It's time for change: inequities and determinants of health-related quality of life among gender and sexually diverse young people in Australia.
Adolescence
Gender
Health-related quality of life
Mental health
Sexual orientation
Journal
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
ISSN: 1573-2649
Titre abrégé: Qual Life Res
Pays: Netherlands
ID NLM: 9210257
Informations de publication
Date de publication:
12 Apr 2024
12 Apr 2024
Historique:
accepted:
12
02
2024
medline:
12
4
2024
pubmed:
12
4
2024
entrez:
11
4
2024
Statut:
aheadofprint
Résumé
This study was guided by three research aims: firstly, to examine the longitudinal trends of health-related quality of life (HR-QoL) among gender and sexuality diverse (LGBTQA2S+) young people through adolescence (ages 14-19); secondly, to assess longitudinal associations between poor mental health and HR-QoL among LGBTQA2S+ young people through adolescence; and thirdly, to examine differences in HR-QoL among LGBTQA2S+ young people during early adolescence (ages 14 and 15) depending on select school-, peer-, and parent-level factors. This study used three of nine available waves of data from a large population-level, probability sample-based, longitudinal cohort study, namely the K' cohort: children aged 4-5 years old at time of study enrolment followed-up biennially (~ 61% retention rate). HR-QoL weighted means and standard deviations were calculated using Child Health Utility 9D (CHU-9D) scores for LGBTQA2S+ participants at ages 14 and 15 (Wave 6), ages 16 and 17 (Wave 7), and ages 18 and 19 (Wave 8). To strategically identify policy-relevant modifiable behavioural factors suitable for prevention and early intervention, non-parametric Wilcoxon signed-rank tests tested differences in mean CHU-9D ranks at ages 14 and 15 (Wave 6) between groups (gender identity: trans vs. cis; identity-level sexuality: gay, lesbian, bisexual, or other diverse sexuality vs. heterosexual; group-level sexuality: sexually diverse vs. not sexually diverse) and selected school factors (school acceptance, belonging, freedom of expression), peer factors (peer relationship quality, trust, respect), and family factors (parental acceptance, understanding, trust), with Hedge's g correction statistics computed for effect sizes. Longitudinal associations between gender, sexuality, and poor mental health (depressive symptoms, anxiety, symptoms, self-harm thoughts/behaviour, and suicidal thoughts/behaviour) and HR-QoL were tested using mixed-effects models with random intercepts and random slopes for nested clustering (participants within postcodes). HR-QoL disparities disproportionately affecting LGBTQA2S+ groups relative to their cisgender, heterosexual peers, were well-established by age 14 to 15 relatively steeper reductions in HR-QoL were observed throughout adolescence among all LGBTQA2S+ groups, with HR-QoL widening the most for trans participants. Poor mental health was significantly associated with HR-QoL declines. LGBTQA2S+ participants with positive school- and parent factors related to feelings of acceptance, belonging, and freedom of self-expression, reported significantly higher HR-QoL during early adolescence. Evidence-based public health policy responses are required to address the dire HR-QoL inequities among LGBTQA2S+ young people, particularly trans young people. Prioritising the promotion of school- and family-based interventions which foster LGBTQA2S+ inclusivity, acceptance, and a sense of belonging from early adolescence through young adulthood, represents a feasible, evidence-based, and cost-effective response to address these HR-QoL disparities.
Identifiants
pubmed: 38605187
doi: 10.1007/s11136-024-03633-z
pii: 10.1007/s11136-024-03633-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
NSW Health. (2022). NSW LGBTIQ+ health strategy 2022–2027. https://www.health.nsw.gov.au/lgbtiq-health/Publications/lgbtiq-health-strategy.pdf
Strauss, P., Cook, A., Winter, S., Watson, V., Wright Toussaint, D., & Lin, A. (2020). Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: Findings from Trans Pathways. Psychological Medicine, 50(5), 808–817.
pubmed: 31280740
Hill, A. O., Lyons, A., Jones, J., McGowan, I., Carman, M., Parsons, M., Power, J., & Bourne, A. (2021). Writing themselves in 4: The health and wellbeing of LGBTQA+ young people in Australia. Australian Research Centre in Sex, Health and Society, La Trobe University.
Robinson, K. H., Bansel, P., Denson, N., Ovenden, G., & Davies, C. (2014). Growing up queer: Issues facing young Australians who are gender variant and sexuality diverse. Young and Well Cooperative Research Centre.
Veale, J., Byrne, J., Tan, K. K. H., Guy, S., Yee, A., Nopera, T.M.-L., & Bentham, R. (2019). Counting ourselves: The health and wellbeing of trans and non-binary people in Aotearoa New Zealand. Transgender Health Research Lab.
