Excess burdens and mental health consequences of physical violence victimization among sexual minority adolescents and young adults in Colombia and Honduras: a pooled population-based study

Abstract

Few studies have quantified burdens and psychological impacts of physical violence victimization among sexual minority adolescents and young adults (AYA) in Central and South America—where AYA experience among the highest rates of violence victimization globally. Accordingly, data from two population-based household surveys implemented in Colombia and Honduras between 2017 and 2018 were pooled to characterize disparities and mental health sequelae of physical violence victimization among AYA aged 13–24 years by sexual minority status. Framed by minority stress theory, sex-stratified weighted multivariable logistic regression with linearized variance correction determined if: (1) sexual minority AYA exhibited elevated odds of lifetime physical violence victimization by various perpetrators; and (2) violence-exposed sexual minority AYA reported worse mental health outcomes than their heterosexual counterparts. In the pooled sample of 10,414 AYA (mean age: 18.3 years, 50% female), 2% reported same-sex attraction and/or sexual behavior. Sexual minority AYA experienced significantly elevated burdens of physical violence victimization by parents/caregivers or adult relatives (adjusted odds ratio [aOR]=1.86, 95% confidence interval [CI]: 1.09–3.16, p<0.022) compared to heterosexual AYA. Among violence-experienced AYA (n = 3,774), sexual minority AYA were significantly more likely than heterosexual AYA to report self-harming behaviors (aOR=3.36, 95% CI: 1.71–6.61, p<0.001), suicidal ideation (aOR=3.43, 95% CI: 1.63–7.24, p=0.001), and attempted suicide (aOR=2.79, 95% CI: 1.21–6.44, p=0.017). This study provides evidence of excess burdens and mental health consequences of physical violence victimization among sexual minority AYA in Colombia and Honduras, suggesting supportive services (i.e., acute post-violence care, longer-term mental health services) must be adequately prioritized and tailored to sexual minority survivors of violence.

Introduction

Violence victimization remains a leading cause of physical, emotional, and psychological morbidity among children and adolescents worldwide. Recent estimates show that one in two children globally will experience or witness violence by age 17 (Hillis et al., 2016). Violence experienced early in life, especially during childhood or adolescence, can have deleterious consequences on developmental trajectories for adolescents and young adults (AYA). Numerous studies have linked violence victimization in childhood and adolescence to subsequent mental health challenges (e.g., anxiety/depression, suicidal ideation) (Fan et al., 2021; Machisa et al., 2016; Nguyen, Padilla, et al., 2019), heavy substance use (Ahmadabadi et al., 2019; Schneider et al., 2022), sexual coercion (Nguyen, Padilla, et al., 2019; Swedo, Sumner, Msungama, et al., 2019), and even violence perpetration in adulthood (Forke et al., 2018; Roberts et al., 2010; VanderEnde et al., 2016). Prevention and adequate response to violence against children and AYA are necessary to optimize wellbeing among survivors and interrupt cycles of violence.

Moreover, evidence suggests that sexual minority populations, including men who have sex with men and women who have sex with women, experience elevated risks of violence victimization in childhood and adolescence (Balsam et al., 2010; Capaldi et al., 2024; Juárez-Chávez et al., 2021; Tran et al., 2022). While the term “sexual minority” encompasses individuals self-identifying as lesbian, gay, bisexual, pansexual, or queer, this designation also refers to individuals who are attracted to and/or have sexual encounters with persons of the same sex or gender, regardless of whether they self-identify as a sexual minority (Morrison et al., 2016; Blondeel et al., 2018; Suen et al., 2020). Prior studies have documented elevated rates of violence victimization among sexual minority populations globally (Davis et al., 2020; Poteat et al., 2020; Müller et al., 2021; E. C. Levine & Button, 2022). Much of this research attributes this undue burden of violence to targeted discrimination against persons with minoritized sexual identities, especially in contexts where same-sex behaviors are heavily stigmatized or even criminalized (Schwartz et al., 2015; Li et al., 2017; Evens et al., 2019; Malta et al., 2019).

