Family rejection of lesbian, gay and bisexual children linked to poor health in early childhood

Dec 30 2008

For the first time, researchers have established a clear link between family rejection of lesbian, gay and bisexual (LGB) adolescents and negative health outcomes in early adulthood.

The findings will be published in the January issue of Pediatrics , the journal of the American Academy of Pediatrics, in a peer-reviewed article entitled "Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay and Bisexual Young Adults."

The paper, authored by Caitlin Ryan, PhD, Director of the Family Acceptance Project and her team at the César E. Chávez Institute at San Francisco State University, shows that negative parental behaviors toward LGB children dramatically compromises their health. The discovery has far reaching implications for changing how families relate to their LGB children and how a wide range of providers serve LGB youth across systems of care. The California Endowment, a health foundation dedicated to expanding access to affordable, quality health care for underserved individuals and communities, funded the study and development of resource materials.

"For the first time, research has established a predictive link between specific, negative family reactions to their child's sexual orientation and serious health problems for these adolescents in young adulthood such as depression, illegal drug use, risk for HIV infection, and suicide attempts," said Ryan, who is the lead author of the paper. "The new body of research we are generating will help develop resources, tools and interventions to strengthen families, prevent homelessness, reduce the proportion of youth in foster care and significantly improve the lives of LGBT young people and their families." (The Family Acceptance Project focuses on lesbian, gay, bisexual and transgender youth.)

Major Research Findings:

• Higher rates of family rejection during adolescence were significantly associated with poorer health outcomes for LGB young adults.
• LGB young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse, compared with peers from families that reported no or low levels of family rejection.
• Latino males reported the highest number of negative family reactions to their sexual orientation in adolescence.

"This study clearly shows the tremendous harm of family rejection, even if parents think they are well-intentioned, following deeply held beliefs or even protecting their children," said Sten Vermund, MD, a pediatrician and Amos Christie Chair of Global Health at Vanderbilt University.

"In today's often hostile climate for LGBT youth, it is especially important to note that both mental health issues like depression and suicide and HIV risk behaviors were greatly increased by rejection," Dr. Vermund said. "Given the ongoing HIV epidemic in America, in which half of all new cases of HIV are found in men who have sex with men and there is growing concern about prevention messages reaching young people, it is vital that we share these findings with parents and service providers who work with youth in every way.

"When put to practical, day-to-day use and shared with families and those who serve LGBT youth, these findings will lead to healthier, more supportive family dynamics and better lives for LGBT young people."

The prevailing approach by pediatricians, nurses, social workers, school counselors, peer advocates and community providers has focused almost exclusively on directly serving LGBT youth, and does not consider the impact of family reactions on the adolescent's health and well-being.

Subsequent work with ethnically diverse families by the Family Acceptance Project indicates that parents and caregivers can modify rejecting behavior once they understand the serious impact of their words and actions on their LGBT children's health. In addition, even a little change in parental behavior appears to have a clear impact on decreasing LGBT young people's risk. This new family-related approach to working with LGBT youth being developed by the Family Acceptance Project engages families as allies in decreasing the adolescent's risk and increasing their well-being while respecting the family's deeply held values.

"The new family-related behavioral approach to care being developed by the Family Acceptance Project offers great promise to change the future for LGBT youth and their families by helping parents and caregivers learn how to support their LGBT children and to prevent these extremely high levels of risk related to family rejection," said Erica Monasterio, MN, FNP, in the Division of Adolescent Medicine and Family Health Care Nursing at UCSF. "Rather than seeing families as part of the problem, this approach engages them as an essential resource in promoting healthy outcomes for their LGBT children."

"We are using our research to develop a new model of family-related care to decrease the high levels of risk for LGBT young people that restrict life chances and full participation in society," said Ryan. "Our easy-to-use behavioral approach will help families increase supportive behaviors and modify behaviors their LGBT children experience as rejecting that significantly increase their children's risk. However, redirecting practice and professional training ­ from not asking about family reactions to a young person's LGBT identity to engaging families in promoting their LGBT children's well-being requires a substantial shift on the part of both mainstream and LGBT providers, health systems and community programs."

The paper is the first of many research papers on outcomes related to family acceptance and rejection of LGBT adolescents, supporting positive LGBT youth development and providing family-related care to be released by the Family Acceptance Project.