Minority Stressors and Internalizing Symptoms in Sexual and Gender Minority Adolescents: A Systematic Review and Meta-Analysis

Abstract

Sexual and gender minority (SGM) adolescents are at elevated risk for internalizing symptoms, such as anxiety and depression, due in part to chronic exposure to minority stress. To provide a comprehensive synthesis of this literature, we conducted a meta-analysis of 32 studies, yielding 162 effect sizes from 41,360 participants aged 8– 22. All included studies examined the association between minority stress, defined as stigma-related stressors such as discrimination, victimization, and internalized stigma, and internalizing outcomes in SGM youth. The random-effects meta-analysis revealed a small but significant association (r = .25) between minority stress and internalizing symptoms, consistent across stressor type, symptom type (depressive or anxiety symptoms), age group, sample type, and study region. Moderator analyses identified some variation by racial/ethnic compositions such that effects were stronger in studies with more Native Hawaiian/Pacific Islander youth and by publication year, but no consistent differences emerged across other study characteristics (e.g., study quality). Despite increasing conceptual clarity in recent years, substantial methodological heterogeneity, limited representation of specific subgroups, and underassessment of protective factors likely attenuate observed effects. This meta-analysis underscores the need for intersectionally informed, developmentally grounded research that more accurately captures the complexity of minority stress and internalizing symptoms in SGM adolescents. To advance the field, future studies should prioritize recruiting large and diverse samples, employ analytic strategies that model intersecting identities, and develop youth-informed measures that reflect the cumulative, chronic, and context-dependent nature of minority stress during adolescence.