Mental health symptoms and severity differed across a cohort of lesbian, gay, bisexual, and questioning (LGBQ) adolescents, highlighting the need to consider behavioral health separately for each group.

Lesbian, gay, or bisexual youth demonstrate higher rates of depression, anxiety, self-harm, and suicidal ideation than do youth who identify as heterosexual, several studies have reported. Youth who identify as “unsure” or “questioning” are at an even higher risk of suicidality, depression, and victimization than their LGB counterparts.

With a lack of research focusing on the subgroup of youth identifying as questioning or bisexual, Annie Shearer and her colleagues at Drexel University in Philadelphia sought to assess the behavioral health of heterosexual and LGBQ youth in a large primary care sample ( J Adolesc Health. 2016. doi: 10.1016/j.jadohealth.2016.02.005 ).

The cohort included 2,513 youth aged 14-24 years, with 61% female. Same sex attraction was reported in 2%, attraction to both sexes was reported in 4%, attraction to the opposite sex was reported by 92%, and unsure sexuality preferences were reported in 2%.

The study was conducted using a Web-based screening tool, the Behavioral Health Screen owned by the Children’s Hospital of Philadelphia, in 10 primary care offices in semiurban and rural communities. Deidentified data were collected on demographics, social factors, medical history, and psychiatric factors including depression, anxiety, substance use, suicidality, and trauma.

An analysis of the data demonstrated females identifying as questioning or bisexual had higher scores for traumatic distress, anxiety, and depression than did their heterosexual peers; there were no differences among lesbian, bisexual, or questioning females in these areas. Female youth in those three sexual minority groups had significantly higher lifetime suicide scores. Bisexual females reported higher scores for current suicide as well as substance abuse.

Male participants identifying as bisexual or gay reported significantly higher scores for traumatic distress and depression, with gay participants reporting higher anxiety scores. Bisexual male youth had significantly higher lifetime suicide scores. There did not appear to be a higher risk for questioning males. There were no differences between the groups in terms of current suicide or substance use scores.

Study limitations included the complex nature of sexuality and the self-reported nature of the data, the investigators noted.

“Our findings underscore the willingness of sexual minority youth to disclose the same-sex attractions in PC [primary care] settings,” the authors concluded. “Medical providers should in turn be receptive to this information and engage youth in conversations about these issues, particularly in contexts where the same-sex or bisexual attractions are stigmatized.”

“Although sexual orientation does not cause mental illness,” clinicians should be aware of the association between LGBQ status and mental health, Ms. Shearer and her colleagues said.

The study was funded by a grant from the Substance Abuse and Mental Health Services Administration. Coauthor Guy Diamond, Ph.D., reported potential royalty payments if the Behavioral Health Screen is made public.