Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents.

Epidemiological research has indicated that sexual minority adults are at increased risk for internalizing disorders, including major depression (Cochran & Mays, 2000; Cochran, Mays, & Sullivan, 2003; Gilman, Cochran, Mays, Ostrow, & Kessler, 2001; Sandfort, de Graaf, Bijl, & Schnabel, 2001) and anxiety disorders (Cochran & Mays, 2000; Cochran et al., 2003; Gilman et al., 2001; Sandfort et al., 2001). A recent meta-analysis found that sexual minority individuals are twice as likely as heterosexuals to have a lifetime mood disorder, and 1.87 times more likely to have a lifetime anxiety disorder (Meyer, 2003). Similar findings exist for externalizing disorders (Burgard, Cochran, & Mays, 2005; Cochran, Keenan, Schober, & Mays, 2000; Drabble, Midanik, & Trocki, 2005). Although research on the mental health of sexual minority youth is lacking relative to adults, sexual minority adolescents also appear to be at increased risk for both externalizing (Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998; Hatzenbuehler, Corbin, & Fromme, 2008; Russell, Driscoll, & Truong, 2002) and internalizing disorders. Indeed, recent studies with comparison groups and nationally representative or community samples have documented that sexual minority adolescents are at elevated risk for depressive symptoms compared with their heterosexual peers (D'Augelli, 2002; Fergusson, Horwood, & Beautrais, 1999; Fergusson, Horwood, Ridder, & Beautrais, 2005; Russell & Joyner, 2001; Safren & Heimberg, 1999). The few studies that have examined anxiety symptoms have also found them to be elevated among sexual minority youth relative to heterosexuals (e.g., Fergusson et al., 1999; Lock & Steiner, 1999). Despite the growing evidence that there is an increased risk of internalizing symptoms among sexual minority adolescents, the determinants of this elevated risk remain inadequately understood. Although gay-related stressors are likely to be contributors to internalizing symptoms among sexual minority adolescents (e.g., Rosario, Rotheram-Borus, & Reid, 1996), researchers are increasingly interested in understanding the role of normative psychological processes that have been shown to predict mental health problems in general samples of adolescents (Diamond, 2003; Savin-Williams, 2001). Such information will facilitate the development of evidence-based preventive interventions that seek to reduce the prevalence of psychiatric morbidity among sexual minority youth. With rare exception (e.g., Safren & Heimberg, 1999), however, established psychological processes have not been examined as mediators of the relationship between sexual orientation status and psychopathological outcomes among sexual minority adolescents. The present study sought to address this gap in the literature. Specifically, we focused on emotion regulation deficits as predictors of elevated internalizing symptoms in sexual minority adolescents. Emotion regulation refers to the processes involved in monitoring, evaluating, and modifying emotional reactions in the pursuit of one's goals (Thompson, 1994). The adaptive regulation of emotions is a principal developmental task during adolescence (Steinberg et al., 2006; Zeman, Cassano, Perry-Parrish, & Stegall, 2006), and considerable individual variability exists in the extent to which youth acquire adaptive strategies for managing their emotions (Saarni, 1999). Emotion regulation deficits are increasingly understood as important predictors of internalizing psychopathology among general samples of adolescents. For example, children and adolescents with anxiety disorders have been found to have poorer emotional understanding, to experience negative emotions with greater intensity, to have more difficulty managing negative emotions, and to have lower confidence in their ability to manage their emotions than non-anxious youth (Southam-Gerow & Kendall, 2000; Suveg & Zeman, 2004). Adolescent depression has also been linked to poor emotion regulation skills (Abela, Brozina, & Haigh, 2002; Garber, Braafladt, & Weiss, 1995; Silk, Steinberg, & Morris, 2003). Taken together, prior research therefore suggests that emotion regulation deficits might account for increased levels of internalizing symptomatology among sexual minority adolescents. However, no study has examined maladaptive emotion regulation as a predictor of the development of depression and anxiety symptoms in this population. The current investigation therefore had three primary aims. First, given the paucity of community-based samples of sexual minority adolescents including a heterosexual comparison group, the study sought to determine whether mental health disparities emerged in internalizing symptomatology between sexual minority adolescents and their heterosexual peers. We hypothesized that the sexual minority adolescents would report increased levels of depressive and anxiety symptoms. Second, we aimed to evaluate emotion regulation deficits as longitudinal predictors of these internalizing symptoms. Third, we examined emotion regulation deficits as mediators of the relationship between sexual minority status and internalizing symptomatology. We hypothesized that deficits in emotion regulation would account for disparities in the development of internalizing symptoms between sexual minority and heterosexual adolescents.