The relationship between bias-based peer victimization and depressive symptomatology across sexual and gender identity

Abstract

Objective

The current study examined the prevalence of seven types of bias-based victimization (sexual orientation, gender, expression of gender, race or ethnicity, disability, religion, and physical appearance), with an emphasis on identifying similarities and differences by sexual and gender identity, and explored the association between victimization and depressive symptomatology for different subgroups.

Methods

Data from the Teen Health and Technology Study were collected nationally online between 2010 and 2011 from 5,542 13 to 18-year-old youth in the United States.

Results

Half of all youth reported experiencing some form of bias-based victimization. Sexual and gender minority youth were more likely than heterosexually-identified and cisgender youth to perceive that they had been targeted because of their sexual orientation, gender, gender expression, physical appearance, or religion. Cisgender girls were also more likely to experience bias-based victimization compared with cisgender boys. Being targeted because of one’s appearance was associated with concurrent odds of depressive symptomatology for nearly all youth. Victimization due to one’s perceived or actual sexual orientation or victimization due to one’s gender expression was only associated with increased odds of depressive symptomatology for heterosexual and cisgender youth, respectively.

Conclusions

Findings from the current study add to the growing body of research documenting the heightened risk for experiencing multiple types of bias-based victimization among sexual and gender minority youth. They further emphasize the importance of making distinctions within subgroups of sexual and gender minority youth. The emotional consequences of bias-based victimization for youth require that prevention should be a high priority for schools and communities.

Peer bullying and harassment are widespread. Data from the 2015 Youth Risk Behavior Surveillance survey indicated that 20% of youth in 9th-12th grade were bullied on school property and 15.5% were bullied online or through texting (Kann et al., 2016). This type of peer victimization represents a significant public health concern for youth due to serious consequences for victims, including physical health consequences, such as headaches, tiredness, abdominal pain, and upset stomach/nausea (Fekkes, Pijpers, Fredriks, Vogels, & Verloove-Vanhorick, 2006; Hager & Leadbeater, 2013; Kowalski & Limber, 2013); emotional consequences, such as depression (Hill, Mellick, Temple, & Sharp, 2017) and anxiety (Copeland, Wolke, Angold, & Costello, 2013); and academic consequences, such as poor grades (Lacey & Cornell, 2013). Rates of bullying and harassment are even higher for sexual minority youth, 34% and 28% of whom reported having been bullied at school and online or through text messages, respectively (Musu-Gillette, Zhang, Wang, Zhang, & Oudekerek, 2017). While GLSEN’s National School Climate Survey found that gender minority youth were particularly at risk for experiencing harassment and assault and were more likely to feel unsafe at school (Kosciw, Greytak, Giga, Villenas, & Danischewski, 2016). Although research has largely focused on global measures of bullying and other forms of peer aggression, there is a notable absence of the examination of specific forms of bias-based peer victimization across different subgroups of sexual and gender minority youth, with cisgender¹ and heterosexual comparisons. To address this paucity, we examine the prevalence of youth’s experiences with different kinds of bias-based harassment and sexual victimization with an emphasis on identifying similarities and differences by sexual identity and by gender identity. Further, due to the noted negative outcomes of peer victimization, we also explore whether youth’s perceptions of the biases motivating their victimization experiences are related to concurrent depressive symptomatology.

Bias-based peer victimization, similar to bias-motivated crime, is the intentional, or perceived, use of claimed or perceived identities, such as sexual orientation, race, immigration status, or gender, to target an individual or group (Bradshaw & Johnson, 2011). The Indicators of School Crime and Safety Survey found that, in 2015, 7% of 12-to-18-year-olds had been targeted by hate-related words in the previous year (Musu-Gillette et al., 2017), one of the many ways of assessing bias-based victimization. Research has documented that victimization is higher among certain subgroups of youth —for example, youth who are overweight (Bucchianeri, Eisenberg, & Neumark-Sztainer, 2013; Neumark-Sztainer et al., 2002), sexual minority youth (Kosciw et al., 2016), gender minority youth (Reisner, Greytak, Parsons, & Ybarra, 2015), racial/ethnic minority youth (Mendez, Bauman, Sulkowski, Davis, & Nixon, 2016; Rhee, Lee, & Jung, 2017), and immigrant youth (Maynard, Vaughn, Salas-Wright, & Vaughn, 2016).

A better understanding of the scope and consequences of bias-based victimization among youth is important if we are to address the negative health consequences of youth victimization and craft more effective prevention programs. As has been found with adults (McDevitt, Balboni, Garcia, & Gu, 2001), evidence is emerging that bias-based victimization has a greater negative impact on youth than non-bias-based victimization. For example, when youth perceived that peer harassment incidents were bias-based, it impacted their functioning in school even after controlling for other aggravating incident features, such as the use of a weapon, the use of sexual language, and injury, among others (Turner, Mitchell, Jones, & Shattuck, 2016). This finding was supported in an additional study that found that significant elevations in trauma symptoms were associated with peer victimization that had a bias or discriminatory component relative to peer victimization experiences without this characteristic (Turner, Finkelhor, Shattuck, Hamby, & Mitchell, 2015). Furthermore, being targeted by multiple forms of bias-based victimization is associated with particularly high distress (Grollman, 2012). Given that research has documented the increased risk for bias-based victimization faced by sexual and gender minority youth (Burton, Marshal, Chisolm, Sucato, & Friedman, 2013; Day, Perez-Brumer, & Russell, 2018), it is important to better understand the comparative rates and impact of victimization among subgroups of these youth.

Existing literature has found that sexual and gender minority youth often report poorer mental health outcomes such as depression, anxiety disorders, and suicidal ideation (King et al., 2008; Reisner, Vetters, et al., 2015; Safren & Heimberg, 1999) compared with heterosexual and cisgender youth. These disparities in mental health outcomes are generally thought to be due to chronic stressors, including bias-based victimization, due to the marginalized status that sexual and gender minorities have in society (Meyer, 2003). In addition, cisgender girls have a well-documented higher incidence of increased risk for depression compared with cisgender boys (Hyde, Mezulis, & Abramson, 2008; Nolen-Hoeksema & Girgus, 1994).