Despite the disproportionate toll of violence victimization experienced by sexual minority populations worldwide, there have been few population-based studies comparing the burdens and consequences of violence by sexual minority status in low- and middle-income countries, where the proportion of AYA experiencing violence is exceedingly high (Sumner et al., 2015; Swedo, Sumner, Hillis, et al., 2019; Jeong et al., 2021). A multi-country study in Europe, including some middle-income countries, found that adult sexual minority women exhibited a greater likelihood of anticipated and actual intimate partner violence than their heterosexual counterparts (Scheer et al., 2022). Other studies in Central America (Wheeler et al., 2014), India (Chakrapani et al., 2019), and South Africa (Dunkle et al., 2013) have quantified prevalence and correlates of violence among adult sexual minority men but have not compared these estimates with burdens in heterosexual populations. Emerging data from high-income countries suggest that sexual minority AYA may exhibit worse mental health outcomes following adverse and traumatic events compared to non-sexual minority AYA—attributable, at least in part, to diminished access to social assets and resources (e.g., peer support, access to tailored supportive services) that foster resilient coping (Kuyper & Bos, 2016; McConnell et al., 2016).

To address these gaps in the literature, this study pooled population-based surveys from Colombia and Honduras to assess burdens and consequences of violence victimization among sexual minority AYA in Latin America—a region where violence against AYA is disproportionately elevated, attributed in large part to pervasive organized crime and protracted armed conflict (Abaya et al., 2021; McEniry et al., 2019). Colombia has among the most progressive legal frameworks for sexual minority rights in Latin America, legally recognizing same-sex unions (including adoption rights) and prohibiting discrimination against persons with minoritized gender and sexual identities (Malta et al., 2019). While Honduras also has some legal protections against discrimination based on sexual orientation and gender identity, same-sex marital unions are constitutionally prohibited, though consensual same-sex sexual activity remains legal (Malta et al., 2019). Despite geographic variations in legal status and rights of sexual minority persons, heterosexist and homophobic violence remains disconcertingly high in both countries. In Colombia, a nationally representative study found that one in three lesbian, gay, and bisexual persons have experienced physical violence in their lifetimes (Roldán et al., 2024), and rates are highest in areas most impacted by armed conflict and narcotrafficking (Dehnen, 2024). While there has been no study formally assessing burdens of violence against sexual minority persons in Honduras, human rights organizations have issued warnings over alarming increases in violence and homicides of LGBTQIA+ persons—including 264 murders, primarily of gay men, between 2009 and 2017—in the country (Moloney, 2017). Findings from the present study will, therefore, contribute to the limited, albeit burgeoning, scholarship characterizing violence and its consequences among sexual minority persons in Latin America (Barrientos et al., 2024).

Understanding the burden of, and psychological comorbidities associated with, physical violence victimization among sexual minority AYA in diverse settings—including Central and South America—is critical to guiding prioritization and implementation of support services, from acute post-violence care to longer-term mental health services, for survivors of violence. Guided by minority stress theory (Brooks, 1981; Meyer, 2003), which situates deleterious mental and physical health outcomes among sexual minority persons in the milieu of heterosexism and homophobia, the present study seeks to quantify disparities in physical violence victimization and associated mental health consequences (i.e., anxiety/depression symptoms, self-harming behaviors, suicidality) by sexual minority status among AYA in Colombia and Honduras.

Methods

Study Procedures and Population

Data are derived from the Colombia and Honduras Violence Against Children Surveys (VACS) (Chiang et al., 2016), implemented between 2017 and 2018. VACS were cross-sectional, population-based household surveys of female and male AYA measuring the prevalence and consequences of violence experienced in childhood and early adulthood. Briefly, multistage cluster sampling was used to identify ≥200 enumeration areas per country, from which households were mapped and selected for recruitment using systematic random sampling (Nguyen, Kress, et al., 2019). In the final sampling stage, one eligible female or male aged 13–24 years was randomly selected from the household for participation. Sex-specific sampling within enumeration areas, whereby females and males were recruited from separate enumeration areas, minimized the likelihood that survivors of violence and their assailants would both be enrolled in the study.

After obtaining informed consent from the head of household and informed consent (or assent from those under 18 years) from an eligible household member, interviewers administered a face-to-face, structured questionnaire, typically lasting 45–60 minutes, to participants in a private meeting place. Tiered, country-specific violence response plans were developed to refer participants to (i) local social services, (ii) counselors or social workers, or (iii) emergency protective services, depending on the type(s) and acuity of violence disclosed by participants (Chiang et al., 2016). All participants were provided an opportunity at the conclusion of the survey to indicate their level of comfort answering questions administered by VACS interviewers and receive a referral to local services.

