Abstract
Purpose: The study purpose was to examine how the COVID-19 pandemic may be differentially impacting the well-being of sexual and gender minority (SGM) youth compared with their non-SGM counterparts. Specifically, we looked at perceptions of mental and physical health impact and relevant aspects of coping with the pandemic such as engagement in prosocial activities that might ultimately promote resilience.
Methods: Survey data were collected between November 27, 2020, and December 11, 2020, from 990 adolescents and emerging adults aged 13–23 years. Participants were recruited through advertisements on Facebook and Instagram with an effort to overrecruit SGM youth. Questions asked youth about their perception of the impact of the COVID-19 pandemic on their physical and mental health, the types of prosocial activities engaged in during the pandemic, and how they felt they were doing now versus before the pandemic.
Results: SGM youth reported a significantly greater impact from the pandemic than non-SGM youth. Both SGM youth and cisgender heterosexual females reported greater impact on their mental health compared with cisgender heterosexual males, with cisgender sexual minority females and gender minority youth reporting the highest mental health impact. Gender minority youth also reported feeling less connected to their families and less safe at home as a result of the pandemic.
Conclusion: Health professionals, educators, and advocates need to help assess SGM youth for negative impact from the pandemic and help them connect with other youth and support resources online as they move forward. Youth may also benefit from programs connecting them to volunteer work and neighbors.
Keywords: COVID-19, gender minority, health, sexual minority, well-being, youth
Introduction
The COVID-19 pandemic and associated health policies such as school closures may be amplifying existing mental health disparities for already marginalized youth and emerging adults, including sexual and gender minority (SGM) youth1 and adults.2,3 Before the COVID-19 pandemic, SGM youth faced substantial health inequities, including increased substance use,4,5 depressive symptomatology,6,7 anxiety,8,9 and suicidal behavior.10–13 Even though pandemic-related policies are designed to help keep people safe, they may have presented particular difficulties for SGM youth, including confinement in possibly abusive homes,1,14–16 discomfort at home due to caregivers who may not know about their SGM identity,16,17 and lack of access to mental health services and community supports more accessible to them at school and in the community.14,15 Taken together, it is critical to understand how the pandemic may be contributing to mental health disparities for SGM adolescents and emerging adults.
The current study considers how the COVID-19 pandemic may be differentially impacting the well-being of SGM adolescents and emerging adults compared with their non-SGM counterparts. The analyses examine perceptions of mental and physical health impact and relevant aspects of coping with the pandemic such as engagement in prosocial activities that might ultimately promote resilience.
Methods
Participants
The Exploring Your YOU-niverse Study is one in a series of independent national surveys of adolescents and emerging adults. This most recent survey was designed to understand youth exposure to self-directed violence. Data were collected from a cohort of 1031 youth and emerging adults aged 13–23 years between November 27, 2020, and December 11, 2020. To promote a diverse sample, demographic quotas were identified. Once the targeted number of participants in a particular group had been achieved (e.g., aged 13–17, cisgender girls), subsequent youth in this group who were otherwise eligible were deemed ineligible. Questions about the COVID-19 pandemic were placed at the end of the survey. Ninety percent of participants answered questions about the pandemic and are included in these analyses; thus, the analytical sample for the current article is n = 990. Table 1 provides details of the demographic characteristics of the analytic sample by sexual and gender identity. The protocol was reviewed and approved by the Pearl Institutional Review Board (IRB), the IRB of record for the Center for Innovative Public Health Research.
Table 1.
Demographic Characteristics of the Analytic Sample, by Sexual and Gender Identity
| Cisgender heterosexual males (n = 192) n (%) | Cisgender sexual minority males (n = 231) n (%) | Cisgender heterosexual females (n = 232) n (%) | Cisgender sexual minority females (n = 163) n (%) | Gender minority AFAB/AMAB (n = 172) n (%) | p | |
|---|---|---|---|---|---|---|
| Age | ||||||
| 13–17 years | 144 (75.0) | 160 (69.3) | 172 (74.1) | 99 (60.7) | 91 (52.9) | <0.001 |
| 18–23 years | 48 (25.0) | 71 (30.7) | 60 (25.9) | 64 (39.3) | 81 (47.1) | |
| Racea | ||||||
| White | 150 (78.1) | 171 (74.0) | 165 (71.1) | 124 (76.1) | 140 (81.4) | 0.15 |
| Black | 13 (6.8) | 21 (9.1) | 22 (9.5) | 19 (11.7) | 12 (7.0) | 0.47 |
| Asian | 21 (10.9) | 18 (7.8) | 27 (11.6) | 13 (8.0) | 12 (7.0) | 0.38 |
| Native American | 1 (0.5) | 9 (3.9) | 5 (2.2) | 4 (2.5) | 6 (3.5) | 0.23 |
| Mixed race | 11 (5.7) | 24 (10.4) | 23 (9.9) | 20 (12.3) | 25 (14.5) | 0.08 |
| Hispanic/Latino ethnicity (any race) | 40 (20.8) | 42 (18.2) | 47 (20.3) | 24 (14.7) | 24 (13.9) | 0.29 |
| Family income | ||||||
| Lower than average | 39 (20.3) | 49 (21.2) | 31 (13.4) | 37 (22.7) | 52 (30.2) | 0.008 |
| Similar to average | 90 (46.9) | 121 (52.4) | 133 (57.3) | 84 (51.5) | 76 (44.2) | |
| Higher than average | 52 (27.1) | 46 (19.9) | 44 (19.0) | 31 (19.0) | 30 (17.4) | |
| Not sure | 11 (5.7) | 15 (6.5) | 24 (10.3) | 11 (6.7) | 14 (8.1) | |
| Current schooling | ||||||
| Middle school (6–8 grade) | 27 (14.1) | 20 (8.7) | 53 (22.8) | 28 (17.2) | 25 (14.5) | <0.001 |
| High school (9–12 grade) | 115 (59.9) | 155 (67.1) | 110 (47.4) | 85 (52.1) | 92 (53.5) | |
| High school graduate (not enrolled) | 16 (8.3) | 8 (3.5) | 10 (4.3) | 8 (4.9) | 16 (9.3) | |
| Dropped out | 7 (3.7) | 2 (0.9) | 8 (3.5) | 0 | 4 (2.3) | |
| Higher education (trade or college) | 27 (14.1) | 46 (19.9) | 51 (22.0) | 42 (25.8) | 35 (20.3) | |
Each identified race is in comparison with all others. Hispanic/Latino ethnicity is compared with non-Hispanic/Latino ethnicity. Gender minority youth were not further categorized by their sexual identity because only a few identified as heterosexual, thereby resulting in an unstable analytical cell (n = 2).
