Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Mar 1.
Published in final edited form as: J Fam Psychol. 2024 Jan 15;38(2):201–211. doi: 10.1037/fam0001183

Stigma and Anxiety and Depressive Symptoms in Parents of Sexual and Gender Minority Youth

Kirsty A Clark 1,2, Alexandra P Argiros 2, Lea R Dougherty 3, John E Pachankis 4
PMCID: PMC10922310  NIHMSID: NIHMS1948054  PMID: 38227468

Abstract

Parents of sexual and gender minority (SGM) youth play an important role in supporting their SGM child’s mental health in the face of stigma. Yet, parents of SGM youth may themselves experience stigma, including discrimination/rejection, and its emotional consequences, including vicarious stigma and shame. The current cross-sectional study leveraged a national sample of parents of SGM youth to investigate associations between parents’ stigma experiences and self-reported anxiety and depression symptoms. Further, we additionally explored sociodemographic and contextual correlates of parents’ stigma experiences. Participants included 264 parents (Mage = 46) who reported having at least one SGM child under age 30 (Mage = 18). The LGB-Affiliate Stigma Measure (LGB-ASM) assessed parents’ experiences of discrimination/rejection (e.g., actual and anticipated rejection experiences due to having an SGM child), vicarious stigma (e.g., worry and concern for one’s SGM child), and shame (e.g., feeling embarrassed for having an SGM child). Parents indicated their anxiety and depressive symptoms using respective PROMIS-short forms. Results showed that vicarious stigma and shame, but not discrimination/rejection, were uniquely associated with parents’ increased symptoms of anxiety (vicarious stigma: β = 1.59, p < .001; shame: β = 2.15, p < .001) and depression (vicarious stigma: β = 0.90, p < .01; shame: β = 2.77, p < .001). Further, parents with more accepting religious, racial, ethnic, and/or cultural communities reported lower stigma experiences. This study advances understanding of how the psychological consequences of stigma extend beyond SGM people themselves and contribute to mental health difficulties in parents of SGM youth.

Keywords: stigma, minority stress, shame, mental health, parenting

Introduction

In recent years, there has been a sharp increase in the number of sexual and gender minority (SGM) youth who are coming out at younger ages, and approximately one in four U.S. teens now identify as lesbian, gay, bisexual, queer, or questioning (Fish, 2020; Mpofu et al., 2023). As a result, an expanding cohort of parents and caregivers is faced with the important task of navigating the complexities of parenting an SGM child. Although considerable research has focused on understanding the vital role parents play in supporting their SGM children (e.g., Abreu et al., 2019; Bouris et al., 2010), limited attention has been directed toward examining the experiences of parents themselves in terms of exposure to stigma due to their affiliation with their SGM child. Minority stress theory (Brooks, 1981; Meyer, 2003) posits that exposure to stigma, underpinned by anti-SGM social and structural norms, drives adverse mental health outcomes among SGM people, a tenet empirically supported in meta-analyses (de Lange et al., 2022; Dürrbaum & Sattler, 2020). Yet, the psychological impact of stigma on parents of SGM youth remains a relatively underexplored area of research, leaving a significant void in understanding how anti-SGM stigma may impact broader family systems, potentially influencing not only the mental health of SGM youth but also that of their parents.

Stigma Experiences and Parents of SGM Children

A strong body of qualitative research shows that parents of SGM children experience exposure to anti-SGM stigma and discrimination and its emotional consequences including worry and concern for their child’s wellbeing, and feelings of shame, guilt, and self-blame. For example, qualitative studies with family members, mostly parents, of LGB individuals conducted in the months leading up to and following the 2006 passage of state-level same-sex marriage ban amendments identified prevalent themes of anti-SGM stigma including worry for an LGB family member’s well-being and safety, concerns about being personally judged and avoiding conversations about gay rights, and related feelings of anger, anxiety, distress, hurt and depression related to the marriage amendments (Arm et al., 2009; Horne et al., 2011). In a qualitative study characterizing the experiences and needs of parents of gender minority children, parents’ stigma experiences were widespread including facing negativity and safety concerns, losing friends and family members, being ostracized, and experiencing hostility and harassment (Riley et al., 2011). Recent qualitative research with parents of gender minority children conducted in the wake of state-level bans on gender-affirming care identified many similar themes, including concerns for their child’s safety, fears and worries about feeling unable to protect their child, and parents’ anxiety and anger (Abreu et al., 2022). In another qualitative study, similar fears and worries were echoed by parents of gay and lesbian youth as well as feelings of guilt, shame, self-blame, and concern about societal perceptions of them and their child (LaSala, 2010).

Sparked in part by the robust qualitative research documenting stigma experiences in parents of SGM youth, Robinson and Brewster (2016) developed and evaluated a measure assessing stigma experiences in family and friends of LGB people – the LGB affiliate stigma measure (LGB-ASM). Exploratory and confirmatory factor analyses yielded three factors, including discrimination/rejection (i.e., discrimination or rejection due to affiliation with an LGB loved one), vicarious stigma (i.e., worry/concern experienced when an LGB loved one is affected by prejudice and discrimination), and shame (i.e., feelings of shame or guilt about being affiliated with an LGB loved one). Yet despite the scale’s promise in assessing multiple domains of stigma experiences in parents of SGM youth, only two studies to date have used the LGB-ASM, neither of which linked parents’ stigma experiences to mental health outcomes. One study examined associations between LGB-ASM subscales and attachment style in parents of LGB individuals, finding that greater parental stigma exposure was significantly associated with higher levels of parental insecure attachment (Mastropaolo et al., 2018). The other study examined socio-cultural correlates of the LGB-ASM in two Chinese communities and found that greater endorsement of Western culture and less perceived anti-SGM stigma were associated with less self-reported stigma experiences (Yao et al., 2021). However, in the latter study only a quarter of the sample reported having an LGB close friend or family member.

Two studies have quantitatively linked vicarious stigma to parental mental health, yet neither used the comprehensive LGB-ASM assessment or involved parents of transgender children. One of these studies of parents of LGB children found that concern about a child’s marginalization due to their LGB identity was associated with worse parental psychological functioning (Rith, 2020). Another study found that parents’ child-oriented concern (i.e., worry about how their child’s LGB identity may negatively impact their child’s life and well-being) and family-oriented concern (i.e., worry about their child’s LGB identity interfering with family expectations and responsibilities) were positively associated with parents’ anxiety and depressive symptoms, respectively (Chan et al., 2022). These studies suggest that vicarious stigma may be associated with mental health difficulties in parents of SGM youth, calling for additional research to characterize associations between other stigma domains identified in the LGB-ASM (i.e., discrimination/rejection and shame) and parent mental health.

The Present Study

To date, a robust body of qualitative research has depicted how parents of SGM youth experience anti-SGM stigma, including discrimination/rejection and its emotional consequences, including vicarious stigma, and shame. Yet, quantitative research on parents’ stigma experiences has been nearly nonexistent, limiting empirical understanding of how the negative psychological consequences of anti-SGM stigma may extend beyond SGM people themselves to affect the psychological wellbeing of their parents. Consequently, in a national sample of parents of SGM youth, we investigated parents’ stigma experiences and associations with parents’ self-reported symptoms of anxiety and depression.

