latent class analysis, we identified four classes based on drinking locations and companions (private settings, social settings, social and private settings, multiple settings). These classes did not differ in minority stress. Drinking in multiple settings was associated with more problematic alcohol use within the same timepoint and these differences were maintained six months later. However, drinking in multiple settings did not predict subsequent changes in problematic alcohol use when problematic alcohol use at the prior wave was controlled for. Based on these findings, SM-AFAB who drink in multiple settings may be an important subpopulation for interventions to target. Interventions could focus on teaching SM-AFAB strategies to limit alcohol consumption and/or minimize alcohol-related consequences.

Bisexual people are at increased risk for anxiety and depression compared to heterosexual and gay/lesbian people, but little is known about people who use other labels to describe attractions to more than one gender (e.g., pansexual, queer; collectively "bi+"). In addition, some people use more than one label to describe their sexual orientation, but research has yet to examine whether using one versus multiple labels is associated with identity-related experiences or mental health. To address these gaps, we explored potential differences in disclosure, minority stress, and mental health among bi+ adults based on primary sexual identity and multiple label use. As part of a larger project, 669 bi+ adults completed an online survey. Primary sexual identities included bisexual (53.2%), pansexual (26.3%), and queer (20.5%), and 55.2% used multiple labels. Compared to bisexual participants, pansexual participants reported higher disclosure, discrimination from heterosexual people, and depression. Pansexual participants also reported higher anxiety and lower internalized binegativity, but these associations became non-significant after adjusting for demographics. Queer participants reported higher disclosure, discrimination from heterosexual people, and anxiety, but only the difference in disclosure remained significant in adjusting analyses. Finally, participants who used multiple labels reported higher disclosure and discrimination from heterosexual and gay/lesbian people, but only the difference in discrimination from gay/lesbian people remained significant in adjusted analyses. Findings highlight the heterogeneity of bi+ individuals and the importance of considering bisexual, pansexual, and queer individuals as unique groups as well as considering whether bi+ individuals use one or multiple sexual identity labels.

Sexual minority young persons may be at risk for compounding mental health effects of the COVID-19 pandemic due to their existing vulnerabilities for psychological inequities. Indeed, recent research has documented that sexual minority young persons are experiencing compounding psychiatric effects associated with the COVID-19 pandemic. Further, researchers and practitioners hypothesized that sexual minority youth and young adults may experience unique hardships related to their sexual and gender identities and familial conflict as a result of the COVID-19 pandemic and living arrangement changes with their parents and families. This study aims to investigate whether there are changes in sexual minority (and non-sexual minority) young adults' (SMYAs) mental health and wellbeing among those living with and living without their parents before and after the start of COVID-19. Among a cross-sectional sample of SMYAs (n=294; M=22 years; age range=18-26) and non-SMYAs (n=874; M=22 years; age range=18-26) defined by whether they were living with or living without their parents before and after the start of COVID-19, we retrospectively analyzed changes in psychological distress and wellbeing. SMYAs who returned to their parents' homes during post-onset of COVID-19 reported greater mental distress and lower wellbeing, followed by those who were living with their parents both before and after the start of COVID-19. Patterns were not consistent among non-SMYAs, and lower magnitudes of change were seen. There is a significant public health need for mental health services and family education resources for supporting SMYAs in the context of COVID-19 and beyond.

The present study used a minority stress theory framework to investigate the direct and indirect relations of minority stressors (transgender discrimination experiences, internalized transphobia, identity nondisclosure), sense of belonging, and hopelessness with depression and anxiety symptoms in a sample of 301 trans and gender-diverse adults living in the United States. This study also explored the moderating effect of having knowledge of antitrans legislative efforts in one's state of residence on the overall pattern of results through a nested model comparison of the hypothesized path analysis. Participants were recruited using Internet-based forums, listservs, and social media, and survey data were collected online. Significant moderation effects were found, such that for those who reported having knowledge of antitrans legislative efforts in their state of residence reported a stronger association of external stressors (discrimination) than internal stressors (internalized transphobia, identity nondisclosure) on sense of belonging and hopelessness than their peers who did not have any knowledge of such legislative efforts. Furthermore, hopelessness emerged as a stronger predictor for those who were aware of antitrans legislative efforts. Implications of study findings for counseling, advocacy, and future research are discussed.

Research has consistently shown mental health differences between sexual minority subgroups with bisexual people often reporting higher levels of psychological distress than lesbians and gay men. Relationship status has been suggested, but not well studied, as a potential factor contributing to subgroup differences in mental health. Using a national probability sample of non-transgender sexual minority adults across 3 age cohorts (18-25, 34-41, 52-59 years), we assessed group differences in psychological distress (Kessler 6) between lesbian/gay (N = 505), bisexual (N = 272), and queer/pansexual (N=75) respondents. We examined whether relationship status (single/partnered) moderated the relationship between sexual identity and psychological distress. Among those that were partnered, we tested whether key partner characteristics related to sexual identity - gender of partner (cisgender same-sex/transgender or cisgender different-sex) and partner sexual identity (same or mixed sexual orientation relationship) - were significantly associated with psychological distress. In bivariate analyses, bisexual and queer/pansexual respondents reported more psychological distress than gay/lesbian respondents, among both men and women. In multivariable analyses, there was not a significant main effect of sexual identity, but there was a significant interaction between sexual identity and partnership status on psychological distress among women. Specifically, while there were no significant differences in psychological distress between subgroups of single women, among partnered women, queer/pansexual women had more distress than lesbian/gay women. Further, partnership was associated with reduced distress among lesbian/gay women, but not among bisexual or queer/pansexual women. Among men, there were no significant interaction effects between sexual identity and partnership status on psychological distress. Being in a mixed orientation relationship, but not gender of partner, was a significant predictor of psychological distress among both women and men across sexual identities. Additional research should assess the partnership dynamics contributing to the association between partnership characteristics and mental health among sexual minority populations.

Transgender and gender diverse (TGD) individuals are disproportionately exposed to traumatic and high-impact minority stressors which can produce an array of transdiagnostic symptoms. Some clinical presentations align well with established evidence-based treatments, but others may require patient-centered modifications or combined approaches to address treatment needs. In this study, we employed a novel, bottom-up approach to derive insights into preferred intervention strategies for a broad range of trauma- and TGD-minority stress-related expressions of clinical distress. Participants (18 TGD individuals, 16 providers) completed a q-sort task by first sorting cards featuring traumatic experiences and/or minority stressors and transdiagnostic psychiatric symptoms into groups based on perceived similarity. Next, participants sorted interventions they believed to be most relevant for addressing these concerns/symptoms. We overlayed networks of stressors and symptoms with intervention networks to evaluate preferred intervention strategies. TGD networks revealed transdiagnostic clustering of intervention strategies and uniquely positioned the expectancy of future harm as a traumatic stressor. Provider networks were more granular in structure; both groups surprisingly emphasized the role of self-defense as intervention. While both networks had high overlap, their discrepancies highlight patient perspectives that practical, material, and structural changes should occur alongside traditional clinical interventions.