Lin, Y., Xie, H., Huang, Z., Zhang, Q., Wilson, A., Hou, J., Zhao, X., Wang, Y., Pan, B., Liu, Y., Han, M., & Chen, R. (2021). The mental health of transgender and gender non-conforming people in China: A systematic review. The Lancet Public Health, 6(12), e954–e969.
pubmed: 34838199
The Trevor Project. (2022). 2022 National Survey on LGBTQ Youth Mental Health.
Wilson, C., & Cariola, L. A. (2019). LGBTQI+ youth and mental health: A systematic review of qualitative research. Adolescent Research Review, 5(2), 187–211.
Tan, K. K. H., Treharne, G. J., Ellis, S. J., Schmidt, J. M., & Veale, J. (2021). Enacted stigma experiences and protective factors are strongly associated with mental health outcomes of transgender people in Aotearoa/New Zealand. International Journal of Transgenderism, 22(3), 269–280.
Meyer, I. H., Russell, S. T., Hammack, P. L., Frost, D. M., & Wilson, B. D. M. (2021). Minority stress, distress, and suicide attempts in three cohorts of sexual minority adults: A U.S. probability sample. PLoS ONE, 16(3), e0246827.
pubmed: 33657122
pmcid: 7928455
Katz-Wise, S. L., Sarda, V., Austin, S. B., & Harris, S. K. (2021). Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents. PLoS ONE, 16(6), e0250500.
pubmed: 34077452
pmcid: 8171963
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.
pubmed: 12956539
pmcid: 2072932
Tan, K. K. H., Treharne, G. J., Ellis, S. J., Schmidt, J. M., & Veale, J. (2019). Gender minority stress: A critical review. Journal of Homosexuality, 67(10), 1471–1489.
pubmed: 30912709
Zheng, S., He, A., Yu, Y., Jiang, L., Liang, J., & Wang, P. (2021). Research trends and hotspots of health-related quality of life: A bibliometric analysis from 2000 to 2019. Health and Quality of Life Outcomes, 19(1), 130.
pubmed: 33892744
pmcid: 8063463
Kaplan, R. M., & Hays, R. D. (2022). Health-related quality of life measurement in public health. Annual Review of Public Health, 43(1), 355–373.
pubmed: 34882431
Yin, S., Njai, R., Barker, L., Siegel, P. Z., & Liao, Y. (2016). Summarizing health-related quality of life (HRQOL): Development and testing of a one-factor model. Population Health Metrics, 14, 22.
pubmed: 27408606
pmcid: 4940947
Marmot, M. (2020). Health equity in England: The Marmot review 10 years on. BMJ, 368, m693.
pubmed: 32094110
Shah, V., Stokes, J., & Sutton, M. (2021). Inequalities in health-related quality of life: Repeated cross-sectional study of trends in general practice survey data. British Journal of General Practice, 71(704), e178–e184.
Government of Western Australia Department of Health. (2019). Western Australian lesbian, gay, bisexual, transgender, intersex (LGBTI) health strategy 2019–2024.
Department of Families, Fairness, and Housing. (2022). Pride in our future - Victoria’s LGBTIQ+ strategy 2022-32.
Mendoza, C., Poggi, H., Flores, M., Morales, C., & Martínez-Aguayo, A. (2021). Quality of life in Chilean transgender children and adolescents. Hormone Research in Paediatrics, 94(9–10), 333–342.
pubmed: 34788756
O’Bryan, J., Scribani, M., Leon, K., Tallman, N., Wolf-Gould, C., Wolf-Gould, C., Wolf-Gould, C., & Gadomski, A. (2020). Health-related quality of life among transgender and gender expansive youth at a rural gender wellness clinic. Quality of Life Research, 29(6), 1597–1607.
pubmed: 32002786
Engel, L., Majmudar, I., Mihalopoulos, C., Tollit, M. A., & Pang, K. C. (2023). Assessment of quality of life of transgender and gender-diverse children and adolescents in Melbourne, Australia, 2017–2020. JAMA Network Open, 6(2), e2254292-e.