Measures

The primary independent variable of interest in the present study was sexual minority status, defined as either self-reported same-gender attraction (“Do you feel attracted to men, women, both men or women, or none?”) or same-gender sexual behavior in the past year (“In the past 12 months, with whom have you had sex: men only, women only, or both men and women?”). Other studies have demonstrated the importance of capturing sexual minority status using attraction- and behavior-based measures, as sexual minorities may avoid disclosing same-sex attraction in certain socio-political contexts to protect their privacy/safety (Caldwell et al., 2023; Wiginton et al., 2021; Zahn et al., 2016) or may engage in same-sex behavior despite identifying as heterosexual (Glick et al., 2020; Igartua et al., 2009; Mustanski et al., 2014). The independent variable was assessed dichotomously (sexual minority versus non-sexual minority).

Drawing from theorized antecedents and psychological sequelae of physical violence victimization articulated in minority stress theory (Brooks, 1981; Meyer, 2003), primary outcomes were grouped into one of two domains: (i) lifetime experiences of physical violence and (ii) indicators of psychological wellbeing. Violence victimization measures, adapted from globally established definitions for various types of violence (Schraiber et al., 2010), assessed lifetime experiences with physical violence by various perpetrators, including peers, parents/caregivers, relatives, and other adults in participants’ communities/neighborhoods. Definitions for all physical violence variables are described in Table 1. Because some participants did not yet have sexual partners, physical violence perpetrated by intimate partners was not considered in the present study. All physical violence indicators items were measured and analyzed dichotomously (ever versus never experienced).

Table 1.

Definitions and measurement of lifetime physical violence victimization in the Violence Against Children Surveys (VACS).

Violence Indicator	Definition
Physical violence by similarly aged peers	Has someone your own age ever: (1) Slapped, pushed, shoved, shook, or intentionally threw something at you to hurt you? (2) Punched, kicked, whipped, or beat you with an object? (3) Choked, smothered, tried to drown you, or burned you intentionally? (4) Used or threatened you with a knife, gun, or other object?
Physical violence by parents, caregivers, or relatives	Has a parent, adult caregiver, or other adult relative ever: (1) Slapped, pushed, shoved, shook, or intentionally threw something at you to hurt you? (2) Punched, kicked, whipped, or beat you with an object? (3) Choked, smothered, tried to drown you, or burned you intentionally? (4) Used or threatened you with a knife, gun, or other object?
Physical violence by other adults in the community	Has an adult in your community/neighborhood—for example, a teacher, police, employer, religious or community leader, neighbor, or another adult you don’t know—ever: (1) Slapped, pushed, shoved, shook, or intentionally threw something at you to hurt you? (2) Punched, kicked, whipped, or beat you with an object? (3) Choked, smothered, tried to drown you, or burned you intentionally? (4) Used or threatened you with a knife, gun, or other object?

Measures of mental health included: (i) moderate-to-severe mental distress, assessed using the Kessler Psychological Distress Scale—a 6-item, 5-point (“none of the time” to “all of the time”) measure of emotional and/or psychological distress symptomology in the past 30 days, with scores of ≥5 indicating moderate-to-severe psychosocial distress (versus mild-to-no distress, or scores <5) (Kessler et al., 2002); (ii) self-harm, defined as ever hurting oneself intentionally in any way (yes versus no); (iii) suicidal ideation, defined as ever contemplating killing oneself (yes versus no); and (iv) attempted suicide, defined as ever trying to kill oneself (yes versus no).

Other cofactors of interest included age in years, sex, ethnicity (indigenous identity or afro-descendance versus non-ethnic minority identity), schooling and employment status (in-school versus out-of-school and employed versus out-of-school and unemployed), internal migration history (ever versus never), and peer support (dichotomized from a 4-item response pattern, “not at all” to “a lot”, to the question, “How often do you talk to your friends about important things?”).

Data Analysis

Data were managed and analyzed in Stata/IC 15.1 (StataCorp LLC, College Station, TX). First, observations from the Colombia and Honduras VACS were appended to generate a pooled, multi-country sample. Descriptive sample statistics (frequencies and proportions) were then calculated for the pooled sample, stratified by sex. To determine if lifetime violence victimization experiences varied significantly by sexual minority status, design-based F-tests were computed, comparing the prevalence of physical violence across sexual minority and non-sexual minority AYA. A similar procedure was followed to compare mental health outcomes by sexual minority status, restricted to participants reporting lifetime experiences of physical violence victimization.

