What does the scholarly research say about the link between family acceptance and LGBT youth well-being?


Overview: We identified 42 peer-reviewed studies that met our criteria for adding to knowledge about the links between family support and the health and well-being of LGBT youth. Of those, 25 found that accepting behavior by parents toward their children’s sexual orientation or gender identity is linked to the health and well-being of LGBT youth. Another 17 studies found that family support in general (i.e. not necessarily in response to children’s sexual orientation or gender identity) is linked to the health and well-being of LGBT youth. The upshot is that families that engage in rejecting behavior raise the risk of significant harms for their LGBT children. Many studies used convenience samples of several dozen to several hundred subjects, but some studies used population samples and some sampling pools reached nearly 2000. Taken together, the studies on family support show that—whatever their values—families can take specific steps to protect their children against the heightened risks facing LGBT youth. This research review consists of ten findings and links to the supporting scholarship on which they are based. For more information, visit the Family Acceptance Project, a leader in research on family acceptance and LGBT youth. Click here to view our methodologyClick here for a printer-friendly PDF of this overview report.

Suggested Citation: What We Know Project, Cornell University, “What Does the Scholarly Research Say about the Link Between Family Acceptance and LGBT Youth Well-Being?” (online literature review), 2016.


1. LGBT youth face heightened risks of numerous mental and physical health dangers including depression, suicidality, substance abuse, psychological distress, low self-esteem, HIV/AIDS infection, and others.

2. Research shows that rejecting behaviors by parents can increase these risks, including contributing to far higher levels of suicidal behavior and depression.

3. Family, long thought of as playing a neutral or negative role in LGBT youth well-being, can play a key protective role against these physical and mental health risks. Several studies confirmed the importance of sexuality-specific acceptance (over generalized support), and of parental support over peer support.

4. Among the behaviors that protect against these health risks, according to research by the Family Acceptance Project, are affirming children’s sexual orientation and gender expression, talking with children about their LGBT identity, defending them when experiencing peer victimization, connecting them to an LGBT role model, and welcoming their LGBT peers into the home. Research suggests that the number and quality of accepting behaviors matters to youth well-being.

5. Most families with ambivalent or negative views about sexual minorities still love their children, and believe they are helping them to fit in and thrive by rejecting their sexual orientation and/or gender identities; yet such families have been shown to successfully modify their behavior when they learn how harmful rejecting behavior can be to their children’s mental and physical health.

6. Disclosure (coming out) to family is an important part of LGBT youth’s healthy development, and in the long-term can reduce the stress associated with worrying about future rejection; however, research shows that the short-term effects of disclosure can include added stress resulting from social isolation and family conflict, particularly if parents react in rejecting ways.

7. Research shows that LGBT youth are coming out at younger ages than in the past, which can mean longer periods of time when they are in the home and “out,” and hence a greater chance of both family-related stress and the possibility of positive interventions. Family acceptance awareness must often now begin with children, not adolescents.

8. Both LGB and transgender (as well as heterosexual) youth may exhibit gender-nonconforming behavior, which in turn may trigger rejecting behavior by parents whether or not their children have “come out” to them. Research suggests that parents, practitioners and providers should be aware of the possibility that such reactions can cause profound harm to LGBT youth.

9. Family background, including race, class, ethnicity, religion, national and regional origin and other factors, can play a role in shaping how parents and youth respond to LGBT identity. Practitioners and policymakers should be aware of the complex and diverse ways in which different populations may view family, sexuality identity and gender expression.

10. More research is needed on the specific factors that best predict rejecting family behaviors, the factors that contribute to positive family climates, and intervention approaches with records of evidence-based success; however, a great deal is already known about the information and support that families and LGBT youth need, and parents, practitioners and policymakers should act on this knowledge if they wish to minimize the health risks for the LGBT population.

Below are 25 studies that link accepting behavior by parents toward their children’s sexual orientation or gender identity to the health and well-being of LGBT youth. Click here to jump to 17 studies that link general family support to the health and well-being of LGBT youth.

Click on any thumbnail to view its abstract; click below each thumbnail to visit the source website.

Bouris, A., et al. (2010). A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda. The Journal of Primary Prevention, 31(5-6), 273- 309.

Relatively little is known about how parents influence the health and well-being of lesbian, gay, and bisexual (LGB) adolescents and young adults. This gap has led to a paucity of parent-based interventions for LGB young people. A systematic literature review on parental influences on the health of LGB youth was conducted to better understand how to develop a focused program of applied public health research. Five specific areas of health among LGB young people aged 10–24 years old were examined: (a) sexual behavior; (b) substance use; (c) violence and victimization; (d) mental health; and (e) suicide. A total of 31 quantitative articles were reviewed, the majority of which were cross-sectional and relied on convenience samples. Results indicated a trend to focus on negative, and not positive, parental influences. Other gaps included a dearth of research on sexual behavior, substance use, and violence/victimization; limited research on ethnic minority youth and on parental influences identified as important in the broader prevention science literature; and no studies reporting parent perspectives. The review highlights the need for future research on how parents can be supported to promote the health of LGB youth. Recommendations for strengthening the research base are provided.

Bregman, H. R., Malik, N. M., Page, M. J. L., Makynen, E., & Lindahl, K. M. (2013). Identity profiles in lesbian, gay, and bisexual youth: the role of family influences. Journal of Youth and Adolescence, 42, 417–430.