Using data from a national sample of adolescents, aged 13 to 18 years in the United States, we aim to fill these noted gaps in the literature by a) examining the prevalence of bias-based victimization experienced because of sexual orientation, gender, expression of gender, race or ethnicity, disability, religion, and physical appearance reported by a national sample of youth; and b) exploring whether specific forms of bias-based victimization are related to depressive symptomatology among youth. Given the noted disparities in bias-based victimization (Kahle, 2017; Kosciw et al., 2016), and in mental health outcomes (King et al., 2008), analyses will have an emphasis on identifying similarities and differences by sexual identity and gender identity.

Methods

Data for the Teen Health and Technology study were collected online between August 2010 and January 2011 from 5,907 13–18-year-olds in the United States (U.S.). The survey protocol was reviewed and approved by the Chesapeake Institutional Review Board (IRB), the University of New Hampshire IRB, and GLSEN Research Ethics Review Committee. A waiver of parental permission was granted for the study to protect youth who would potentially be placed in harm’s way if their sexual or gender minority status was unintentionally disclosed to their caregivers.

Participants and Procedures

Participants were recruited from the Harris Poll Online (HPOL) opt-in panel (n=3,989 respondents). HPOL was an opt-in panel of people whose members are recruited through a variety of methods, including targeted mailings, word of mouth, and online advertising. Current participants were randomly recruited through email invitations that referenced a survey about their “online experiences.” To obtain an oversample of lesbian, gay, bisexual, and transgender (LGBT) youth, participants were also recruited through referrals from GLSEN (n=1,918 respondents). Specifically, GLSEN sent emails about the survey to their list of then-current national student contacts, consisting of thousands of high school students across the U.S. who either previously participated in GLSEN’s programs or signed up to receive information about GLSEN’s programs and resources. The email referred to a survey about “health and the Internet” and indicated that we were interested in hearing from LGBT youth. GLSEN also publicized the survey through an advertisement on Facebook.

The survey questionnaire was self-administered online. The measures included those used in the present study, as well as others that were part of the overall goal of the Teen Health and Technology Study. The response rate for the HPOL sample was 7% and was calculated as the number of individuals who started the survey divided by the number of email invitations sent, less any email invitations that were returned as undeliverable. The response rate is similar to other national studies of youth that have been conducted during the same period but lower than that reported by studies conducted in previous years. Multiple studies have noted lower survey response rates because it is increasingly more difficult to reach and engage youth (Lenhart, Purcell, Smith, & Zickuhr, 2010; Mitchell & Jones, 2011). The response rate for the GLSEN sample cannot be calculated given that the denominator (i.e., the number of youth who saw the Facebook advertisement) is indeterminable.

Weighting

Weighting procedures were used so that the data more closely replicated a nationally representative sample, and were used to align the two samples, so that they could be combined into one data set. Specifically, data from the HPOL sample were weighted to known demographics of 13 to 18 year-olds who participated in the 2009 Current Population Survey (United States’ Census Bureau, 2009), including biological sex, age, race/ethnicity, parents’ highest level of education, school location, and U.S. region. From this weighted HPOL sample, a demographic profile was then created for the 5% of youth who identified as LGBT and was applied to the GLSEN respondents who identified as LGBT (93%), stratified by sex. However, even with that demographic weight applied, the LGBT youth recruited through GLSEN differed on nine characteristics (e.g. being out to one’s parents) compared to those recruited through HPOL. Therefore, a second weight was applied to align these behavioral and attitudinal differences between the two samples and a final postweight was applied so that the GLSEN and HPOL LGBT youth each accounted for 50% of the combined total LGBT sample. Additional details about the weighting process are available in the methodology report for the study (Center for Innovative Public Health Research, 2011).

Measures

Sexual identity.

Sexual identity was measured with the following question: “Below is a list of terms that people often use to describe their sexuality or sexual orientation. How would you describe your sexuality or sexual orientation? Please select all that apply.” Response options included: gay, lesbian, bisexual, straight/heterosexual, questioning, queer, other, and not sure. Youth who selected “other” were asked to specify their identity as an open-ended response, the vast majority of whom wrote-in either pansexual or asexual. As youth were permitted to endorse multiple options, mutually exclusive categories were created at the data-cleaning stage so that analyses could compare youth across categories. Only youth who exclusively endorsed a heterosexual identity were coded as heterosexual; all others were classified as one of three broad sexual minority categories. Similar to previous publications using the same data set (Ybarra, Espelage, & Mitchell, 2014; Ybarra, Rosario, Saewyc, & Goodenow, 2016), responses were categorized based upon the following hierarchy: lesbian/gay, bisexual, queer; questioning; unsure; other; and straight/heterosexual. Thus, if individuals identified as both “gay” and “questioning”, they were categorized as “gay/lesbian/queer/other”; if individuals identified as “bisexual” and “other,” they were categorized as “bisexual.” For the current study, four categories resulted: Heterosexual exclusively; gay/lesbian/queer/other (GLQO); bisexual; and questioning/unsure. We used identity, as opposed to attraction or behavior, to determine sexual minority status because of its implications for well-being: studies among adults suggest that ownership of a stigmatized sexual identity is more related to the social stress and subsequent negative mental health outcomes than either behavior or attraction (Meyer, 2003).

Sex and gender identity.