First, to examine how parents’ stigma experiences contribute to mental health, we used the psychometrically validated LGB-ASM to examine associations among three domains of stigma experiences (i.e., discrimination/rejection, vicarious stigma, shame) and parents’ self-reported anxiety and depression. We hypothesized that parents who reported more stigma experiences would have greater anxiety and depressive symptoms. Second, to uncover parents most in need of support, we assessed associations among stigma experiences and both sociodemographic (e.g., race/ethnicity, age, sexual orientation) and contextual (e.g., religious and cultural community norms) factors. This aim was more exploratory in nature, so we did not make any hypotheses related to sociodemographic correlates of parents’ stigma experiences.

Method

Participants and Procedures

Between 2018 and 2019, parents residing in the US with at least one SGM child1 younger than 30 years old were invited to complete the Supporting Parents to Affirm their Children’s Experiences of Stigma (SPACES) study. The SPACES study involved an online, cross-sectional survey of parent-child relationship factors and parent and child mental health. Parents with multiple SGM children were directed to keep one child in mind as they completed the survey. SPACES participants were recruited through multi-pronged non-probability sampling approaches leveraging partnerships with national SGM parent-focused organizations (e.g., PFLAG) including through online advertisements (e.g., Facebook, Google), targeted e-mail listservs, community-based flyers, and word-of-mouth. Informed consent was obtained from all participants, and participants who completed the SPACES study received a $10 gift card. After screening for bots, duplicates, and fraudulent responses, 264 valid responses were included in the final sample. The SPACES study was approved by the University of Maryland Institutional Review Board. Previous research drawing upon the SPACES study sample has reported upon parents’ explicit and implicit acceptance and rejection towards their SGM child and associations with child mental health (Clark et al., 2021; Hubachek et al., 2023) as well as parents’ perspectives on supportive intervention content for parents of SGM youth (Seager van Dyk et al., 2022).

Measures

Sociodemographic Characteristics

Parent Demographics.

Parents reported their own age (in years). Sexual orientation included six possible response options: heterosexual; gay; lesbian; bisexual; queer; uncertain, don’t know for sure. For statistical analyses, respondents who selected gay and lesbian were collapsed into a single category. A question assessing gender identity had 10 possible response options: man, woman, transgender man, transgender woman, gender queer, gender non-conforming, Two-Spirit, Hijra, other, and I don’t know. For statistical analyses, gender identity was collapsed into a binary variable denoting parents who selected man or woman versus those who selected one of the 8 other diverse gender identities. Educational attainment had eight possible response options: some high school, high school diploma or GED, some college or Associate’s Degree, currently enrolled in college, 4-year college degree, some graduate school, currently enrolled in graduate school, and graduate degree. For statistical analyses, this variable was collapsed to denote respondents as attaining a 4-year college degree versus not. A question assessing marital status had six possible response options: married, living with partner, divorced, single, widowed, and other. For statistical analyses, this variable was collapsed to a binary variable denoting respondents as married or living with partner versus divorced, separated, widowed, or single. A question assessing race had six possible response options: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White, and Multiracial. For analyses, this variable was collapsed to denote respondents as White versus a person of color. Additionally, participants reported whether or not they identified as Hispanic or Latino.

SGM Child Demographics.

Parents reported their SGM child’s age (in years). A question assessing the child’s sexual orientation had six possible response options: heterosexual; gay; lesbian; bisexual; queer; uncertain, don’t know for sure. Gay and lesbian were combined for analyses. Parents reported this child’s sex assigned at birth as male, female, or intersex. No respondents selected that their child was intersex. A question assessing the child’s current gender identity had 10 possible response options: man/boy, woman/girl, transgender man/boy, transgender woman/girl, gender queer, gender non-conforming, Two-Spirit, Hijra, other, and I don’t know. Using the sex assigned at birth and current gender identity questions, child’s gender identity was classified as cisgender (sex at birth congruent with child’s gender identity) or transgender (sex at birth incongruent with child’s gender identity). Parents were also asked how old (in years) their child was when they found out about their child’s SGM identity.

Sociocultural Context.

Several questions assessed parents’ sociocultural context. Parents reported their religious affiliation and state of residence. State of residence was classified into one of four U.S. Census Regions (West, Midwest, South, Northeast). A question assessing hometown urbanicity asked parents to describe the area in which they grew up based on five possible response options: large central city, medium size city, suburb of a large or medium size city, small city, or town/village/unincorporated area. For statistical analyses, these options were collapsed to denote those who grew up in an urban area versus small city or rural area. Parents also reported whether any co-parent is aware of their child’s SGM identity using the following response options: yes, no, I don’t know, no co-parent. For analyses, the latter three options were collapsed. Additionally, two questions developed for the SPACES study assessed the degree to which parents perceived that their cultural and religious communities were open/accepting of SGM people using a scale ranging from 0 (not at all) to 5 (very much) (i.e., “Do you feel that your race, ethnicity, and/or culture is open to LGBTQ individuals?”; “Does your religion accept LGBTQ individuals?”).

Parents’ Stigma Experiences

A revised Lesbian, Gay, Bisexual AS Measure (LGB-ASM), a 17-item scale that was developed and validated in a sample of family members and close friends of LGB people (Robinson & Brewster, 2016), was used to assess stigma experiences in parents of SGM youth. The LGB-ASM assesses stigma experiences and related emotional consequences across three subscales: discrimination/rejection (e.g., actual and anticipated rejection experiences due to having an SGM child), vicarious stigma (e.g., worry and concern for one’s SGM child) and shame (e.g., feeling embarrassed for having an SGM child). Participants rate their level of agreement with items on a scale from 1 (strongly disagree) to 6 (strongly agree) with an option for “not applicable” if the item was not relevant. Relevant items were averaged to compute subscale scores; “not applicable” responses were considered missing and did not contribute to averages. We revised LGB-ASM items to be inclusive of minority gender identities (i.e., revising ‘LGB’ to ‘LGBTQ’) and to focus specifically on the stigma experiences of parents with an SGM child (i.e., changing ‘family member or close friend’ to ‘child’). Internal consistency was high across the subscales (discrimination/rejection, α = .94; vicarious stigma, α = .93; shame, α = .94).

Parent Mental Health

Anxiety and Depressive Symptoms.

Anxiety and depressive symptoms were assessed separately with the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety – Short Form 8a and the PROMIS Depression – Short Form 8a. These 8-item instruments assess past-week symptoms of anxiety (e.g., overwhelming worry, hyper-arousal) and depression (e.g., worthlessness, hopelessness), respectively, over the past week on a scale from 1 (never) to 5 (always; Cella et al., 2010; Pilkonis et al., 2011). For each scale, a sum score was calculated from the raw scores of all items, with higher scores reflecting more symptoms. Internal consistency was high for both scales (anxiety α = .93; depression α = .96).

Statistical Analyses

De-identified data, study materials, and study analysis code are available upon reasonable request from the authors. This study was not pre-registered. Statistical analyses were conducted in SAS version 9.4. Descriptive statistics including frequencies and proportions for categorical variables and means and standard deviations for continuous variables were used to summarize variables of interest.

To test our hypotheses, we conducted three sets of linear regression models to model associations between parents’ stigma experiences and their mental health: (1) univariate associations between each stigma experiences subscale and anxiety and depressive symptoms; (2) multivariable associations between each stigma experiences subscale and anxiety and depressive symptoms adjusted for parent age, sexual orientation, gender identity, educational attainment, marital status, race, and ethnicity; and (3) multivariable associations between all stigma experiences subscales entered together and anxiety and depressive symptoms, respectively. Model predictors were assessed for multicollinearity and model fit was assessed with R-squared, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) values.