Multiple responses possible.
AFAB, assigned female at birth; AMAB, assigned male at birth.
Procedures
Participants were recruited through study advertisements (ads) on Facebook and Instagram. Facebook allows targeted ads based on age and sex as well as “affinity” targeting by race and ethnicity. Online ads encouraged potential participants to “have their voice heard” and “make a difference.” Survey aims were not mentioned to reduce self-selection bias based upon interest in a particular topic. Those who were interested clicked on the ad that linked them to a secure survey website.
The first survey page provided a study description and screening questions to determine eligibility. Those who were eligible (i.e., 13–23 years of age, living in the United States, and English speaking) were then asked to read an assent form and indicate their willingness to participate in the survey before continuing to the main survey. A waiver of caregiver permission was granted by the Pearl IRB because requiring it could potentially place youth in situations where their sexual or gender identity, sexual experiences, and/or sexual attraction could be unintentionally disclosed to their caregivers. Appropriate mechanisms were in place to protect the youth, such as localized referrals to mental health supports provided remotely by a team clinician. Participants were given a $5 Amazon gift code as an incentive for completing the survey. Ineligible youth were directed to a web page that included links to general resources for youth, for example, a health website for young women.18
Measures
Perceived impact of the COVID-19 pandemic
A series of questions created for this survey was included to examine both how the pandemic has impacted participants' lives and to determine the types of social interactions in which they have engaged. Participants were asked, in the past 3 months, how much the pandemic has impacted their (1) mental health, (2) physical health, (3) school work/work, and (4) screen time—looking at your phone, a tablet, and other screens. Response options ranged from not at all (1) to a lot (3).
Participants were also asked to describe how they feel now versus before the pandemic across eight different statements designed for this study, including “I feel more connected to my family”; “I have learned new things/discovered new hobbies”; and “I feel less safe at home physically or emotionally.” Response options ranged from (1) does not apply to me to (10) applies to me very much. The amount of missing data for this set of items was high (9%–18%) so we examined missing responses as a separate variable in these analyses.
COVID outreach
Participants were asked how many times they had done nine different things in the past 2 weeks (0 times, 1–2 times, 3–9 times, 10–19 times, 20–39 times, and 40+ times); sample items include the following: “I have talked to family virtually (such as FaceTime and Zoom)”; “I have volunteered for programs to help other people deal with the impact of the pandemic”; and “I have reached out to friends who I think may be having a hard time because of the pandemic.” Missing data (no more than 2%) were replaced by the item mean. Reliability for this 9-item scale was acceptable (α = 0.75). Given low cell stability for higher frequency endorsement options, response options were recoded to reflect any endorsement (1) versus none (0).
Finally, participants were provided with a place to provide an open-ended response to share more about how the pandemic has impacted them.
Demographic characteristics
Age was reported in this article as 13–17 versus 18–23 years. Self-reported household income comprised three answer choices: lower than average, about average, and higher than average and also included a “not sure” option. Youth reported their race (White, Black, Asian, Native American, and mixed race with multiple response options possible) and, separately, their ethnicity (Hispanic or Latino [any race]). Youth also indicated their current status in school: middle school (6–8 grade), high school (9–12 grade), high school graduate (not enrolled), dropped out, and higher education (trade or college).
To assess gender identity, participants were first provided with the following question and definition: “What is your gender? Gender refers to cultural values (roles, behaviors, activities and attributes) that a society associates with males and females. Gender also refers to how one defines oneself. For many people, there isn't a difference between these terms, but for some people, their gender is different from their biological sex. Biological sex is determined by our chromosomes, our hormones and reproductive organs. Typically, we are assigned the sex of male or female at birth.”19 Response options were male; female; female-to-male (FTM)/transgender male/trans man; male-to-female (MTF)/transgender female/trans woman; gender queer/nonbinary/pangender; other (specify); I don't understand this question; and decline to answer. Participants were allowed to endorse multiple options.
Sexual identity was assessed with the following question: “Below is a list of terms that people often use to describe their sexuality or sexual orientation.19 How would you describe your sexuality or sexual orientation? Please select all that apply.” Response options included Gay, Lesbian, Bisexual, Straight/heterosexual, Questioning, Queer, Pansexual, Asexual, Other (specify), Unsure, and Decline to answer. Participants were allowed to endorse multiple options.
