Twelve hundred fifty-three surveys were collected in the 18 schools. The surveys of 38 students (3%) were excluded from data analysis; 35 because they left at least 80% of the items unanswered, and 3 because of erratic answering patterns. An additional 183 respondents were excluded from the analysis sample because they had missing data on sex (n=11) or on all three indicators of emotional distress (n=172), resulting in a total sample size of 1,032.
The sample reflected the racial and ethnic diversity of Boston public high school students. More than a quarter (30.7%) were Hispanic/ Latino, 44.8% were non-Hispanic Black, 13.7% were non-Hispanic White, and 10.8% were Asian, Native Hawaii or Other-Pacific Islander, bi- or multi-racial, or reported being of another race category. The age of respondents ranged from 13 to 19 years, with a mean of 16.3 (SD=1.3). More than half (58.3%) of the respondents were female.
shows the distribution of sexual orientation and transgendered status of respondents. It remains unclear whether those students who checked “not sure” for sexual orientation or “don't know” for transgender are questioning their identity or did not understand the question. For analyses, we coded those students who answered don't know or unsure as having missing data on sexual orientation, transgender status, or LGBT status. Nearly 10% of the respondents identified themselves as lesbian, gay, bisexual, and/or transgendered (LGBT) (103 out of 1,032).
Sexual Orientation and Transgendered Status of Respondents, n=1,032
Demographic Differences in Sexual Orientation and Transgender Status
Girls were significantly more likely than boys to report a minority sexual orientation (including being mostly heterosexual, bisexual, mostly homosexual, or 100% homosexual) (13.3% vs. 5.3%, p<0.0001). Although more than half of the transgendered students chose female as their sex (11 out of 17), there were no statistically significant sex differences in transgendered status. There was little variation in sexual orientation by age and there were only modest differences by race/ethnicity. Whites were the most likely to have a minority sexual orientation (16.2%), followed by Hispanic/ Latinos (9.3%), those in the “other” race category (9.0%), and Blacks (8.5%) (p=0.07). There were too few transgendered students to discern differences by race/ethnicity or age.
Indicators of Emotional Distress
The mean score on the 5-item scale of depressive symptomatology was 13.4 (SD=4.0). (The scale ranged from 5 to 25, with higher scores indicating more intense depressive symptomatology.) The scale demonstrated high internal consistency, as measured by a Cronbach's alpha coefficient of 0.75. The depressive symptomatology score for girls (M=14.3, SD=3.9) was significantly higher than the score for boys (M=12.2, SD=3.9) (F statistic=69.3, p<0.0001). There were no statistically significant differences in depressive symptomatology by either age or race/ethnicity.
Less than one-tenth of the sample reported having engaged in self-harm (7.6%) or having experienced suicidal ideation (8.6%) in the 12 months preceding survey administration. Although girls had significantly higher rates of suicidal ideation compared to boys (11.0% vs. 5.2%, p=0.0014), there were only modest, non-statistically significant differences in self-harm by sex (8.0% vs. 7.1%, p=0.63). There was little difference in the prevalence of suicidal ideation and self-harm by race/ethnicity and age.
shows the prevalence of indicators of emotional distress by LGBT status stratified by self-reported sex/gender. For these and most of the remaining analyses we analyzed LGBT youth as a single group (24 males, 79 females), with heterosexual, non-transgendered students as the comparison group (330 males, 430 females). This was done to maximize power and because results from individual group analyses (i.e., transgendered vs. not; minority sexual orientation vs. heterosexual) showed similar patterns (data not shown).
Indicators of Emotional Distress Among Boston Youth, Stratified by Self-Reported Sex/Gender (n=863)
Among both males and females, LGBT youth displayed more emotional distress as compared to heterosexual, non-transgendered youth as evidenced by significantly higher prevalence rates for suicidal ideation and self-harm. The prevalence of self-harm was particularly high among LGBT males; with 41.7% reporting (10 out of 24). LGBT youth also had significantly higher depressive symptomatology scores than heterosexual, non-transgendered youth.
About seven percent of the respondents reported that they had experienced discrimination because someone thought they were gay, lesbian, or bisexual. There were no notable differences in rates of perceived discrimination by age, race, or sex. Not surprisingly, youth with a minority sexual orientation were significantly more likely than heterosexual youth to report perceived discrimination (33.7% vs. 4.3%, p<0.0001). Similarly, a larger percentage of transgendered youth reported discrimination than non-transgendered youth (18.8% vs. 6.4%). LGBT youth as a whole had a substantially increased prevalence of perceived discrimination compared to heterosexual, non-transgendered youth (31.3% vs. 3.7%, p<0.0001). Among LGBT youth, a significantly larger percentage of males reported discrimination (12 out of 24, 50%) than LGBT females (19 out of 75, 25.3%).