To conduct exploratory analyses to assess associations between parent demographics, SGM child demographics, sociocultural context, and each of the stigma experiences subscales, we ran separate univariate linear regression models regressing each of the three stigma experiences subscales (dependent variables) onto each parent demographic (e.g., age), SGM child demographic (e.g., sexual orientation), and sociocultural context (e.g., perceived religious acceptance of SGM people) variables. Univariate associations significant at p < 0.10 were then entered into a multivariable model to assess adjusted relationships between parent demographics, SGM child demographics, sociocultural context, and each of the stigma experiences subscales. Of note, the variable measuring level of acceptance of one’s religious community was not entered into any multivariable models because doing so excluded 78 respondents who reported being religiously unaffiliated.

Across study variables, there was very little missing data, ranging from n = 1 (0.4%) missing a vicarious stigma score and n = 8 (3.0%) missing parent age, with 94% of the SPACES sample having complete data across all measured variables; thus, we handled missing data with listwise deletion. We report estimates, 95% confidence intervals (CI), and p-values. Analyses were two-tailed and statistical significance was assessed at p < 0.05.

Results

Sociodemographic Factors

Parent demographics, SGM child demographics, and sociocultural context variables are summarized in Table 1. Regarding parent demographics, parents were, on average, 46 years old (SD = 8.5). Most parents identified as heterosexual (77.7%) or bisexual (15.5%) and as women (79.9%). Most parents were White (85.2%) and non-Hispanic (85.6%). More than half the sample had obtained a 4-year college degree or completed graduate school (61.4%). Approximately two-thirds of the sample was married (67.1%) with 14.0% being divorced or separated.

Table 1.

Sample sociodemographic factors, N = 264

Variable n / [M] % / [SD]
Parent Demographics
Age (n = 256) [45.55] [8.52]
Sexual orientation
 Heterosexual 205 77.65
 Gay/Lesbian 10 3.79
 Bisexual 41 15.53
 Queer 6 2.27
 Uncertain; don’t know for sure 2 0.76
Gender identity
 Man 48 18.18
 Woman 211 79.92
 Transgender man 2 0.76
 Transgender woman 0 0
 Gender queer 2 0.76
 Gender non-conforming 1 0.38
Highest education
 High school diploma or less 35 13.26
 Some college or associate’s degree/currently enrolled 67 25.38
 4-year college degree 66 25.00
 Some or completed graduate school 96 36.36
Marital status
 Married 177 67.05
 Living with partner 24 9.09
 Divorced / separated 37 14.02
 Single 23 8.71
 Widowed 3 1.14
Hispanic
 Yes 38 14.39
 No 226 85.61
Race/ethnicity
 American Indian or Alaska Native 6 2.27
 Asian 6 2.27
 Black/African American 18 6.82
 Native Hawaiian or other Pacific Islander 1 0.38
 White 225 85.23
 Multiracial 8 3.03
SGM Child Demographics
Age [18.38] [5.27]
Age offspring came out to parent (n = 262) [15.15] [4.85]
Years since offspring came out to parent (n = 261) [3.67] [3.43]
Sexual orientation
 Heterosexual 11 4.17
 Gay/Lesbian 133 50.38
 Bisexual 65 24.63
 Queer 24 9.09
 Uncertain; don’t know for sure 31 11.74
Sex assigned at birth
 Male 108 40.91
 Female 156 59.09
Gender identity
 Man/boy 69 26.14
 Woman/girl 86 32.58
 Transgender man/boy 43 16.29
 Transgender woman/girl 21 7.95
 Gender queer 12 4.55
 Gender Non-Conforming/Non-binary 27 10.23
 Two-Spirit 2 0.76
 I don’t know/Other 4 1.52
Sociocultural Context
Race/ethnicity is accepting of sexual and gender minorities (n = 260)1 [3.20] [1.09]
Coparent knows offspring is sexual or gender minority
 Yes 216 81.82
 No/I don’t know/ No co-parent 48 18.18
Parent religious affiliation
 Protestant 95 35.98
 Unitarianism 7 2.65
 Catholicism 55 20.83
 Judaism 13 4.93
 Hinduism 1 0.38
 Buddhism 2 0.76
 Other 13 4.92
 No religious affiliation 78 29.55
Religion is accepting of sexual or gender minorities (n = 196)2 [2.77] [1.65]
Type of area (urbanicity) of parent hometown
 Urban 190 71.97
 Small city or rural 74 28.03
Region parent resides currently
 West 79 29.92
 Midwest 43 16.29
 South 79 29.92
 Northeast 63 23.86
Open in a new tab
1

“Do you feel that your race, ethnicity, and/or culture is open to LGBTQ individuals?” 0 (not at all) to 5 (very much)

2

“Does your religion accept LGBTQ individuals?” 0 (not at all) to 5 (very much)

Regarding SGM child demographics, parents reported that their SGM children were, on average, 18 years old (SD = 5.3) and had come out to their parent at approximately age 15 (SD = 4.9). Regarding sexual orientation, approximately half of SGM youth were gay/lesbian (50.4%), one-quarter were bisexual (24.6%), with fewer being uncertain (11.7%), queer (9.1%), or heterosexual (4.2%). Most SGM youth were assigned female sex at birth (59.1%) versus male sex at birth (40.9%). There was a relatively broad diversity of gender identities among SGM youth, including 32.6% women/girls, 26.2% men/boys, 16.3% transgender men/boys, 8.0% transgender women/girls, 10.2% gender non-conforming/gender non-binary, 5.0% genderqueer, 0.8% Two-Spirit, and 1.5% classified as unknown or other.

Regarding sociocultural context, most parents reported having a co-parent who knew about their child’s SGM identity (81.8%). On the question assessing how open their racial, ethnic, and/or cultural community is towards SGM people, parents reported an average score of 3.2 out of 5, suggesting moderate openness/acceptance. Approximately 70% of parents reported a religious affiliation with the majority being Protestant (36.0%) or Catholic (20.8%). On the question assessing how open their religion is towards SGM people, parents reported an average score of 2.8 out of 5, suggesting neutral openness/acceptance. Most parents grew up in an urban community (72.0%). Regarding current place of residence, participants were fairly evenly dispersed across US regions with parents reporting living in 42 different states and the District of Columbia.

Pearson Correlations

Average scores for parents’ stigma experiences and anxiety and depression symptoms, as well as Pearson correlations are presented in Table 2. Regarding stigma experiences subscales, parents of SGM youth reported the highest mean score on vicarious stigma (M = 3.96, SD = 1.27) followed by discrimination/rejection (M = 2.28, SD = 1.30) and then shame (M = 1.66, SD = 1.27). Parents’ scores on the anxiety (M = 17.36, SD = 6.99) and depression (M = 14.56, SD = 7.05) measures reflected relatively low symptoms, as expected in this non-clinical sample of parents. There were weak-to-moderate positive correlations among all variables of interest (r range = .23–.48, all p < .001) with a strong correlation between discrimination/rejection and shame (r = .70, p < .001) and between anxiety and depressive symptoms (r = .82, p < .001).

Table 2.