Youth were categorized into one of five groups based on their responses to the above sexual identity and gender identity questions as well as their assigned sex at birth (What sex were you assigned at birth on your original birth certificate? [male or female]): (1) cisgender heterosexual males (n = 192), (2) cisgender sexual minority males (n = 231), (3) cisgender heterosexual females (n = 232), (4) cisgender sexual minority females (n = 163), (5) gender minority assigned male at birth (AMAB, n = 37) or assigned female at birth (AFAB, n = 135). Gender minority AMAB and AFAB youth were combined due to low cell stability for AMAB participants. Gender minority youth were not further categorized by their sexual identity because only a few identified as heterosexual, thereby resulting in an unstable analytical cell (n = 2). Cisgender refers to people who identify their gender as the same as the sex they were assigned at birth.
Statistical analysis
Given the exploratory nature of this article, the analyses are mainly descriptive. We first provide percentages of the perceived impact of the pandemic by sexual and gender identity, comparing differences using chi-square statistics. We then present data from the open-ended question about how youth said the pandemic had impacted them; qualitative coding of the open-ended responses was conducted using content analysis with codes developed by the third author and a research assistant following guidelines for qualitative coding.20,21 All responses were coded by the research assistant and 50% were checked for consistency by the third author. Next, we used analysis of variance to compare differences in how participants were feeling now versus before the pandemic across sexual and gender identity groups. Finally, chi-square analyses were conducted to compare the types of prosocial activities youth engaged in during the pandemic by sexual and gender identity. All quantitative analyses were also analyzed by sexual identity among sexual minority subgroups. The following groups were created due to cell size restrictions: (1) gay and lesbian youth, (2) bisexual, pansexual, and queer youth, and (3) asexual, questioning, unsure, and other youth. Significant differences are noted in the Results section.
Results
Perceived impact of the COVID-19 pandemic by sexual and gender identity
Participants were asked to indicate, in the past 3 months, how much the pandemic has impacted their mental health, physical health, schoolwork/work, and screen time. Significant differences were noted by sexual and gender identity, particularly for mental health (Table 2). Most participants, regardless of sexual and gender identity, reported that the pandemic had impacted their mental health “a lot,” ranging from 42.2% of cisgender heterosexual males to 71.5% of gender minority youth. Pairwise comparisons revealed that all subgroups reported significantly more mental health impact compared with cisgender heterosexual males. Gender minority youth reported significantly more impact than all other groups except cisgender sexual minority females.
Table 2.
Perceived Impact of the COVID-19 Pandemic by Sexual and Gender Identity
| COVID-19 impact | Cisgender heterosexual males (n = 192) n (%) | Cisgender sexual minority males (n = 231) n (%) | Cisgender heterosexual females (n = 232) n (%) | Cisgender sexual minority females (n = 163) n (%) | Gender minority AFAB/AMAB (n = 172) n (%) | p |
|---|---|---|---|---|---|---|
| Past 3 months impact of pandemic on: | ||||||
| Mental health | ||||||
| Not at all | 36 (18.7) | 26 (11.3)a | 21 (9.1)a | 5 (3.1)a,b,c | 5 (2.9)a,b,c | <0.001 |
| A bit | 75 (39.1) | 80 (34.6) | 87 (37.5) | 48 (29.5) | 44 (25.6) | |
| A lot | 81 (42.2) | 125 (54.1) | 124 (53.5) | 110 (67.5) | 123 (71.5) | |
| Physical health | ||||||
| Not at all | 55 (28.7) | 48 (20.8)a | 46 (19.8) | 32 (19.6) | 31 (18.0)a | 0.06 |
| A bit | 94 (49.0) | 108 (46.7) | 120 (51.7) | 88 (54.0) | 79 (45.9) | |
| A lot | 43 (22.4) | 75 (32.5) | 66 (28.5) | 43 (26.4) | 62 (36.1) | |
| School work/work | ||||||
| Not at all | 24 (12.5) | 10 (4.3)a | 23 (9.9) | 5 (3.1)a,c | 8 (4.7)a | 0.004 |
| A bit | 48 (25.0) | 55 (23.8) | 56 (24.1) | 33 (20.3) | 41 (23.8) | |
| A lot | 120 (62.5) | 166 (71.9) | 153 (65.9) | 125 (76.7) | 123 (71.5) | |
| Screen time | ||||||
| Not at all | 15 (7.8) | 18 (7.8) | 10 (4.3) | 5 (3.1)a,b | 11 (6.4) | 0.03 |
| A bit | 38 (19.8) | 42 (18.2) | 32 (13.8) | 15 (9.2) | 26 (15.1) | |
| A lot | 139 (72.4) | 171 (74.0) | 190 (81.9) | 143 (87.7) | 135 (78.5) | |
Higher scores equal greater impact.
Significantly different from cisgender heterosexual males.
Significantly different from cisgender sexual minority males.
Significantly different from cisgender heterosexual females.
Fewer, but still a notable percentage of, youth reported that the pandemic had impacted their physical health “a lot”—from 22.4% of cisgender heterosexual males to 36.1% of gender minority youth. The main differences were for cisgender sexual minority males and gender minority youth compared with cisgender heterosexual males. The majority of youth also reported that the pandemic had impacted their schoolwork/work as well as their screen time, with cisgender heterosexual males reporting the lowest percentages of being impacted “a lot” and cisgender sexual minority female youth reporting the highest rates of impact in these areas. No significant differences were found by sexual identity among sexual minority subgroups.