We assessed sex by asking youth, “What is your biological sex?” After youth were asked their sex, gender identity was assessed with the following question: “What is your gender? Your gender is how you feel inside and can be the same or different than the answer you gave above. Please select all that apply.” Response options were as follows: male, female, transgender, other (please specify). Multiple response options were possible. Youth who selected a gender different from their sex, but did not endorse ‘transgender’ as their gender identity, were asked the follow-up question, “Are you of transgender experience?” Based upon their responses, youth were coded into one of the following categories: cisgender male (i.e., exclusively endorsed a male gender identity and were male at birth), cisgender female (i.e., exclusively endorsing a female gender identity and were female at birth), transgender (i.e., reported their gender identity as transgender or agreed that they were of transgender experience), and gender nonconforming/other (i.e., youth who selected both male and female gender identities or selected “other” as their gender identity).

Perceived reasons for peer victimization.

All participants, were queried about whether other youth had aggressed on them for specific reasons. The question was worded as follows: “In the past 12 months, how often have others bullied, sexually harassed, or said or done something to you to hurt you because...?: a) you are gay, lesbian or bisexual or people think you are gay, lesbian, or bisexual; b) of your gender (because you are a boy, girl, or transgender); c) of how you express your gender (how traditionally “masculine” or “feminine” you are in your appearance or how you act); d) of your race or ethnicity or because people think you are a certain race or ethnicity; e) of your disability or because people think you are disabled; f) of your religion or because people think you are a certain religion; and g) of the way you look or your body size. Response options for each ranged from (1) never in the past 12 months to (5) every day or almost every day. Youth were also permitted to select “does not apply to me.” Responses were coded as (0) never being bullied or sexually harassed for this perceived reason versus (1) being bullied or sexually harassed for this perceived reason at least once in the past 12 months. Youth who said that the item did not apply to them were coded as 0.

Depressive symptomatology.

The 10-item Center for Epidemiologic Studies Depression Scale-Revised, which is a shortened version of the Center for Epidemiologic Studies Depression Scale (α = .93) (Haroz, Ybarra, & Eaton, 2014), was used to measure depressive symptomatology. Items included “My appetite was poor” and “I lost interest in my usual activities.” Response options ranged from (0) not at all or less than 1 day in the last week to (4) nearly every day for 2 weeks, with possible scores ranging from 0 to 40. Responses were then dichotomized with respondents coded as (1) having depressive symptomatology if they had a score of 11 or more, versus (0) no depressive symptomatology, if they had a score of 10 or less. This scoring is commensurate with the cut-off of 16 for the fuller Center for Epidemiological Studies Depression Scale, which has a possible range of 0–60 (Eaton, Muntaner, Smith, Tien, & Ybarra, 2004).

Demographic characteristics and process variables.

Age.

Youth were asked their age as an open-ended response. Responses ranged from 13–18 years old.

Household income.

Youth’s family income was assessed by asking youth, “How would you describe your family’s income?” Youth had three options: lower than average, about average, and higher than average. Those who indicated that their income was lower than average were compared to all other youth.

Urbanicity.

The degree to which youth’s communities were urban or rural was measured by asking where the respondent’s school was located. Response options included: in an urban or city area, in a suburban area next to a city, or in a small town or rural area.

Race and Ethnicity.

Ethnicity was measured by asking youth if they were of Spanish or Hispanic origin, and their ethnicity was coded as Hispanic versus non-Hispanic. Race was queried with 16 response options. Youth’s self-report of their race was coded as White, Black/African-American, Asian or Pacific Islander, Native American or Alaskan Native, and Mixed/Other Racial Background.

Dishonesty on the survey and not being alone while taking the survey.

The survey included several process variables at the end, two of which asked youth to respond how much they agreed or disagreed with the statement: “I answered the questions honestly.” Another question asked youth “Have there been other people in the room while you were doing this survey?”

Data Analyses

Identifying the analytic sample

To be included in the analyses, youth needed to provide “valid” responses (e.g., not “do not want to answer”) to at least 80% of the questions. They also needed to have a survey length of at least 5 minutes and meet the age validation (i.e., report one’s age at the beginning and end of the survey within a year of each other). A total of 227 (3.9%) respondents did not meet these valid data requirements, resulting in a final analytic sample size of 5,542 (3,777 recruited through HPOL and 1,765 through GLSEN).

Analytic procedures

Using Stata/SE 14.2, (StataCorp, 2014) missing (i.e., do not want to answer’) data were imputed using best-set regression. Chi-square tests, corrected for survey weights (i.e., design-based F statistics), were used to measure statistical differences in the rates of various types of bias-based peer victimization across sexual identity and across gender identity. For comparisons that were significant, post-hoc comparisons were made to identify which specific groups varied from each other.

In addition to reporting rates by sexual and gender identity, the relative adjusted odds of concurrent depressive symptomatology were estimated using logistic regression. Models included demographic variables, all seven types of bias-based harassment, and two survey process variables. Because of different stressors for LGBT and non-LGBT youth that could impact their relative likelihood of mental health distress (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009; Russell, Ryan, Toomey, Diaz, & Sanchez, 2011), youth were stratified by sexual and gender identity.

Results

By survey design, nearly 38% of youth in the sample identified as a sexual minority, 8% identified as a gender minority, 29% lived in a low-income household, 40% were racial/ethnic minorities, and 38% lived in a rural community. Further, 28% of youth had depressive symptomatology and 50% of youth reported that they experienced at least one of the seven forms of bias-based victimization (sexual orientation, gender, expression of gender, race or ethnicity, disability, religion, and physical appearance). Age, income, race/ethnicity, urbanicity, and honesty on the survey were similarly distributed across gender identities. However, gender minority youth were less likely to identify as heterosexual and were more likely to report depressive symptomatology compared to cisgender youth. Cisgender girls were more likely to report not being alone while taking the survey. Sample characteristics are provided in Table 1.

Table 1.