Pearson correlations among variables of interest in sample of parents of SGM youth, N = 264

M [SD] Discrimination/Rejection Vicarious Stigma Shame PROMIS Anxiety
Discrimination/ Rejection a 2.28 [1.30] — — — —
Vicarious Stigma a 3.96 [1.27] .44 *** — — —
Shame a 1.66 [1.27] .70 *** .25 *** — —
PROMIS Anxiety b 17.36 [6.99] .30 *** .33 *** .40 *** —
PROMIS Depression b 14.56 [7.05] .34 *** .23 ** .48 *** .82 ***
Open in a new tab
a

Scale range = 1 – 6 with higher scores reflecting more stigma experiences.

b

Scale range = 8 – 40 with higher scores reflecting more psychological symptoms.

***

p < .001.

Associations between Parents’ Stigma Experiences and Anxiety and Depressive Symptoms

Associations between discrimination/rejection, vicarious stigma, and shame and parent anxiety and depressive symptoms are modeled in Table 3. Each stigma experiences subscale was positively associated with higher anxiety and depressive symptoms in both univariate models (step 1) and models adjusted for covariates (step 2). In the adjusted models where all AS subscales were entered as a group (step 3), vicarious stigma and shame were independently associated with both anxiety symptoms (vicarious stigma: β = 1.59; 95% CI [0.89, 2.29]; shame: β = 2.15; 95% CI [1.26, 3.04]) and depressive symptoms (vicarious stigma: β = 0.90; 95% CI [0.22, 1.59]; shame: β = 2.77; 95% CI [1.89, 3.65]). Discrimination/rejection was not significantly associated with either anxiety or depressive symptoms. Lower AIC and BIC and higher R-squared values indicated that, for both anxiety and depression, step 3 models (with all stigma experiences subscales added together with covariates) were the optimally fitting models. There was no evidence of multicollinearity based on an eigensystem analysis of covariance comparison (Belsley et al., 1980; Schreiber-Gregory, 2017).

Table 3.

Associations between stigma experiences and anxiety and depression symptoms in parents of SGM youth, N = 264

Anxiety Symptomsb
Step 1: Univariate Step 2: Each Scale Modeled Separately with Covariatesc Step 3: All Scales Modeled Together with Covariatesc
Parameter Est. 95% CI P R-Squared Est. 95% CI P R-Squared Est. 95% CI P R-Squared
Discrimination/ Rejectiona 1.59 [0.97, 2.22] < .001*** .09 1.54 [0.90, 2.18] < .001*** .14 −0.55 [−1.44, 0.35] .23
Vicarious Stigma a 1.81 [1.18, 2.44] < .001*** .11 1.90 [1.26, 2.54] < .001*** .17 1.59 [0.89, 2.28] < .001*** .26
Shamea 2.18 [1.56, 2.80] < .001*** .16 2.24 [1.57, 2.91] < .001*** .20 2.15 [1.26, 3.04] < .001***
Depressive Symptomsb
Step 1: Univariate Step 2: Each Scale Modeled Separately with Covariatesc Step 3: All Scales Modeled Together with Covariatesc
Parameter Est. 95% CI P R-Squared Est. 95% CI P R-Squared Est. 95% CI P R-Squared
Discrimination/ Rejectiona 1.83 [1.20, 2.46] < .001*** .11 1.73 [1.10, 2.37] < .001*** .17 −0.46 [−1.34, 0.42] .31
Vicarious Stigma a 1.29 [0.63, 1.94] < .001*** .05 1.38 [0.72, 2.04] < .001*** .14 0.90 [0.22, 1.59] .0099** .29
Shamea 2.70 [2.10, 3.30] < .001*** .23 2.72 [2.08, 3.36] < .001*** .27 2.77 [1.89, 3.65] < .001***
Open in a new tab
a

Scale range = 1 – 6 with higher scores reflecting more stigma experiences.

b

Scale range = 8 – 40 with higher scores reflecting more psychological symptoms.

c

Covariates included: parent age, sexual orientation, gender identity, educational attainment, marital status, race, and ethnicity.

*

p < .05.

**

p < .01.

**

p < .001.

Associations Between Parent Demographics, SGM Child Demographics, and Sociocultural Context and Stigma Experiences Subscales

Univariate and multivariable associations between parent demographics, SGM child demographics, and sociocultural context and stigma experiences are presented as a Supplemental Table. In this section, we focus on describing associations that were statistically significant in multivariable associations.

Discrimination/Rejection.

The only variables significantly associated with discrimination/rejection were having an SGM child who is bisexual versus gay/lesbian (β = −0.44; 95% CI [−0.82, −0.07]) and having a more accepting racial, ethnic, or cultural community (β = −0.27; 95% CI [−0.41, −0.12]).

Vicarious Stigma.

Parents of SGM children who themselves identified as gay/lesbian (β = −1.02; 95% CI [−1.74, −0.29]) or queer (β = −1.06; 95% CI [−2.05, −0.07]), versus heterosexual, reported lower vicarious stigma. Parents with SGM children who were queer, versus gay/lesbian, (β = 0.82; 95% CI [0.24, 1.40]) and assigned male, versus female, sex at birth (β = 0.59; 95% CI [0.29, 0.88]) reported higher vicarious stigma. Parents with a more accepting racial, ethnic, or cultural community reported lower vicarious stigma (β = −0.16; 95% CI [−0.29, −0.03]).

Shame.

Older parent age was associated with lower shame (β = −0.05; 95% CI [−0.08, −0.03]). Parents who were Hispanic, versus not Hispanic, (β = 0.50; 95% CI [0.08, 0.91]) or a person of color, versus white, (β = 0.56; 95% CI [0.16, 0.97]) reported higher shame. Increasing age of one’s SGM child was associated with higher shame (β = 0.05; 95% CI [0.01, 0.10]) as was having an SGM child assigned male, versus, female sex at birth (β = 0.46; 95% CI [0.18, 0.73]). Parents of SGM youth who were heterosexual (β = −0.75; 95% CI [−1.44, −0.05]) or bisexual (β = −0.51; 95% CI [−0.86, −0.16]), versus gay/lesbian, reported lower shame. The only sociocultural context variable that remained significant in the multivariable model was a positive association between being religiously affiliated, versus unaffiliated, and higher shame (β = 0.40; 95% CI [0.10, 0.71]).

Discussion

In a national sample of parents of SGM youth, the purpose of this study was to examine the role of parents’ stigma experiences, operationalized as discrimination/rejection, vicarious stigma, and shame, on parent mental health. We further examined the sociodemographic and contextual correlates of parents’ stigma experiences. Findings suggest that at the same time that parents of SGM youth play a crucial role in supporting the mental health of their SGM children (Bouris et al., 2010; Newcomb et al., 2019), such parents also experience anti-SGM stigma and its emotional correlates. Descriptive data showed that parents on average reported moderate-to-high vicarious stigma and lower-to-moderate discrimination/rejection experiences. Parents, on average, reported a low level of shame. This study found that parents’ vicarious stigma and shame were independently associated with higher anxiety and depressive symptoms. This study also found that parents with more accepting religious communities reported less discrimination/rejection, vicarious stigma, and shame, and those with more accepting racial, ethnic, and/or cultural communities reported less discrimination/rejection and vicarious stigma. Findings advance understanding of how the psychological consequences of minority stress extend beyond SGM people themselves and contribute to mental health difficulties in parents of SGM youth.

