Date of Award

Spring 5-2019

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

J. MICHAEL WILKERSON, PHD, MPH

Second Advisor

MARIA FERNANDEZ-ESQUER, PHD

Third Advisor

ALAN NYITRAY, PHD, MS

Abstract

Sexual and gender (SGM) adolescents face a higher burden of mental health disorders than their heterosexual and cisgender peers. SGM adolescents living in Texas are vastly understudied. Using three papers, this dissertation aimed to address this gap in knowledge concerning SGM adolescents in Texas. The aim of paper 1 was to analyze data from an online state-wide survey of SGM adolescents and adults in Texas to: 1) estimate the prevalence of anxiety, depression, and suicidal ideation; and 2) to determine which demographic, social support, and discrimination variables are associated with self-reported measures of depression, anxiety, and suicidal ideation. The aim of paper 2 was to: 1) conduct a secondary analysis of cross-sectional data from a drop-in center serving SGM adolescents to estimate the prevalence of depression and suicidal ideation in this sample; and 2) to examine associations between depression and suicidal ideation with measures examining their experience at school. The aim of paper 3 was to use qualitative data from parent-adolescent dyadic interviews to develop a concise explanatory model of the association between adverse childhood experiences (ACEs), maladaptive coping skills, and poor mental health among SGM adolescents. In Paper 1, our findings reflected similar findings from national samples. Poor mental health was positively associated with identifying as non-monosexual, not being out to most or all people, not feeling at home with heterosexual peers or the SGM community, and experiencing discrimination in the past month. We also found identifying as Hispanic and non-Hispanic Black was protective. In Paper 2, we found SGM adolescents who were at a very high risk for suicidal ideation appeared to benefit from participating in a drop-in center. However, even with the support of peers, role models, and mentors provided by the drop-in center, we found school connectedness to be an important aspect of SGM adolescents’ mental health. In paper 3, we found ACEs appeared to be the primary precursor to poor mental health. As a result of these adverse childhood experiences, adolescents developed poor coping skills when dealing with stress and anxiety. Inability to trust adults and be open about their needs were related to symptoms of mental distress. Given the implications of our findings, future research on SGM youth in Texas should include examining racial and ethnic differences among SGM adolescents’ mental health, developing school-based interventions for promoting school connectedness, and adapting trauma-informed, family-focused interventions for SGM adolescents.

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