Change in depressive symptoms among treatment-seeking college students who are sexual minorities

Changes in students' depressive symptoms during the course of treatment at college counseling centers were examined by sexual orientation. In Study I, results showed that depressive symptoms decreased similarly across sexual orientation groups during the course of treatment. In Study 2, family support did not moderate the relationship between pre- and posttreatment depressive symptoms but had a direct effect on posttreatment depressive symptoms for students questioning their sexual identity. Clinical implications are discussed. Keywords: sexual identity, depression ********** When compared with individuals who are heterosexual, sexual minorities have been found to be at a higher risk for psychological distress (Cochran, Sullivan, & Mays, 2003; King et al., 2008; Mustanski, Garofalo, & Emerson, 2010). In a meta-analysis, adults who identified as lesbian, gay, or bisexual were 1.5 times more likely to be at risk for depression and anxiety disorders, 2 times more likely to attempt suicide, and 1.5 times more likely to have alcohol and other substance dependence than adults who identified as heterosexual (King et al., 2008). In a sample examining a racially diverse population of youth who identified as sexual minorities, one third of participants' symptoms met the diagnostic criteria for at least one mental disorder, 17% for a conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder (Mustanski et al., 2010). In addition, 31% of youth who are sexual minorities have reported at least one suicide attempt in their lifetime. Not surprisingly, individuals who identify as sexual minorities use mental health services more frequently than individuals who identify as heterosexual (Cochran et al., 2003; McAleavey, Castonguay, & Locke, 2011). Differences in psychological distress have been found across sexual orientation and gender identity categories. For example, differences in the prevalence of specific mental health diagnoses have also emerged when examining sexual orientation identities by gender identity. Men who are gay or bisexual appear to be at risk for depression and panic attacks (Cochran et al., 2003), suicide attempts across the life span (King et al., 2008), and anxiety disorders, schizophrenia, and psychotic diagnoses (Bolton & Sareen, 2011) when compared with men who are heterosexual. Women who are lesbian or bisexual show greater prevalence of generalized anxiety disorder (Cochran et ah, 2003) and substance use disorders (e.g., Bolton & Sareen, 2011) in comparison to heterosexual women. Differences within the sexual minority community have also been identified, although research studies exploring these differences are sparse (Bieschke, Paul, & Blasko, 2007). For example, men and women who are bisexual have been found to exhibit the highest risk for suicide attempts, with rates 3 times higher than heterosexual individuals (Bolton & Sareen, 2011). Youth who identify as bisexual, however, may show greater overall resiliency than individuals who identify with other sexual minority orientations, given that they were found to have lower prevalence of distress across mental health diagnoses (Mustanski et ah, 2010). Whether examining between or within sexual identity groups, sexual minorities experience a heightened level of psychological distress when compared with heterosexuals. Minority Stress Theory Minority stress theory (MST; Meyer, 1995, 2003) provides a model for understanding the elevated level of distress experienced by individuals who identify as sexual minorities. The basic premise of MST is that sexual minority identity status places individuals at risk of facing external stressors (e.g., family distress) on the basis of their identified or perceived sexual orientation identity. These external stressors are theorized to contribute to problematic internal processes, including fear of rejection and distaste for one's own minority group, that lead to or exacerbate mental health symptoms (Meyer, 2003). …