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The Association Between Sexual Identity, Depression, and Adolescent Substance Use

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Abstract

Sexual minority youth (SMY) represent a population vulnerable to several adverse health consequences. Specifically, SMY experience depression and substance use at substantially higher rates than heterosexual peers. Better understanding the relationship between depression and substance use among SMY may help reduce morbidity and mortality. We hypothesize that depression will moderate increased substance use rates seen in SMY. Weighted logistical analyses of covariance, adjusted for race/ethnicity, sex, and age, compared the relationship between sexual identity, depression, and substance use (14 outcomes), using data from the 2019 Youth Risk Behavior Survey (n = 13,677) of high school students. SMY reported depression at rates nearly double than heterosexual peers (63.9% vs 33.0%). Except for vaping and alcohol, SMY had significantly higher odds of all SU (aORs 1.41–2.45, p < 0.001–0.0011). After adjusting for depression, odds of all SMY substance use decreased; most relationships remained significant (aORs 0.73–1.89), though the relationship between SMY and lifetime cannabis use became non-significant. The relationship between SMY and current vaping became significant and the relationship between SMY and alcohol and binge-drinking remained non-significant. SMY are at higher risk for use of most substances and depression compared to heterosexual youth. As depression consistently plays a role in the relationship between sexual minority status and adolescent substance use across a wide variety of substances, it may be a modifiable risk factor for substance use among sexual minority youth that should be screened for and treated. This study additionally provides important information for future studies examining nuances of SMY substance use patterns.

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Availability of Data

Data for this study came from the 2019 Youth Risk Behavior Survey, publicly available at: https://www.cdc.gov/healthyyouth/data/yrbs/data.htm.

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Funding

Devika Bhatia, M.D. was supported by post-doctoral grant NIMH T32MH015442.

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Authors and Affiliations

  1. University of Colorado School of Medicine, Anschutz Health Sciences Building, Suite 5242, 1890 N Revere Ct, Aurora, CO, 80045, USA

    Devika Bhatia, Owen Berg, Robert Davies, Susan Mikulich Gilbertson & Joseph Sakai

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  1. Devika Bhatia
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  2. Owen Berg
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  3. Robert Davies
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  4. Susan Mikulich Gilbertson
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  5. Joseph Sakai
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Contributions

DB and JS conceptualized the research question, executed the study design, performed preliminary analyses, and contributed to writing of the manuscript. RD and OB contributed to study design and writing of the manuscript. SM contributed to study design, performed formal study analysis, and contributed to writing of the manuscript.

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Correspondence to Devika Bhatia.

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The authors declare no competing interests.

Ethical Approval

IRB review was conducted by Colorado Multiple Institutional Review Board. The protocol was deemed Not Human Subjects Research because data were deidentified and publicly available.

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Bhatia, D., Berg, O., Davies, R. et al. The Association Between Sexual Identity, Depression, and Adolescent Substance Use. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01630-w

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