What adolescents and emerging adults are saying about how the COVID-19 pandemic has impacted them, by sexual and gender identity
Youth were provided with an option to share any other information about how the pandemic had impacted them, and 31% (n = 304) of participants provided open-ended comments. The third author worked with a research assistant to describe different effects staying as close as possible to the words of the youth. The research assistant then coded all responses for the presence or absence of each of these impacts using principles of content coding. Separate summaries were created by sexual and gender identity group membership. Overall, youth talked about a variety of ways that the COVID-19 pandemic has impacted their lives, including social isolation/interpersonal problems (32.6%), negative impact on mental or physical health (28.9%), school education stress (16.5%), positive changes (24.0%), and in other ways (e.g., financial stress, political tensions, screen time; 24.0%). We provide some examples that illustrate how the pandemic has affected youth of different sexual and gender identities (Table 3).
Table 3.
What Adolescents and Emerging Adults Are Saying About How the COVID-19 Pandemic Has Impacted Them, by Sexual and Gender Identity
| Totals (n = 304) n (%) | Cisgender heterosexual males (n = 68) n (%) | Cisgender sexual minority males (n = 51) n (%) | Cisgender heterosexual females (n = 71) n (%) | Cisgender sexual minority females (n = 53) n (%) | Gender minority AFAB/AMAB (n = 61) n (%) | p | |
|---|---|---|---|---|---|---|---|
| Social isolation/interpersonal problems | 99 (32.6) | 25 (36.8) | 13 (25.5) | 27 (38.0) | 15 (28.3) | 19 (31.1) | 0.53 |
| “It's let me have a lot more time to think about myself. I had a lot of self-discovery, including finding out I was trans and pansexual. But now I have a to more to hide from my family since everything I do from home. I don't have as much time to express myself.” (gender minority youth) | |||||||
| “Because I'm stuck at home with my parents who aren't supportive of my transition, I'm Constantly uncomfortable whenever my dead name is called or I have to be with my parents.” (gender minority youth) | |||||||
| “I'm one of the only people I know not currently living with my family right now, and I am also employed (which I am very grateful for), but I have not seen messaging for people like me. Everyone is so excited to have more time for hobbies and family, and I don't have those joys. It makes me sad to think that others can be close with their families and have lots of time for creativity.” (cisgender sexual minority female) | |||||||
| “Being away from people so much, I feel I've turtled myself inside my own head for too long that it's kind of hard to connect with people.” (cisgender sexual minority female) | |||||||
| “The pandemic has forced me to move back home instead of living on campus. As a result, I live with my very homophobic family, which has placed me under considerable stress.” (cisgender sexual minority male) | |||||||
| “My dad has gotten a lot worse. That's about it. My mom is still nice though. And my sister. But my dad just yells a lot and places blame on my sister and I for things he has done, which he did before the pandemic but i used to be able to just avoid that, now it's inevitable.” (cisgender sexual minority male) | |||||||
| Negative impact on mental or physical health | 88 (28.9) | 11 (16.2) | 14 (27.5) | 28 (39.4) | 16 (30.2) | 19 (31.1) | 0.05 |
| “It sucks, I've had mental health issues, skin rashes, and been feeling down. I'm gonna talk to someone though and hopefully get better soon.” (cisgender sexual minority male) | |||||||
| “I lost my 50 day streak of not self harming because I felt unneeded in the world and I would never be capable of being in a relationship because I don't even love myself. I had a lot of time to think, so I'm not doing that well.” (cisgender sexual minority female) | |||||||
| “I feel physically exhausted and lethargic everyday because my stress has been almost unmanageable.” (gender minority youth) | |||||||
| School education stress | 50 (16.5) | 10 (14.7) | 10 (19.6) | 16 (22.5) | 6 (11.3) | 8 (13.1) | 0.42 |
| “During the pandemic completing school work has become very stressful and difficult and before the pandemic i had a tight group of relatable friends but now i dont really have anyone.” (gender minority youth) | |||||||
| “I'm awful at doing school online but that's all I can do right now. I'm usually really smart, but my grades are going down cause of this.”(cisgender heterosexual female) | |||||||
| “The heavy courseload that my university has given us during these remote semesters has left me constantly burnt out and I feel like I have very little control over my life and future right now.” (cisgender sexual minority female) | |||||||
| “Since I don't have internet at home and my mother is a single parent with five kids, I failed an entire semester.” (cisgender heterosexual male) | |||||||
| Positive changes | 73 (24.0) | 13 (19.1) | 14 (27.5) | 13 (18.3) | 13 (24.5) | 20 (32.8) | 0.28 |
| “I used to hate every single interaction with people I don't know. But now even though I still don't like it all that much or feel comfortable but now I'm a little more out there than before.” (cisgender sexual minority female) | |||||||
| “The only way the pandemic has really impacted me is that I'm able to do better in school now that I do not have to be in person. Before when I had to be in person it would cause me a lot of anxiety which caused me to focus more on my anxiety than on school.” (cisgender sexual minority male) | |||||||
| “It gave me a lot of time to assess myself and think about who I am. It also helped me grow closer to my friends and realize the problems with my family.” (gender minority youth) | |||||||
| Other | 73 (24.0) | 13 (19.1) | 14 (27.5) | 13 (18.3) | 13 (24.5) | 20 (32.8) | 0.98 |
| “obviously a lot of families are struggling financially, but our community has been providing free bfast and lunch for kids 18 and under for the entirety of the pandemic, no questions asked:)” (cisgender sexual minority female) | |||||||
| “Well I got sick for 3 months from January to March, proceeded to lose my job because of that, and have been too scared to look for more work, causing me to fall behind on rent leaving me potentially homeless come January. I would say covid has impacted me quite a lot overall.” (gender minority youth) | |||||||
How adolescents and emerging adults report they are feeling now versus before the pandemic
When asked how they were feeling now versus before the pandemic, some differences were noted across sexual and gender identity subgroups (Table 4). Gender minority youth had the lowest average scores for feeling more connected to their family—significantly less than each other subgroup. They were also the most likely to not respond to this question. Similarly, gender minority youth had the lowest scores for feeling that they were coping well—different from all subgroups except cisgender sexual minority females. Gender minority youth had the highest scores for enjoying not having the social pressure of needing to be with people. When asked whether they feel less safe at home physically or emotionally, we again found that gender minority youth had the highest scores; they were significantly more likely to report this compared with all other subgroups.