Our finding that stigma experiences are associated with anxiety and depressive symptoms in parents of SGM youth corroborates previous studies in which parents describe feelings of sadness, anger, worry, concern, hypervigilance, and anxiety in relation to anti-SGM stigma targeting their children (Arm et al., 2009; Chan et al., 2022; Horne et al., 2011; Riley et al., 2011). Further, this finding supports quantitative studies conducted with other parents of stigmatized children, including children with intellectual, developmental, and mental health disorders, documenting associations between parents’ exposure to stigma toward these statuses and psychological difficulties (Chen et al., 2021; Mitter & Scior, 2019; Recio et al., 2021). Our findings extend upon this work by highlighting the role of vicarious stigma and shame in parents’ anxiety and depression; shame, in particular, was strongly associated with anxiety and depressive symptoms. Previous developmental research on parental reactions to an SGM child’s identity disclosure (“coming out”) have highlighted shame and related constructs (e.g., guilt) as frequent emotional reactions from parents (Savin-Williams & Dube, 1998). Recent prospective research with SGM youth themselves has documented shame as a key emotional mechanism underlying sexual orientation disparities in psychological symptoms including anxiety and depression (Pachankis et al., 2023). The present findings reveal that shame also occupies an important role in the mental health of parents of SGM youth.

In the model in which all stigma experiences subscales were entered together, the association between parents’ discrimination/rejection and anxiety and depressive symptoms was not significant, whereas we did find significant associations between parents’ vicarious stigma and shame and parents’ anxiety and depressive symptoms. This pattern of findings might suggest that parents’ reactions to discrimination/rejection, in the form of feeling vicarious stigma or shame, may be more important in the onset and maintenance of anxiety and depression among parents of SGM youth than their exposure to stigma itself. In other words, parents who have obtained resources and developed skills to cope with exposure to anti-SGM discrimination/rejection without reacting with vicarious stigma or shame may be protected from poorer mental health outcomes. Future longitudinal research could help to untangle the temporal ordering of stigma experiences and mental health among parents of SGM youth, for example by measuring parents’ discrimination/rejection experiences at an initial time point, vicarious stigma and shame at a subsequent time point, and anxiety and depressive symptoms at still a later time point.

The current study identified numerous sociodemographic and contextual correlates of parents’ stigma experiences. For instance, our findings demonstrate that anti-SGM religious animus is correlated with experiences of stigma and anxiety and depressive symptoms in parents of SGM youth. While the current study is the first to assess the role of religious acceptance in parents’ stigma experiences, this finding is aligned with research showing that SGM people themselves who reside in less accepting religious communities face heightened exposure to stigma and associated negative emotional and health consequences (Crowell et al., 2015; Hatzenbuehler et al., 2012; Macbeth et al., 2022).

In terms of discrimination/rejection, parents who perceived that their racial, ethnic, and/or cultural community was more accepting of SGM people reported lower discrimination/rejection. Previous research drawing upon intersectionality theory, whereby interlocking forces of power and oppression at a macro level (e.g., racism, ethnicism) uniquely affect the experiences of people holding multiply marginalized social identities (e.g., Black and gay, see Bowleg, 2013), has demonstrated that racial and ethnic minority SGM people frequently report cultural norms of hetero-masculinity, patriarchy, and traditional family dynamics that can culminate in anti-SGM discrimination and rejection (for a review, see Worthen, 2018). The current study documents that less accepting racial, ethnic, and cultural community norms also contribute to parents’ fears of being discriminated against and aligns with previous qualitative research with Latinx parents of SGM youth documenting that heteronormative Latinx-specific cultural norms (e.g., machismo) strongly influenced their acceptance towards their SGM children (Abreu et al., 2020).

Parents who reported SGM children with a bisexual, versus gay/lesbian, sexual orientation reported lower discrimination/rejection. It is possible that parents of bisexual, versus gay/lesbian, children may anticipate less rejection from others due to a perception of greater societal acceptance of bisexual people. Alternatively, this finding may reflect a propensity of parents towards engaging in bi-invisibility and/or bi-erasure in which parents of bisexual, versus gay/lesbian, children may perceive that their children’s bisexual sexual orientation is less stable or valid and, thus, less of a rejection concern (Davila et al., 2019). Future research can help to clarify this association.

This study identified several relevant sociodemographic and contextual correlates of vicarious stigma, including parent sexual orientation, child sex assigned at birth and sexual orientation, and religious and cultural community norms. Parents who reported their own sexual orientation as gay/lesbian or queer, versus heterosexual, reported lower vicarious stigma. Parents of SGM youth who have themselves navigated the challenges of having a minority sexual orientation may have developed resilience strategies (Asakura & Craig, 2014) and believe that their SGM child will do the same. Further, gay/lesbian and queer parents of SGM youth likely conceptualize SGM lives with greater nuance than heterosexual parents including the uniquely joyful and pleasurable aspects of holding an SGM identity (Robinson & Schmitz, 2021). Such personal insights may buffer against vicarious stigma. Notably, this finding suggests that gay/lesbian and queer parents of SGM youth might serve as important role models for heterosexual parents of SGM youth who are more prone to worry about for their SGM child’s future. Further, this finding highlights the importance of assessing diverse sexual orientations and gender identities in studies of parents of SGM youth as well as in general parenting studies to capture the diversity of SGM identities represented among parents.

Other sociodemographic correlates of vicarious stigma included parents who reported that their child’s sexual orientation was queer, versus gay/lesbian, and that their sex was male, versus female, suggesting that parents of queer youth and SGM youth assigned male sex at birth may have the most worries and concerns about their child facing anti-SGM stigma. Racial, ethnic, and/or cultural community acceptance was negatively associated with vicarious stigma such that as community acceptance decreased, worries and concerns for one’s child’s future increased. This finding corroborates previous qualitative research highlighting complex feelings and fears in racial and ethnic minority parents of SGM youth who often grapple with worries that their child will face anti-SGM stigma in addition to facing racism (for a review, see Clark & Pachankis, 2020).

In terms of shame, parents who identified as Hispanic and/or a person of color reported higher levels of shame related to their child’s SGM identity than did non-Hispanic and White parents, respectively. This finding corroborates previous research finding that Black and Latino, versus non-Hispanic White, parents reported the most difficulty accepting their child’s sexual orientation (Huebner et al., 2019). Previous research highlights that racial and ethnic minority parents of SGM youth often face additional barriers to coming to terms with their child’s SGM identity across axes of identity including closer ties to fundamentalist religious communities, fewer community-focused supportive resources, community norms reinforcing traditional family values and masculinity and femininity, and the pervasive influence of structural racism, all of which may exacerbate the emotional process of shame (Abreu et al., 2020; Gattamorta et al., 2019; Potoczniak et al., 2009).

In the present study, parents of gay/lesbian, versus heterosexual or bisexual, youth and those assigned male, versus female, sex at birth reported higher levels of shame, which may reflect previous research suggesting that gay boys/men often have more troubled relationships with their parents (especially their fathers; Conley, 2011). Additionally, parents of SGM youth who were religiously affiliated, versus unaffiliated, reported higher shame, perhaps given that religious doctrine can position SGM identities and associated behaviors (e.g., same-gender attraction and sexual behavior) as sinful and changeable (Tobin & Moon, 2019). Indeed, harmful religious-based efforts to change SGM people’s sexual orientations or gender identities often induce shame through narratives in which SGM people are coerced or manipulated to believe that submitting to a higher power can remove their SGM identity, attractions, or behaviors (Super & Jacobson, 2011). While almost all work to date on associations between religion and shame have focused on SGM people themselves, the current findings highlight that deeply held religious beliefs might also exacerbate feelings of shame, and related anxiety and depression, in parents of SGM youth, an important avenue for future research.