Each outcome varying significantly by sexual minority status was then separately introduced into logistic regression models, adjusting for country of residence (accounting for socio-political differences by geography) and a theoretically informed set of potential confounders in the relationship between sexual minority status, lifetime violence victimization, and mental health (Flores et al., 2022; Glick et al., 2022; Meyer, 2003; Orr et al., 2021; Whitton et al., 2016; Yarwood et al., 2022), including: age, sex, ethnicity, schooling and employment status, internal migration history, and peer support. Logistic models were fit to the overall pooled sample and subsequently stratified by sex. Multivariable logistic estimates were reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

Consistent with best-practices for multi-country pooling of nationally representative population-based surveys (Deaton & Tortora, 2015; G. A. Levine et al., 2022), country-specific sampling weights were de-normalized and subsequently rescaled, so observations from Colombia and Honduras would be weighted equally in analysis. To account for the hierarchically clustered nature of observations within stratified geographic areas selected for inclusion, linearized standard errors were implemented across analyses as a variance correction for multistage cluster sampling. Given the paucity of missing observations (<3% of records were incomplete), complete case analysis and model-wise deletion were used to handle missing data.

Ethics

To ensure appropriate protections for the rights and welfare of study participants, the Ethics and Research Methods Committee of the National Institute of Health of Colombia, the Ethics Committee on Biomedical Research of the Universidad Nacional Autónoma de Honduras, and the U.S. Centers for Disease Control and Prevention Institutional Review Board independently reviewed and approved the VACS Colombia and Honduras study protocols. All participants provided written informed consent (or assent if younger than 18 years) prior to survey administration.

Results

Sample Characteristics

Table 2 presents sex-stratified descriptive statistics from the pooled sample of 10,414 AYA (females: 49.9%, n = 5,254; males: 50.1%, n = 5,169) participating in the Colombia (n = 5,218) and Honduras (n = 5,196) VACS. The mean participant age was 18.3 years (95% CI: 18.1–18.4 years), with slightly over half aged 18–24 years (55.5%). Approximately half of participants identified as ethnic minorities (50.0%) and were in-school (47.8%). One-fourth reported histories of internal migration (29.2%), and three-fourths endorsed having “some” or “a lot” of peer support (76.5%). Females were significantly more likely than males to be out-of-school and unemployed (29.2% vs. 7.8%, p<0.001) and report little-to-no peer support (29.5% vs. 17.6%, p<0.001).

Table 2.

Weighted descriptive characteristics of the pooled sample of adolescents and young adults (aged 13–24 years) participating in the Violence Against Children Surveys (VACS) in Colombia and Honduras, by sex (N = 10,414).

Characteristics	Overall (N = 10,414)		Females (n = 5,245)		Males (n = 5,169)		p-value
	number	%	number	%	number	%
Socio-demographics
Age group							0.073
13–17 years	5,031	44.5	2,365	42.9	2,666	46.0
18–24 years	5,383	55.5	2,880	57.1	2,503	54.0
Country							0.649
Colombia	5,218	50.0	2,708	49.0	2,510	51.0
Honduras	5,196	50.0	2,537	51.0	2,659	49.0
Identifies as an ethnic minority	5,482	50.0	2,398	43.2	3,084	56.8	<0.001
Sexual minority by orientation and/or behavior	212	2.2	103	2.5	109	1.8	0.240
Schooling and employment status							<0.001
In-school	5,226	47.8	2,518	46.7	2,708	48.9
Out-of-school and employed	3,214	33.7	1,199	24.1	2,015	43.3
Out-of-school and unemployed	1,971	18.5	1,526	29.2	445	7.8
Ever migrated internally	2,999	29.2	1,550	27.6	1,449	30.8	0.107
Peer support							<0.001
Not very much or not at all	2,358	23.5	1,503	29.5	855	17.6
Some or a lot	8,049	76.5	3,738	70.5	4,311	82.4
Lifetime physical violence victimization
Physical violence by any perpetrator	3,774	36.5	1,732	32.7	2,042	40.3	0.003
Physical violence by similarly aged peers	2,448	24.3	888	17.3	1,560	31.4	<0.001
Physical violence by parents, caregivers, or relatives	2,041	19.7	1,140	20.7	901	18.8	0.310
Physical violence by other adults in the community	619	6.2	216	4.5	403	7.8	0.002
Mental health
Moderate-to-severe mental distress, past 30 days	4,882	47.8	2,746	54.1	2,136	41.3	<0.001
Self-harm, lifetime	1,136	11.3	712	13.5	424	9.0	0.002
Suicidal ideation, lifetime	1,133	10.7	880	17.1	253	4.3	<0.001
Attempted suicide, lifetime	633	6.2	523	10.1	110	2.2	<0.001

Notes: Bolded values represent statistically significant (p<0.05) bivariate differences by sex, per design-based F-tests.