Sexual identity development is a central task of adolescence and young adulthood and can be especially challenging for sexual minority youth. Recent research has moved from a stage model of identity development in lesbian, gay, and bisexual (LGB) youth to examining identity in a non-linear, multidimensional manner. In addition, although families have been identified as important to youth’s identity development, limited research has examined the influence of parental responses to youth’s disclosure of their LGB sexual orientation on LGB identity. The current study examined a multidimensional model of LGB identity and its links with parental support and rejection. One hundred and sixty-nine LGB adolescents and young adults (ages 14-24, 56% male, 48% gay, 31% lesbian, 21% bisexual) described themselves on dimensions of LGB identity and reported on parental rejection, sexuality-specific social support, and non-sexuality-specific social support. Using latent profile analysis (LPA), two profiles were identified, indicating that youth experience both affirmed and struggling identities. Results indicated that parental rejection and sexuality-specific social support from families were salient links to LGB identity profile classification, while non-sexuality specific social support was unrelated. Parental rejection and sexuality-specific social support may be important to target in interventions for families to foster affirmed LGB identity development in youth.

D’Amico, E., & Julien, D. (2012). Disclosure of sexual orientation and gay, lesbian, and bisexual youths’ adjustment: associations with past and current parental acceptance and rejection. Journal of GLBT Family Studies, 8(3), 215-242.

One hundred eleven self-identified gay, lesbian, and bisexual (GLB) youths who had disclosed sexual orientation to parents and 53 GLB youths who had not disclosed to parents participated in a study that examined (1) the associations between parent-child relationship quality in childhood to GLB youths’ coming out; (2) the associations between GLB youths’ coming out to parents, on the one hand, and GLB youths’ identity and psychological maladjustment, and alcohol and drug consumption, on the other hand; and (3) the unique associations between past and current family relationship characteristics and GLB youths’ current identity and psychological adjustment, and alcohol and drug consumption. Results showed that, compared to undisclosed youths, disclosed youths reported higher levels of acceptance from their mothers and fathers in child- hood, and lower levels of rejection by fathers in childhood. Also, as compared to undisclosed youths, a smaller proportion of disclosed youths reported they had engaged in alcohol and drug consumption behaviors. Among disclosed youths, past and current parental acceptance and rejection accounted for unique variance of youths’ current identity and psychological maladjustment, whereas cur- rent rejection of sexual orientation accounted for unique variance of current youths’ alcohol and drug consumption. Research and clinical implications of these findings are discussed.

D’amico, E., Julien, D., Tremblay, N., Chartrand, E. (2015). Gay, lesbian, and bisexual youths coming out to their parents: parental reactions and youths’ outcomes. Journal of GLBT Family Studies, 11(5), 411-437.

This study examines the contribution of parental reactions to their child’s identity development and psychological adjustment following their child’s coming out as gay, lesbian, or bisexual (GLB). Interviews on parental reactions were administered to 53 parents, and questionnaires on identity and adjustment were administered to their 53 GLB youths. Parental interviews were coded using 10 positive and negative dimensions of parental reactions. There were no gender differences in levels of positive and negative parental reactions and in levels of GLB youths’ outcomes. However, as expected, parents’ support of their child’s sexual orientation, parents’ attempts to control their child’s sexual orientation, and parents’ struggles with their child’s sexual orientation were significantly associated with dimensions of youths’ identity and psychological adjustment. Parents’ gender also moderated the strength of the associations between parental reactions and youths’ outcomes. This study is of clinical relevance for intervention regarding sexually diverse populations

D’Augelli, A. R., Hershberger, S. L., & Pilkington, N. W. (1998). Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. American Journal of Orthopsychiatry, 68(3), 361–371.

Lesbian, gay, and bisexual youngsters, aged 14–21 and living at home, were studied for patterns of disclosure of sexual orientation to families. Three-quarters had told at least one parent, more often the mother than the father. Those who had disclosed were generally more open about their sexual orientation than those who had not, and few of the nondisclosed expected parental acceptance. Those who had disclosed reported verbal and physical abuse by family members, and acknowledged more suicidality than those who had not “come out” to their families.

D’Augelli, A. R. (2002). Mental health problems among lesbian, gay, and bisexual youths ages 14–21. Clinical Child Psychology and Psychiatry, 7(3), 433–45..

The mental health problems of lesbian, gay, and bisexual (lgb) youths were studied using a sample of 542 youths from community settings. Information about the development of sexual orientation, problems related to sexual orientation, parents’ reactions, and victimization based on sexual orientation was related to mental health symptoms and suicidality. Lesbian, gay, and bisexual youths were found to demonstrate more symptoms than a comparison group of adolescents. Over one- third of the sample reported a past suicide attempt. More symptoms were related to parents not knowing about youths’ sexual orientation or with both parents having negative reactions to youths’ sexual orientation. More than three-quarters had been verbally abused because of their sexual orientation, and 15 percent reported physical attacks. More than one-third said they had lost friends because of their sexual orientation. Youths who had experienced more victimization and who had lost friends reported more mental health symptoms. Mental health professionals are urged to attend to the distinct problems of these youths, especially dealing with conflicts with families and peers.

D’Augelli, A. R., Grossman, A. H., Salter, N. P., Vasey, J. J., Starks, M. T., & Sinclair, K. O. (2005). Predicting the suicide attempts of lesbian, gay and bisexual youth. Suicide and Life Threatening Behaviors, 35(6), 646–660.

In this study predictors of serious suicide attempts among lesbian, gay, and bisexual (LGB) youth were examined. Three groups were compared: youth who reported no attempts, youth who reported attempts unrelated to their sexual orientation, and youth whose attempts were considered related to their sexual orientation. About one third of respondents reported at least one suicide attempt; however, only half of the attempts were judged serious based on potential lethality. About half of all attempts were related to youths’ sexual orientation. Factors that differentiated youth reporting suicide attempts and those not reporting attempts were greater childhood parental psychological abuse and more childhood gender-atypical behavior. Gay-related suicide attempts were associated with identifiability as LGB, especially by parents. Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males. Assessment of past parental psychological abuse, parental reactions to childhood gender atypical behavior, youths’ openness about sexual orientation with family members, and lifetime gay-related verbal abuse can assist in the prediction of suicide attempts in this population.

