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Family matters

Researchers find family rejection a predictor of negative health outcomes in LGB youth

Family support may be more important than previously thought for the health and well-being of lesbian, gay, and bisexual (LGB) youth. A study, published in the January 1 issue of Pediatrics, found that higher rates of family rejection were associated with poorer health outcomes. LGB youth who reported higher rates of family rejection were 8.4 times more likely to report having attempted suicide, 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 their peers who reported no or low levels of family rejection.

Based on in-depth interviews with families or caregivers and their LGB children, the researchers identified 106 specific behaviours that parents use to express rejection or acceptance. Some “rejecting behaviours” identified were verbally expressing shame, blocking access to gay friends, or pressuring a child to change their sexual orientation or gender identity. The researchers then administered a survey to 224 white and Latino self-identified LGB youth aged 21-25. They assessed an individual’s level of rejection based on the frequency of having experienced specific rejecting behaviours. The survey also assessed nine negative health outcomes among the participants such as depression, life-time suicide attempts, sexual-risk behaviour, and substance abuse.

Caitlin Ryan, the paper’s lead author and a clinical social worker, explained that though it is difficult to generalize, low self-esteem as a result of rejection by parents or caregivers may be partly responsible for poor health outcomes.

“For a child who only hears negative messages about who they are, who is punished or excluded from the family…you could see how their sense of the future is more limited,” she said. “Those are the kinds of experiences that could lead a person to really live in the present. You know, ‘Why should I bother to use a condom,’ or ‘Why should I bother to use a seatbelt, what difference does it make?’”

Common sense?

Although the link between family rejection and poor health outcomes may seem evident, Ryan explained that parents are generally surprised by the results.

“For more than two years we’ve actually been sharing these findings with very ethnically diverse families…and we find that they are shocked. First of all, they’re shocked because they didn’t realize that these very specific behaviours had consequences…. Secondly, they’re shocked by the very high risk related to those behaviours,” she said.

Stephanie Brill, co-founder and Director of Gender Spectrum Education and Training – a Seattle- based organization that supports parents and caregivers of lesbian, gay, bisexual, and transgender (LGBT) children through support groups and an annual conference – explained that families are largely unaware of the effects of their rejecting behaviours because a lot of these behaviours are a result of the parents’ desire to protect their children.

“When parents parent an LGBT child in isolation, frequently without support or other resources, of course they do their best, but their best often unknowingly happens to be the worst. In other words, as they try to get their children to change, perhaps to ensure their safety, they unknowingly are rejecting their child which then leads to all these now well-researched potential outcomes that are negative,” Brill said.

Ryan agreed that parents’ reactions are often motivated by good intentions.

“What we saw was that these specific behaviours of trying to change them [LGBT youth], or prevent them from being who they were, came from love and concern. They wanted their children to have a good life, to fit in, to be happy. And when they learned that their child experienced these behaviours as rejection, as very hurtful, as a very deep kind of wound, they were shocked,” Ryan said.

Staying positive

Though the paper focused largely on negative, rejecting behaviours, Ryan also hopes that this information will help promote positive behaviours among parents. Specifically, she stressed that the project is less about parents’ personal beliefs, and more about how they interact with their children.

“We have not done this work to change families’ deeply held beliefs, we are really working with them as an ally to decrease their children’s risk. There are a lot of behaviours that we’ve identified on the positive end that parents can do to support their children and a very neutral one for parents that are rejecting and conflicted is just to sit with their child and talk with them,” Ryan said.

Brill agreed that education about what appropriate and ideal parenting behaviour might be for parents or caregivers of LGBT youth, would go a long way in helping them cope.

“I think the most important thing is for each and every parent to recognize that where they are now, where they’re starting from is perfectly fine, but that the goal is to grow, step by step incrementally toward greater acceptance,” Brill said.

The next step

This research is part of a much bigger project that has consumed the better part of the past seven years for Ryan. She and her team will now work to develop interventions and a new family-related approach to help families help their LGBT children.

“I think part of what we’re able to do here is to create a bridge between parent and child, to help the parent understand that there are very specific empirically identified behaviours that can help their children, and others that put them at great risk,” Ryan said.

Brill was enthusiastic about the results of the study and hoped that they will help parents of LGBT children better understand their role in their LGBT child’s life.

“Frequently by the time a parent starts parenting a preteen or a teenager they often feel like their role is no longer so significant and what this study shows us, is absolutely that it is untrue, that the parent or caregiver’s role is actually the most critical in terms of future longterm health, well-being, and resiliency of LGBT children,” Brill said.

In Ryan’s words, “We have a great sense of hope because we’re building on something very, very deep, which is the bond that families have with [their children]. Underneath whatever disappointment or anger that may emerge when a parent finds out that a child is LGBT…underneath all of that, is love.”