One-third of participants reported lifetime physical violence victimization (36.5%); the most frequently reported perpetrators of physical violence were peers (24.3%), parents/caregivers or relatives (19.7%), or other adults in the community (6.2%). Rates of physical violence victimization by different perpetrators differed significantly by sex, with males disclosing higher rates of physical violence by any perpetrator (40.3% vs. 32.7%, p=0.003) and peer-perpetrated physical violence (31.4% vs. 17.3%, p<0.001).

Nearly half of AYA reported psychological and/or emotional symptoms consistent with moderate-to-severe mental distress in the past month (47.8%), which was significantly elevated in females relative to males (54.1% vs. 41.3%, p<0.001). While self-harming behaviors (11.3%), suicidal ideation (10.7%), and attempted suicide (6.2%) were less common, each of these factors was disproportionately elevated in females compared to males (self-harm: 13.5% vs. 8.2%, p=0.002; suicidal ideation: 17.1% vs. 4.3%, p<0.001; attempted suicide: 10.1% vs. 2.2%, p<0.001).

Physical Violence and Mental Health Consequences by Sexual Minority Status

Overall, 2.1% (n = 212/10,162) of AYA self-reported orientation and/or behavior consistent with sexual minority status, and rates were comparable by sex (see Table 2). Figure 1 displays the proportion of AYA reporting physical violence victimization and mental health consequences, stratified by sexual minority status. Relative to non-sexual minority AYA, sexual minority AYA were significantly more likely to report lifetime exposure to physical violence by parents/caregivers or relatives (31.6% vs. 19.7%, p=0.031) (see Figure 1a). Among AYA disclosing any history of physical violence (n = 3,774), sexual minority AYA reported lifetime self-harming behaviors (42.3% vs. 16.9%, p<0.001), suicidal ideation (43.2% vs. 17.7%, p<0.001), and attempted suicide (29.3% vs. 11.3%, p=0.005) with significantly greater frequency than non-sexual minority AYA (see Figure 1b).

Figure 1.

Prevalence of (a) lifetime physical violence victimization among adolescents and young adults (N = 10,414) and (b) mental health consequences among adolescents and young adults reporting lifetime physical violence victimization (N = 3,774), by sexual minority status.

In multivariable analysis (see Table 3), relative to non-sexual minority AYA, sexual minority AYA exhibited significantly greater odds of lifetime physical violence perpetrated by parents/caregivers or relatives (aOR=1.86, 95% CI: 1.09–3.16, p=0.022). Logistic models stratified by sex revealed that male (aOR=2.33, 95% CI: 1.11–4.85, p=0.024), compared to female (aOR=1.80, 95% CI: 0.86–3.76, p=0.120), AYA drove the observed relationships between sexual minority status and physical violence perpetrated by parents/caregivers or relatives.

Table 3.

Weighted multivariable logistic estimates of physical violence victimization and mental health outcomes among sexual minority (versus non-sexual minority) adolescents and young adults in Colombia and Honduras, by sex.