D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and ptsd among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21(11), 1462–1482.

This study examined childhood gender atypicality, lifetime victimization based on sexual orientation, and current mental health, including trauma symptoms and posttraumatic stress disorder (PTSD), among 528 lesbian, gay, and bisexual youth. Nearly 80% reported verbal victimization, 11% physical, and 9% sexual, with males reporting significantly more victimization. Victimization began, on average, at age 13. Verbal attacks occurred as early as age 6, physical attacks at 8, and sexual attacks at 9. Youth who were considered gender atypical in childhood reported more victimization and more current mental health symptoms. PTSD was found in 9% of youth and was associated with past physical victimization.

D’Augelli, A. R., Hershberger, S. L., & Pilkington, N. W. (2001). Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths. Suicide and Life Threatening Behaviors, 31(3), 250–264.

Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families’ reactions to youths’ sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.

Elizur, Y., & Mintzer, A. (2001). A framework for the formation of gay male identity: process associated with adult attachment style and support from family and friends. Archives of Sexual Behavior, 30, 143 – 168.

We propose a novel conceptual framework for the study of gay male identity formation in relation to the person’s self, family, and social relations. The three basic processes of gay male identity are defined—self-definition, self-acceptance, and disclosure—and theoretically linked to attachment style and social support. The results, based on an Israeli sample of gay men (n = 121), indicated that self-acceptance and friends’ support predict secure attachment in close adult relationships, and that self-definition and support from family and friends predict disclosure. Supportive family attitudes toward same-sex orientation mediated the effect of general family support on disclosure. These results suggest that the independent assessment of identity processes provides a flexible alternative to stage models’ assumption of a single linear developmental process, that the formation of gay identity is associated with inner models of adult relationships, and that support of family and friends have a different role in the coming out process and in the formation of one’s adult attachment model.

Elizur, Y., & Ziv, M. (2001). Family support and acceptance, gay male identity, and psychological adjustment: a path model. Family Process, 40, 125–140.

While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N= 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure.The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.

Elze, D. (2002). Risk factors for internalizing and externalizing problems among gay, lesbian, and bisexual adolescents. Social Work Research, 26, 89–100.

This study investigated the risk factors associated with internalizing and externalizing problems among 169 gay, lesbian, and bisexual adolescents, ages 13 to 18, in northern New England, who were recruited through multiple methods. Data were gathered on individual, family, and community risk factors and youths’ mental health and behavioral functioning. The youths did not differ on internalizing or externalizing problems by gender or by sexual orientation. Multivariate analyses demonstrated that risk factors unrelated to sexual orientation explained 18 percent and 19 percent of the variance in internalizing and externalizing problems, respectively. Risk factors related to sexual orientation explained an additional 4 percent of the variance in youths’ internalizing problems and 1 percent in youths’ externalizing problems. The results suggest that adolescent service providers should carefully assess gay, lesbian, and bisexual adolescents for concerns related and not directly related to their sexual orientation, as well as concerns specific to their identity. Even youths with positive feelings about their sexual orientation may be at risk.

Heatherington, L., & Lavner, J. (2008). Coming to terms with coming out: review and recommendations for family systems-focused research. Journal of Family Psychology, 22(3), 329-343.

For lesbian, gay, and bisexual (LGB) adolescents and young adults, coming out to family members, especially parents, is a major psychological decision and hurdle due to both perceived fears and actual negative consequences. But beyond the literature on factors associated with the decision to come out and parents’ initial reactions to the disclosure, empirical studies of what unfolds afterward, and how the family adjusts to the LGB adolescent’s identity over time, are sparse and scattered. This article reviews and integrates findings from studies of the individual-, dyadic-, and family-level variables associated with positive outcomes, focusing particularly on relationship variables. Methodological concerns within this body of research are discussed, and research recommendations are offered. A preliminary working model of how families successfully come to terms with coming out is proposed to guide future research that will advance theory and clinical work with LGB youth and their families.

Hershberger, S. & D’Augelli, A. (1995). The impact of victimization on the mental health and suicidality of lesbian, gay, and bisexual youths. Developmental Psychology, 31(1),65-74.

Lesbian, gay, and bisexual youths 15 to 21 years old were studied to determine the impact of verbal abuse, threat of attacks, and assault on their mental health, including suicide. Family support and self-acceptance were hypothesized to act as mediators of the victimization and mental health-suicide relation. Structural equation modeling revealed that in addition to a direct effect of victimization on mental health, family support and self-acceptance in concert mediated the victimization and mental health relation. Victimization was not directly related to suicide. Victimization interacted with family support to influence mental health, but only for low levels of victimization.

Floyd, F. J., Stein, T. S., Harter, K. S. M., Allison, A., & Nye, C. L. (1999). Gay, lesbian, and bisexual youths: separation-individuation, parental attitudes, identity consolidation, and well-being. Journal of Youth and Adolescence, 28(6), 719–739.

The study examines separation-individuation during adolescence and young adulthood for gay, lesbian, and bisexual youths, and evaluates the consequences of parent-youth relationships for well-being and sexual orientation identity development. Seventy-two youths completed interview and questionnaire measures of relatedness, autonomy, and conflictual independence in relation to mothers and fathers, along with self-reports of parent attitudes, identity consolidation, and well-being. When youths perceived that their parents had relatively accepting attitudes regarding sexual orientation they demonstrated closer relatedness and greater conflictual independence with parents, but not greater autonomy. Both accepting parental attitudes and greater separation-individuation predicted more positive well-being for the youths, though only parental attitudes predicted greater consolidation of sexual orientation identity. Although mothers were generally closer and more supportive than fathers, relationships with both parents were important, independent predictors of personal adjustment. The discussion proposes mutual influences among separation-individuation, perceived acceptance by parents, identity consolidation and well-being.

