Stigma as a factor of psychogenic depression among adolescents with homosexuality and bisexuality

Erzin Alexandr Igorevich assistant of the Department of Clinical Psychology and Psychotherapy at Orenburg State Medical University 460000, Russia, Orenburg Region, Orenburg, str. Sovetskaya, 6 dr-wagner@mail.ru Other publications by this author

Semenova Tat98ana Sergeevna Medical psychologist, Orenburg Regional Clinical Psychiatric Hospital No. 1 460000, Russia, Orenburg, Tsvillinga Street 5 555_sts@mail.ru Other publications by this author

Introduction

At the end of the XIX century, the problem of human homosexuality became an object of science in multiple countries. In Russia, it had been taboo for a great while; only since the mid 1990’s, the topic of deviant sexual orientation became open for discussion.

Today it is commonly believed that sexuality of a person is defined by the biological, social, and psychological determinants. There are at least three positions towards defining the “standards of normality” of human sexual behavior ^[1]. The position of individual, physiological norm considers homosexuality and bisexuality as abnormal phenomena, due to the fact that a homosexual sexual intercourse is incapable of leading to pregnancy. In accordance with the position of partnership norm, homosexuality can be a norm, if both partners are mature, seeking mutual satisfaction, and cause health damage to each other and others. However, the criterion of differentiation of gender in terms of such approach does not allow accepting homosexuality as one of the variants of normality. The latter position – the position of legal norm, views homosexuality as normal in cases, if the legislation of the state, which citizens are the individuals with homosexual orientation, does not consider homosexuality as legal violation.

Today it is a known fact that up to 6-17% of all teenagers at certain period of their life have experienced sexual attraction to persons of same gender ^[2].

The scholars believe ^[3] that approximately 64% homosexual teenagers are exposed to bullying among the age-mates. School bullying, including verbal aggression and abuse, is a pretty common phenomenon for many homosexual teenagers. This can be complicated by the negative attitude and condemnation from parents and other relatives ^[4]. Swearer et al. (2008) demonstrated that the most widespread form of school discrimination LGBT-teenager are the mockery, causing damage to property, social isolation, and abuse. The most popular type of homophobic behavior implies putting insulting label on homosexual and bisexual persons ^[5].

Homosexuality does not give rise to depression; nevertheless, the rejection by other people and social discrimination that face the individuals with homosexual orientation, often leads to the emergence of depressive syndromes. A significant amount of homosexuals experiences the fear of recourse to specialized medical aid, which can aggravate the health condition. As a result, the majority of teenagers with homosexual and bisexual orientation suffer from the symptoms of psychogenic depression and neurotic disorders ^[6,7,8].

The teenagers who identify themselves with gays, lesbians, or bisexual are 2-7 times more prone to suicidal thoughts and attempts. The highest risk of suicidal behavior is observed in situations when a teenager realizes his homosexual identity at an earlier age, when the family conflicts caused by the fact that his sexual orientation contradicts the family values, force to run away from home, or if a teenager cannot share his problems with anyone but parents. There is not much empirical data on the completed suicides, but the evidence shows that a disproportionally high number of self-murders is committed particularly among homo- and bisexuals ^[9].

A large evidence base testifies to the fact that LGBT-people experience a higher level of depression and anxiety ^{[10, 11, 12, 13, 14]}.

With reference to the impact of separate types of stigmatization upon the health of homosexuals, it is demonstrated that the realizes stigma closely correlates with suicidal thoughts ^[15],[16], emotional distress ^[17], and mental health issues ^[18].

Materials and Methods

The selection of research involved 70 teenagers in the age of 12-16 (average age 14.05), who have experiences sexual/erotic attraction to the persons of same gender, or referred themselves to homosexuals/bisexuals. The selection was conducted through the major Russian online titled “Children-404”.