Violence victimization and mental health outcomes	Overall		Females		Males
	aOR (95% CI)	p-value	aOR (95% CI)	p-value	aOR (95% CI)	p-value
ALL ADOLESCENTS AND YOUNG ADULTS (N = 10,414)
Physical violence by any perpetrator	1.06 (0.63–1.75)	0.836	1.09 (0.54–2.21)	0.808	1.17 (0.56–2.44)	0.673
Physical violence by similarly aged peers	0.99 (0.55–1.76)	0.960	1.20 (0.47–2.76)	0.675	0.87 (0.38–2.02)	0.751
Physical violence by parents, caregivers, or relatives	1.86 (1.09–3.16)	0.022	1.80 (0.86–3.76)	0.120	2.33 (1.11–4.85)	0.024
Physical violence by other adults in the community	1.03 (0.43–2.46)	0.950	1.50 (0.39–5.65)	0.549	0.73 (0.25–2.15)	0.569
ADOLESCENTS AND YOUNG ADULTS REPORTING LIFETIME PHYSICAL VIOLENCE VICTIMIZATION (N = 3,774)
Moderate-to-severe mental distress, past 30 days	2.02 (0.91–4.48)	0.082	7.51 (2.23–25.30)	0.001	1.17 (0.45–3.07)	0.742
Self-harm, lifetime	3.36 (1.71–6.61)	<0.001	5.78 (2.32–14.44)	<0.001	1.70 (0.58–4.95)	0.329
Suicidal ideation, lifetime	3.43 (1.63–7.24)	0.001	3.35 (1.29–8.68)	0.013	3.71 (1.29–10.70)	0.015
Suicide attempt, lifetime	2.79 (1.21–6.44)	0.017	1.90 (0.72–5.06)	0.197	6.41 (1.68–24.44)	0.007

Notes: Weighted multivariable logistic regression models with linearized standard errors were adjusted for age, sex (only in the overall sample), ethnic minority identity, schooling and employment status, internal migration history, peer support, and country. Multivariable logistic estimates are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Bolded values represent statistically significant (p<0.05) multivariable logistic estimates of physical violence victimization and mental health consequences by sexual minority status.

Among AYA exposed to any lifetime physical violence (see Table 3), sexual minority AYA were significantly more likely than non-sexual minority AYA to report self-harming behaviors (aOR=3.36, 95% CI: 1.71–6.61, p<0.001), suicidal ideation (aOR=3.43, 95% CI: 1.63–7.24, p=0.001), and attempted suicide (aOR=2.79, 95% CI: 1.21–6.44, p=0.017). Most of these relationships were modified by sex; while the associations of moderate-to-severe psychological distress (aOR=7.51, 95% CI: 2.23–25.30, p=0.001) and self-harm (aOR=5.78, 95% CI: 2.32–14.44, p<0.001), respectively, with sexual minority status were highest among females, the relationship between sexual minority status and attempted suicide (aOR=6.41, 95% CI: 1.68–24.44, p=0.007), respectively, were substantially outsized in males relative to females. Associations of suicidal ideation and sexual minority status were comparable among male (aOR=3.71, 95% CI: 1.29–10.70, p=0.015) and female (aOR=3.35, 95% CI: 1.29–8.68, p=0.013) AYA.

Discussion

This study, which pooled population-based surveys in Colombia and Honduras, identified disproportionately elevated burdens of lifetime physical violence victimization, specifically perpetrated by parents/caregivers or relatives, among sexual minority AYA. Similarly, significant disparities in mental health consequences were identified by sexual minority status among AYA with histories of physical violence victimization. These findings contribute to burgeoning scholarship on violence against sexual minorities in Latin America, reporting significantly elevated violence victimization burdens among sexual minority AYA relative to their non-sexual minority counterparts.

The published literature has attributed violence against sexual minorities in the region to socially engineered and structurally reinforced heterosexism and homophobia (Davis et al., 2020; Swan et al., 2021). Other studies have framed perpetrators of physical and sexual violence against sexual minorities as pursuing “corrective” action for perceived deviations from codified gender and sexual norms (Flores et al., 2022; Hunter-Gault, 2015). This is consistent with findings from the present study, which show that physical violence against sexual minority AYA in Colombia and Honduras was most frequently perpetrated by parents/caregivers or adult relatives, who tend to serve as enforcers of social norms and discipline in the lives of AYA in Central and South America (Bott et al., 2021; González et al., 2014; Van der Kooij et al., 2018). The excess burdens of parent/caregiver-perpetrated physical violence victimization were particularly pronounced among male AYA, aligning with scholarship attributing these gendered disparities in physical violence to the heightened visibility of sexual minority males’ non-conformity to hegemonic gender norms (e.g., appearance, speech) (D’Augelli et al., 2006; Herek, 2009; Katz-Wise & Hyde, 2012). Preventing heterosexist and homophobic violence against AYA in Colombia and Honduras will require a tiered, multipronged approach inclusive of shifting harmful gender and sexual norms while introducing progressive legislation that protects and affirms the rights of sexual minority persons.

