Developmental Trajectories of Substance Use and Mental Health for Sexual Minority Youth: A Systematic Review

• In Event: 3-091 - Methodological Advances in Sexual Minority Youth Research: Developmental and Longitudinal Findings

Integrative Statement

Introduction: Research indicates increased risk of poor mental health and substance use for sexual minority youth (SMY), compared to heterosexual peers (Russell & Fish, 2016). The onset of these disparities may be rooted in adolescence, when differences in mental health and substance use between SMY and heterosexual peers emerge. Earlier studies investigating SMY-health predominantly utilized cross-sectional population-based studies; however, these only capture the data of a population for a specific timepoint, whereas the development of mental health and substance use is dynamic, especially in adolescence and young adulthood (Chen & Jacobson, 2012). More recent studies have examined developmental trajectories of mental health and substance use, and sexual orientation disparities therein. In the present study we systematically reviewed this developmentally-oriented literature to identify whether indeed systematic differences in the trajectories of mental health (Hypothesis 1) and substance use (Hypothesis 2) between SMY and heterosexual youth could be observed and explored potential within-group effects among lesbian, gay, and bisexual SMY.
Methods: The review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA; Moher et al., 2009). Databases Web of Science, MEDLINE and PsycINFO were searched using variations and Boolean connectors using relevant key-terms related to sexual orientation (e.g., sexual minority youth), research design (e.g., trajector*) and outcomes (e.g., depressive symptoms, alcohol use). A PRISMA-flowchart of the study selection procedure is illustrated in Figure 1. Extracted data comprised: (1) sample characteristics, (2) study design, (3) trajectory characteristics, and (4) explanatory and moderating variables.
Results: In total sixteen studies, utilizing eight unique datasets were included. Twelve studies investigated substance use and five studies investigated mental health trajectories. A clear majority of studies revealed stronger increases in alcohol (k = 10) and marijuana (k = 5) use over time for SMY compared to heterosexual peers, especially in frequency of drunkenness. SMY within-group differences in alcohol and marijuana use were inconsistent between studies; however, sexual minority boys consistently showed a stronger increase in alcohol use compared to sexual minority girls. Regarding smoking trajectories (k = 5), only sexual minority girls showed stronger increase compared to heterosexual peers. Two studies examined trajectories of illicit drug use, neither found between or within-group differences. For mental health, SMY showed a stronger increase in anxiety (k = 1), but stronger decrease in suicidality (k = 2) than heterosexual youth. Regarding depression (k = 4), three studies found stronger increases for SMY compared to heterosexual peers.
Conclusion: As expected, SMY showed steeper increase in substance use and mental health problems over time than heterosexual youth, but the difference in mental health problems did not diminish, except for suicidality. Additionally, although SMY within-group differences were present, they were inconsistent between studies. Findings highlight the need for preventive and early-stage interventions to inhibit further growth of disparities in substance use and mental health for SMY.

Authors

• Hidde Ozinga, University of Groningen
  Presenting Author

• Laura Baams, University of Groningen
  Non-Presenting Author

• Tina Kretschmer, University of Groningen
  Non-Presenting Author