Perceived Discrimination, LGBT Status, and Depressive Symptomatology
Respondents who reported having been discriminated against on the basis of minority sexual orientation were significantly more likely than those who had not felt this way to report self-harm (25.0% vs. 6.3%) and suicidal ideation (23.9% vs. 7.4%), and also had significantly higher mean scores on the depressive symptomatology scale (M=15.6, SD=4.3 vs. M=13.3, SD=3.9). We tested our expectation that the association between perceived discrimination and emotional distress would vary by LGBT status in multiple regression models. Specifically, we examined whether the interaction term of perceived discrimination and LGBT status was associated with increased levels of depressive symptomatology and found that the term was statistically significant for males (F= 5.22, p<0.05), but not for females (F=1.58, p=0.21) (). (Due to limited power, we were unable to examine if perceived discrimination modified the association between LGBT status and self-harm or suicidal ideation in a similar manner as depressive symptoms.) Results indicate that, in the absence of perceived sexual orientation-based discrimination, LGBT males and females have similar levels of depressive symptoms as their heterosexual, non-transgendered peers. By contrast, in the face of discrimination, LGBT males have higher levels of depressive symptomatology as compared to heterosexual, non-transgendered boys, and LGBT girls had slightly lower levels of depressive symptomatology as compared to heterosexual, non-transgendered girls.
Depressive Symptomatology Scores by LGBT Status and Perceived Discrimination
Perceived Discrimination as a Mediator of the Association between LGBT Status and Emotional Distress
Because descriptive results showed that there were associations between LGBT status and depressive symptomatology, self-harm and suicidal ideation, and between LGBT status and perceived discrimination on the basis of sexual orientation, we ran the full mediation analysis strategy. summarizes the results of the regression analyses for each indicator of emotional distress stratified by self-reported sex/gender. We did not control for race/ethnicity or age in the mediation analyses because these variables were not significantly associated with LGBT status or indicators of emotional distress.
The mediating effect of perceived discrimination on the association between LGBT status and emotional distress among Boston public high school students
The mediation analyses for depressive symptomatology are presented in the top rows of . Model 1 for boys and girls shows that LGBT status was associated with significantly increased depressive symptoms for girls and boys. Model 2 shows the association between LGBT status and depressive symptoms adjusting for the effect of perceived discrimination on the basis of sexual orientation. The addition of perceived discrimination attenuated the effect of LGBT status on depressive symptoms for girls by 23%. Evidence for the mediating role of perceived discrimination was obtained by conducting a Sobel test (Z-score 2.55, p<0.05). Among boys, the attenuation in the effect of LGBT status on depressive symptoms was even more pronounced (56%), and results of the Sobel test revealed that perceived discrimination was a highly significant mediator of this relationship (Z-score 2.81, p<0.005).
Results for self-harm stratified by sex are presented in the center rows of . Model 1 shows that LGBT girls and boys had significantly increased risks of self-harm compared to their heterosexual, non-transgendered peers. Model 2 shows that the addition of perceived discrimination slightly increased the effect of LGBT status on self-harm among girls by 2%, so that the effect of LGBT status was not statistically significant. The Sobel test for mediation revealed that perceived discrimination was not a significant intervening variable between LGBT status and acts of self-harm (Z-score 0.89, p=0.37) for girls. Among boys the effect of GBT status on self-harm was attenuated by 57% after accounting for the role of perceived discrimination. Results of the Sobel test indicated that discrimination on the basis of sexual orientation strongly mediates the relationship between LGBT status and self-harm among boys (Z-score 4.16, p<0.0001).
Results of the stratified analysis for suicidal ideation are presented in the bottom rows of . Model 1 shows that LGBT girls and boys had significantly increased risks of suicidal ideation compared to their heterosexual, non-transgendered counterparts. Model 2 shows results of the final step of mediation analysis by regressing suicidal ideation on LGBT status while controlling for perceived discrimination among girls and boys. With the addition of the proposed mediator to the model the effect of LGBT status was reduced by 1%, among girls. Perceived discrimination did not mediate the relationship between LGBT status and suicidal ideation (Z-score 0.56, p=0.5) among girls. For boys, the main effect of LGBT status was attenuated by 37% with the addition of perceived discrimination to the model, and results of the Sobel test indicated that it was a significant mediator of the relationship between LGBT status and suicidal ideation (Z-score 3.5, p<0.001).