Jeremy T. Goldbach

Emotions influence health behaviors and outcomes, yet little research has examined the emotion–health relationship among sexual minorities. The few studies in this area have used general measures of feelings without regard for identity, despite the literature positing emotions as culturally and contextually specific. This critical limitation obscures inferences made in studies that have found emotions to predict mental health outcomes for sexual minorities. This study begins to address this gap by developing and examining the preliminary validation of the Sexual Minority Identity Emotion Scale, a measure of shame and pride specific to the identity experiences of sexual minority adolescents. The initial pool of items emerged from a qualitative study and was refined through a multistep review. The measurement’s factor structure and criterion validity were examined using a nationwide sample of 273 sexual minority adolescents from the United States. The scale has four factors with strong internal reliability, adequate criterion validity, and utility in health research.

Purpose Experiences of sexuality‐based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post‐traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14‐17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. Methods A nationwide sample of SMA residing in the United States (N = 2,558; aged 14‐17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent‐driven sampling methods to complete a cross‐sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. Findings On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = –0.288, 95% CI = [–0.491, –0.085]), depressive (b = –0.158, 95% CI = [–0.270, –0.047), and PTSD symptoms PTSD (b = –0.349, 95% CI = [–0.596, –0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. Conclusions SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.