Le, L.K.-D., Richards-Jones, S., Chatterton, M. L., Engel, L., Lawrence, D., Stevenson, C., Pepin, G., Ratcliffe, J., Sawyer, M., & Mihalopoulos, C. (2021). Australian adolescent population norms for the child health utility index 9D—Results from the young minds matter survey. Quality of Life Research, 30(10), 2895–2906.
pubmed: 33999321
pmcid: 8126511
Potter, E. C., & Patterson, C. J. (2019). Health-related quality of life among lesbian, gay, and bisexual adults: The burden of health disparities in 2016 Behavioral Risk Factor Surveillance System Data. LGBT Health, 6(7), 357–369.
pubmed: 31526230
Yette, E. M., & Ahern, J. (2018). Health-related quality of life among Black sexual minority women. American Journal of Preventive Medicine, 55(3), 281–289.
pubmed: 30122211
pmcid: 6192701
Kim, S., & Choi-Kwon, S. (2021). Physical and mental health related quality of life and their influencing factors on sexual minority women in Korea. International Journal of Environmental Research and Public Health, 18(4), 2115.
pubmed: 33671565
pmcid: 7926774
Perales, F., & Campbell, A. (2020). Health disparities between sexual minority and different-sex-attracted adolescents: Quantifying the intervening role of social support and school belonging. LGBT Health, 7(3), 146–154.
pubmed: 32155106
Leung, E., Kassel-Gomez, G., Sullivan, S., Murahara, F., & Flanagan, T. (2022). Social support in schools and related outcomes for LGBTQ youth: A scoping review. Discover Education, 1, 18.
pubmed: 36407890
pmcid: 9662773
Schlief, M., Stefanidou, T., Wright, T., Levy, G., Pitman, A., & Lewis, G. (2023). A rapid realist review of universal interventions to promote inclusivity and acceptance of diverse sexual and gender identities in schools. Nature Human Behaviour, 7(4), 556–567.
pubmed: 36781989
pmcid: 10129865
Johns, M. M., Beltran, O., Armstrong, H. L., Jayne, P. E., & Barrios, L. C. (2018). Protective factors among transgender and gender variant youth: A systematic review by socioecological level. Journal of Primary Prevention, 39(3), 263–301.
pubmed: 29700674
Department of Social Services. Growing up in Australia: The Longitudinal Study of Australian Children (LSAC) - overview 2022. https://www.dss.gov.au/about-the-department/longitudinal-studies/growing-up-in-australia-lsac-longitudinal-study-of-australian-children-overview
Soloff, C., Lawrence, D., & Johnstone, R. (2004). LSAC technical paper No. 1-sample design. Australian Institute for Family Studies.
Amos, R., Manalastas, E. J., White, R., Bos, H., & Patalay, P. (2020). Mental health, social adversity, and health-related outcomes in sexual minority adolescents: A contemporary national cohort study. The Lancet Child & Adolescent Health, 4(1), 36–45.
Stevens, K. (2009). Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Qualitative Life Research, 18(8), 1105–1113.
Ratcliffe, J., Stevens, K., Flynn, T., Brazier, J., & Sawyer, M. (2012). An assessment of the construct validity of the CHU9D in the Australian adolescent general population. Quality of Life Research, 21(4), 717–725.
pubmed: 21837445
Stevens, K., & Ratcliffe, J. (2012). Measuring and valuing health benefits for economic evaluation in adolescence: An assessment of the practicality and validity of the child health utility 9D in the Australian adolescent population. Value in Health, 15(8), 1092–1099.
pubmed: 23244812
Furber, G., & Segal, L. (2015). The validity of the Child Health Utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services. Health and Quality of Life Outcomes, 13(1), 22.
pubmed: 25890377
pmcid: 4340862
Angold, A., Costello, E., Messer, S., Pickles, A., Winder, F., & Silver, D. (1995). The development of a questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–149.
Daraganova, G. (2017). Self-harm and suicidal behaviour of young people aged 14–15 years old. In LSAC annual statistical report 2016. Australian Institute of Family Studies.
Turner, N., Joinson, C., Peters, T. J., Wiles, N., & Lewis, G. (2014). Validity of the Short Mood and Feelings Questionnaire in late adolescence. Psychological Assessment, 26(3), 752–762.
pubmed: 24749755
Spence, S. H., Barrett, P. M., & Turner, C. M. (2003). Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17(6), 605–625.
pubmed: 14624814
Arendt, K., Hougaard, E., & Thastum, M. (2014). Psychometric properties of the child and parent versions of Spence Children’s Anxiety Scale in a Danish community and clinical sample. Journal of Anxiety Disorders, 28(8), 947–56.
pubmed: 25445085
Bailey, S., Newton, N., Perry, Y., Davies, C., Lin, A., Marino, J. L., Skinner, SR., Grummitt, L., & Barrett, E. (2023). Minority stressors, victimisation and associations with mental health and school climate among gender and sexuality diverse young people in Australia: Findings from a nationally representative cohort study. Journal of Adolescence.