Padilla, Y. C., Crisp, C., & Rew, D. L. (2010). Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: results from a national survey. Social Work, 55(3), 265–275.

Although gay, lesbian, and bisexual (GLB) adolescents face many of the same developmental challenges as do heterosexual adolescents, they must also deal with the stress of being part of a stigmatized group. The purpose of this study was to examine the extent to which family support and involvement with the queer community may buffer the effects of life stress on substance use among GLB youths. Drawing on a large national online survey, the authors examined drug use in 1906 GLB youths 12 to 17 years of age. Overall, 20 percent of the youths reported using illegal substances in the past 30 days. Results from multivariate analyses revealed that stress, as measured by suicidal ideation, significantly increased the risk of drug use. A positive reaction from the mother to the youth’s coming out served as a significant protective factor, whereas involvement in a queer youth group had no effect. The authors found evidence that, for GLB adolescents, parental acceptance of sexual identity is an important aspect of a strong family relationship and, thus, has important ramifications for their healthy development. Implications of the findings for social work practice are discussed.

Rosario, M., Schrimshaw, E., & Hunter, J. (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: critical role of disclosure relations. Psychology of Addictive Behaviors, 23,175–184.

Research on whether disclosure of sexual orientation promotes lower substance use among lesbian, gay, and bisexual (LGB) individuals has been inconsistent. One reason for this may be that disclosure results in accepting and rejecting reactions. The current report longitudinally examines whether the types of reactions to disclosure are associated with substance use and abuse among an ethnically diverse, urban sample of 156 LGB youths (ages 14 – 21 years). Neither the number of disclosures nor the numbers of accepting or neutral disclosure reactions experienced were associated with substance use or abuse. However, the number of rejecting reactions to disclosure was associated with current and subsequent alcohol, cigarette, and marijuana use even after controlling for demographic factors, social desirability, and emotional distress. Further, high numbers of accepting reactions were found to moderate or protect youths from the negative role of rejecting reactions on alcohol use, but not other substances. This research indicates that, rather than disclosure per se, it is the number of accepting and rejecting reactions in response to disclosure that are critical to understanding substance use among LGB youths. Further, the results suggest that to be maximally effective in helping LGB youths, substance use prevention and treatment efforts should address the rejecting reactions to disclosure of sexual orientation.

Rothman, E. F., Sullivan, M., Keyes, S., & Boehmer, U. (2012). Parents’ supportive reactions to sexual orientation disclosure associated with better health: results from a population-based survey of LGB adults in Massachusetts. Journal of Homosexuality, 59,186–200.

This study investigated associations between coming out to parents, experiences of parental support, and self-reported health behaviors and conditions among a population-based sample of LGB individuals using data collected via the 2002 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS; N = 177). We explored the following two hypotheses: 1) Lesbian, gay, and bisexual (LGB) individuals who had never disclosed their sexual orientation to a parent would report higher levels of risk behaviors and poorer health conditions than those who had come out; and 2) among LGB respondents who had come out to their parents, the individuals whose parents had reacted unsupportively would report higher levels of risk behaviors and poorer health conditions than those who had come out to parents who were supportive. Approximately two thirds of gay and bisexual (GB) males and lesbian and bisexual (LB) females reported receiving adequate social and emotional support from the parent to whom they first disclosed their sexual orientation. Among LB females, no disclosure of sexual orientation to a parent was associated with significantly elevated levels of past-month illicit drug use (AOR 12.16, 95% CI 2.87-51.54), fair or poor self-reported health status (AOR 5.71, 95% CI 1.45-22.51), and >15 days of depression in the past month (AOR 5.95, 95% CI 1.78-19.90), controlling for potential confounders. However, nondisclosure to a parent by GB males was not associated with greater odds of any of the health indicators assessed. Among GB males, those with unsupportive parents were significantly more likely to report current binge drinking (AOR 6.94, 95% CI 1.70-28.35) and >15 days depression in the past month (AOR 6.08, 95% CI 1.15-32.15), and among LB females, those with unsupportive parents were significantly more likely to report lifetime illicit drug use (AOR 11.43, 95% CI 2.50-52.30), and >15 days depression in the past month (AOR 5.51, 95% CI 1.36-22.36). We conclude that coming out may be associated with better health for LB women, and that parents who react nonsupportively when their children disclose LGB sexual orientation may contribute to children’s increased odds of depression and hazardous substance use.

Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346-352.

OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults.

METHODS. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys.

RESULTS. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual 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 men reported the highest number of negative family reactions to their sexual orientation in adolescence.

CONCLUSIONS. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.

Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205-213.

ISSUE: The role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established.

METHODS: A quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents’ sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults (N = 245).

FINDINGS: Family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors.

CONCLUSIONS: Family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.

Savin-Williams, R. C. (1989). Coming out to parents and self- esteem among gay and lesbian youths. Journal of Homosexuality, 18(1–2), 1–35.

The significance of the parents for the coming out process and for the self-evaluation of 317 gay and lesbian youths between the ages of 14 and 23 years was assessed in the current study. Responses from a 10-page questionnaire are analyzed, and these findings are discussed in the context of sex differences for both adolescents and parents, the importance of the parents for the self-esteem of gay and lesbian youth, and limitations of the current investigation.

Savin-Williams, R. C. (1989). Parental influences on the self- esteem of gay and lesbian youths: a reflected appraisals model. Journal of Homosexuality, 17, 93–109.

