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Sexual minorities more vulnerable to depression from early adolescence to young adulthood

Mental health disparities between heterosexuals and sexual minorities were present as early as age 10 years, increased throughout school years and persisted to young adulthood, according to data from an observational study published in The Lancet Child & Adolescent Health.

The findings showed that sexual minority youth from the U.K. experienced more depressive symptoms and reported more self-harm than heterosexual youth from early adolescence and into early adulthood.

“Few population-based cohort studies have compared depressive symptoms in sexual-minority adolescents and heterosexual adolescents over time, and fewer still have investigated self-harm,” Madeleine Irish, MSc, from the psychological medicine department, King’s College London, and colleagues wrote. “Existing cohort studies mostly use short follow-up periods to mid-adolescence and are either small — and thus might lack statistical power — or retrospective, which might introduce information bias.”

Researchers compared trajectories of depressive symptoms in sexual minority and heterosexual teenagers from the U.K. using the short Mood and Feelings Questionnaire at seven timepoints between ages 10 years and 21 years. They also evaluated self-harm at ages 16 years and 21 years via a questionnaire adapted from the Child and Adolescent Self-harm in Europe study. In secondary analysis, the investigators assessed lifetime self-harm with suicidal intent.

To measure depressive symptoms, the researchers used linear multilevel models with growth curves. They also used logistic multilevel models to evaluate self-harm in the previous year at ages 16 years and 21 years, and multinomial regression to determine lifetime self-harm with and without suicidal intent at age 21 years.

Analysis revealed that sexual minority youth had higher depressive symptoms when measured at age 10 years compared with heterosexual youth (mean score 4.58 vs. 3.79). This increased with age; at each timepoint, depressive symptoms rose by 0.31 points among heterosexuals (95% CI, 0.27-0.34) as measured by the short Mood and Feelings Questionnaire and by 0.49 points among sexual minorities (95% CI, 0.4-0.59), according to the results. However, depressive symptoms dropped by 0.11 points (95% CI, –0.15 to –0.06) from age 19 years among heterosexuals and by 0.19 points (95% CI, –0.24 to –0.15) from age 18 years among sexual minority teenagers.

The results showed that at age 16 and 21 years sexual-minority adolescents were four times more likely to report self-harm in the prior year compared with heterosexuals (adjusted OR = 4.23; 95% CI, 2.9–6.16), with no evidence that this risk diminished as participants aged. At age 21 years, sexual minority participants were also four times more likely to report lifetime self-harm with suicide intent than heterosexuals (RR = 4.53; 95% CI, 3.02-6.78).

“Our findings illustrate the potential importance of mental health problems before conscious self-identification and labelling of sexual-minority orientation,” Irish and colleagues wrote. “It is relevant for clinicians and those working in public mental health to be aware that any young person who identifies as not exclusively heterosexual could be at increased risk of persistent future mental health problems.”

Addressing mental health inequality between sexual minorities should be a priority in the future, the researchers concluded.

“The findings highlight the urgent need for policy makers, public health researchers, health care professionals and educators to join forces to address the underlying causes of this inequity and reduce the burden of disease on vulnerable young people,” Rohan Borschmann, PhD, DPsych, and Jennifer Marino, DNP, of Royal Children’s Hospital, Melbourne, Australia, wrote in a related comment. – by Savannah Demko

Disclosures: Irish reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Borschmann and Marino report no relevant financial disclosures.