title: Understanding wellbeing and psychopathology in sexual minority adolescents in the UK: A multi-methods investigation
Creators: name: Amos, Rebekah
Publisher: name: University of Liverpool Repository
Year: 2023

description: Adolescent mental health has declined in recent decades and will likely be associated with poor adult mental health and related health comorbidities in future. Within the UK a tumultuous political and economic climate is seeing widening disparities between the minority and majority groups. One form of minoritized status that merits attention during adolescence and beyond, relates to sexuality. Research consistently shows that sexual minorities experience significantly worse mental health outcomes, with adolescence being a key point of vulnerability. However, research conducted with sexual minority adolescent populations has been limited in the UK. The aim of this PhD was to investigate the prevalence of adversities in sexual minority adolescents, to understand their experiences of mental-ill health and of wellbeing, as well as the social circumstances contributing to such outcomes. This body of work aimed to add to the existing theoretical literature and to provide focus for future interventions. To do so this PhD utilises a range of methodological approaches from literature synthesis, population-based analyses, experimental psychology approaches to critical qualitative inquiry. This PhD consists of six chapters and four studies. Chapter 1 summarizes the extant literature, the political and social context in the UK and the methodological approaches adopted within this PhD. Chapter 2 identifies factors associated with subjective wellbeing in sexual minority adolescents utilising a systematic review methodology. A model of minority wellbeing was proposed, whereby factors associated with higher levels of wellbeing tended to have an external locus e.g., family/social support; whilst those factors associated with lower levels of wellbeing tended to have a more internals locus e.g., internalised homonegativity. In the absence of existing estimates, Chapter 3 uses data from The Millennium Cohort Study to provide contemporary population-based estimates of mental health, adversity, and health problems in sexual minority adolescents growing up today. Sexual minorities were more likely to experience greater mental ill-health, worse interpersonal difficulties, and poorer health related outcomes than their heterosexual counterparts. These adversities also cumulated at higher levels for sexual minorities. Chapter 4 tested the postulations of an existing sexual minority mental ill-health theoretical model (the Psychological Mediation Framework). Using an experimental approach, associations between sexual minority status, emotional dysregulation, minority specific mechanisms (i.e., internalised homonegativity), depression and wellbeing were tested via an Implicit Association Test (IAT). Support for the Psychological Mediation Framework was mixed, where conscious internalised homonegativity was linked to depression but not when it was subconscious. The relationship between minority specific mediators, depression and wellbeing varied based on whether internalised homonegativity was conscious or not and in some cases showed counterintuitive relationships (unconscious internalised homonegativity linked to higher levels of wellbeing). To contextualise and further understand these findings, developing a new theoretical framework that would map the pathways associated with mental health outcomes in sexual minority adolescents in the UK was explored. Chapter 5 employed a constructivist grounded theory methodology. Sexual minorities across the UK were interviewed about their sexual identity navigation. Findings led to the development of the Dynamic Identity Formation of Sexual minority adolescent’s theory (DIFS). Sexual identity navigation was dynamic, seeing a movement between cultures such as heternormativity and gender binarism and queerness, the enactment of these cultures, to the experience of the individual. The culture of queerness ran parallel to heternormativity and was usually accessed later in one’s developmental journey. As pernicious as the enactment of heternormativity and gender binarism could be, so could the culture of queerness – in both cultural spaces young people experienced othering. Chapter 6 summarises the contribution this PhD has for the research field, the strength of this work and future directions. Overall, it appears that sexual minorities experience significant disparities in their mental health in the UK today. Subtle messaging and social processes such as othering are having more detrimental impacts than are currently realised and can have a significant impact on an individual in the absence of discrete victimisation events. Younger sexual minorities seem particularly vulnerable as they navigate their minoritised identity. All empirical chapters have been or are pending submission to peer reviewed journal and variation in the structure of chapters reflects the recommendations of each journal.