Lesbian, gay, bisexual, queer adults have high rates of adverse childhood experiences

Lesbian, gay, bisexual and queer people had higher exposure to all adverse childhood experiences compared with heterosexual adults, according to a cross-sectional study in a research letter published in JAMA Psychiatry.

“Sexual minority individuals (eg, lesbian, gay, bisexual and queer people) experience high rates of bullying and violence, a predictor of worse mental health, but little research has examined adverse childhood experiences (ACEs) occurring before age 18 years among sexual minority individuals,” Nathaniel M. Tran, BA, of the department of health policy at Vanderbilt University in Tennessee, and colleagues wrote. “This study uses a large, multistate probability sample to (1) characterize population-level prevalence of ACEs by sexual orientation and (2) estimate the association between level of ACE exposure and mental distress in adulthood by sexual orientation.”

Tran and colleagues obtained data from the 2019 Behavioral Risk Factor Surveillance System among (BRFSS) among states that implemented both the optional sexual orientation and the ACE modules. Sexual minority identity served as the exposure variable. Weighted prevalence and odds of ACEs and frequent mental distress and the number of bad mental health days in the past month, stratified by ACE exposure level, served as outcomes.

Researchers analyzed data of 61,871 adults, of whom 6.7% identified as lesbian, gay, bisexual or queer. Compared with heterosexual adults, these individuals were more likely to identify as women (57% vs. 52%), be younger (88% vs. 73% aged younger than 65 years) and identify with underrepresented racial or ethnic identities (36% vs. 29%). A total of 64% of heterosexual adults experienced one or more ACEs, and 26% experienced three or more ACEs. A total of 83% of lesbian, gay, bisexual or queer adults experienced one or more ACEs, and 52% experienced three of more ACEs. Lesbian, gay, bisexual or queer adults had increased risk for all eight types of ACEs compared with heterosexual adults. Disparities among lesbian, gay, bisexual or queer adults were greatest for sexual abuse (adjusted OR = 2.94; 95% CI, 2.46-3.51), household mental illness (adjusted OR = 2.43; 95% CI, 2.06-2.87) and emotional abuse (adjusted OR = 2.3; 95% CI, 1.97-2.68), and they experienced more bad mental health days per month at all levels of ACE exposure compared with heterosexual individuals.

“Findings highlight the importance of earlier ACE screening and clinician training on effective approaches to reduce sexual minority mental health disparities across the life course,” Tran and colleagues wrote.