A longitudinal and experience sampling investigation of rejection sensitivity and its role in sexual minority adolescents' mental health

PROJECT SUMMARY Mental health disparities are a significant public health concern. Sexual minority adolescents (SMA) are disproportionately affected by mental health problems such as depression and suicidality relative to their heterosexual peers. These disparities are greatest during adolescence and persist into adulthood, and are generally attributed to the unique interpersonal stressors they face (e.g., sexual orientation-related rejection). Given that rejection is a robust risk factor for mental health problems, especially during adolescence, it has historically been the focus of research on SM individuals’ mental health. However, in addition to experiences of rejection, expectations of rejection and the emotions that accompany them also play important roles in mental health. The rejection sensitivity (RS) theory proposes that early experiences of rejection can lead to a disposition to anxiously expect, readily perceive, and intensely react to rejection, which can compromise one’s mental health. Despite evidence that RS is associated with mental health problems among SM adults, our understanding of its development and role in SMA’s mental health is limited in important ways (e.g., nearly all prior studies have been cross-sectional studies of adults, and there has been a lack of attention to different emotions that can accompany expectations of rejection, underlying mechanisms, and protective factors). Given these gaps, to better understand and address the mental health disparities affecting SMA, the goals of the proposed R01 are to determine the role of sexual orientation-related rejection in the development of different types of RS and their respective mental health consequences among SMA, to identify mechanisms through which RS influences mental health in this population, and to identify protective factors in the development of RS. We will recruit a cohort of 500 SMA (ages 14-17) to participate in a longitudinal and experience-sampling study. Data will be collected at four biannual assessments (baseline, 6-, 12-, 18-months) to determine the longitudinal relations among sexual orientation-related rejection, RS (anxious and angry), and mental health (depression, suicidal ideation, and reactive aggression). In addition, participants will complete a 6-week experience-sampling study (4 assessments per day, administered in two 3-week bursts) to examine antecedents and consequences of RS as they occur in daily life. These data will be used to accomplish three specific aims: (1) Determine the longitudinal and daily relations among sexual orientation-related rejection, RS (anxious and angry), and mental health (depression, suicidal ideation, and reactive aggression); (2) Identify mechanisms (social withdrawal, self- and other-blame, and sexual orientation concealment) underlying the longitudinal and daily relations between RS and mental health problems; and (3) Examine sexual orientation-related social support and acceptance as protective factors in the development of RS. The proposed R01 will advance our understanding of the development of RS, its consequences, the underlying mechanisms, and protective factors, which will inform interventions to reduce the mental health disparities affecting SMA.