Multiply marginalized: An intersectional perspective of mental health and sexual behavior across the life course among sexual minority youth of color

Background: Sexual minority youth face disparities in mental health, and disparities regarding sexual health are disproportionately concentrated in youth of color. However, little research has examined the mental health and sexual behavior of sexual minority youth of color (SMYoC). Less is known about how these behaviors look among racial and ethnic subgroups of SMYoC, and how these associations change across time. This dissertation sought to understand the landscape of adolescent mental health from an intersectional perspective and to examine how adolescent mental health shaped sexual behavior and risk throughout the life course among different racial and ethnic groups of SMYoC.Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, I conducted multivariate analysis to determine differences in depressive symptoms and suicidality between racial and ethnic subgroups of SMYoC in early adolescence. I also assessed how STI infection and sexual behaviors changed across time from early adolescence to adulthood by applying conditional logistic regression models to produce group-level growth curves for each racial and ethnic subgroup. Finally, I adjusted the conditional models to determine the influence of early adolescent depressive symptomology and suicidality on the growth curves. Results: I found no differences in depressive symptoms, suicidal ideation, or suicide attempts. However, racial and ethnic groups differed in their odds of a suicide attempt that required medical attention. Native American SMY reported greater odds than the entire sample (OR=57.00, 95% CI: 4.37, 742.70), and Asian SMY reported lower odds than the entire sample (OR=0.04, 95% CI: 0.00, 0.69). In the second study, adolescent depressive symptoms predicted increased risk of chlamydia infection during emerging adulthood (OR=1.26, 95% CI: 1.03, 1.54). Adolescent depressive symptoms and suicidality did not predict changes in contraceptive use and sex under the influence of alcohol, although there were sex differences.Conclusions: Public health needs to consider the influence of race and ethnicity in suicide prevention efforts targeting SMYoC. Additionally, conversations about sexual risk in this population should be structured with an understanding of mental health as a determinant of behavior. Additional research is needed to assess within-group differences in racial and ethnic subgroups of SMYoC.