NIMH Grant Addresses Mental Health Crisis Among Sexual Minority Adolescents:

In May 2023, Brian Feinstein, PhD, was awarded a $3.6 million, five-year National Institute of Mental Health grant to advance understanding of the development of rejection sensitivity among sexual minority adolescents and to inform interventions to improve their mental health. The work of Dr. Feinstein and his team comes at a time when, he said, the LGBTQ+ community is seeing a new rise in “messaging that ‘who you are is not accepted in society’” — a scenario that he believes could have long-term consequences on their well-being.

Helix sat down with Dr. Feinstein to ask about the logistics of his latest research project and the challenges to health and well-being faced by sexual minority youth and adults.

Helix: The Emergency Care Research Institute (ECRI) this spring listed pediatric mental health as the leading patient safety concern of 2023, describing it as a “national public health emergency.” What are sexual minority adolescents (SMA) in particular experiencing right now?

Dr. Feinstein: I absolutely agree that there is a national crisis with respect to pediatric mental health, and there is a dire need for a better understanding of youth mental health and greater access to mental health care for youth. We’ve known for decades that sexual minority youth are disproportionately affected by nearly every adverse mental health outcome — they are more likely than heterosexual youth to experience mood and anxiety disorders, to use substances, and to seriously consider, attempt and die by suicide — and these disparities are rooted in their exposure to rejection, discrimination and victimization.

“We’ve known for decades that sexual minority youth are disproportionately affected by nearly every adverse mental health outcome.”

From a logistical perspective, how will you be collecting data for your study?

We’re going to be recruiting 500 sexual minority adolescents ages 14 to 17 throughout the United States. All of our procedures are remote; participants will complete online surveys at four different time points across a year and a half. In addition, at two different time points, the experience-sampling component comes in — participants will download an app on their phones and, for three weeks at a time, they’ll be answering questions four times a day. We’ll be getting a lot of in-the-moment, real-time data about what they’re experiencing.

Your study will include a longitudinal and experience-sampling study using methods established in your prior work. What can you tell us about this previous research and what you’ve learned about sexual minority adolescents?

I’ve done a lot of work focused on the construct of rejection sensitivity, which refers to both an expectation that somebody’s going to be rejected and feelings of anxiety about being rejected. What we see with sexual minority people in particular is that having a history of experiencing rejection, for example, being bullied or victimized because of one’s identity, can contribute to developing a sense that people are going to continue to reject you in your day-to-day life. Even when that’s not happening, simply carrying with you this kind of mindset — expecting and worrying about rejection — can continue to contribute to depression, suicidal ideation and other adverse mental health outcomes.

“... we don’t know much about how experiencing, expecting and worrying about rejection contribute to increases or changes in mental health over time.”

You point to the fact that nearly all prior studies on mental health among sexual minorities have been cross-sectional studies of adults.

One of the major limitations is that most of the work in this area has been solely focused on adults, and most of it has studied people at a single time point, so we don’t know much about how experiencing, expecting and worrying about rejection contribute to increases or changes in mental health over time.

My colleagues and I are particularly interested in how these processes unfold at the daily level. If a sexual minority adolescent experiences rejection or if they’re worried about rejection, does that contribute to them feeling more depressed an hour later, or that evening, or the next day? One of the goals of this project is really to understand these temporal dynamics; in other words, we want to know how long experiencing, expecting and worrying about rejection influences sexual minority adolescents’ mental health.

How effective are current interventions aimed at improving the mental health of the SMA population?

The reality is that there’s a lack of interventions that have been developed specifically for addressing the unique challenges that sexual minority adolescents face. Frankly, this isn’t very different for adults, where it’s only in the last maybe five to 10 years that interventions have been designed to improve mental health by addressing the unique stressors that sexual minority people experience related to rejection, discrimination and internalizing negative societal attitudes toward their identity. We’re really in a very nascent stage of research when it comes to sexual minority youth.

When you mention negative societal attitudes, we’ve recently seen growing challenges to acceptance — multiple bills filed in more than 20 state legislatures targeting LGBTQ+ issues, like access to gender-affirming care and participation in sports by transgender athletes. What are your thoughts on the impacts these measures and advocacy for them might have on the SMA community?

I think the consequences of what we’re seeing now are going to be pretty dire and long-lasting. There’s data to support that when sexual minority youth and adults live in states that have more affirming laws and policies that specifically name sexual orientation as a protected characteristic, they fare better in terms of their mental health than those living in states without affirming laws and policies.

The sociopolitical climate for LGBTQ+ people had been getting better in some respects — and that’s not to say that it won’t continue to improve in some places — but unfortunately, with all of the recent anti-LGBTQ+ legislative efforts, LGBTQ+ youth are receiving messages, often on a daily basis, that they’re not valued in society. Their literal rights and access to health care are being taken away. Over the next five to 10 years, we’re likely to see growing inequities based on what’s happening right now.

“... one of the outcomes [of the study] will be that we’ll be letting them know that there are people out there who care about them and their mental health.”

With that in mind, along with generating data that will inform interventions generally, what are some ideal outcomes of your research and the advancements it might generate?

For the 500 sexual minority adolescents that we’ll be recruiting into the study, one of the outcomes will be that we’ll be letting them know that there are people out there who care about them and their mental health.

A lot of youth don’t have that — they don’t have opportunities to share the experiences they’re having. What we often find in our work with sexual minority adolescents is they’re so eager just to have adults who want to hear what’s going on in their lives. I hope our research will increase the visibility of the need to understand and address the mental health challenges facing sexual minority youth, while letting sexual minority youth know that they’re not alone.

Dan Moran is the communications director with RFU’s Division of Marketing and Brand Management.