Intervention Implications

Results of the current study highlight two important implications for intervention. First, reductions in laws, policies, institutional practices, and public attitudes that deny or fail to protect the equal rights of SGM people can prevent parents’ stigma experiences from occurring in the first place. Given the association of these forms of structural stigma and SGM people’s mental health (Hatzenbuehler et al., 2023), they are likely also associated with parents’ treatment and well-being. Anti-SGM stigma can plausibly be reduced through contact interventions in which SGM people share their perspectives with others (Broockman & Kalla, 2016), those that expose the public to accepting norms toward SGM people (Tankard & Paluck, 2017), and those that reduce moral animus toward SGM people and experiences (Powell et al., 2015).

Second, parent-focused interventions to help parents of SGM youth cope with stigma may be one way to help reduce stigma and associated psychological difficulties. LGBTQ-affirmative cognitive behavioral therapy (CBT) attempts to alleviate the role of minority stress in the development and maintenance of psychological problems (Pachankis, 2018) and is associated with reductions in anxiety and depressive symptoms in SGM youth and young adults (Craig et al., 2021; Pachankis, 2022a). Given that LGBTQ-affirmative CBT seeks to address responses to stigma, such as hypervigilance and internalization of stigma (Pachankis et al., 2022b), adaptations to address parent exposure to stigma and its emotional consequences (e.g., shame) may be beneficial in improving parents’ coping skills and mental health. In addition to the potential promise of LGBTQ-affirmative CBT for parents of SGM youth, family-based therapy targeting SGM youth and parents may be effective in reducing stigma and its psychological consequences in parents of SGM youth. Attachment-based family therapy (ABFT) has been adapted for SGM young adults and their nonaccepting parents to help process parents’ negative emotions towards their child’s identity (Diamond & Shpigel, 2014) with preliminary evidence showing that mothers engaged in ABFT experienced decreases in maternal attachment-based anxiety and avoidance (Diamond et al., 2012). The effects of ABFT on parents’ emotional responses to stigma (e.g., shame) have not yet been explored and represent an important future direction. Such interventions should be tailored to meet the needs of parents within less-accepting religious, racial, ethnic, and/or cultural communities. For instance, Abreu and colleagues (2020) administered an expressive writing intervention for Latinx parents focused on strengths and challenges related to their culture that influenced the process of coming to accept their SGM child. While this intervention was focused on parents’ acceptance behaviors, future research might also find that expressive writing interventions may help parents of SGM youth address stigma related to culture-specific beliefs and norms. To our knowledge, the effects of SGM-affirmative parent support groups on parents’ stigma experiences, emotional consequences, and associated mental health have not been studied, representing an important future direction for research and intervention. Given findings from the present study, parents who themselves identify as gay or lesbian may be helpful leaders in parent-focused support groups as they may be less negatively impacted by vicarious stigma and can serve as a role model for heterosexual parents of SGM youth.

Limitations

Results of this study must be interpreted in light of several limitations. First, this research uses a single cross-sectional survey. As mentioned previously, future longitudinal research is needed to better understand the mechanistic role of stigma in the mental health of parents of SGM youth. Second, this study only included parent reports. Future research integrating parent and child reports is needed to understand how parents’ stigma experiences are associated with their children’s mental health. Research conducted without regard for SGM identity has shown that parent mental health is strongly associated with child mental health (Goodman et al., 2011; Wickersham et al., 2020). Given our findings that stigma is linked to worse mental health for parents of SGM youth, it will be important to examine the impact of these stigma experiences on the SGM child. Third, this study utilized a non-probability sample and participants may not be representative of the parents of SGM youth in the US population. Parent who volunteer to take a survey about their SGM child’s identity may be different than those who do not, including more accepting (Clark et al., 2021). Further, most parents in the current study identified as non-Hispanic, White, limiting potential sub-analyses by parent race and ethnicity. Future research should aim to recruit a more representative sample of parents of SGM youth including oversampling for racial and ethnic minority parents of SGM youth. Fourth, the measure used in the current study assessed parents’ exposure to overt forms of discrimination/rejection but did not assess exposure to microaggressions. Previous research with SGM people has shown that even exposure to more subtle forms of discrimination/rejection is associated with poorer mental health outcomes (Nadal et al., 2010), representing an important avenue for future study with parents of SGM youth. Finally, due to sample size, we collapsed some demographic categories in statistical models (e.g., child’s gender identity was collapsed into cisgender versus transgender), which might have obscured differences in outcomes between some demographic subgroups. Relatedly, some demographic categories were still small after collapsing into larger categories, which might have limited power to detect significant differences.

Conclusion

In a national sample of parents of SGM youth, the current study evaluated the role of stigma experiences in parents’ mental health. Findings revealed that parents of SGM youth frequently experience anti-SGM stigma and associated increased anxiety and depressive symptoms. This study lays the groundwork for future prospective, multi-informant research to study the psychological consequences of stigma exposure on parents of SGM youth and their children. Further, these findings call for intervention research to identify how to best support parents of SGM youth as they navigate raising a child with a stigmatized minority sexual orientation or gender identity.

Supplementary Material

Supplemental Material

Acknowledgements

This study was supported by the David R. Kessler, M.D. ‘55, Resource Fund for LGBTQ Mental Health at Yale School of Public Health. This study was also supported by departmental funds from Department of Psychology, University of Maryland College Park. Dr. Clark’s time on this project was funded by the National Institute of Mental Health (K01MH125073). The authors thank Elisa Park for providing support with references.

Footnotes

1

Although the SPACES study included parents with SGM children, adolescents, and young adults up to age 29 years old, in the present paper we use the terms “SGM child” or “SGM youth” rather than the age-neutral term “SGM offspring” because we did not assess whether SGM children were biological offspring, adopted, and/or stepchildren.