This study also highlighted the sex-specific mental health consequences of physical violence victimization among sexual minority AYA, with associations between sexual minority status and mental health consequences of physical violence victimization varying by sex. While psychological distress symptomology and self-harming behaviors were more common among violence-exposed sexual minority female relative to male AYA, lifetime attempted suicide was substantially elevated among sexual minority male AYA reporting lifetime physical violence victimization compared to sexual minority female AYA. Prior scholarship has documented sex-based disparities in self-harming behaviors and suicidality among sexual minority youth, potentially attributed to gendered differences in disclosure and help-seeking for violence victimization and mental health conditions (Calton et al., 2016; McDermott et al., 2018; Scheer & Baams, 2021). These findings are also consistent with gendered patterns of non-suicidal self-injury and suicidality observed in the extant literature, with males engaging in self-harming behaviors less frequently than females but attempting suicide more frequently than females (Miranda-Mendizabal et al., 2019; Victor et al., 2018). For sexual minority male AYA specifically, suicidality may be exacerbated by perceived pressures to conceal their sexual identities and/or behaviors as well as disconnection from gender-congruent social support networks (Blosnich et al., 2016; Fernandez et al., 2025; King et al., 2008). Beyond resourcing interventions to interrupt cycles of violence perpetrated against sexual minority AYA, services attentive to gendered differences in need (e.g., network weaving for sexual minority male AYA) are critical to addressing mental health comorbidities among male and female AYA survivors of violence.

This study is subject to several limitations. First, given the sensitivity of various survey measures collected via self-report, estimates of sexual minority status, physical violence, psychological distress, and self-harming behaviors are subject to response bias and, thus, are likely underestimated in the present study, potentially biasing estimates toward the null. Second, indicators of sexual minority status were ascertained from self-reported measures of same-gender attraction and/or sexual behavior, which are explicitly inattentive to sexual orientation and gender identity/expression—likely underestimating the prevalence of sexual minority AYA in the study population. Third, although this study identified significant differences in physical violence victimization by sexual minority status, physical violence measures in the VACS were devoid of assessments of perceived perpetrator motivation; thus, excess burdens of physical violence victimization among sexual minority AYA cannot explicitly be attributed to heterosexism or homophobia. Fourth, the study’s cross-sectional design inhibits temporal assessment of associations between sexual minority status, physical violence victimization, and mental health outcomes. Fifth, while the covariate adjustment set included numerous factors with potential to attenuate differences in physical violence victimization and mental health outcomes, findings may be susceptible to residual confounding by unmeasured factors in the Colombia and Honduras VACS. Finally, data were collected in 2017–2018, predating recent socio-political reforms (e.g., expanded workplace protections for LGBTQIA+ persons in Colombia, new legislation prohibiting housing discrimination against LGBTQIA+ persons in Honduras) with potential to attenuate observed burdens and disparities in physical violence victimization and associated mental health consequences among sexual minority AYA. These limitations notwithstanding, the present study provides critical insight into the violence victimization and mental health experiences of sexual minority AYA in Colombia and Honduras, which are critical conduits to evidence-based violence prevention/response programming and policymaking for sexual minority persons in Latin America.

With these limitations in mind, future research should endeavor to: (1) develop and implement validated measures of sexual minority status in Central and South America; (2) longitudinally examine the relationships between physical violence victimization and mental health sequelae among sexual minority AYA; (3) qualitatively explore mechanisms through which heterosexist and homophobic violence perpetrated against sexual minority AYA generate sex-specific mental health responses to physical violence victimization; and (4) adapt/tailor evidenced-based interventions to mitigate perpetration and mental health consequences of physical violence among sexual minority AYA in Latin America.

Conclusions

This study is among the first to quantify excess burdens of lifetime physical violence victimization and mental health consequences among sexual minority AYA in Latin America, leveraging population-based data from Colombia and Honduras. Relative to non-sexual minority AYA, sexual minority AYA were significantly more likely than heterosexual AYA to report parent/caregiver-perpetrated physical violence, as well as self-harming behaviors and suicidality in the context of physical violence victimization. Sex-stratified analyses further illuminated gendered differences in burdens and mental health consequences of physical violence victimization among sexual minority AYA, reaffirming the need for sex-specific interventions in this context. Beyond structural interventions (i.e., progressive policymaking) for violence prevention among sexual minority AYA, post-violence care services that are attentive and responsive to the unique psychosocial needs of sexual minority survivors of violence, including affirming mental health services for acute and chronic psychiatric conditions, are imperative in this context.