Youth Characteristics by Gender Identity

		By Gender Identity
Variable	All youth (n = 5,542) % (n)	Cisgender boys (n = 2,260) % (n)	Cisgender girls (n = 2,840) % (n)	Transgender youth (n = 189) % (n)	Gender non-confirming youth (n = 253) % (n)	Design-based F
Age (M (SE))	15.70 (.03)	15.6 (.05)	15.7 (.05)	15.8 (.21)	15.6 (.16)	.98
Sexual Identity
Heterosexual	61.6 (3380)	71.6 (1497)	59.5 (1861)	4.9 (6)	11.5 (16)	36.6***
GLQO	16.9 (1359)	20.2 (661)	10.0 (422)	55.1 (123)	39.8 (153)
Bisexual	18.9 (655)	6.4 (60)	27.5 (463)	32.4 (53)	46.0 (79)
Questioning/unsure	2.6 (148)	1.7 (42)	3.0 (94)	7.7 (7)	2.7 (5)
Depressive symptomatology	28.1 (1637)	18.2 (476)	32.9 (869)	63.3 (124)	53.2 (168)	38.1***
Low income	29.0 (1325)	27.8 (504)	29.2 (686)	39.6 (59)	26.6 (76)	1.7
Hispanic ethnicity	19.4 (672)	20.8 (278)	18.2 (341)	21.6 (19)	14.1 (34)	.83
Race
White	59.9 (3844)	60.5 (1657)	59.6 (1901)	56.5 (129)	58.8 (157)	1.6
Black/African-American	12.7 (469)	12.3 (140)	13.2 (306)	8.4 (7)	13.2 (16)
Asian or Pacific Islander	2.6 (187)	2.0 (59)	3.1 (112)	1.8 (6)	2.5 (10)
Native American or Alaskan Native	1.0 (54)	.63 (19)	1.3 (27)	1.1 (4)	.89 (4)
Mixed/other racial background	4.6 (318)	3.8 (108)	4.6 (154)	10.6 (24)	10.5 (32)
Type of community
Urban or city area	28.5 (1639)	29.1 (648)	27.0 (815)	37.0 (81)	35.4 (95)	1.5
Suburban area	33.0 (2179)	34.2 (904)	32.0 (1128)	32.4 (62)	32.6 (85)
Small town or rural area	38.5 (1724)	36.8 (708)	41.0 (897)	30.6 (46)	32.0 (73)
Process Variables
Dishonesty on survey	1.3 (65)	1.2 (24)	1.4 (37)	.10 (1)	1.2 (3)	1.0
Not alone while taking survey	32.5 (1750)	27.9 (633)	37.3 (979)	25.6 (70)	28.7 (68)	8.9***

^***p ≤ .001.

^**p ≤ .01

^*p <.05

Note: Unweighted n’s and weighted percentages. Racial categories are non-Hispanic. GLQO refers to youth who identified as Gay/Lesbian/Queer/Other. Depression symptomatology is defined as meeting the clinical cutoff (a score of 27%) for endorsed symptoms associated with major depression.

Rates of bias-based victimization by sexual identity among boys

Among boys, there were differences across sexual identity for youth who had been victimized due to their actual or presumed sexual orientation, with sexual minority boys being far more likely to have been victimized compared to heterosexually-identified boys (Table 2). Specifically, boys in all sexual minority categories experienced this significantly more than heterosexually-identified boys. Within sexual minority identities, GLQO boys experienced victimization due to their sexual orientation more than bisexual boys and questioning/unsure boys. Similar differences across sexual identity were observed for youth who had been victimized due to their gender expression, with sexual minority boys reporting more than heterosexual boys. In addition, GLQO boys reported having been victimized due to their gender expression more than questioning/unsure boys, but not bisexual boys.

TABLE 2.

Perceived Reason for Having Been Victimized by Sexual Identity-Sex Among Boys (%, weighted)

	All Boys (n = 2,377)
Perceived reasons for having been victimized	Heterosexual (n = 1,504)	GLQO (n = 746)	Bisexual (n = 84)	Questioning/unsure (n = 43)	Design-based F
Sexual orientation	3.7	69.5a	46.6ab	30.6ab	122.1***
Gender	2.7	14.6a	8.7	15.5	14.1***
Gender expression	6.8	51.0a	51.8a	30.2ab	66.0***
Race or ethnicity	10.4	15.6	19.9	15.4	1.91
Disability	5.8	4.9	7.7	13.5	.56
Religion	7.1	14.0a	16.5	7.9	4.2*
Physical appearance	22.7	40.0a	36.9a	46.6a	8.8***

^***p ≤ .001

^**p ≤ .01

^*p < .05 for overall difference

Note: For chi-square results

^adenotes a significant post-hoc difference compared to heterosexual boys (e.g. GLQO boys versus heterosexual boys; bisexual boys versus heterosexual boys, and Questioning/unsure boys versus heterosexual boys)

^bdenotes a significant post-hoc difference comparing GLQO and other sexual minority boys (e.g. GLQO boys versus bisexual boys; GLQO versus Questioning/unsure boys), and

^cdenotes a significant post-hoc difference comparing bisexual and Questioning/unsure boys.

Although there were differences across sexual identity for victimization due to one’s actual or perceived religion or gender, only GLQO boys had significantly higher rates than heterosexual boys for both of these forms of bias-based bullying or sexual harassment. Having been victimized due to the way one looks was significantly more common among all sexual minority boys compared to heterosexual boys. There were no significant differences across sexual identity for having been victimized due to one’s race or ethnicity nor due to a disability.

Rates of bias-based victimization by sexual identity among girls

There were differences across sexual identity for every bias-based form of victimization assessed among girls with the exception of having been bullied due to a disability (Table 3). Particularly, all sexual minority girls were more likely to have been victimized due to their actual or presumed sexual orientation compared to heterosexual girls, as were GLQO girls compared to both bisexual and questioning/unsure girls. Bisexual girls were also more likely to experience this form of biased victimization compared to questioning/unsure girls. Similarly, victimization due to their gender expression was more common among girls of all sexual minority identities compared to heterosexual girls and among GLQO girls compared to both bisexual and questioning/unsure girl.

TABLE 3.

