Multi-Method Assessment of Self-Regulation as a Moderator of the Associations Between Social Support and Service Use With Mental Health in LGBTQ+ Emerging Adults

Abstract

Background: LGBTQ + individuals face higher levels of oppression and discrimination which contributes to large mental health disparities. This includes risk of social rejection and increased barriers to receiving appropriate and affirming therapeutic and medical services. Method: N = 142 (Mage = 21.97, SD = 3.17) LGBTQ + emerging adults completed self-report, behavioral, and physiological indices of self-regulation and self-report social support, service use, and mental health symptoms. Structural equation modeling examined (1) direct effects of social support, service use, and self-regulation on mental health and (2) self-regulation as a moderator. Results: There were direct effects of social support, service use, and self-regulation on mental health. No significant moderations were found, and behavioral measures of self-regulation were not related to mental health outcomes. Discussion: Social support, service use, and self-reported self-regulation may be independently important protective factors for LGBTQ + individuals. Continued work is needed examining multi-method assessment of self-regulation in this population, particularly considering physiological measures.

Keywords

respiratory sinus arrhythmia self-regulation LGBTQ+social support service use

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References

Abbott

(2022). Letter to “the honorable jaime masters”. https://gov.texas.gov/uploads/files/press/O-MastersJaime202202221358.pdf

Almazan

A. N.

Keuroghlian

A. S.

(2021). Association between gender-affirming surgeries and mental health outcomes. JAMA Surgery, 156(7), 611–618. https://doi.org/10.1001/jamasurg.2021.0952

Arbuthnott

Frank

(2000). Trail making test, part B as a measure of executive control: Validation using a set-switching paradigm. Journal of Clinical and Experimental Neuropsychology, 22(4), 518–528. https://doi.org/10.1076/1380-3395(200008)22:4;1-0;FT518

Arnett

J. J.

Tanner

J. L.

(2011). Themes and variations in emerging adulthood across social classes. In Arnett

J. J.

Kloep

Hendry

L. B.

Tanner

J. L.

(Eds.), Debating emerging adulthood: Stage or process? (pp. 31–50). Oxford University Press.

Arnett

J. J.

Žukauskienė

Sugimura

(2014). The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569–576. https://doi.org/10.1016/S2215-0366(14)00080-7

Arnoldussen

van der Miesen

A. I.

Elzinga

W. S.

Alberse

A. M. E.

Popma

Steensma

T. D.

de Vries

A. L.

(2022). Self-perception of transgender adolescents after gender-affirming treatment: A follow-up study into young adulthood. LGBT Health, 9(9), 238–246. https://doi.org/10.1089/lgbt.2020.0494

Beauchaine

(2001). Vagal tone, development, and gray’s motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Development and Psychopathology, 13(2), 183–214. https://doi.org/10.1017/S0954579401002012

Beauchaine

T. P.

(2015). Respiratory sinus arrhythmia: A transdiagnostic biomarker of emotion dysregulation and psychopathology. Current opinion in psychology, 3, 43–47. https://doi.org/10.1016/j.copsyc.2015.01.017

Beauchaine

T. P.

Bell

Knapton

McDonough‐Caplan

Shader

Zisner

(2019). Respiratory sinus arrhythmia reactivity across empirically based structural dimensions of psychopathology: A meta‐analysis. Psychophysiology, 56(5), Article e13329. https://doi.org/10.1111/psyp.13329

10.

Beauchaine

T. P.

Bell

Z. E.

(2019). Respiratory sinus arrhythmia as a transdiagnostic biomarker of emotion dysregulation. In Beauchaine

T. P.

Crowell

S. E.

(Eds.), The Oxford handbook of emotion dysregulation (153-166). Oxford University Press.

11.

Bradford

Reisner

Honnold

Xavier

(2013). Experiences of transgender-related discrimination and implications for health: Results from the Virginia transgender health initiative study. American Journal of Public Health, 103(10), 1820–1829. https://doi.org/10.2105/AJPH.2012.300796

12.

Brain and Body Center . (2007). CardioEdit/CardioBatch [computer software]: University of Illinois.

13.

Brooks

V. R.

(1981). Minority stress and lesbian women. Free Press.

14.

Buchmann

Ritter

Müller

S. T.

Haynes

Ghisleni

Tuura

Hasler

(2022). Associations between heart rate variability, peripheral inflammatory markers and major depressive disorder. Journal of affective disorders, 304, 93–101.

15.

Bylsma

L. M.

(2021). Emotion context insensitivity in depression: Toward an integrated and contextualized approach. Psychophysiology, 58(2), Article e13715. https://doi.org/10.1111/psyp.13715

16.

Campbell

A. A.

Wisco

B. E.

(2021). Respiratory sinus arrhythmia reactivity in anxiety and posttraumatic stress disorder: A review of literature. Clinical Psychology Review, 87, Article 102034. https://doi.org/10.1016/j.cpr.2021.102034

17.

Clarke

D. E.

Kuhl

E. A.

(2014). DSM-5 cross-cutting symptom measures: A step towards the future of psychiatric care? World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 13(3), 314–316. https://doi.org/10.1002/wps.20154

18.

