Box Turtle Bulletin

Study Identifies Link Between Rejecting Parents and Negative Health Among LGB Youth

Caitlin Ryan, David Huebner, Rafael M. Diaz, Jorge Sanchez. “Family rejection as a predictor of negative health outcomes in White and Latino Lesbian, Gay and Bisexual young adults.” Pediatrics 123, No. 1 (January 2009): 346-352. (DOI: 10.1542/peds.2007-3524)

In a new paper published this month, Dr. Caitlin Ryan and her colleagues at San Francisco State University were able to demonstrate a predictive link between specific, negative family reactions to their child’s sexual orientation and serious health problems for these adolescents in young adulthood. According to this study, such adverse health problems include depression, illegal drug use, risk for HIV infection, and suicide attempts. This study appeared in the January issue of the journal Pediatrics, the official journal of the American Academy of Pediatrics, and is being hailed as a landmark departure from previous studies, which tended to look at a wider range of sources of social rejection — schools, peers, etc. This study looked specifically at parental acceptance or rejection and its impact on LGB youth health.

The study was based on questionnaires administered to a sample of 224 white and latino LGB young adults, aged 21 to 25, and open about their sexual orientation to at least one parent or guardian. (Twenty-one additional participants who identified as transgender were also recruited, but their numbers were too small for statistical analysis, and thus were excluded from this particular study.) Participants were recruited through various venues, including bars, clubs, LGBT service agencies and community groups, all within 100 miles of San Francisco.

On average, participants became aware of their same-sex attractions at the age of 10.76 years. They came out to themselves at age 14.16 on average, came out to others at age 15.32 on average, and came out to family at age 15.82 on average. Men were on average aware of their same-sex attractions about two years earlier than women, and they came out to themselves about one year earlier than women.

Study participants were asked a series of questions resulting in 51 close-ended items that assessed the presence and frequency of each rejecting parental or guardian reaction to the participant’s sexual identity when they were teenagers. The questionnaire used, the FAP Family Rejection Scale, has a high internal consistency (Cronbach’s α = .98).

Levels of depression were assessed using the Center for Epidemiologic Studies Depression Scale. Substance use and abuse were quantified in 3 ways: heavy alcohol drinking in the past 6 months, use of illicit drugs in the past 6 months, and substance use–related problems in the last 5 years. Sexual behavior was assessed in the last 6 months by asking about number, gender, and type of sexual partners, type of sexual activity, and whether condoms were used when activity involved anal or vaginal penetration.

Compared to peers who reported no or low levels of family rejection, LGB young adults who reported higher levels of family rejection during adolescence were:

• 8.4 times more likely to report having attempted suicide,
• 5.9 times more likely to report high levels of depression,
• 3.4 times more likely to use illegal drugs,
• 3.4 times more likely to engage in unprotected sexual intercourse.

To give you an idea of how dramatic an effect that higher levels of family rejection can have on an individual, here’s something else to ponder. Compared to peers who reported no or low levels of family rejection, LGB young adults who reported only moderate levels of family rejection during adolescence were:

• 2.3 times more likely to report having attempted suicide,
• 2.9 times more likely to report high levels of depression,
• 1.4 times more likely to use illegal drugs,
• about as likely (1.04 times) to engage in unprotected sexual intercourse.

Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence.

While these findings are very important, it’s important to keep in mind some of the study’s limitations. The biggest one that jumped out at me — and one the research authors didn’t address — was whether there were any confounding factors leading to these outcomes. For example, in this particular sample, what were the subjects’ experiences with peer rejection, bullying or violence? If subjects who experienced a high degree of rejection by their parents also happened to experience a greater degree of bullying, for example, then outcomes attributed to rejecting parents could have been affected by bullying as well. Since the researchers weren’t able to control for those outside factors, we don’t really know what, if any, external influences may have contributed to these outcomes.

And also, this study has all the usual weaknesses of virtually every other social science study. The authors caution:

There are several limitations to the study. This is a retrospective study that measures young adults’ reported experiences that occurred several years earlier, which may introduce some potential for, recall bias. To minimize this concern, we created measures that asked whether a specific family event related to their LGB identity actually occurred (eg, verbal abuse), rather than asking generally about “how rejecting” parents were. Although we went to great lengths to recruit a diverse sample drawing from multiple venues, our sample is technically one of convenience, and thus shares the limitations inherent in all convenience samples. Thus, these data might not represent all subpopulations of LGB young adults, as well as individuals who are neither white nor Latino. The study focused on LGB non-Latino white and Latino young adults to permit more in-depth assessment of cultural issues and experiences related to sexual orientation and gender expression, so it did not include all other groups and drew from 1 urban geographic area. Subsequent research should include greater ethnic diversity to assess potential differences in family reactions. Lastly, given the cross-sectional nature of this study, we caution against making cause–effect interpretations from these findings.

Nevertheless, this study highlights some important implications for identifying youth at risk for family violence and for being ejected from their homes. We know that LGB youth are overrepresented in foster care, juvenile detention, and among homeless youth. And we also know that conflict over an adolescent’s sexual and gender identity is one of the primary reasons for being kicked out of the home. And for whatever reason, this study seems to suggest that Latino gay and bisexual men are at a particularly higher risk of being rejected by their parents.

This study opens a long-neglected area of research. Further research which replicates and improves on this study is badly needed. But one thing for certain, those groups — specifically, certain ex-gay groups come to mind — which encourage parents to engage in rejecting behaviors with their children bear a tremendous responsibility. The cost to the well-being of LGB youths can be staggering.