Table 4.
Adolescent and Emerging Adults' Report of How They Are Feeling Now Versus Before the Pandemic, by Sexual and Gender Identity
| Cisgender heterosexual males (n = 192) M (SE)/n (%) | Cisgender sexual minority males (n = 231) M (SE)/n (%) | Cisgender heterosexual females (n = 232) M (SE)/n (%) | Cisgender sexual minority females (n = 163) M (SE)/n (%) | Gender minority AFAB/AMAB (n = 172) M (SE)/n (%) | p | |
|---|---|---|---|---|---|---|
| More connected to my family, M (SE) | 4.7 (0.23) | 3.8 (0.23)a | 4.8 (0.21)b | 3.5 (0.24)a,c | 2.9 (0.24)a,b,c,d | <0.001 |
| No response, n (%) | 19 (9.9) | 39 (16.9)a | 21 (9.1)b | 21 (12.9) | 38 (22.1)a,c,d | 0.001 |
| I am coping well, M (SE) | 5.9 (0.24) | 4.9 (0.21)a | 5.3 (0.20) | 4.0 (0.22)a,b,c | 3.5 (0.22)a,b,c | <0.001 |
| No response, n (%) | 16 (8.3) | 24 (10.4) | 19 (8.2) | 14 (8.6) | 17 (9.9) | 0.91 |
| Don't really feel all that different than before, M (SE) | 4.6 (0.26) | 3.9 (0.25)a | 3.9 (0.23)a | 3.6 (0.26)a | 3.3 (0.24)a | 0.005 |
| No response, n (%) | 15 (7.8) | 33 (14.3) | 31 (13.4) | 21 (12.9) | 24 (13.9) | 0.28 |
| Enjoy not having the social pressure of needing to be with people, M (SE) | 4.6 (0.26) | 4.6 (0.25) | 5.0 (0.25) | 5.6 (0.26)a,b | 6.2 (0.27)a,b,c | <0.001 |
| No response, n (%) | 20 (10.4) | 28 (12.1) | 27 (11.6) | 12 (7.4) | 14 (8.1) | 0.45 |
| Reconnected with people that I lost touch with, M (SE) | 3.5 (0.22) | 3.3 (0.21) | 3.7 (0.22) | 3.1 (0.25) | 3.4 (0.27) | 0.48 |
| No response, n (%) | 28 (14.6) | 35 (15.1) | 38 (16.4) | 16 (9.8) | 30 (17.4) | 0.33 |
| Have time to do things that I did not have time for before, M (SE) | 5.8 (0.25) | 5.1 (0.22) | 5.1 (0.21)a | 4.7 (0.25)a | 4.3 (0.26)a,b,c | 0.001 |
| No response, n (%) | 16 (8.3) | 28 (12.1) | 17 (7.3) | 11 (6.7) | 21 (12.2) | 0.17 |
| Learned new things/discovered new hobbies, M (SE) | 5.7 (0.24) | 5.4 (0.21) | 5.4 (0.21) | 5.2 (0.26) | 5.1 (0.26) | 0.43 |
| No response, n (%) | 20 (10.4) | 22 (9.5) | 13 (5.6) | 8 (4.9) | 11 (6.4) | 0.15 |
| Feel less safe at home physically or emotionally, M (SE) | 3.1 (0.27) | 3.3 (0.24) | 2.9 (0.23) | 3.1 (0.26) | 4.2 (0.29)a,b,c,d | 0.01 |
| No response, n (%) | 38 (19.8) | 45 (19.5) | 43 (18.5) | 24 (14.7) | 31 (18.0) | 0.75 |
Significantly different from cisgender heterosexual males.
Significantly different from cisgender sexual minority males.
Significantly different from cisgender heterosexual females.
Significantly different from cisgender sexual minority females.
M, mean; SE, standard error.
Among sexual identity subgroups, bisexual, pansexual, and queer youth (mean [M] = 3.51, standard deviation [SD] = 0.27) were more likely to say they did not really feel any different than before the pandemic compared with gay and lesbian youth (M = 3.37, SD = 0.27) and asexual, questioning, unsure, and other youth (M = 5.33, SD = 0.48) (F = 6.75, p = 0.001). No other differences were noted for differential feelings now versus before the pandemic by sexual identity among sexual minority subgroups.
