Abstract
Introduction
Sexual and gender minority youth (SGMY) often report more experiences of rejection from their family environment which is typically linked with negative implications for their overall well-being. A factor frequently associated with increased rates of psychological distress and rejection from others is that of possessing a nonconforming gender expression. Family rejection is often categorized under the umbrella of minority stress theory; however, initial conceptualizations of minority stress theory did not account for other factors such as gender expression and cisnormativity and how these impact SGMY especially within the realm of family rejection.
Methods
In April of 2020, 150 adolescents who identified as a sexual or gender minority were recruited via Qualtrics Survey platform. Participants completed a series of self-report measures on demographics, minority stress, psychological distress, and their family environment’s views of gender identity and expression.
Results
We observed significant correlations connecting family rejection of gender expression to anxiety and depression and minority stressors. Moreover, family rejection of gender expression accounted for additional variance in anxiety but not depression. Neither family rejection nor support of gender expression moderated the relationships between minority stress with anxiety or depression.
Conclusions
These findings suggest that gender expression plays a role in experiences of family rejection and overall minority stress.
Policy Implications
Results illustrate implications for extending our thinking of family support beyond the binary categories of acceptance and rejection of queer identity. This can assist in informing policy on best practices for creating supportive environments for SGMY to help alleviate distress caused by lack of family support.
Similar content being viewed by others
Data Availability
The data that support the findings of this study are available from the corresponding author, Christopher Palmer, upon reasonable request.
Code Availability
Not applicable.
References
Alanko, K., Santtila, P., Salo, B., Jern, P., Johansson, A., & Sandnabba, N. K. (2011). Testing causal models of the relationship between childhood gender atypical behaviour and parent-child relationship. British Journal of Developmental Psychology, 29(2), 214–233. https://doi.org/10.1348/2044-835x.002004
Allen, S. H., Fish, J. N., McGuire, J. K., & Leslie, L. A. (2022). Beyond the (family) binary: Family environment heterogeneity among transgender adults. Journal of Marriage and Family, 84(4), 941–961. https://doi.org/10.1111/jomf.12835
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Anderson, S. M. (2020). Gender matters: The perceived role of gender expression in discrimination against cisgender and transgender LGBQ individuals. Psychology of Women Quarterly, 44(3), 323–341. https://doi.org/10.1177/0361684320929354
Baams, L., Dubas, J. S., Russell, S. T., Buikema, R. L., & van Aken, M. A. G. (2018). Minority stress, perceived burdensomeness, and depressive symptoms among sexual minority youth. Journal of Adolescence, 66, 9–18. https://doi.org/10.1016/j.adolescence.2018.03.015
Bailey, J. M., & Zucker, K. J. (1995). Childhood sex-typed behavior and sexual orientation - a conceptual analysis and quantitative review. Developmental Psychology, 31(1), 43–55. https://doi.org/10.1037/0012-1649.31.1.43
Baumeister, R. F., Bratslavsky, E., Finkenauer, C., & Vohs, K. D. (2001). Bad is stronger than good. Review of General Psychology, 5(4), 323–370. https://doi.org/10.1037/1089-2680.5.4.323
Bidell, M. P. (2014). Is there an emotional cost of completing high school? Ecological factors and psychological distress among LGBT homeless youth. Journal of Homosexuality, 61(3), 366–381.
Bos, H., de Haas, S., & Kuyper, L. (2019). Lesbian, gay, and bisexual adults: Childhood gender nonconformity, childhood trauma, and sexual victimization. Journal of Interpersonal Violence, 34(3), 496–515. https://doi.org/10.1177/0886260516641285
Bouris, A., Guilamo-Ramos, V., Pickard, A., Shiu, C., Loosier, P. S., Dittus, P., Gloppen, K., & Michael Waldmiller, J. (2010). A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: Time for a new public health research and practice agenda. Journal of Primary Prevention, 31(5–6), 273–309. https://doi.org/10.1007/s10935-010-0229-1
Brooks, V. R. (1981). Minority stress and lesbian women. Lexington Books.
Burton, C. M., Marshal, M. P., Chisolm, D. J., Sucato, G. S., & Friedman, M. S. (2013). Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: A longitudinal analysis. Journal of Youth Adolescence, 42(3), 394–402. https://doi.org/10.1007/s10964-012-9901-5
Chang, C. J., Feinstein, B. A., Meanley, S., Flores, D. D., & Watson, R. J. (2021). The role of LGBTQ identity pride in the associations among discrimination, social support, and depression in a sample of LGBTQ adolescents. Annals of LGBTQ Public and Population Health, 2(3), 203–219.
Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835–855. https://doi.org/10.1016/S0005-7967(99)00130-8
Chodzen, G., Hidalgo, M. A., Chen, D., & Garofalo, R. (2019). Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. Journal of Adolescent Health, 64(4), 467–471. https://doi.org/10.1016/j.jadohealth.2018.07.006
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Earlbaum Associates.
Cook, S. H., Sandfort, T. G. M., Nel, J. A., & Rich, E. P. (2013). Exploring the relationship between gender nonconformity and mental health among Black South African gay and bisexual men. Archives of Sexual Behavior, 42(3), 327–330. https://doi.org/10.1007/s10508-013-0087-z
D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21(11), 1462–1482. https://doi.org/10.1177/0886260506293482
DeChants, J. P., Shelton, J., Anyon, Y., & Bender, K. (2022). “It kinda breaks my heart”: LGBTQ young adults’ responses to family rejection. Family Relations, 71(3), 968–986. https://doi.org/10.1111/fare.12638
Dürrbaum, T., & Sattler, F. A. (2020). Minority stress and mental health in lesbian, gay male, and bisexual youths: A meta-analysis. Journal of LGBT Youth, 17(3), 298–314. https://doi.org/10.1080/19361653.2019.1586615
Eaton, N. R. (2014). Trans-diagnostic psychopathology factors and sexual minority mental health: Evidence of disparities and associations with minority stressors. Psychology of Sexual Orientation & Gender Diversity, 1(3), 244–254. https://doi.org/10.1037/sgd0000048
Ebesutani, C., Reise, S. P., Chorpita, B. F., Ale, C., Regan, J., Young, J., Higa-McMillan, C., & Weisz, J. R. (2012). The Revised Child Anxiety and Depression Scale-Short Version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychological Assessment, 24(4), 833–845. https://doi.org/10.1037/a0027283
Eekhout, I., de Vet, H. C., Twisk, J. W., Brand, J. P., de Boer, M. R., & Heymans, M. W. (2014). Missing data in a multi-item instrument were best handled by multiple imputation at the item score level. Journal of Clinical Epidemiology, 67(3), 335–342. https://doi.org/10.1016/j.jclinepi.2013.09.009
Feinstein, B. A. (2020). The rejection sensitivity model as a framework for understanding sexual minority mental health. Archives of Sexual Behavior, 49(7), 2247–2258. https://doi.org/10.1007/s10508-019-1428-3
Feinstein, B. A., Goldfried, M. R., & Davila, J. (2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80(5), 917–927. https://doi.org/10.1037/a0029425
Feinstein, B. A., Wadsworth, L. P., Davila, J., & Goldfried, M. R. (2014). Do parental acceptance and family support moderate associations between dimensions of minority stress and depressive symptoms among lesbians and gay men? Professional Psychology: Research and Practice, 45(4), 239–246. https://doi.org/10.1037/a0035393
Frost, D. M. (2017). The benefits and challenges of health disparities and social stress frameworks for research on sexual and gender minority health. Journal of Social Issues, 73(3), 462–476. https://doi.org/10.1111/josi.12226
Frost, D. M., Meyer, I. H., Lin, A., Wilson, B. D. M., Lightfoot, M., Russell, S. T., & Hammack, P. L. (2022). Social change and the health of sexual minority individuals: Do the effects of minority stress and community connectedness vary by age cohort? Archives of Sexual Behavior, 51(4), 2299–2316. https://doi.org/10.1007/s10508-022-02288-6
Frost, D. M., Meyer, I. H., & Schwartz, S. (2016). Social support networks among diverse sexual minority populations. American Journal of Orthopsychiatry, 86(1), 91.
Fulginiti, A., Rhoades, H., Mamey, M. R., Klemmer, C., Srivastava, A., Weskamp, G., & Goldbach, J. T. (2021). Sexual minority stress, mental health symptoms, and suicidality among LGBTQ youth accessing crisis services. Journal of Youth and Adolescence, 50(5), 893–905. https://doi.org/10.1007/s10964-020-01354-3
Gattamorta, K. A., Salerno, J. P., & Laporte, R. R. (2022). Family rejection during COVID-19: Effects on sexual and gender minority stress and mental health among LGBTQ university students. Lgbtq Family-an Interdisciplinary Journal, 18(4), 305–318. https://doi.org/10.1080/27703371.2022.2083041
Gattis, M. N. (2013). An ecological systems comparison between homeless sexual minority youths and homeless heterosexual youths. Journal of Social Service Research, 39(1), 38–49. https://doi.org/10.1080/01488376.2011.633814
Goldbach, J. T., Schrager, S. M., & Mamey, M. R. (2017). Criterion and divergent validity of the Sexual Minority Adolescent Stress Inventory. Frontiers in Psychology, 8, 2057. https://doi.org/10.3389/fpsyg.2017.02057
Gordon, A. R., & Meyer, I. H. (2007). Gender nonconformity as a target of prejudice, discrimination, and violence against LGB individuals. Journal of LGBT Health Research, 3(3), 55–71. https://doi.org/10.1080/15574090802093562
Green, A. E., Price, M. N., & Dorison, S. H. (2022). Cumulative minority stress and suicide risk among LGBTQ youth. American Journal of Community Psychology, 69(1–2), 157–168.
Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. https://doi.org/10.2105/Ajph.2012.301069
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford.
Herek, G. M. (2004). Beyond “homophobia”: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research & Social Policy: A Journal of the NSRC, 1(2), 6–24. https://doi.org/10.1525/srsp.2004.1.2.6
Herek, G. M. (2009). Hate crimes and stigma-related experiences among sexual minority adults in the United States: Prevalence estimates from a national probability sample. Journal of Interpersonal Violence, 24(1), 54–74. https://doi.org/10.1177/0886260508316477
Johnson, K. L., Gill, S., Reichman, V., & Tassinary, L. G. (2007). Swagger, sway, and sexuality: Judging sexual orientation from body motion and morphology. Journal of Personality and Social Psychology, 93(3), 321. https://doi.org/10.1037/0022-3514.93.3.321
Katz-Wise, S. L., Ehrensaft, D., Vetters, R., Forcier, M., & Austin, S. B. (2018). Family functioning and mental health of transgender and gender-nonconforming youth in the trans teen and family narratives project. The Journal of Sex Research, 55(4–5), 582–590.
Kelleher, C. (2009). Minority stress and health: Implications for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people. Counselling Psychology Quarterly, 22(4), 373–379. https://doi.org/10.1080/09515070903334995
Klaufus, L., Verlinden, E., van der Wal, M., Kosters, M., Cuijpers, P., & Chinapaw, M. (2020). Psychometric evaluation of two short versions of the Revised Child Anxiety and Depression Scale. BMC Psychiatry, 20(1), 47. https://doi.org/10.1186/s12888-020-2444-5
Klein, A., & Golub, S. A. (2016). Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT Health, 3(3), 193–199. https://doi.org/10.1089/lgbt.2015.0111
MacMullin, L. N., Bokeloh, L. M., Nabbijohn, A. N., Santarossa, A., van der Miesen, A. I., Peragine, D. E., & VanderLaan, D. P. (2021). Examining the relation between gender nonconformity and psychological well-being in children: The roles of peers and parents. Archives of Sexual Behavior, 50(3), 823–841.
McConnell, E. A., Birkett, M., & Mustanski, B. (2016). Families matter: Social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. Journal of Adolescent Health, 59(6), 674–680. https://doi.org/10.1016/j.jadohealth.2016.07.026
McGuire, J. K., Catalpa, J. M., Lacey, V., & Kuvalanka, K. A. (2016). Ambiguous loss as a framework for interpreting gender transitions in families. Journal of Family Theory & Review, 8(3), 373–385. https://doi.org/10.1111/jftr.12159
McGuire, J. K., Okrey-Anderson, S., Schaefer, C., Conner, J., & Berg, D. R. (2019). Measurement of family gender environment (FGE) in transgender and cisgender young and middle adolescents and their parents. Presentation at the 2019 Society for Research in Child Development (SRCD) Biennial Meeting, Baltimore, Maryland.
Meanley, S., Flores, D. D., Listerud, L., Chang, C. J., Feinstein, B. A., & Watson, R. J. (2021). The interplay of familial warmth and LGBTQ+ specific family rejection on LGBTQ+ adolescents’ self-esteem. Journal of Adolescence, 93, 40–52. https://doi.org/10.1016/j.adolescence.2021.10.002
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Mills, K. W. R., Rehder, P. D., & McCurdy, A. L. (2018). The significance of parenting and parent–child relationships for sexual and gender minority adolescents. Journal of Research on Adolescence, 28(3), 637–649. https://doi.org/10.1111/jora.12404
Mustanski, B. (2011). Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: A call to action for a scientifically informed approach. Archives of Sexual Behavior, 40(4), 673–686. https://doi.org/10.1007/s10508-011-9745-1
Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223. https://doi.org/10.1542/peds.2015-3223
Pachankis, J. E. (2015). A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Archives of Sexual Behavior, 44(7), 1843–1860. https://doi.org/10.1007/s10508-015-0480-x
Peterson, R. A. (1994). A meta-analysis of Cronbach’s coefficient alpha. Journal of Consumer Research, 21(2), 381–391. https://doi.org/10.1086/209405
Pollitt, A. M., Fish, J. N., & Watson, R. J. (2023). Measurement equivalence of family acceptance/rejection among sexual and gender minority youth by disclosure status. Journal of Family Psychology, 37(2), 195.