Armsden, G., & Greenberg, M. (1987). The inventory of parent and peer attachment: Individual differences and their relationship to psychological well-being in adolescence. Journal of Youth and Adolescence, 16, 427–454.
pubmed: 24277469
Gray, S., Romaniuk, H., & Daraganova, G. (2017). LSAC annual statistical report 2017-Chapter 6: Adolescents’ relationships with their peers. Australian Institute of Family Studies.
Ridenour, T. A., Greenberg, M. T., & Cook, E. T. (2006). Structure and validity of people in my life: A self-report measure of attachment in late childhood. Journal of Youth and Adolescence, 35(6), 1037–1053.
pubmed: 17476310
pmcid: 1862408
Moreira, H., Fonseca, A., & Canavarro, M. (2017). Assessing attachment to parents and peers in middle childhood: Psychometric studies of the Portuguese version of the People in My Life Questionnaire. Journal of Child and Family Studies, 26, 1318–1333.
Marti-Pastor, M., Perez, G., German, D., Pont, A., Garin, O., Alonso, J., Gotsens, M., & Ferrer, M. (2018). Health-related quality of life inequalities by sexual orientation: Results from the Barcelona Health Interview Survey. PLOS ONE, 13(1), e0191334.
pubmed: 29364938
pmcid: 5783362
Department of Health. (2021). National preventive health strategy 2021–2030.
National Mental Health Commission. (2021). National children’s mental health and well-being strategy. Australian Government.
White Hughto, J. M., & Reisner, S. L. (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health, 1(1), 21–31.
pubmed: 27595141
pmcid: 5010234
Strauss, P., Lin, A., Winter, S., Waters, Z., Watson, V., Wright Toussaint, D., & Cook, A. (2020). Options and realities for trans and gender diverse young people receiving care in Australia’s mental health system: Findings from trans pathways. Australian & New Zealand Journal of Psychiatry, 55(4), 391–399.
Poteat, V. P., Sinclair, K. O., DiGiovanni, C. D., Koenig, B. W., & Russell, S. T. (2013). Gay–straight alliances are associated with student health: A multischool comparison of LGBTQ and heterosexual youth. Journal of Research on Adolescence, 23(2), 319–330.
Parodi, K. B., Holt, M. K., Green, J. G., Katz-Wise, S. L., Shah, T. N., Kraus, A. D., & Xuan, Z. (2022). Associations between school-related factors and mental health among transgender and gender diverse youth. Journal of School Psychology, 90, 135–149.
pubmed: 34969484
Day, J. K., Fish, J. N., Grossman, A. H., & Russell, S. T. (2020). Gay-straight alliances, inclusive policy, and school climate: LGBTQ youths’ experiences of social support and bullying. Journal of Research on Adolescence, 30(Suppl. 2), 418–430.
pubmed: 30861243
World Health Organization. (1986). Ottawa charter for health promotion: First International Conference on Health Promotion Ottawa. https://www.healthpromotion.org.au/images/ottawa_charter_hp.pdf
Fantus, S., & Newman, P. A. (2021). Promoting a positive school climate for sexual and gender minority youth through a systems approach: A theory-informed qualitative study. Educational Publishing Foundation.
Goldstein, T., Koecher, A., Baer, P., & Hicks, B. L. (2018). Transitioning in elementary school: Parent advocacy and teacher allyship. Teaching Education, 29(2), 165–177.
Craig, S. L., McInroy, L. B., & Austin, A. (2018). “Someone to have my back”: Exploring the needs of racially and ethnically diverse lesbian, gay, bisexual, and transgender high school students. Children & Schools, 40(4), 231–239.
Malpas, J., Pellicane, M. J., & Glaeser, E. (2022). Family-based interventions with transgender and gender expansive youth: Systematic review and best practice recommendations. Transgender Health, 7(1), 7–29.
pubmed: 36644030
pmcid: 9829155
Morgan, H., Raab, D., Lin, A., Strauss, P., & Perry, Y. (2023). Knowledge is power: Trans young people’s perceptions of parental reactions to their gender identity, and perceived barriers and facilitators to parental support. LGBTQ+ Family, 19(1), 35–53.
Morgan, H., Wells, L., Lin, A., Strauss, P., & Perry, Y. (2023). Parental challenges, facilitators and needs associated with supporting and accepting their trans child’s gender. LGBTQ+ Family, 19(1), 70–86.
Ratcliffe, J., Chen, G., Stevens, K., Bradley, S., Couzner, L., Brazier, J., Sawyer, M., Roberts, R., Huynh, E., & Flynn, T. (2015). Valuing child Health Utility 9D Health States with young adults: Insights from a time trade off study. Applied Health Economics and Health Policy, 13(5), 485–492.
pubmed: 26135244