Engagement in different types of prosocial activities during the pandemic by sexual and gender identity
Many of the participants had engaged in some form of prosocial activity in the 2 weeks before the survey regardless of sexual and gender identity (Table 5). Highly endorsed forms of outreach included activities aimed at social integration, including talking to friends virtually, and spending time with friends or family that they did not live with, face-to-face, both inside and outside. Differences were noted across sexual and gender identity subgroups for some activities, with gender minority youth being the least likely to spend time with friends and family inside and outside that they do not live with in-person and talking with family virtually with significant differences between them and most or all other subgroups.
Table 5.
Prosocial Activity During the COVID-19 Pandemic by Sexual and Gender Identity
| Cisgender heterosexual males (n = 192) n (%) | Cisgender sexual minority males (n = 231) n (%) | Cisgender heterosexual females (n = 232) n (%) | Cisgender sexual minority females (n = 163) n (%) | Gender minority AFAB/AMAB (n = 172) n (%) | p | |
|---|---|---|---|---|---|---|
| I have talked to friends virtually | 156 (81.3) | 185 (80.1) | 173 (74.6) | 131 (80.4) | 142 (82.6) | 0.29 |
| I have spent time with people, like friends or family, face to face outside that I do not live with in-person | 149 (77.6) | 179 (77.5) | 182 (78.5) | 113 (69.3)c | 109 (63.4)a,b,c | 0.002 |
| I have spent time with people, like friends or family, face to face inside that I do not live with in-person | 152 (79.2) | 169 (73.2) | 178 (76.7) | 112 (68.7)a | 114 (66.3)a,c | 0.03 |
| I have talked to family virtually | 116 (60.4) | 139 (60.2) | 136 (58.6) | 107 (65.6) | 84 (48.8)a,b,c,d | 0.03 |
| I have reached out to friends who I think may be having a hard time because of the pandemic | 125 (65.1) | 149 (64.5) | 164 (70.7) | 116 (71.2) | 123 (71.5) | 0.34 |
| I have reached out to family who I think may be having a hard time because of the pandemic | 84 (43.7) | 96 (41.6) | 105 (45.3) | 63 (38.7) | 68 (39.5) | 0.65 |
| I have spent time helping a child, sibling, or a younger family member with online school | 96 (50.0) | 108 (46.7) | 139 (59.9)a,b | 96 (58.9)b | 75 (43.6)c,d | 0.002 |
| I have helped neighbors who I think may be having a hard time because of the pandemic | 41 (21.3) | 48 (20.8) | 60 (25.9) | 33 (20.3) | 20 (11.6)a,b,c,d | 0.01 |
| I have volunteered for programs to help other people deal with the impact of the pandemic | 43 (22.4) | 34 (14.7)a | 42 (18.1) | 28 (17.2) | 18 (10.5)a,c | 0.04 |
Significantly different from cisgender heterosexual males.
Significantly different from cisgender sexual minority males.
Significantly different from cisgender heterosexual females.
Significantly different from cisgender sexual minority females.
Participants also reported engaging in a variety of types of helping behaviors during the pandemic, including reaching out to friends and to family who they thought may be having a hard time because of the pandemic; however, no significant differences were noted by sexual and gender identity. Both cisgender sexual minority and heterosexual females were the most likely to have spent time helping a child, sibling, or younger family member with online school. Gender minority youth were the least likely to have helped neighbors who they thought might be having a hard time. Finally, some participants had volunteered for programs to help other people deal with the impact of the pandemic—ranging from 10.5% of gender minority youth to 22.4% of cisgender heterosexual male youth. When examined across sexual identity subgroups, the only significant difference was that asexual, questioning, unsure, and other youth were more likely to say that they had helped younger children with online school (63.5%) compared with bisexual, pansexual, and queer youth (57.3%) and gay and lesbian youth (41.9%) (X2 = 12.0, p = 0.003).
Discussion
Findings from this national study provide further evidence of the toll that the COVID-19 pandemic and public health policies, such as school closings, may have had on the health of many adolescents and emerging adults, regardless of sexual and gender identity.22–25 The study also extends our understanding of how the pandemic may have differentially impacted the health of SGM youth. Gender minority youth in particular were more likely than cisgender youth to report that the pandemic had impacted their mental and physical health, which is also highlighted in qualitative work conducted with queer and trans youth.26
The data suggest some specific areas that health and education professionals can target moving forward. One focus should be on family and home life. All groups of SGM youth in this study were less likely to feel connected with their family compared with cisgender heterosexual youth. The pandemic is a time where the nuclear family has been emphasized and even celebrated. Youth with tenuous family support might therefore be especially vulnerable to pandemic-related stress. Importantly, gender minority youth had the highest scores on feeling less safe at home physically or emotionally. This supports prior research identifying how pandemic-related mitigation policies may be furthering existing health disparities by resulting in confinement in possibly abusive homes1,14–16 and discomfort at home due to family who may not know about their SGM identity.16,17 Indeed, a qualitative essay developed from conversations with trans and queer youth about the impact of the pandemic documented the challenges faced by these youth and their friends related to the loneliness, lack of support, lack of privacy, and stigma stemming from isolation in, oftentimes, unsupportive homes.26 Furthermore, SGM youth may reconceptualize and define family differently from their cisgender counterparts. Indeed, the role of “chosen family”—not necessarily biological family—is important to consider in clinical settings and applied research alike.27 Whether and how stressors related to family and home instabilities will persist and continue to impact health and well-being as we move through the next phases of the pandemic is important to direct scarce but needed public health resources.
