JMIR Publications

ABSTRACT

Background:

There is a high prevalence of bullying victimization among Sexual Minority Youth (SMY), particularly in educational settings, which affects their mental health negatively. However, previous studies have scarcely explored the symptomatic relationships between anxiety, depression, and post-traumatic stress disorder (PTSD) among SMY who experienced bullying on college campuses in the past.

Objective:

The objectives of our study were: (1) to investigate the anxiety-depression-PTSD network structures of gay/lesbian, bisexuals, and other SMY who were bullied on college campuses in the past; (2) to compare symptomatic associations in the anxiety-depression-PTSD networks among bullied SMY and heterosexual groups.

Methods:

This study was conducted cross-sectional, recruiting college participants from Jilin Province, China. Data analysis was run on a subset of the data extracted after screening for sexual orientation and history of bullying victimization, as measured by self-reported questionnaires. SMY were then divided into three subgroups: gay/lesbian (homosexual); bisexual; other. Validated scales were used to examine the severity of mental health symptoms: the seven-item Generalized Anxiety Disorder Scale (GAD-7) measuring anxiety, the nine-item Patient Health Questionnaire (PHQ-9) measuring depression, and the ten-item Trauma Screening Questionnaire (TSQ-10) measuring PTSD symptoms. Combining the undirected and Bayesian network analyses, the anxiety-depression-PTSD networks were compared among SMY subgroups, and the difference in mental health between heterosexuals and SMY was investigated. Chi-square tests were used to compare the difference in categorical variables, while independent-sample T-tests were run on continuous variables.

Results:

In this large-scale sample of 89,342 participants, 12,249 identified as SMY, in which 1,603 (13.1%) reported being bullied on college campuses in the past year. First, in the global and SMY subgroups’ network structures, sad mood and irritability were identified as central and bridge symptoms of the anxiety-depression-PTSD network; emotional cue reactivity was a central symptom of PTSD in all networks. Second, according to the completed partially directed acyclic graph (CPDAG) results, anhedonia had the highest prediction for activating other symptoms in the anxiety-depression-PTSD network; feeling afraid was connected to symptoms from anxiety to the PTSD community. Third, compared to their heterosexual counterparts, SMY exhibited a stronger association between difficulty concentrating and appetite. Finally, the “sad mood-appetite” edge was strongest in the gay/lesbian network; the “irritability-exaggerated startle response” edge was strongest in the bisexual network.

Conclusions:

For the first time, this study identified the most central and bridge symptoms (sad mood, irritability) within the depression-anxiety-PTSD network of SMY with past bullying-victim experiences on college campuses. Emotional cue reactivity, anhedonia, and feeling afraid were other vital symptoms in this comorbid network. Findings also showed that differences exist in symptomatic relationships between bullied heterosexuals and SMY, as well as between SMY subgroups. Consequently, refined targeted interventions should be formulated to relieve the symptoms of anxiety, depression, and PTSD comorbidity.