Based on a population of 317 gay and lesbian youths (aged 14–23 yrs), the current investigation explored the appropriateness of a reflected appraisals perspective in predicting the degree to which parental attitudes, as perceived by youth, affected their self-esteem and comfortableness being gay. A lesbian was most comfortable with her sexual orientation if she also reported that her parents accepted her homosexuality; these variables did not, however, predict her level of self-esteem. Among gay males, parental acceptance predicted comfortableness being gay if the parents were also perceived as important components of a youth’s self-worth; a male most comfortable with his sexual orientation had the highest level of self-esteem. Results are discussed in terms of (1) sex of parent, (2) sex-role development, (3) comparisons of gays and lesbians, and (4) research on gay and lesbian youth.

Shilo, G. (2011). Effects of family and friend support on LGB youths’ mental health and sexual orientation milestones. Family Relations, 30(3), 318-330.

This study examined the effects of social support components and providers on mental health and sexual orientation (SO) milestones of lesbian, gay, and bisexual (LGB) youths. Data were collected on 461 self-identified LGB adolescents and young adults. Family acceptance and support yielded the strongest positive effect on self-acceptance of SO, whereas friends’ support and acceptance yielded the strongest positive effect on disclosure of SO. Family support had the strongest negative effect on youth’s mental distress, whereas friends’ and family support had the strongest positive effect on well-being. These findings highlight the importance of the daily perceptions of LGB youth within social and familial settings, indicating that both positive and negative aspects of support affect youths’ mental health and identity development.

Snapp, S., Watson, R.J., Russell, S.T., Diaz, R., & Ryan, C. (2015). Social support networks for LGBT young adults: low cost strategies for positive adjustment. Family Relations, 64(3), 420-430.

Lesbian, gay, bisexual, and transgender (LGBT) youth and young adults are known to have compromised physical and mental health, and family rejection has been found to be an important risk factor. Yet few studies have examined the positive role that support from parents, friends, and the community have for LGBT young adults. In a cross-sectional study of 245 LGBT non-Latino White and Latino young adults (ages 21–25) in the United States, sexuality-related social support was examined in association with measures of adjustment in young adulthood. Family, friend, and community support were strong predictors of positive outcomes, including life situation, self-esteem, and LGBT esteem. However, family acceptance had the strongest overall influence when other forms of support were considered. Implications for the unique and concurrent forms of social support for LGBT youth and young adult adjustment are discussed.

Willoughby, B. L., Doty, N. D., & Malik, N. M. (2010). Victimization, family rejection, and outcomes of gay, lesbian, and bisexual young people: the role of negative GLB identity. Journal of GLBT Family Studies, 6, 403–424.

Victimization and family rejection of sexual orientation are two salient stressors facing gay, lesbian, and bisexual (GLB) young people. While initial research has established a link between these sexuality-related stressors and GLB youths’ mental health outcomes, the factors that underlie this relationship remain unclear. The current study examines the role of negative GLB identity (i.e., negative feelings about one’s own sexual orientation) in mediating the relationship between sexuality-related stress (i.e., victimization, family rejection) and youth outcomes (i.e., internalizing problems, substance use, and cigarette smoking). Participants included 81 GLB young people (ages 14 to 25 years) recruited through college groups, youth organizations, study advertisements, and friend referrals. Path analyses revealed that victimization and family rejection experiences were related to youths internalizing problems via negative GLB identity. However, stressors and health risk behaviors were not related through negative GLB identity, although some direct relationships between stressors, substance use, and smoking emerged. Limitations and implications of the present study are discussed.

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Below are 17 studies that link general family support to the health and well-being of LGBT youth. Click here to jump to the 25 studies that link accepting behavior by parents toward their children’s sexual orientation or gender identity to the health and well-being of LGBT youth.

Click on any thumbnail to view its abstract; click below each thumbnail to visit the source website.

Ackard, D. M., Fedio, G., Neumark-Sztainer, D., & Britt, H. R. (2008). Factors associated with disordered eating among sexually active adolescent males: gender and number of sexual partners. Psychosomatic Medicine, 70(2), 232–238.

OBJECTIVE: To examine the prevalence of disordered eating behaviors among sexually active adolescent males by gender and number of sex partners, and examine psychosocial well-being by sex partner factors among boys reporting disordered eating.

METHOD: Data were collected from 10,095 9(th) and 12(th) grade Minnesota Student Survey participants who reported sexual intercourse in the past year.

RESULTS: The use of any disordered eating behaviors was reported by 39.4% of the sexually active males reporting only female sex partners, 53.4% reporting only male sex partners, and 56.4% reporting both female and male sex partners. Rates of specific disordered eating behaviors were associated with higher numbers of sex partners (male and/or female) and same gender of sex partner, and were highest among those males who reported 3 or more of both genders of sex partners. Among sexually active males reporting disordered eating, poorer emotional well-being and less family connectedness were associated with greater number of partners and with same-sex partners.

CONCLUSIONS: Sexually active males, especially those with multiple and/or same-sex partners, may benefit from interventions targeted at reducing disordered eating behaviors. Among sexually active males engaging in disordered eating behaviors, enhancing emotional health and improving family connectedness may be beneficial, especially among those with sex partners of the same gender and/or with multiple sex partners. The identification of specific psychosocial characteristics that are commonly associated with sexually active adolescent males and who exhibit disordered eating behaviors may provide direction toward the development of appropriate early identification, prevention, and treatment efforts.

Doty, N., Willoughby, B., Lindahl, K., & Malik, N. (2010). Sexuality related social support among lesbian, gay, and bisexual youth. Journal of Youth and Adolescence, 39(10), 1134–1147.