Another focus is the need to enhance both formal and informal support systems for SGM youth with attention to increasing acceptance and inclusiveness. For example, school closures and home quarantines likely allow for only limited access to mental health services and community supports.14,15 Yet, the current study found that cisgender sexual minority females and gender minority youth were more likely to report that they enjoyed not having the social pressure of needing to be with people. This finding may reflect an everyday stressor for these youth that might have been alleviated by the pandemic and warrants additional attention. For example, everyday stress before the pandemic may have included interacting with peers who are judgmental or not accepting. Future work might explore whether, in these specific contexts, the pandemic may have temporarily alleviated these and other stressors related to discrimination and stigma. SGM-affirming practice shows promise in medicine and mental health sectors alike,28 although recent research underscores that more training and educational programs are needed.29 Online interventions to promote caregiver support of sexual minority youth also demonstrate promise.30
The findings also highlight the resilience of many youth who were trying their best to stay connected. We saw a lot of endorsement by youth, regardless of sexual and gender identity, of talking with friends and family virtually and spending time with friends and family with whom they did not live during the pandemic. However, gender minority youth and often cisgender sexual minority females were least likely to endorse such social integration efforts. At the same time, not all youth struggled, even among SGM youth. The open-ended comments provided by participants in the current study suggest positive impacts for some youth and, in line with current recommendations, it is important to include perspectives of well-being and resilience for SGM youth.31 Future research should seek to understand the characteristics and relevant contexts of SGM youth who fared well during the pandemic.
Youth were also frequently trying to help others. In a short 2-week time period, many had reached out to friends, family, or neighbors whom they thought might be having a hard time because of the pandemic. A notable percentage had even volunteered for programs to help other people deal with the impact of the pandemic. We found less helping from a community perspective (neighbors, volunteering) for gender minority youth. This raises the question of connectedness to neighbors more broadly. If gender minority youth feel more isolated/stigmatized or judged by neighbors, they may be less likely to offer to help (which requires making oneself vulnerable to rejection). Similarly, gender minority youth may be less likely to volunteer in the community (in general) due to stigma and discrimination even if there was not a pandemic.
Limitations
The cross-sectional nature of this study limits inferences about the impact of the pandemic using pre/post methods; we relied on youths' perceptions of impact. Although the sample is national and therefore geographically diverse, it is not representative. Further attention to living situation and developmental level is necessary to explicate effects. Furthermore, there was interpretive ambiguity about the impact of the COVID-19 pandemic, specifically, whether the items referred to a negative or positive impact. Open-ended responses indicated that much of this was indeed negative, but did note some positive impact as well. Future work should ask youth to rate the impact using a scale from positive to negative.
The language used to assess sexual and gender identity was not always optimal, for example, best practice is to include “cisgender” in the gender options. It is also best practice to use the term “sex assigned at birth” instead of biological sex. The sample size limited our ability to examine outcomes by sexual identity subgroups more specifically. This resulted in the imperfect grouping of some identities, for example, asexual youth do not fit with questioning and unsure youth but, together, they comprised a general “other” category. The sample was also predominately White and future research should include more diversity in the racial and ethnic breakdown of participants across sexual and gender identities. Although the current study did not measure participants' outness to caregivers nor perceived caregiver acceptance of SGM status, this is important information to include in future research, specifically in relation to the quality of the home experience during COVID-19 restrictions. Finally, the measure of safety at home combined both emotional and physical safety; it will be important in future research to measure these experiences separately.
Conclusion
These findings suggest that the COVID-19 pandemic and associated public health policies have affected the mental and physical health of adolescents and emerging adults in the short term, especially SGM youth. The current study extends our understanding of the needs of SGM youth in this public health crisis and begins to identify ways in which youth will need to be supported by adolescent health and education professionals. Understanding whether and how these impacts persist in the long term is also critical to informing public health efforts. Ultimately, this will strengthen current work to improve the well-being of SGM youth through large-scale prevention, intervention, and health promotion programs.
Authors' Contributions
K.J.M. conceptualized and designed the study, acquired the data, conducted the data analysis, interpreted the data, and drafted the article. V.B. and M.L.Y. helped acquire and interpret the data and critically revised the article for important intellectual content. K.L.G. and L.M.J. helped interpret the data and critically revised the article for important intellectual content. All authors reviewed and approved the final version of the article before submission and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of the work are appropriately investigated and resolved.
Disclaimer
The funder/sponsor did not participate in the work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD083072b (Principal Investigator Ybarra); internal research funds were also provided from nongovernmental sources: the University of New Hampshire and Rutgers University.