Methods: stigmatization and bullying were assessed with the help of the developed by authors brief survey that included such items as the parents’ attitude towards children’s homosexual orientation; verbal aggression at school among the age-mates; at least one instance of violence based on the intolerance towards genderqueer. Manifestation of stigma was assessed in accordance with the answers of the respondents ranging from 0 (absence of stigmatization) to 3 (most sever level of stigmatization). The degree of homosexual attraction was assessed by using the Kinsey Scale. Such technique was applied for describing the sexual experience of an individual and responses at the time of examination. The level of depression was assessed according to Beck Depression Inventory. For statistical processing of the data, the authors used structural modelling. Calculations were conducted in IBM SPSS Statistics 22 using the software package Amos.

Results and discussion

The descriptive statistics have shown that 51 (72.9%) of the examined teenager had at least one sexual intercourse with same-gender partner. The rest 19 (27.1%) did not have homosexual experience, but had continuous attraction to same gender. The Kinsey Scale allowed determining that 14 (20%) of the respondents were homosexual; 3 (4.3%) mostly homosexual, occasionally heterosexual; 5 (7.1%) mostly homosexual, but heterosexual more than occasionally. Accordingly, 48 (68.6%) of female teenagers were referred to as bisexual; 11 (15.7%) were lesbians; 4 (5.7%) of male teenagers were bisexual; while the other 7 (10%) were homosexual.

As demonstrated by the structured interview in form of short survey, 67 (95.7%) were subject to stigmatization and bullying. Only 3 (4.3%) of the participants answered that they have never experienced the effect of stigma. All 67 respondents stated that they felt neutral or negative (more often) parents’ attitude towards their sexual orientation; 49 (70%) of the teenagers said that they became victims of verbal aggression (abusive language, labeling, mockery) from their age-mates at school; 24 (34.3%) of the participants admitted that at least once they were beaten by the classmates due to their homosexuality. In addition, 8 (11.4%) answered that they were subjected to recurrent physical abuse.

As to the level of manifestation of depressive symptoms, the authors have determined that 14 (20%) of the teenagers had a mild depression in accordance with the Beck Inventory ^[19,20]; 7(10%) of the respondents moderate level of depression; severe depression was identified among 19 (27.2%) of the participants. General depression study results are presented in the Image 1.

Image 1. Average indexes of manifestation of depression according to A. Beck’s Depression Inventory

Note: CA – cognitive-affective subscale; SSD – subscale of somatic manifestations of depression.

The diagram indicates that the group of homosexual teenagers demonstrates an overall high level of expression of depression. In comparison, according to Beck’s Inventory, the norm of depression among adolescents must not exceed 9 points. The established by the authors level of depression testifies to the fact that in majority of cases the teenagers already at the time of examination show manifestations of emotional disorders that require clinical-psychological intervention.

As demonstrated by the structural modelling (Image 2), stigmatization and school bullying directly affect the level of depression among homosexual and bisexuals adolescents.

Image 2. Model of impact of stigmatization upon depression among homosexual adolescents

It turned out that significant number of factors that affect the emergence of depressive symptoms among homosexual teenagers implies the negative attitude of society towards manifestations of homosexuality.

Conclusions

The research demonstrated that 67 out of 70 examined teenagers were subjected to stigmatization and bullying due to their sexual orientation. Abusive language, labeling, mockery, stigma, stereotypes, and school bullying – are the main directions of anti-homosexual discrimination faced by the teenagers belonging to sex minorities. It also can be aggravated by such considerable factor as the negative attitude and disapproval of their parents.

The authors discovered that more than half of the respondents suffer from mild, moderate, or severe forms of psychogenic depression. At the same time, stigmatization and bullying play substantial role in emergence of stress and affective disorders of psychogenic nature that can manifest at the emotional and somatic levels. It is likely that the fear of disclosing sexual orientation, low self-esteem, learning difficulties, and daily issues can also contribute to manifestation of depressive symptoms; however, the aforementioned determinants have not been taken into account in the context of this research.

This work suggests further study of personal resources and cognitive styles, which help overcoming the impact of stigma and stresses among adolescents with homosexuality and bisexuality. The authors see the extension of this research in development/modification of the existing models of psychotherapy and psychosocial support for young people suffering from depression due to their sexual orientation.