Lesbian, gay, and bisexual (‘‘LGB’’) youth may face significant stressors related to their sexual orientation. Few studies, however, have examined youth’s experiences of support for coping with these stressors. The current study compared LGB youth’s perceptions of support for sexuality stress to their support for other types of problems. The links between sexuality stress, sexuality support, and emotional distress were also examined. Ninety-eight LGB youth (ages 18–21, 33% female) rated support from family, heterosexual friends, and sexual minority friends for dealing with problems related, and not related, to their sexuality. From family and heterosexual friends, support for sexuality stress was less available than support for other stressors. Sexual minority friends provided the highest levels of sexuality support. In regression analyses, higher levels of sexuality support related to decreased emotional distress and buffered against the negative effects of sexuality stress on emotional distress. Sexuality support, although less available than other types of support, may be especially relevant to mental health among LGB youth.

Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among gay, lesbian and bisexual youth: the role of protective factors. Journal of Adolescent Health, 39, 662–668.

Purpose: Many reports have indicated that gay, lesbian and bisexual (GLB) youth are particularly vulnerable to poor outcomes, including suicide. Certain protective factors are likely to reduce this risk. The present study examines four protective factors (family connectedness, teacher caring, other adult caring, and school safety) and their association with suicidal ideation and attempts among adolescents with same-gender experience.

Methods: Data come from the 2004 Minnesota Student Survey of 9th and 12th grade students; 21,927 sexually active youth were grouped according to the gender of their sex partner(s) into GLB and non-GLB groups. Four protective factors and suicidal ideation and attempts were compared across groups. Logistic regression was used to examine the influence of protective factors on suicide, and predicted probabilities of suicidal ideation and attempts were estimated using general linear modeling.

Results: There were 2,255 respondents who reported same-gender experience. Over half of GLB students had thought about suicide and 37.4% reported a suicide attempt. GLB youth reported significantly lower levels of each protective factor than their non-GLB peers. Family connectedness, adult caring, and school safety were significantly protective against suicidal ideation and attempts. Risk associated with a GLB sexual orientation is largely mediated through protective factors.

Conclusions: Sexual orientation alone accounts for only a small portion of variability in suicidal ideation and attempts. If protective factors were enhanced among GLB youth, suicide in this population is expected to be considerably lower. Protective factors examined here are amenable to change and should be targeted in interventions.

Espelage, D. L., Aragon, S. R., Birkett, M., & Koenig, B. W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: what influence do parents and schools have? School Psychology Review, 37(2), 202–216.

Homophobic teasing is often long-term, systematic, and perpetrated by groups of students (Rivers, 2001); it places targets at risk for greater suicidal ideation, depression, and isolation (Elliot & Kilpatrick, 1994). This study fills a gap in the literature by examining buffering influences of positive parental relations and positive school climate on mental health outcomes for high school students who are questioning their sexual orientation. Participants were 13,921 high school students from a Midwestern U.S. public school district. Students completed a survey consisting of a wide range of questions related to their school experiences (bullying, homophobia, school climate), parental support, mood, and drug-alcohol use. Students were categorized into three groups: (a) youth who identified as heterosexual, (b) youth who questioned their sexual orientation, and (c) youth who identified as lesbian, gay, or bisexual (LGB). As hypothesized, sexual minority youth were more likely to report high levels of depression-suicide feelings and alcohol-marijuana use; students who were questioning their sexual orientation reported more teasing, greater drug use, and more feelings of depression and suicide than either heterosexual or LGB students. Sexually questioning students who experienced homophobic teasing were also more likely than LGB students to use drugs-alcohol and rate their school climate as negative. Finally, positive school climate and parental support protected LGB and questioning students against depression and drug use.

Friedman, M. S., Koeske, G. F., Silvestre, A. J., Korr, W. S., & Sites, E. W. (2006). The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. Journal of Adolescent Health, 38(5), 621–623.

This study hypothesized that gender-role nonconformity is associated with suicidality, and bullying mediates this relationship. Gay males retrospectively answered questions pertaining to elementary, middle, and high school. Support for the hypotheses was found. Results can help screen gay youth for suicidality and support the need for policies prohibiting harassment based on sexual orientation.

Garofalo, R., Mustanski, B., & Donenberg, G. (2008). Parents know and parents matter; is it time to develop family-based HIV prevention programs for young men who have sex with men? Journal of Adolescent Health, 43(2), 201–204.

We examined the potential for a family-based HIV prevention approach for gay and bisexually-identified young men who have sex with men (MSM). The majority of our urban, ethnically-diverse sample disclosed their sexual orientation to parents, who were generally supportive. Family connectedness significantly decreased the odds of an HIV positive status.

Holtzen, D.W., Kenny, M.E., & Mahalik, J.R. (1995). Contributions of parental attachment to gay or lesbian disclosure to parents and dysfunctional cognitive processes. Journal of Counseling Psychology, 42,350–355.

This study examined the relationships among parental attachment, sexual self-disclosure to parents, and dysfunctional cognitions in a sample of 113 gay and lesbian adults. The results of canonical analysis revealed that characteristics of secure attachment to mother and father were positively associated with disclosure to parents and length of time since disclosure, and they were negatively associated with self-reports of dysfunctional cognitions. These results suggest that attachment quality warrants further investigation as a factor that may facilitate disclosure to parents and reduce the risk for dysfunctional cognitions.

Homma, Y., & Saewyc, E. M. (2007). The emotional well- being of asian-american sexual minority youth in school. Journal of LGBT Health Research, 3(1), 67–78.