Perceived reason for Having Been victimized by Sexual Identity-Sex Among Girls (%, weighted)

	All Girls (n = 2,840)
Perceived reasons for having been victimized	Heterosexual (n = 1,876)	GLQO (n = 613)	Bisexual (n = 571)	Questioning/unsure (n = 105)	Design-based F
Sexual orientation	1.7	61.2a	49.6ab	25.7abc	172.2***
Gender	6.5	28.0a	22.2a	18.6a	30.6***
Gender expression	7.2	50.4a	29.2ab	26.5ab	68.9***
Race or ethnicity	9.7	15.1a	15.4a	14.6	3.8**
Disability	3.0	6.5	4.3	3.8	2.3
Religion	7.8	19.9a	19.1a	13.8	13.6***
Physical appearance	28.7	48.5a	54.5a	42.7a	26.0***

^***p ≤ .001.

^**p ≤ .01 for overall difference

Note: For chi-square results

^adenotes a significant post-hoc difference compared to heterosexual girls (e.g. GLQO girls versus heterosexual girls; bisexual girls versus heterosexual girls, and Questioning/unsure girls versus heterosexual girls)

^bdenotes a significant post-hoc difference comparing GLQO and other sexual minority girls (e.g. GLQO girls versus bisexual girls; GLQO versus Questioning/unsure girls), and

^cdenotes a significant post-hoc difference comparing bisexual and Questioning/unsure girls.

In addition, both GLQO and bisexual girl were more likely than heterosexual girls to experience victimization motivated by their race or ethnicity or religion. Finally, all sexual minority girls were more likely to have been victimized due to their physical appearance and their gender compared to heterosexually-identified girls.

Rates of bias-based victimization across gender identity

Across gender identity, there were differences in experience with every measured form of bias-based peer victimization, except having been victimized due to one’s race or ethnicity. Gender minority youth were more likely to experience victimization due to their sexual orientation, gender, gender expression, and the way they look compared to cisgender boys (Table 4). The same was true when compared with cisgender girls, except having been victimized for the way they look, which was similar for cisgender girls and gender nonconforming youth.

TABLE 4.

Perceived Reasons for Having Been Victimized by Gender Identity (%, weighted)

	All youth (N = 5,542)
Perceived reasons for having been victimized	Cisgender boys (n = 2,260)	Cisgender girls (n = 2,840)	Transgender (n = 189)	Gender non-conforming (n = 253)	Design-based F
Sexual orientation	19.4	20.6	65.8ab	66.3ab	42.7***
Gender	3.8	11.9a	53.4ab	28.2abc	74.4***
Expression of gender	17.3	16	80.8ab	54.7abc	74.6***
Race or ethnicity	11.5	12	21.9	17.5	2.6
Disability	5.8	3.6a	8.2	5.5	3.6*
Religion	9	12a	19.2a	21.3a	6.4***
Physical appearance	26.5	38a	57.5ab	45.3a	18.3***

^***p ≤ .001.

^**P ≤ .01

^*p <.05 for overall difference

Note: For chi-square results

^adenotes a significant post-hoc difference compared to cisgender boys (e.g. cisgender boys versus cisgender girls; cisgender boys versus transgender youth; cisgender boys versus gender non-confirming youth)

^bdenotes a significant post-hoc difference compared to cisgender girls (e.g. cisgender girls versus transgender youth; cisgender girls versus gender non-confirming youth), and

^cdenotes a significant post-hoc difference comparing transgender youth and gender non-conforming youth.

All other youth, cisgender girls, transgender youth, and gender nonconforming youth, were more likely to have experienced victimization due to their religion compared to cisgender boys. In addition, cisgender girls were more likely to have been victimized due to their gender and for the way they look compared to cisgender boys. Cisgender boys, on the other hand, were more likely to experience victimization due to a disability compared to cisgender girls. Finally, having been victimized for their gender and gender expression both was more common among transgender youth compared to gender nonconforming youth.

Influence of bias-based victimization on depressive symptomatology

After controlling for demographic and process variables, victimization due to one’s sexual orientation, gender, disability, and the way they look were each significantly related to depressive symptomatology among heterosexual boys above and beyond the other perceived reasons for having been victimized (Table 5). Among GLQO boys, victimization due to their gender, race or ethnicity, and the way they look was significantly related to increased adjusted odds of experiencing depressive symptomatology and victimization due to their sexual orientation decreased these odds. There was not enough power to examine the influence of these forms of bias-based victimizations on depressive symptomatology among bisexual and questioning/unsure boys.

TABLE 5.

Adjusted Odds of Factors Related to Depressive Symptomatology by Sexual Identity among Boys

	Heterosexual (n = 1,504)	GLQO (n = 746)
Variable	Adjusted Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)
Perceived Reasons for Having Been Victimized
Sexual orientation	2.8 (1.2, 6.3)**	.37 (.16, .84)*
Gender	3.7 (1.5, 8.8)**	3.3 (1.5, 7.3)**
Expression of gender	1.1 (.51, 2.2)	1.1 (.56, 2.1)
Race or ethnicity	.70 (.35, 1.4)	3.0 (1.3, 6.7)*
Disability	2.8 (1.5, 5.2)**	.91 (.25, 3.4)
Religion	1.5 (.82, 2.7)	1.1 (.54, 2.3)
Physical appearance	2.5 (1.6, 3.8)***	2.2 (1.2, 4.1)**
Demographic characteristics
Age	1.2 (1.0, 1.3)*	1.3 (1.0, 1.5)**
Low income	1.7 (1.1, 2.6)*	1.1 (.55, 2.1)
Hispanic ethnicity	2.5 (1.5, 4.3)**	2.3 (1.1, 5.0)
Race
White	1.0 (Ref)	1.0 (Ref)
Black/African-American	1.5 (.71, 3.3)	1.2 (.33, 4.5)
Asian or Pacific Islander	1.7 (.57, 5.2)	.76 (.20, 2.9)
Native American or Alaskan Native	1.0 (.12, 8.8)	.86 (.15, 4.8)
Mixed/Other Racial Background	2.7 (1.1, 6.4)*	.95 (.35, 2.6)
Type of community
Urban or city area	1.0 (Ref)	1.0 (Ref)
Suburban area	.80 (.48, 1.3)	.80 (.38, 1.7)
Small town or rural area	.77 (.46, 1.3)	.89 (.43, 1.9)
Dishonesty on survey	.35 (.04, 3.0)	.57 (.12, 2.7)
Not alone while taking survey	1.1 (.68, 1.6)	.68 (.38, 1.2)

^***p ≤ .001.

