Sleep problems among LGBTQ+ youth exacerbated by sexual identity-based discrimination
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Key takeaways:
- Adolescents who identify as a sexual minority have poor measures of sleep duration, latency and disturbance.
- Discrimination based on sexuality partly brought about some of these sleep outcomes.
WASHINGTON — Adolescents of a sexual minority reported fewer hours of sleep per night, longer sleep latency and more sleep disturbances, according to an abstract presented at the American Thoracic Society International Conference.
“Our findings highlight the importance of clinicians talking with their early adolescent patients about social stressors and sleep,” Jean-Marie Bruzzese, PhD, professor of applied developmental psychology, Sarah I. Leonard, MPhil, MSN, RN, PhD candidate, and Kasey B. Jackman, PhD, RN, PMHNP-BC, psychiatric-mental health nurse practitioner, all at Columbia School of Nursing, told Healio in a statement. “Additionally, clinicians should not assume early adolescents are too young to identify as a sexual minority or experience discrimination based on sexual identity. It is essential for clinicians to communicate acceptance and affirmation of sexual minority identities.”
In a cross-sectional analysis of data from the Adolescent Brain and Cognitive Development Study, Bruzzese, Leonard, Jackman and colleagues analyzed 9,419 adolescents (77% white; 53% assigned male at birth) aged 11 to 12 years to see how sexual minority identity — such as lesbian, gay or bisexual — was related to sleep duration, latency and disturbances. They also sought to find out if discrimination based on sexuality mediates these relationships.
The validated Sleep Disturbance Scale for Children was used to determine the three outcomes in adolescents. Researchers adjusted for sex assigned at birth, puberty level, anxiety, depression and date of recorded data in relation to the COVID-19 pandemic when evaluating each outcome in either linear regression or binary logistic regression models.
Of the total cohort, 399 individuals identified as a sexual minority, 362 identified as questioning and 8,658 identified as heterosexual.
When evaluating sleep duration, fewer hours of sleep per night were observed in sexual minority (P = .009) and questioning (P = .019) adolescents than in heterosexual adolescents.
Compared with the 0.3% of heterosexual adolescents who slept for less than 5 hours per night, a greater percentage of sexual minority (1.5%) and questioning (1.4%) adolescents reported this duration of sleep. Further, a lower percentage of sexual minorities or questioning adolescents reported 9 to 11 hours of sleep than adolescents who identified as heterosexual (25.6% vs. 27.3% vs. 32.3%), according to the abstract.
Longer sleep latency was also observed in adolescents identifying as a sexual minority (P < .001) or questioning (P = .001). It took more than 60 minutes for 8% of sexual minority adolescents and 8.3% of questioning adolescents to fall asleep, whereas this timeframe was only found in 3.2% of heterosexual individuals. Additionally, fewer adolescents identifying as sexual minority or questioning were able to fall asleep in less than 15 minutes compared with adolescents identifying as heterosexual (20.1% vs. 27.6% vs. 35.6%).
Lastly, the odds for experiencing a sleep disturbance were greater in those who identified as sexual minority (aOR = 1.68; P < .001) and questioning (aOR = 1.72; P < .001). Of the adolescents who reported a sleep disturbance, more identified as sexual minorities or questioning than as heterosexual (44.4% vs. 43.4% vs. 28%), according to the abstract.
Researchers further observed greater odds for discrimination based on sexual identity in those who identified as a sexual minority (aOR = 1.62; P = .02) or as questioning (aOR = 1.71; P = .007). Besides the outcome of sleep latency, this type of discrimination “partially mediated” the link between sexual identity and sleep using Baron and Kenny’s methods, according to the abstract.
“While sleep disparities among sexual minority adults are known, this was the first study to examine sleep disparities based on sexual identity among early adolescents,” Bruzzese, Leonard and Jackman told Healio. “On all the sleep outcomes we examined, there were indeed significant disparities based on sexual identity in this sample of 10- to 12-year-olds. In addition, consistent with the Minority Stress model, sexual identity discrimination mediated the relationship between sexual identity and sleep. We were surprised, however, that the effect was small — it accounted for less than 5% of the association.”
Despite this small effect, Bruzzese, Leonard and Jackman said sexual identity-based discrimination must be addressed, especially in children.
“Policies are needed that address discrimination based on sexual minority identity,” Bruzzese, Leonard and Jackman told Healio. “Clinicians, researchers and educators must challenge social norms and attitudes that contribute to sexual minority stress for early adolescents.
“Future studies should examine how minority stress processes account for the sleep disparities identified in our study, including how minority stress might intersect with other forms of oppression,” they added. “It would also be important to conduct qualitative research to gain a deeper understanding of how sexual minority adolescents experience minority stress and its relationship with sleep.”
For more information:
Jean-Marie Bruzzese, PhD, can be reached at jb3958@cumc.columbia.edu.