Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis

Denise Yookong Williams; William J Hall; Hayden C Dawes; Ankur Srivastava; Spenser R Radtke; Magdelene Ramon; D Bouchard; Wan-Ting Chen; Jeremy T Goldbach

doi:10.3389/fpsyt.2023.1205581

Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis

Front Psychiatry. 2023 Jul 20:14:1205581. doi: 10.3389/fpsyt.2023.1205581. eCollection 2023.

Authors

Denise Yookong Williams¹, William J Hall¹, Hayden C Dawes¹, Ankur Srivastava¹, Spenser R Radtke¹, Magdelene Ramon¹, D Bouchard¹, Wan-Ting Chen¹, Jeremy T Goldbach²

Affiliations

¹ School of Social Work, University of North Carolina, Chapel Hill, NC, United States.
² Brown School of Social Work at Washington University, St. Louis, MO, United States.

Abstract

Background: Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior).

Methods: We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria.

Results: A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]).

Conclusion: Implications for clinical practice, policy, and future research are discussed.

Keywords: LGB; adolescents; internalized homophobia; internalized stigma; queer; sexual minority; transgender; youth.

Publication types

Systematic Review

Grants and funding

The authors of this article were supported by an award (R01MD015109) from the National Institute of Minority Health and Health Disparities of the National Institutes of Health in the creation of this scholarship.