_____________________________________________ Promoting the Health of Gender and Sexual Minorities
tremendous source of stress for some youth, and the effects of frequent, repeated ridicule have been found to be cumula- tive [77]. Also, self-labeling at an earlier age exposes the GSM youth to verbal harassment and/or assault for a longer period of time. This longer exposure increases the risk of stress and the potential for damaging effects on the youth’s health unless access to helping resources is provided. This increased risk for GSM youth may be the result of externalized and internalized homophobia that is more pronounced during adolescence than at other times in the life cycle [78]. The effects of ridicule should also be applied to transgender youth. Young gay men are more likely than heterosexual men to experience increased harassment, especially if they display behaviors that are interpreted as feminine [72]. The effects of prolonged, chronic stress associated with discrimination may contribute to health problems, such as hypertension, in adult gay men [79]. LGBTQIA youth may employ many coping strategies in an attempt to understand themselves and their place in society. Some may withdraw physically and emotionally, perhaps in an effort to avoid discovery. Others may turn to substance use or develop eating disorders. Among LGBTQIA youth, the rates of suicide ideation and attempts have been reported to be alarmingly high [80]. Some LGBTQIA youth strive for academic or athletic achievement, perfectionism, or become overly involved in extracurricular activities in an effort to avoid their feelings [10]. Still others, as a reaction against unacceptable thoughts and attractions, may exaggerate their heterosexuality and engage in promiscuous behavior [81]. Many become homeless. According to a report published by the National LGBTQ Task Force (NLGBTQTF), an estimated 20% to 40% of the 1.6 million homeless American youth are LGBT [82]. Some of these youth, when they came out to their parents or guardians, were told to leave home. Some left home to escape physical, sexual, or emotional abuse. Youth who end up at homeless shelters have also reported being threatened, belittled, and abused by shelter staff [82].
Legal events have occurred that demonstrate a growing aware- ness of the specific legal needs of the GSM youth population. For example, in 1996, a gay student in the Wisconsin public school system was awarded over $900,000 in damages when a federal jury found school officials liable for not protecting the student, who had experienced several years of harassment, including physical and psychological assault. During the years of harassment, the student had dropped out of school twice, required surgeries for injuries from assaults, run away from home, and tried to kill himself several times. He was subse- quently diagnosed with post-traumatic stress disorder [83]. In the spring of 2009, an 11-year-old Massachusetts boy died by suicide after enduring constant bullying at the middle school he attended, including being called “gay” and “faggot,” even though the boy had not identified himself as gay [84]. Just two weeks later, the suicide of an elementary school student in Georgia was also attributed to anti-LGBT bullying. This student also had not identified himself as gay. Their deaths prompted the introduction of the Safe Schools Improvement Act, H.R. 2262. This act (which amends the Safe and Drug-Free Schools and Communities Act of 1994) requires schools to implement comprehensive antibullying policies and to include bullying and harassment data in their needs assessment report- ing. Any school that receives federal funding must implement an antibullying policy that identifies categories often targeted by bullies, such as race, religion, sexual orientation, and gender identity/expression [85]. GSM youth must eventually develop interpersonal skills that allow them to meet other GSM youth. Like other adolescents, they must develop a sense of personal attractiveness and a healthy self-esteem while learning that risky sexual activity, more common among these adolescents, does not promote emotional health. They must learn same-sex relationship skills while integrating their public and private selves to create their LGBTQ identity. Not all LGBTQIA youth experience difficul- ties; many are resilient and resourceful, manage stressors well, and develop into productive and healthy adults [86]. Research exploring development of this resiliency is needed. There is a vital connection between a sense of community and psychological well-being. While other minorities have family to role model for them and protect them, sexual minority youth usually do not have such support. Sexual minority adults who could serve as positive role models may fear that they will be accused of “recruiting members” or behaving inappropriately [10]. Sexual minority adults are often sensitive to stimulating false beliefs among the general population. Although many LGBTQIA youth are self-disclosing at younger ages, many factors affect the decision to do so. For example, disclosure of one’s sexual orientation to healthcare providers may depend on where in the sexual identity process the indi- vidual finds herself or himself [62]. Physical factors, such as being deaf, or social factors, such as financial support, may also have an impact on the coming-out process. Disclosing too early
The American Academy of Child and Adolescent Psychiatry recommends that clinicians should inquire about circumstances commonly encountered by youth with sexual and gender minority status that confer increased psychiatric risk,
including bullying, substance abuse, and suicide. (https://www.jaacap.org/article/S0890- 8567(12)00500-X/fulltext. Last accessed September 27, 2024.) Level of Evidence : Expert Opinion/Consensus Statement
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