This study examined family and school correlates of emotional distress among Asian-American sexual minority youth in the Midwestern United States. Responses from 91 predominantly among Asian-American youth who participated in a state-wide, school-based census survey and reported recent same-gender sexual activity were analyzed. Results showed that sexual minority youth who perceived lower levels of family caring and those with negative perceptions of school climate reported lower self-esteem, which in turn was associated with greater emotional distress. These results highlight the importance of safe and caring environments, and culturally sensitive support for Asian-American sexual minority adolescents.

Mustanski, B., Newcomb, M., Garofalo, R. (2011). Mental health of lesbian, gay, and bisexual youth: a developmental resiliency perspective. J Gay Lesbian Soc, 23, 204–225.

Research suggests that lesbian, gay, and bisexual (LGB) youths are at increased risk for both victimization and internalizing mental health problems, but limited research has studied their association or factors that increase resilience. The sample in this study included 425 LGBs between the ages of 16 and 24 years. The majority had disclosed their sexual orientation to family or friends (98%), and 97% had someone in their lives who was accepting of their orientation. Racial/ethnic minority and female participants in general reported lower levels of disclosure and acceptance. Most participants reported some form of sexual orientation-related victimization (94%). Victimization was associated with psychological distress, but a compensatory model indicated that in the context of this victimization both peer and family support had significant promotive effects. A test of a protective model found social support did not ameliorate negative effects of victimization. The positive effects of family support decreased with age. Peer and family support were particularly important, but they did not significantly dampen the negative effects of victimization. Findings suggest that mental health professionals working with LGB youths should address social support and that public health approaches are needed to reduce levels of victimization.

Needham, B. L., & Austin, E. L. (2010). Sexual orientation, parental support, and health during the transition to young adulthood. Journal of Youth and Adolescence, 39, 1189–1198.

Some recent studies suggest that sexual minorities may have worse health-related outcomes during adolescence because they report lower levels of family connectedness, a key protective resource. Using data from wave 3 of the National Longitudinal Study of Adolescent Health (n = 11,153; 50.6% female; mean age = 21.8 years), this study extends prior research on adolescents to young adults. We examine whether lesbian, gay, and bisexual (LGB) young adults report lower levels of parental support than their heterosexual peers and whether differences in parental support help explain why LGB young adults tend to have worse health-related outcomes. We find that lesbian and bisexual women report lower levels of parental support than heterosexual women and that gay men report lower levels of parental support than bisexual and heterosexual men. Compared to heterosexual women, les- bian and bisexual women have higher odds of suicidal thoughts and recent drug use; bisexual women also have higher odds of elevated depressive symptomatology and heavy drinking. Gay men have higher odds of suicidal thoughts than heterosexual men. With the exception of heavy drinking, parental support either partially or fully mediates each of the observed associations. Even though the transition from adolescence to young adulthood is characterized by increased independence from parents, parental support remains an important correlate of health-related outcomes during this stage of life. Sexual minorities report lower levels of parental support during young adulthood, which helps explain why they have worse health-related outcomes. Interventions designed to strengthen relationships between LGB young adults and their parents could lead to a reduction in health disparities related to sexual orientation.

Pearson, J., & Wilkinson, L. (2013). Family relationships and adolescent well-being: are families equally protective for same-sex attracted youth? Journal of Youth and Adolescence, 42(3), 376–393.

Existing research suggests that sexual minority youth experience lower levels of well-being, in part because they perceive less social support than heterosexual youth. Sexual minority youth with strong family relationships may demonstrate resilience and increased well-being; however, it is also possible that the experience of sexual stigma may make these relationships less protective for sexual minority youth. Using two waves of data from the National Longitudinal Study of Adolescent Health, we explore the links between same-sex attraction, family relationships, and adolescent well-being in a sample of over 13,000 7th-12th grade adolescents (51% female, 52% non-Latino/a white, 17% Latino, 21% African American, and 7% Asian). Specifically, we examine whether lower levels of parental closeness, parental involvement, and family support among same-sex attracted youth explain in part why these youth experience increased depressive symptoms and risk behaviors, including binge drinking, illegal drug use, and running away from home, relative to other-sex attracted youth. Second, we ask whether family relationships are equally protective against depressive symptoms and risk behaviors for same-sex attracted and other-sex attracted youth. We find that same-sex attracted youth, particularly girls, report higher levels of depressive symptoms, binge drinking, and drug use in part because they perceive less closeness with parents and less support from their families. Results also suggest that parental closeness and parental involvement may be less protective against risk behaviors for same-sex attracted boys than for their other-sex attracted peers. Findings thus suggest that interventions targeting the families of sexual minority youth should educate parents about the potentially negative effects of heteronormative assumptions and attitudes on positive adolescent development.

Proctor, C. D., & Groze, V. K. (1994). Risk factors for suicide among gay, lesbian, and bisexual youths. Social Work, 39(5), 504–513.

The study described in this article explores risk factors for suicide among gay, lesbian, and bisexual youths. A convenience sample of 221 self-identified gay, lesbian, and bisexual youths who attended youth groups across the United States and Canada were given the Adolescent Health Questionnaire, which assessed family issues, the social environment, and self-perceptions. The youths’ scores were significantly associated with suicidal ideation and attempts. Implications for social services are discussed.

Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm: findings from the national longitudinal study on adolescent health. Journal of the American Medical Association, 278(10), 823–832.

CONTEXT: The main threats to adolescents’ health are the risk behaviors they choose. How their social context shapes their behaviors is poorly understood.

OBJECTIVE: To identify risk and protective factors at the family, school, and individual levels as they relate to 4 domains of adolescent health and morbidity: emotional health, violence, substance use, and sexuality.

DESIGN: Cross-sectional analysis of interview data from the National Longitudinal Study of Adolescent Health.