^**p < .01.

^*p <.05.

Ref = reference category

Note. There was not enough power to run regression separately for bisexual boys nor for questioning/unsure boys. Ref = reference category; CI = confidence interval. GLQO refers to youth who identified as gay/lesbian/queer/other.

Among heterosexual girls, victimization due to one’s sexual orientation, gender expression, religion, and physical appearance were each significantly related to depressive symptomatology (Table 6). For GLQO girls, victimization due to one’s religion or physical appearance were both related to depressive symptomatology above and beyond all others. Among bisexual girls, victimization based on their gender and the way they looked was significantly related to depressive symptomatology. Similar to boys, there was not enough power for the examination of depressive symptomatology among questioning/unsure girls.

TABLE 6.

Adjusted Odds of Factors Related to Depressive Symptomatology by Sexual Identity among Girls

	Heterosexual (n = 1,876)	GLQO (n = 613)	Bisexual (n = 571)
Variable	Adjusted Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)
Perceived Reasons for Having Been Victimized
Sexual orientation	2.7 (1.0, 6.9)*	.88 (.41, 1.9)	1.4 (.78, 2.7)
Gender	1.2 (.67, 2.1)	1.6 (.79, 3.4)	2.1 (1.1, 4.2)*
Expression of gender	2.5 (1.5, 4.3)***	1.9 (1.0, 3.8)	.76 (.40, 1.4)
Race or ethnicit	1.3 (.84, 2.1)	.43 (.17, 1.1)	1.1 (.47, 2.6)
Disability	1.6 (.83, 3.3)	2.1 (.53, 8.3)	6.1 (.71, 52.6)
Religion	2.0 (1.2, 3.1)**	2.9 (1.1, 7.4)*	1.7 (.83, 3.3)
Physical appearance	1.7 (1.2, 2.3)***	2.2 (1.1, 4.3)*	2.3 (1.2, 4.2)*
Demographic characteristics
Age	1.1 (1.0, 1.2)	.87 (.72, 1.1)	.96 (.80, 1.2)
Low income	1.4 (1.0, 1.9)	2.4 (1.2, 4.6)**	1.5 (.79, 2.7)
Hispanic ethnicity	1.8 (1.1, 2.7)	.67 (.29, 1.5)	1.2 (.50, 2.7)
Race
White	1.0 (Ref)	1.0 (Ref)	1.0 (Ref)
Black/African-American	1.7 (1.1, 2.7)	.86 (.31, 2.4)	.89 (.30, 2.6)
Asian or Pacific Islander	1.4 (.68, 3.0)	2.8 (.57, 14.2)	1.2 (.27, 5.1)
Native American or Alaskan Native	.21 (.04, 1.2)	.61 (.14, 2.7)	.43 (.05, 3.7)
Mixed/Other Racial Background	2.2 (1.2, 3.9)	3.1 (1.1, 9.3)	1.4 (.39, 4.6)
Type of community
Urban or city area	1.0 (Ref)	1.0 (Ref)	1.0 (Ref)
Suburban area	.77 (.54, 1.1)	1.3 (.64, 2.7)	1.3 (.66, 2.7)
Small town or rural area	.94 (.65, 1.4)	.98 (.44, 2.2)	.47 (.23, .94)*
Dishonesty on survey	1.0 (.35, 3.1)	6.0 (.61, 58.2)	.14 (.03, .65)*
Not alone while taking survey	1.6 (1.2, 2.1)	.71 (.37, 1.4)	1.1 (.62, 2.0)

^***p ≤ .001.

^**p ≤ .01.

^*p ≤.05.

Ref = reference category

Note. There was not enough power to run regression separately for questioning/unsure girls.

Among cisgender boys, regardless of sexual identity, victimization due to their sexual orientation, their gender, or due to the way they look were all significantly related to depressive symptomatology (Table 7). Every form of bias-based peer victimization assessed was significantly related to depressive symptomatology for cisgender girls, with the exception of having been bullied due to one’s race or ethnicity.

TABLE 7.

Adjusted Odds of Factors Related to Depressive Symptomatology among Youth by Gender Identity (n = 5,542)