References

  1. Abreu RL, Riggle EDB, & Rostosky SS (2020). Expressive writing intervention with Cuban-American and Puerto Rican parents of LGBTQ individuals. The Counseling Psychologist, 48(1), 106–134. 10.1177/0011000019853240 [DOI] [Google Scholar]
  2. Abreu RL, Rosenkrantz DE, Ryser-Oatman JT, Rostosky SS, & Riggle EDB (2019). Parental reactions to transgender and gender diverse children: A literature review. Journal of GLBT Family Studies, 15(5), 461–485. 10.1080/1550428X.2019.1656132 [DOI] [Google Scholar]
  3. Abreu RL, Sostre JP, Gonzalez KA, Lockett GM, & Matsuno E (2022). “ I am afraid for those kids who might find death preferable ”: Parental figures’ reactions and coping strategies to bans on gender affirming care for transgender and gender diverse youth. Psychology of Sexual Orientation and Gender Diversity, 9(4), 500–510. 10.1037/sgd0000495 [DOI] [Google Scholar]
  4. Arm JR, Horne SG, & Levitt HM (2009). Negotiating connection to GLBT experience: Family members’ experience of anti-GLBT movements and policies. Journal of Counseling Psychology, 56, 82–96. 10.1037/a0012813 [DOI] [Google Scholar]
  5. Asakura K, & Craig SL (2014). “It gets better” … but how? Exploring resilience development in the accounts of LGBTQ adults. Journal of Human Behavior in the Social Environment, 24(3), 253–266. 10.1080/10911359.2013.808971 [DOI] [Google Scholar]
  6. Belsley DA, Kuh E, and Welsh RE (1980). Regression diagnostics: Identifying influential data and sources of collinearity. John Wiley & Sons, Inc. [Google Scholar]
  7. Bouris A, Guilamo-Ramos V, Pickard A, Shiu C, Loosier PS, Dittus P, Gloppen K, & Michael Waldmiller J (2010). A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: Time for a new public health research and practice agenda. The Journal of Primary Prevention, 31(5–6), 273–309. 10.1007/s10935-010-0229-1 [DOI] [PubMed] [Google Scholar]
  8. Bowleg L (2013). “Once you’ve blended the cake, you can’t take the parts back to the main ingredients”: Black gay and bisexual men’s descriptions and experiences of intersectionality. Sex Roles: A Journal of Research, 68, 754–767. 10.1007/s11199-012-0152-4 [DOI] [Google Scholar]
  9. Broockman D, & Kalla J (2016). Durably reducing transphobia: A field experiment on door-to-door canvassing. Science (New York, N.Y.), 352(6282), 220–224. 10.1126/science.aad9713 [DOI] [PubMed] [Google Scholar]
  10. Brooks VR (1981). Minority stress and lesbian women. Lexington Books. [Google Scholar]
  11. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, DeVellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai J-S, Pilkonis P, Revicki D, … Hays R (2010). The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63(11), 1179–1194. 10.1016/j.jclinepi.2010.04.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Chan RCH, Suen YT, & Wong EMY (2022). The influence of concerns about a child’s sexual orientation on mental health among parents of lesbian, gay, and bisexual children in Hong Kong. Archives of Sexual Behavior, 51(7), 3497–3512. 10.1007/s10508-022-02374-9 [DOI] [PubMed] [Google Scholar]
  13. Chen Y-L, Chang C-C, Chen Y-M, Liu T-L, Hsiao RC, Chou W-J, & Yen C-F (2021). Association between affiliate stigma and depression and its moderators in caregivers of children with attention-deficit/hyperactivity disorder. Journal of Affective Disorders, 279, 59–65. 10.1016/j.jad.2020.09.121 [DOI] [PubMed] [Google Scholar]
  14. Clark KA, Dougherty LR, & Pachankis JE (2021). A study of parents of sexual and gender minority children: Linking parental reactions with child mental health. Psychology of Sexual Orientation and Gender Diversity, 9, 300–308. 10.1037/sgd0000456 [DOI] [Google Scholar]
  15. Clark KA, & Pachankis JE (2020). (tech.). Parenting Sexual and Gender Minority Children: A Literature Review and Roadmap for Future Research and Intervention. The Constellation Project. Retrieved April 1, 2023, from https://www.theconstellationproject.org/publications [Google Scholar]
  16. Conley CL (2011). Learning about a child’s gay or lesbian sexual orientation: Parental concerns about societal rejection, loss of loved ones, and child well being. Journal of Homosexuality, 58, 1022–1040. 10.1080/00918369.2011.598409 [DOI] [PubMed] [Google Scholar]
  17. Craig SL, Eaton AD, Leung VWY, Iacono G, Pang N, Dillon F, Austin A, Pascoe R, & Dobinson C (2021). Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada. BMC Psychology, 9(1), 94. 10.1186/s40359-021-00595-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Crowell KA, Galliher RV, Dehlin J, & Bradshaw WS (2015). Specific aspects of minority stress associated with depression among LDS affiliated non-heterosexual adults. Journal of Homosexuality, 62(2), 242–267. 10.1080/00918369.2014.969611 [DOI] [PubMed] [Google Scholar]
  19. Davila J, Jabbour J, Dyar C, & Feinstein BA (2019). Bi+ visibility: Characteristics of those who attempt to make their bisexual+ identity visible and the strategies they use. Archives of Sexual Behavior, 48(1), 199–211. 10.1007/s10508-018-1284-6 [DOI] [PubMed] [Google Scholar]
  20. de Lange J, Baams L, van Bergen DD, Bos HMW, & Bosker RJ (2022). Minority stress and suicidal ideation and suicide attempts among LGBT adolescents and young adults: A meta-analysis. LGBT Health, 9(4), 222–237. 10.1089/lgbt.2021.0106 [DOI] [PubMed] [Google Scholar]
  21. Diamond GM, Diamond GS, Levy S, Closs C, Ladipo T, & Siqueland L (2012). Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings. Psychotherapy (Chicago, Ill.), 49(1), 62–71. 10.1037/a0026247 [DOI] [PubMed] [Google Scholar]
  22. Diamond GM, & Shpigel MS (2014). Attachment-based family therapy for lesbian and gay young adults and their persistently nonaccepting parents. Professional Psychology: Research and Practice, 45, 258–268. 10.1037/a0035394 [DOI] [Google Scholar]
  23. Dürrbaum T, & Sattler FA (2020). Minority stress and mental health in lesbian, gay male, and bisexual youths: A meta-analysis. Journal of LGBT Youth, 17, 298–314. 10.1080/19361653.2019.1586615 [DOI] [Google Scholar]
  24. Fish JN (2020). Future directions in understanding and addressing mental health among LGBTQ youth. Journal of Clinical Child & Adolescent Psychology, 49(6), 943–956. 10.1080/15374416.2020.1815207 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Gattamorta KA, Salerno J, & Quidley-Rodriguez N (2019). Hispanic parental experiences of learning a child identifies as a sexual minority. Journal of GLBT Family Studies, 15, 151–164. 10.1080/1550428X.2018.1518740 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, & Heyward D (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1–27. 10.1007/s10567-010-0080-1 [DOI] [PubMed] [Google Scholar]
  27. Hatzenbuehler ML, Lattanner MR, McKetta S, Pachankis JE (2023). Structural stigma and LGBT global health: A systematic review. Lancet Global Health. [DOI] [PubMed] [Google Scholar]
  28. Hatzenbuehler ML, Pachankis JE, & Wolff J (2012). Religious climate and health risk behaviors in sexual minority youths: A population-based study. American Journal of Public Health, 102(4), 657–663. 10.2105/AJPH.2011.300517 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Horne SG, Rostosky SS, & Riggle EDB (2011). Impact of marriage restriction amendments on family members of lesbian, gay, and bisexual individuals: A mixed- method approach. Journal of Social Issues, 67(2), 358–375. 10.1111/j.1540-4560.2011.01702.x [DOI] [Google Scholar]
  30. Hubachek SQ, Clark KA, Pachankis JE, & Dougherty LR (2023). Explicit and implicit bias among parents of sexual and gender minority youth. Journal of Family Psychology, 37, 203–214. 10.1037/fam0001037 [DOI] [PubMed] [Google Scholar]
  31. Huebner DM, Roche KM, & Rith KA (2019). Effects of family demographics and the passage of time on parents’ difficulty with their lesbian, gay, or bisexual youth’s sexual orientation. Archives of Sexual Behavior, 48(5), 1581–1588. 10.1007/s10508-019-1430-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. LaSala MC (2010). Coming out, coming home: Helping families adjust to a gay or lesbian child. Columbia University Press. [Google Scholar]