PARTICIPANTS: A total of 12118 adolescents in grades 7 through 12 drawn from an initial national school survey of 90118 adolescents from 80 high schools plus their feeder middle schools.

SETTING: The interview was completed in the subject’s home.

MAIN OUTCOME MEASURES: Eight areas were assessed: emotional distress; suicidal thoughts and behaviors; violence; use of 3 substances (cigarettes, alcohol, marijuana); and 2 types of sexual behaviors (age of sexual debut and pregnancy history). Independent variables included measures of family context, school context, and individual characteristics.

RESULTS: Parent-family connectedness and perceived school connectedness were protective against every health risk behavior measure except history of pregnancy. Conversely, ease of access to guns at home was associated with suicidality (grades 9-12: P<.001) and violence (grades 7-8: P<.001; grades 9-12: P<.001). Access to substances in the home was associated with use of cigarettes (P<.001), alcohol (P<.001), and marijuana (P<.001) among all students. Working 20 or more hours a week was associated with emotional distress of high school students (P<.01), cigarette use (P<.001), alcohol use (P<.001), and marijuana use (P<.001). Appearing “older than most” in class was associated with emotional distress and suicidal thoughts and behaviors among high school students (P<.001); it was also associated with substance use and an earlier age of sexual debut among both junior and senior high students. Repeating a grade in school was associated with emotional distress among students in junior high (P<.001) and high school (P<.01) and with tobacco use among junior high students (P<.001). On the other hand, parental expectations regarding school achievement were associated with lower levels of health risk behaviors; parental disapproval of early sexual debut was associated with a later age of onset of intercourse (P<.001).

CONCLUSIONS: Family and school contexts as well as individual characteristics are associated with health and risky behaviors in adolescents. The results should assist health and social service providers, educators, and others in taking the first steps to diminish risk factors and enhance protective factors for our young people.

Sheets, R. L., & Mohr, J. J. (2009). Perceived social support from friends and family and psychosocial functioning in bisexual young adult college students. Journal of Counseling Psychology, 56(1), 152–163.

In this study, the authors investigated the degree to which perceived social support was associated with depression, life satisfaction, and internalized binegativity in a sample of 210 bisexual young adult college students. Two types of social support (general and sexuality specific) and 2 sources of social support (family and friends) were examined. Participants were recruited from the electronic mailing lists of organizations serving lesbian, gay, bisexual, and transgender students on 32 university campuses, and data were gathered via an Internet survey. Results indicated that general social support was most predictive of depression and life satisfaction, whereas sexuality-specific support was most predictive of internalized binegativity. Both family support and friend support contributed to the prediction of each of the outcome variables. Although it was expected that the link between friend support and positive adjustment would be strongest at low levels of family support, none of the interactions between friend and family support was statistically significant.

Teasdale, B., & Bradley-Engen, M. S. (2010). Adolescent same-sex attraction and mental health: the role of stress and support. Journal of Homosexuality, 57(2), 287–309.

This study draws on the social stress model from the sociology of mental health to examine the impact of same-sex attraction on depressed mood and suicidal tendencies. Specifically, we hypothesize that across multiple contexts, adolescents with same-sex attractions are likely to experience more social stress and less social support than heterosexual adolescents. In turn, these experiences increase the likelihood of negative mental health outcomes. Using data from the National Longitudinal Study of Adolescent Health (n = 11,911), we find that adolescents with same-sex attraction are more likely than their heterosexual counterparts to report depressed mood and suicidal tendencies. Moreover, stress and social support were found to mediate a substantial part of the relationship between same-sex attraction and depressed mood. In addition, stress and social support mediated about one third of the relationship between same-sex attraction and suicidal tendencies. These findings give strong support for the social stress model. We conclude with a discussion of the role that alienation plays in same-sex-attracted adolescent mental health.

Ueno, K. (2005). Sexual orientation and psychological distress in adolescence. Examining interpersonal stressors and social support processes. Social Psychology Quarterly, 68(3), 258–277.

Adolescents with homosexual and bisexual orientations have higher levels of psychological distress than other adolescents. Drawing from previous studies, I hypothesize that this epidemiological pattern is due largely to the interpersonal problems that sexual minorities experience at home and at school. Analysis of longitudinal data based on a nationally representative sample showed that sexual minorities in fact experienced more problems with their parents and peers at school; these factors explained a moderate portion of the gap in distress level between sexual minorities and other adolescents. Adolescent friendships in general tend to develop within groups of individuals who share social backgrounds, but this pattern did not apply to sexual orientation; sexual minorities were not connected closely with each other at school. When they knew each other, however, their friendships reduced psychological distress and protected them from the psychological harm associated with interpersonal problems. I use these findings to discuss unique aspects of adolescent sexual orientation as a dimension of social inequality, focusing on implications for coping behaviors and mental health outcomes.

Watson, R.J., Barnett, M., & Russell, S.T. (2015). Parent support matters for the educational success of sexual minorities. Journal of GLBT Family Studies.

Recent research has documented disparities in academic experiences and achievement for sexual minorities. Two important correlates of well-being for all youths are their relationships with family members and experiences at schools. We used nationally representative data to investigate whether the association between perceived maternal and parental support (defined as warm, firm, and accepting parental bonds) and educational outcomes differs for sexual minority compared to heterosexual youths. The sample consisted of 12,064 participants. Results indicated that parent support was significantly associated with grade point average (GPA), school belonging, and school troubles for both sexual minority and heterosexual participants, but the magnitudes differed. In addition, we found a two-way interaction between sexual minority status and parental support in association with school belonging, indicating that for sexual minority youths, low parental support was associated with particularly low levels of school belonging compared to heterosexual youths. This project highlights the importance of family support as a contributor for healthy development.

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