	Cisgender boys (n = 2,260)	Cisgender girls (n = 2,840)	Transgender (n = 189)	Gender non-conforming (n = 253)
Variable	Adjusted Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)	Adjusted Odds Ratio (95% CI)
Perceived Reasons for Having Been Victimized
Sexual orientation	2.0 (1.2, 3.2)**	2.8 (2.0, 4.1)***	.37 (.10, 2.2)	1.8 (.63, 5.2)
Gender	2.2 (1.1, 4.5)*	1.7 (1.1, 2.6)*	2.2 (.56, 8.6)	2.1 (.69, 6.3)
Expression of gender	.88 (.53, 1.4)	1.5 (.98, 2.2)*	1.5 (.24, 8.8)	1.6 (.56, 4.7)
Race or ethnicity	.98 (.56, 1.7)	1.2 (.78, 1.8)	1.9 (.40, 9.4)	.31 (.06, 1.7)
Disability	1.4 (.64, 2.9)	2.3 (1.3, 4.0)**	1.0 (.16, 6.4)	8.0 (.88, 72.7)
Religion	.92 (.55, 1.5)	1.7 (1.2, 2.5)**	9.1 (1.9, 44.0)**	30.9 (2.8, 345.1)**
Physical appearance	2.4 (1.7, 3.4)***	1.8 (1.3, 2.4)***	4.7 (1.3, 17.7)*	2.2 (.84, 5.8)
Demographic characteristics
Age	1.1 (1.0, 1.2)	1.0 (.94, 1.1)	1.1 (.80, 1.6)	1.1 (.81, 1.5)
Low income	1.4 (.96, 2.2)	1.5 (1.1, 2.0)*	.80 (.24, 2.6)	5.3 (1.7, 16.5)**
Hispanic ethnicity	2.0 (1.3, 3.3)	1.4 (.93, 2.1)	2.4 (.52, 10.7)	1.02 (.21, 4.8)
Race
White	1.0 (Ref)	1.0 (Ref)	1.0 (Ref)	1.0 (Ref)
Black/African-American	1.2 (.56, 2.4)	1.2 (.78, 1.9)	16.5 (1.7, 156.4)*	1.2 (.38, 3.5)
Asian or Pacific Islander	2.3 (.87, 6.1)	1.6 (.82, 3.0)	59.7 (2.0, 1804.5)*	19.6 (1.9, 201.1)*
Native American or Alaskan Native	.92 (.23, 3.7)	.47 (.13, 1.7)	.81 (.09, 7.0)	1.7 (.16, 17.2)
Mixed/Other Racial Background	1.6 (.77, 3.6)	1.8 (1.0, 3.1)	3.7 (.77, 17.8)	27.8 (4.9, 158.5)***
Type of community
Urban or city area	1.0 (Ref)	1.0 (Ref)	1.0 (Ref)	1.0 (Ref)
Suburban area	.74 (.47, 1.2)	1.1 (.83, 1.6)	4.2 (1.1, 16.8)	2.3 (.75, 7.1)
Small town or rural area	.70 (.45, 1.1)	.75 (.54, 1.0)	.54 (.14, 2.0)	1.2 (.35, 4.2)
Dishonesty on survey	.71 (.25, 2.0)	.70 (.28, 1.7)	omitted	.12 (.01, 1.7)
Not alone while taking survey	.82 (.56, 1.2)	1.3 (1.0, 1.7)	1.7 (.52, 5.5)	.81 (.34, 2.0)

^***P ≤ .001.

^**P ≤ .01.

^*P <.05

Ref = reference category

Note: Dishonesty on the survey was omitted from the model because only one transgender youth reported having been dishonest on the survey.

For transgender youth, having been victimized due to the way they looked was the only bias-based form of victimization that related to depressive symptomatology. Among gender nonconforming youth, having been victimized due to religion was related to increased adjusted odds of having depressive symptomatology, whereas being victimized due to one’s race or ethnicity had decreased adjusted odds of having depressive symptomatology.

Discussion

This study aimed to examine the prevalence of specific bias-based victimization experiences and whether particular forms of bias-based victimization were concurrently related to depressive symptomatology, both with an emphasis on identifying similarities and differences by sexual and gender identity. Overall, the results indicate that bias-based victimization is pervasive, with half of all youth reporting some experience with it. This is particularly concerning due to emergent findings that bias-based victimization can be even more problematic for youth well-being compared to victimization that is not perceived as bias-based (Turner et al., 2016). Our results also found that some youth were more vulnerable to this form of victimization and to concurrently experience depressive symptomatology.

Bias-based victimization experiences across sexual and gender identities

The current study supports previous findings that sexual and gender minority youth are more likely to experience peer victimization in general compared to heterosexual and cisgender youth (Kosciw et al., 2016; Musu-Gillette et al., 2017). The findings also support research that suggests that sexual and gender minority youth are not only just more likely to be targeted due to their sexual or gender identity, but are also more likely to experience a range of different types of bias-based victimization than other youth, such as victimization related to one’s religion and race/ethnicity. (Bucchianeri, Gower, McMorris, & Eisenberg, 2016). It is possible that their sexual and gender minority status makes them more vulnerable to other types of harassment. Previous research has indeed found that some youth in vulnerable populations have an elevated risk of experiencing multiple forms of bias-based victimization (Bucchianeri et al., 2013), likely due to being a member of multiple stigmatized groups. This is particularly troublesome considering findings that being the target of these multiple forms of bias victimization is associated with high distress (Grollman, 2012).

Extending research in this area, the current study found within-group differences between subgroups of sexual and gender minority youth. For example, contrary to previous studies (Birkett, Espelage, & Koenig, 2009), though questioning and unsure youth had higher rates of bias-based victimization compared to heterosexual youth, they were at a lower risk compared to youth who identified as lesbian, gay, queer, bisexual, or another defined sexual identity (i.e. “other”). It may be that the questioning and unsure youth in this study were less likely to have taken on a stigmatized label and were, thus, less likely to be vulnerable to victimization. This finding suggests that identification with a sexual minority identity might increase the risk for bias-based victimization.

Although some previous studies have found no difference in prevalence of bullying victimization between boys and girls (Gruber & Fineran, 2008; Schneider, O’Donnell, Stueve, & Coulter, 2012), the current study broadens research in this field with the finding that cisgender girls, regardless of sexual identity, are more at risk for bias-based victimization, in the forms of peer aggression and sexual harassment, compared with cisgender boys, particularly related to gender, appearance, and religion.

Associations between bias-based victimization and depressive symptomatology

Having been victimized for the way they look was concurrently associated with depressive symptomatology for youth. Indeed, being targeted because of physical appearance was associated with an increase in the odds of depressive symptomatology for each group of youth, with the exception of gender nonconforming youth. This is worrisome because parents, teachers, and students all report that weight-based bullying, one form of such victimization, is the most common form of harassment experienced by youth (Bradshaw, Waasdorp, O’Brennan, & Gulemetova, 2013; Puhl, Luedicke, & DePierre, 2013). Outside of weight-based victimization, the limited research on victimization based on physical appearance has also focused on physical weakness (Hodges & Perry, 1999) and attraction (Rosen, Underwood, & Beron, 2011) both of which are also related to internalizing problems. However, because we did not specify in our measure, it is possible that youth were targeted because of their physical appearance for these or other reasons. That said, its sheer volume, along with its relationship with psychological well-being and physical health in youth as shown in the current study and others (Eisenberg, Neumark-Sztainer, Haines, & Wall, 2006; Greenleaf, Petrie, & Martin, 2014), suggests that greater attention should be paid to victimization based on physical appearance and that it be taken seriously as a true source of distress for youth.

