Sexual orientation inequalities in mental health across adolescence and early adulthood: exploring the contribution of cumulative experiences of bullying and victimisation over time

Background

Sexual minority ([SM] or LGB+) adolescents experience mental health (MH) inequities and disproportionately high rates of bullying and victimisation. Less is known about the cumulative effects of bullying and victimisation across adolescence on MH in early adulthood, or the moderating role of loneliness and social support in this relationship.

Objective

To investigate cumulative effects of bullying and victimisation in adolescence on MH in early adulthood, including the role of loneliness/social support.

Methods

Drawing on a UK-wide nationally representative sample of individuals (N=12,872/LGB+ 22%) with self-reported bullying and victimisation assessed at ages 11/14/17/23, and MH (psychological distress/self-harm/attempted suicide) at age 23. Logistic models assessed separate associations between cumulative bullying or victimisation (0, 1, ≥2times) and MH, and differences by sexual identity (using appropriate interactions), with adjustment for loneliness and social support.

Findings

Across adolescence, SM individuals experienced higher prevalence of cumulative victimisation (3 times; gay/lesbian:22%, bisexual:22% vs heterosexual:9%) and bullying (2 times; gay/lesbian:35% and bisexual:27% vs heterosexual:18%).

Models revealed substantial inequalities with higher proportions of SM individuals reporting self-harm compared to heterosexual peers with the same levels of experienced victimisation. Among those reporting victimisation 1 and ≥2 times, 15% (95% CI 13-16%) and 23% (21-25%) of heterosexual individuals reported self-harm, increasing to 41% (33-50%) and 53% (47-59%) for bisexual, and 24% (10-39%) and 49% (40-59%) for gay/lesbian individuals, and 24% (11-38%) and 53% (39-67%) for other SM identities, respectively.

Similarly, for heterosexual individuals experiencing victimisation 1 and ≥2 times, 6% (5-8%) and 13% (11-14%) reported attempted suicide respectively. This increased to 21% (13-29%) and 38% (33-44%) for bisexual, and 17% (6-29%) and 34% (24-44%) for gay/lesbian individuals experiencing victimisation 1 and ≥2 times, respectively.

A key finding was that adjustment for loneliness and lack of peer/family support reduced the proportions reporting adverse mental health by 15-45% among SM but not heterosexual individuals. Similar patterns by sexual identity were found for bullying and all indicators of MH.

Conclusions

SM individuals experience higher levels of cumulative bullying and victimisation across adolescence, which is associated with substantially higher rates of mental ill-health in early adulthood. Experiences of loneliness explain MH inequalities to greater extent in SM youth compared to heterosexual peers.

What is already known on this topic

Evidence shows that sexual minority adolescents report both higher levels of bullying and worse mental health compared to heterosexual peers. However, no study has comprehensively examined the cumulative impact of types of bullying (e.g., bullied by peers/siblings or victimised by adverse actions) across adolescence and mental health inequalities by sexuality in early adulthood when individuals navigate access to the labour market and higher education. The role of modifiable factors like social isolation and support remains less understood.

What this study adds

The compounding double disadvantage of sexual minority identity intersectionally layered with cumulative bullying histories across adolescence drive substantial inequities in mental health in early adulthood. Further, these inequities were substantially explained by loneliness and poor social support in sexual minority but not heterosexual young adults. This is the first study to demonstrate the long-term impact of different types and cumulative experiences of bullying in sexual minority sub-groups in a nationally representative sample.

How this study might affect research, practice or policy

Reducing social isolation and improving access to peer support can substantially reduce mental health problems including attempted suicide in sexual minority young adults.