References
- 1. Salerno JP, Williams ND, Gattamorta KA: LGBTQ populations: Psychologically vulnerable communities in the COVID-19 pandemic. Psychol Trauma 2020;12(S1):S239–S242. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Phillips II G, Felt D, Ruprecht MM, et al. : Addressing the disproportionate impacts of the COVID-19 pandemic on sexual and gender minority populations in the United States: Actions toward equity. LGBT Health 2020;7:279–282. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Fish JN, Salerno J, Williams ND, et al. : Sexual minority disparities in health and well-being as a consequence of the COVID-19 pandemic differ by sexual identity. LGBT Health 2021;8:263–272. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Marshal MP, Friedman MS, Stall R, et al. : Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction 2008;103:546–556. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Reisner SL, Greytak EA, Parsons JT, Ybarra ML: Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity. J Sex Res 2014;52:243–256. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Veale JF, Watson RJ, Peter T, Saewyc EM: Mental health disparities among Canadian transgender youth. J Adolesc Health 2017;60:44–49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Zietsch BP, Verweij KJ, Heath AC, et al. : Do shared etiological factors contribute to the relationship between sexual orientation and depression? Psychol Med 2012;42:521–532. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Jones A, Robinson E, Oginni O, et al. : Anxiety disorders, gender nonconformity, bullying and self-esteem in sexual minority adolescents: Prospective birth cohort study. J Child Psychol Psychiatry 2017;58:1201–1209. [DOI] [PubMed] [Google Scholar]
- 9. Bouman WP, Claes L, Brewin N, et al. : Transgender and anxiety: A comparative study between transgender people and the general population. Int J Transgend 2017;18:16–26. [Google Scholar]
- 10. Kaniuka AR, Bowling J: Suicidal self-directed violence among gender minority individuals: A systematic review. Suicide Life Threat Behav 2021;51:212–219. [DOI] [PubMed] [Google Scholar]
- 11. McKay T, Berzofsky M, Landwehr J, et al. : Suicide etiology in youth: Differences and similarities by sexual and gender minority status. Child Youth Serv Rev 2019;102:79–90. [Google Scholar]
- 12. O'Brien KHM, Putney JM, Hebert NW, et al. : Sexual and gender minority youth suicide: Understanding subgroup differences to inform interventions. LGBT Health 2016;3:248–251. [DOI] [PubMed] [Google Scholar]
- 13. Smith DM, Wang SB, Carter ML, et al. : Longitudinal predictors of self-injurious thoughts and behaviors in sexual and gender minority adolescents. J Abnorm Psychol 2020;129:114. [DOI] [PubMed] [Google Scholar]
- 14. Konnoth C: Supporting LGBT communities in the COVID-19 pandemic. In: Assessing Legal Responses to COVID-19. Edited by Burris S, de Guia S, Gable L, et al. Vol No. 20–47:234–239. Boston, MA: Public Health Law Watch, U of Colorado Law Legal Studies Research Paper, 2020. [Google Scholar]
- 15. Green A, Price-Feeney M, Dorison S: Implications of COVID-19 for LGBTQ Youth Mental Health and Suicide Prevention. The Trevor Project. 2020. Available at https://www.thetrevorproject.org/2020/04/03/implications-of-covid-19-for-lgbtq-youth-mental-health-and-suicide-prevention/ Accessed January 21, 2021.
- 16. Salerno JP, Devadas J, Pease M, et al. : Sexual and gender minority stress amid the COVID-19 pandemic: Implications for LGBTQ young persons' mental health and well-being. Public Health Rep 2020;135:721–727. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Fish JN, McInroy LB, Paceley MS, et al. : “I'm kinda stuck at home with unsupportive parents right now”: LGBTQ youths' experiences with COVID-19 and the importance of online support. J Adolesc Health 2020;67:450–452. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Boston Children's Hospital. Center for Young Women's Health. 2021. Available at https://youngwomenshealth.org Accessed August 5, 2021.
- 19. Mitchell KJ, Banyard V, Goodman KL, et al. : Exposure to suicidal behavior and social support among sexual- and gender-minority youth. Pediatrics 2021;147:e2020033134. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Graneheim UH, Lundman B: Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105–112. [DOI] [PubMed] [Google Scholar]
- 21. Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–1288. [DOI] [PubMed] [Google Scholar]
- 22. Guessoum SB, Lachal J, Radjack R, et al. : Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res 2020;291:113264. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. de Miranda DM, da Silva Athanasio B, de Sena Oliveira AC, Silva ACS. How is COVID-19 pandemic impacting mental health of children and adolescents? Int J Disaster Risk Reduct 2020;51:101845. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Magson NR, Freeman JY, Rapee RM, et al. : Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. J Youth Adolesc 2021;50:44–57. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Racine N, Cooke JE, Eirich R, et al. : Child and adolescent mental illness during COVID-19: A rapid review. Psychiatry Res 2020;292:113307. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Paceley MS, Okrey-Anderson S, Fish JN, et al. : Beyond a shared experience: Queer and trans youth navigating COVID-19. Qual Soc Work 2021;20:97–104. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Hailey J, Burton W, Arscott J: We are family: Chosen and created families as a protective factor against racialized trauma and anti-LGBTQ oppression among African American sexual and gender minority youth. J GLBT Fam Stud 2020;16:176–191. [Google Scholar]
- 28. Jadwin-Cakmak L, Bauermeister JA, Cutler JM, et al. : The health access initiative: A training and technical assistance program to improve health care for sexual and gender minority youth. J Adolesc Health 2020;67:115–122. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Zelin NS, Encandela J, Van Deusen T, et al. : Pediatric residents' beliefs and behaviors about health care for sexual and gender minority youth. Clin Pediatr (Phila) 2019;58:1415–1422. [DOI] [PubMed] [Google Scholar]
- 30. Goodman JA, Israel T: An online intervention to promote predictors of supportive parenting for sexual minority youth. J Fam Psychol 2020;34:90. [DOI] [PubMed] [Google Scholar]
- 31. Fish JN: Future directions in understanding and addressing mental health among LGBTQ youth. J Clin Child Adolesc Psychol 2020;49:943–956. [DOI] [PMC free article] [PubMed] [Google Scholar]