Although sexual and gender minority youth were more likely to be victimized due to their sexual orientation, victimization was only related to depressive symptomatology for cisgender and heterosexually-identified youth. Similarly, transgender and gender nonconforming youth were far more likely to experience victimization due to their gender and gender expression; however, this type of victimization was only related to depressive symptomatology for cisgender youth. It may be that being victimized for perceived sexual orientation when one identifies as heterosexual is especially problematic for youth. Indeed, prior studies have found that homophobic name-calling was positively associated with alcohol use among heterosexual youth, a behavior that was thought to serve as a means of trying to improve their social standing with peers (Tucker et al., 2016). It may also be the case that sexual and gender minority youth anticipate some level of victimization due to their sexual orientation and for their gender expression and, because of this anticipation or its regularity, are more desensitized to it. More research is needed to understand whether sexual and gender minority youth are dismissive of homophobic and gender-based teasing and what other protective factors are influential in this process (e.g. supportive social networks).

Victimization because of one’s religion was also significantly related to depressive symptomatology for many of the subgroups of youth in this study. Although we did not specifically assess religious affiliation in the survey, this finding is alarming in many ways due to the recent increase in bias-motived crimes related to religion, particularly those directed at individuals who are Muslim and Jewish (United States Department of Justice, 2017).

Limitations

There are a number of limitations that need to be considered in interpreting findings, including that this is a cross-sectional study and therefore, temporality cannot be determined. Moreover, these data were self-reported; therefore, it is possible that youth reports were not accurate because of intentional or unintentional misreporting. In addition, the entire survey was completed online by youth and this may have introduced common-method variance, particularly pertaining to those youth who may be familiar with completing surveys online compared to those who are not.

Recruiting truly nationally representative samples is increasingly difficult (Pew Research Center for the People & the Press, 2012). These difficulties are further magnified when recruiting youth for studies involving sensitive topics; thusly, comparable to other surveys, our response rate of 7% is lower than desired. Moreover, underlying factors related to self-selection may have affected the sample’s generalizability. For example, it is possible that HPOL panel members may be more digitally literate than non-members or that GLSEN youth are more publicly open about their sexual identity than HPOL LGB+ youth. To address these limitations and to minimize self-selection bias, HPOL participants were randomly recruited from the panel and the study description was purposefully vague so as not to attract youth with specific experiences. Furthermore, as previously mentioned, these potential underlying differences were adjusted for in weighting procedures (Schonlau et al., 2004; Terhanian, Bremer, Smith, & Thomas, 2000).

Finally, due to the low number of youth who identified as questioning/unsure and boys who identified as bisexual, we did not have the power to examine depressive symptomatology among these groups. Such analyses would have contributed to our further understanding of the within-group differences among sexual minority youth.

Research Implications

Further research should be conducted to confirm and provide more information on the differences found in the current study. Findings point to the need to better understand the circumstances under which different subgroups of sexual and gender minority youth experience rates of different types of victimization experiences. Although it is clear that sexual and gender minority youth are at increased vulnerability for experiencing multiple forms of bias-based victimization, it remains unclear if their sexual and gender minority status, in and of itself, serves as the foundation for this vulnerability. The findings also suggest that researchers should, when possible, disaggregate sexual minority youth, because they do not necessarily carry identical risks. Furthermore, as the current study is cross-sectional, additional research should longitudinally examine the relationship between different forms of bias-based victimization, depressive symptomatology, and other health and academic outcomes. In addition, future research should ask to understand more about perpetrators of bias-based victimization. By surveying the victims, we are only able to assess their perception of why they were targeted. However, research on perpetrators would provide more information on how often they are targeting their peers for these bias reasons, the motivation behind this type of victimization, and the degree of co-occurrence between victimization and perpetration.

Clinical and Policy Implications

There are also a number of key clinical and policy implications stemming from the results of the current study. The results highlight that youth-serving professionals and policymakers should avoid assumptions that all youth, even all sexual and gender minority youth, experience harassment in similar ways. Findings further highlight the importance of considering the role that bias-based victimization may have in all youth’s mental well-being, including heterosexual and cisgender youth. In particular, findings from the current study that having been victimized due to one’s actual or perceived sexual orientation was related to increased odds of depressive symptomatology for cisgender and heterosexual youth and not sexual and gender minority youth, suggest that clinicians who work with youth consider the discussion of all forms of bias-based victimization with their clients, regardless of sexual or gender identity.

Finally, district and school policymakers should ensure that bias-based harassment is specifically addressed in both prevention strategies and policies for reprimanding students. As prior researchers have suggested (Espelage, 2013), prevention messaging and programming needs to target not just the bias-based harassment of particular youth, but must also include administrative support and professional development for teachers and staff (Rinehart & Espelage, 2016), such as training for how to appropriately address victims and perpetrators and access to on-campus mental health professionals. They must also work to change school climate and social norms around the acceptability of bias-based victimization, which can include bystander training for students and zero-tolerance policies.

Conclusions

The current study adds to the growing body of research documenting the heightened risk of experiencing multiple types of bias-based victimization among sexual and gender minority youth. The potential emotional consequences of bias-based victimization for youth require that both prevention and treatment strategies be a high priority for schools and communities. The current study suggests that prevention strategies should be expanded by specifically addressing bias-based peer victimization, in its many forms, along with other forms of peer victimization. This study also suggests that resources, particularly mental health, should target youth who may be vulnerable to bias-based victimization depending on the unique demographics of the school and/or community.