Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-Analysis

Introduction: Lesbian, Gay and Bisexual (LGB) adolescents are at disproportionate risk for substance use. It is therefore crucial to understand the risk factors for substance use among LGB adolescents, particularly those unique to their minority status. This study presents results from a systematic review and meta-analysis that attempted to synthesize the current knowledge of minority-related risk factors for substance use among LGB youth..

Methods: This literature search yielded 64 articles that were retrieved and screened for eligibility. Ultimately, 15 reports representing 12 unique LGB samples were eligible. We used standard meta-analysis procedures to synthesize correlation effect sizes (r) across studies. We calculated 86 effect sizes, and categorized these into eight broad minority stress categories: gay-related disclosures, gender/sexual identity, stress, victimization, supportive environment, demographics, and other individual characteristics. We then calculated the random effects mean effect size within each risk category.

Results: Negative disclosure reactions were significantly correlated with substance use among LGB youth (,𝑟. = .24). Sexual identity acceptance was a significant predictor of substance use (,. = .10). There was also evidence that gender identity (,𝑟. = .13) had a modest but statistically significant correlation with substance use. Both general measures of stress (,𝑟. = .19), as well as gay-related stress (,. = .21), were significantly and positively correlated with substance use among LGB youth. There was a significant mean correlation between gay-related victimization and substance use (,. = .24). General victimization (i.e., not specifically gay-related) had an even stronger correlation (,. = .60).  Parental support (,. = .21) and support from other adults at school (,. = .39) both had significant correlations with substance use among LGB youth. Race, and gender had small but statistically significant correlations, as did housing status, internalizing behavior, and externalizing problem behavior.

Conclusions: Negative disclosure reactions were related to higher rates of substance use, but positive disclosure reactions and self-esteem were not associated with substance use. Although numerous studies reported that stress and victimization were related to substance use, the lack of measurement specificity meant it was impossible to assess the extent to which that stress/victimization was gay-related or not, which may have important implications for prevention intervention. Further study, with more sensitive measurement strategy, is needed to clearly understand the relationship between these minority stressors and substance use outcomes.