  33. Macbeth AJ, Vidales CA, & Vogel DL (2022). Perceived parental religiosity as a predictor of depression and substance use among LGBTQ+ individuals: The mediating role of perceived familial stigma. Psychology of Religion and Spirituality, 14, 140–147. 10.1037/rel0000411 [DOI] [Google Scholar]
  34. Mastropaolo C (2018). The role of attachment in experiences of affiliate stigma among parents of lesbian, gay, and bisexual individuals [PhD dissertation, Seton Hall University; ]. https://scholarship.shu.edu/dissertations/2660 [Google Scholar]
  35. Meyer IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. 10.1037/0033-2909.129.5.674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Mitter N, Ali A, & Scior K (2019). Stigma experienced by families of individuals with intellectual disabilities and autism: A systematic review. Research in Developmental Disabilities, 89, 10–21. 10.1016/j.ridd.2019.03.001 [DOI] [PubMed] [Google Scholar]
  37. Mpofu JJ (2023). Overview and methods for the Youth Risk Behavior Surveillance System—United States, 2021. MMWR Supplements, 72(1), 1–12. 10.15585/mmwr.su7201a1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Nadal KL, Rivera DP, & Corpus MJH (2010). Sexual orientation and transgender microaggressions: Implications for mental health and counseling. In Microaggressions and marginality: Manifestation, dynamics, and impact (pp. 217–240). John Wiley & Sons, Inc. [Google Scholar]
  39. Newcomb ME, LaSala MC, Bouris A, Mustanski B, Prado G, Schrager SM, & Huebner DM (2019). The influence of families on LGBTQ youth health: A call to action for innovation in research and intervention development. LGBT Health, 6(4), 139–145. 10.1089/lgbt.2018.0157 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Pachankis JE (2018). The scientific pursuit of sexual and gender minority mental health treatments: Toward evidence-based affirmative practice. American Psychologist, 73, 1207–1219. 10.1037/amp0000357 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Pachankis JE, Harkness A, Maciejewski KR, Behari K, Clark KA, McConocha E, Winston R, Adeyinka O, Reynolds J, Bränström R, Esserman DA, Hatzenbuehler ML, & Safren SA (2022a). LGBQ-affirmative cognitive-behavioral therapy for young gay and bisexual men’s mental and sexual health: A three-arm randomized controlled trial. Journal of Consulting and Clinical Psychology, 90, 459–477. 10.1037/ccp0000724 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Pachankis JE, Hatzenbuehler ML, Klein DN, & Bränström R (2023). The role of shame in the sexual orientation disparity in mental health: A prospective population- based study of multimodal emotional reactions to stigma. Clinical Psychological Science. Online First Ahead of Print. 10.1177/21677026231177714 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Pachankis JE, Soulliard ZA, Seager van Dyk I, Layland EK, Clark KA, Levine DS, & Jackson SD (2022b). Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. Journal of Consulting and Clinical Psychology, 90, 582–599. 10.1037/ccp0000745 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, & Cella D (2011). Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283. 10.1177/1073191111411667 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Potoczniak D, Crosbie-Burnett M, & Saltzburg N (2009). Experiences regarding coming out to parents among African American, Hispanic, and White gay, lesbian, bisexual, transgender, and questioning adolescents. Journal of Gay & Lesbian Social Services: Issues in Practice, Policy & Research, 21, 189–205. 10.1080/10538720902772063 [DOI] [Google Scholar]
  46. Powell B, Quadlin NY, & Pizmony-Levy O (2015). Public opinion, the courts, and same- sex marriage: Four lessons learned. Social Currents, 2(1), 3–12. 10.1177/2329496514562964 [DOI] [Google Scholar]
  47. Recio P, Molero F, Silván-Ferrero P, & Nouvilas-Pallejà E (2021). Perceived discrimination and emotional distress among family caregivers of children with physical disabilities: The mediational role of affiliate stigma and self-efficacy. The American Journal of Orthopsychiatry, 91(3), 367–374. 10.1037/ort0000534 [DOI] [PubMed] [Google Scholar]
  48. Riley EA, Sitharthan G, Clemson L, & Diamond M (2011). The needs of gender-variant children and their parents: A parent survey. International Journal of Sexual Health, 23(3), 181–195. 10.1080/19317611.2011.593932 [DOI] [Google Scholar]
  49. Rith KA (2020). Direct and indirect minority stress experiences of parents with gay, lesbian, or bisexual children [PhD dissertation, ProQuest Information & Learning (US)]. In Dissertation Abstracts International: Section B: The Sciences and Engineering (Vol. 81, Issues 2-B). https://www.proquest.com/docview/2350115805 [Google Scholar]
  50. Robinson BA, & Schmitz RM (2021). Beyond resilience: Resistance in the lives of LGBTQ youth. Sociology Compass, 15(12), e12947. 10.1111/soc4.12947 [DOI] [Google Scholar]
  51. Robinson MA, & Brewster ME (2016). Understanding affiliate stigma faced by heterosexual family and friends of LGB people: A measurement development study. Journal of Family Psychology, 30(3), 353–363. 10.1037/fam0000153 [DOI] [PubMed] [Google Scholar]
  52. Savin-Williams RC, & Dubé EM (1998). Parental reactions to their child’s disclosure of a gay/lesbian identity. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 47(1), 7–13. 10.2307/584845 [DOI] [Google Scholar]
  53. Schreiber-Gregory DN (2017). Multicollinearity: what is it, why should we care, and how can it be controlled? Paper presented at the SAS Global Forum 2017 Conference,Orlando, Florida: SAS Institute Inc. https://support.sas.com/resources/papers/proceedings17/1404-2017.pdf [Google Scholar]
  54. Seager van Dyk I, Clark KA, Dougherty LR, & Pachankis JE (2022). Parent responses to their sexual and gender minority children: Implications for parent-focused supportive interventions. Psychology of Sexual Orientation and Gender Diversity. 10.1037/sgd0000589 [DOI] [Google Scholar]
  55. Super JT, & Jacobson L (2011). Religious abuse: Implications for counseling lesbian, gay, bisexual, and transgender individuals. Journal of LGBT Issues in Counseling, 5, 180–196. 10.1080/15538605.2011.632739 [DOI] [Google Scholar]
  56. Tankard ME, & Paluck EL (2017). The effect of a Supreme Court decision regarding gay marriage on social norms and personal attitudes. Psychological Science, 28(9), 1334–1344. 10.1177/0956797617709594 [DOI] [PubMed] [Google Scholar]
  57. Tobin TW, & Moon D (2019). The politics of shame in the motivation to virtue: Lessons from the shame, pride, and humility experiences of LGBT conservative Christians and their allies. Journal of Moral Education, 48, 109–125. 10.1080/03057240.2018.1534088 [DOI] [Google Scholar]
  58. Wickersham A, Leightley D, Archer M, & Fear NT (2020). The association between paternal psychopathology and adolescent depression and anxiety: A systematic review. Journal of Adolescence, 79, 232–246. 10.1016/j.adolescence.2020.01.007 [DOI] [PubMed] [Google Scholar]
  59. Worthen MGF (2018). “Gay equals White”? Racial, ethnic, and sexual identities and attitudes toward LGBT individuals among college students at a Bible Belt university. The Journal of Sex Research, 55(8), 995–1011. 10.1080/00224499.2017.1378309 [DOI] [PubMed] [Google Scholar]
  60. Yao E, Li Y, & Wang C (2021). The fear of being associated with sexual minority close others: Socio-cultural predictors of sexual minority affiliate stigma. Sexuality & Culture, 25(3), 925–938. 10.1007/s12119-020-09801-w [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplemental Material
NIHMS1948054-supplement-Supplemental_Material.pdf (216.3KB, pdf)

RESOURCES