Puckett, J. A., Maroney, M. R., Levitt, H. M., & Horne, S. G. (2016). Relations between gender expression, minority stress, and mental health in cisgender sexual minority women and men. Psychology of Sexual Orientation and Gender Diversity, 3(4), 489–498. https://doi.org/10.1037/sgd0000201
Rhoades, H., Rusow, J. A., Bond, D., Lanteigne, A., Fulginiti, A., & Goldbach, J. T. (2018). Homelessness, mental health and suicidality among LGBTQ youth accessing crisis services. Child Psychiatry & Human Development, 49, 643–651.
Rieger, G., Linsenmeier, J. A., Gygax, L., Garcia, S., & Bailey, J. M. (2010). Dissecting “gaydar”: Accuracy and the role of masculinity–femininity. Archives of Sexual Behavior, 39, 124–140.
Robinson, B. A. (2018). Conditional families and lesbian, gay, bisexual, transgender, and queer youth homelessness: Gender, sexuality, family instability, and rejection. Journal of Marriage and Family, 80(2), 383–396. https://doi.org/10.1111/jomf.12466
Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. Wiley.
Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology, 12, 465–487. https://doi.org/10.1146/annurev-clinpsy-021815-093153
Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352. https://doi.org/10.1542/peds.2007-3524
Ryan, C., & Rees, R. A. (2012). Supportive families, healthy children: Hel** Latter-day Saint families with lesbian, gay, bisexual & transgender children. San Francisco State University.
Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205–213. https://doi.org/10.1111/j.1744-6171.2010.00246.x
Salerno, J. P., Gattamorta, K. A., & Williams, N. D. (2022). Impact of family rejection and racism on sexual and gender minority stress among LGBTQ young people of color during COVID-19. Psychological Trauma-Theory Research Practice and Policy, 15(4), 637–647. https://doi.org/10.1037/tra0001254
Sarno, E. L., Newcomb, M. E., & Mustanski, B. (2020). Rumination longitudinally mediates the association of minority stress and depression in sexual and gender minority individuals. Journal of Abnormal Psychology, 129(4), 355–363. https://doi.org/10.1037/abn0000508
Sattler, F. A., Zeyen, J., & Christiansen, H. (2017). Does sexual identity stress mediate the association between sexual identity and mental health? Psychology of Sexual Orientation and Gender Diversity, 4(3), 296–303. https://doi.org/10.1037/sgd0000232
Skidmore, W. C., Linsenmeier, J. A., & Bailey, J. M. (2006). Gender nonconformity and psychological distress in lesbians and gay men. Archives of Sexual Behavior, 35(6), 685–697. https://doi.org/10.1007/s10508-006-9108-5
Snapp, S. D., Watson, R. J., Russell, S. T., Diaz, R. M., & Ryan, C. (2015). Social support networks for LGBT young adults: Low cost strategies for positive adjustment. Family Relations, 64(3), 420–430. https://doi.org/10.1111/fare.12124
Spivey, L. A., & Prinstein, M. J. (2019). A preliminary examination of the association between adolescent gender nonconformity and suicidal thoughts and behaviors. Journal of Abnormal Child Psychology, 47(4), 707–716. https://doi.org/10.1007/s10802-018-0479-6
Thoma, B. C., Eckstrand, K. L., Montano, G. T., Rezeppa, T. L., & Marshal, M. P. (2021). Gender nonconformity and minority stress among lesbian, gay, and bisexual individuals: A meta-analytic review. Perspectives on Psychological Science, 16(6), 1165–1183.
Timmins, L., Rimes, K. A., & Rahman, Q. (2020). Minority stressors, rumination, and psychological distress in lesbian, gay, and bisexual individuals. Archives of Sexual Behavior, 49(2), 661–680. https://doi.org/10.1007/s10508-019-01502-2
Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2013). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Psychology of Sexual Orientation and Gender Diversity, 1(S), 71–80. https://doi.org/10.1037/2329-0382.1.S.71
Watson, R. J., Barnett, M. A., & Russell, S. T. (2016). Parent support matters for the educational success of sexual minorities. Journal of GLBT Family Studies, 12(2), 188–202.
Funding
This work was supported by Mammie Phipps Clark Diversity Research Grant 2020 (N-128617–01) through Psi Chi, The International Honor Society in Psychology.
Author information
Authors and Affiliations
Contributions
All authors were involved in the discussion, writing, and revision of the manuscript, and they gave the final approval of the version for submission.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Palmer, C.W., Francis, S.E. The Role of Family Rejection of Gender Expression on Minority Stress and Mental Health of Sexual and Gender Minority Adolescents. Sex Res Soc Policy (2023). https://doi.org/10.1007/s13178-023-00881-5
Accepted:
Published:
DOI: https://doi.org/10.1007/s13178-023-00881-5