Cludius

Mennin

Ehring

(2020). Emotion regulation as a transdiagnostic process. Emotion, 20(1), 37–42. https://doi.org/10.1037/emo0000646

19.

Cohen

Gottlieb

B. H.

Underwood

L. G.

(2000). Social relationships and health. In Cohen

Underwood

L. G.

Gottlieb

B. H.

(Eds.), Social support measurement and intervention: A guide for health and social scientists (pp. 3–25). Oxford University Press. DOI:10.1093/med:psych/9780195126709.003.0001

20.

Corrigan

J. D.

Hinkeldey

N. S.

(1987). Relationship between parts A and B of trail making test. Journal of Clinical Psychology, 43(4), 402–408.

21.

Craig

S. L.

Eaton

A. D.

Leung

V. W.

Iacono

Pang

Dillon

Austin

Pascoe

Dobinson

(2021). Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada. BMC psychology, 9(1), 94. https://doi.org/10.1186/s40359-021-00595-6

22.

Crenshaw

K. W.

(2017). On intersectionality: Essential writings. The New Press.

23.

Diamond

L. M.

Alley

(2022). Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations. Neuroscience & Biobehavioral Reviews, 138, 104720.

24.

Diamond

L. M.

Dehlin

A. J.

Alley

(2021). Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals. Psychoneuroendocrinology, 129, 105215.

25.

Dixon

L. B.

Holoshitz

Nossel

(2016). Treatment engagement of individuals experiencing mental illness: Review and update. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 15(1), 13–20. https://doi.org/10.1002/wps.20306

26.

Eadeh

H. M.

Breaux

Boyd-Rogers

Priest

B. J.

Nikolas

M. A.

(2023). Self-regulation in gender and sexual orientation diverse adults: An exploratory person-centered approach. Journal of LGBT Issues in Counseling, 17(1), 22–39.

27.

Exec. Order No. 14168, 3 C.F.R . (2025). https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/

28.

Faul

Erdfelder

Lang

A.-G.

Buchner

(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.

29.

Fish

J. N.

(2020). Future directions in understanding and addressing mental health among LGBTQ youth. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 49(6), 943–956. https://doi.org/10.1080/15374416.2020.1815207

30.

Fish

J. N.

McInroy

L. B.

Paceley

M. S.

Williams

N. D.

Henderson

Levine

D. S.

Edsall

R. N.

(2020). “I'm kinda stuck at home with unsupportive parents right now”: LGBTQ youths' experiences with COVID-19 and the importance of online support. Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 67(3), 450–452. https://doi.org/10.1016/j.jadohealth.2020.06.002

31.

Florida Department of Health . (2022). Treatment of gender dysphoria for children and adolescents. https://www.floridahealth.gov/_documents/newsroom/press-releases/2022/04/20220420-gender-dysphoria-guidance.pdf?utm_medium=email&utm_source=govdelivery

32.

Goldhammer

Maston

E. D.

Kissock

L. A.

Davis

J. A.

Keuroghlian

A. S.

(2018). National findings from an LGBT healthcare organizational needs assessment. LGBT Health, 5(8), 461–468. https://doi.org/10.1089/lgbt.2018.0118

33.

Graziano

Derefinko

(2013). Cardiac vagal control and children's adaptive functioning: A meta-analysis. Biological Psychology, 94(1), 22–37. https://doi.org/10.1016/j.biopsycho.2013.04.011

34.

Haatveit

B. C.

Sundet

Hugdahl

Ueland

Melle

Andreassen

O. A.

(2010). The validity of d prime as a working memory index: Results from the “bergen n-back task”. Journal of Clinical and Experimental Neuropsychology, 32(8), 871–880. https://doi.org/10.1080/13803391003596421

35.

Hailey

Burton

Arscott

(2020). We are family: Chosen and created families as a protective factor against racialized trauma and anti-LGBTQ oppression among African American sexual and gender minority youth. Journal of GLBT Family Studies, 16(2), 176–191. https://doi.org/10.1080/1550428x.2020.1724133

36.

Heilman

(2021). RSA data training. UNCG Brain and body center. Virtual.

37.

Hendricks

M. L.

Testa

R. J.

(2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460–467. https://doi.org/10.1037/a0029597

38.

Howell

K. H.

Miller-Graff

L. E.

(2014). Protective factors associated with resilient functioning in young adulthood after childhood exposure to violence. Child Abuse & Neglect, 38(12), 1985–1994. https://doi.org/10.1016/j.chiabu.2014.10.010

39.

Zhang

Wang

Mistry

Ran

Wang

(2014). Relation between emotion regulation and mental health: A meta-analysis review. Psychological Reports, 114(2), 341–362. https://doi.org/10.2466/03.20.PR0.114k22w4

40.

Jensen

P. S.

Hoagwood

K. E.

Roper

Arnold

L. E.

Odbert

Crowe

… Wells

(2004). The services for children and adolescents–parent interview: Development and performance characteristics. Journal of the American Academy of Child & Adolescent Psychiatry, 43(11), 1334–1344.

41.

Kirchner

W. K.

(1958). Age differences in short-term retention of rapidly changing information. Journal of Experimental Psychology, 55(4), 352–358. https://doi.org/10.1037/h0043688

42.

Lang

P. J.

Bradley

M. M.

Cuthbert

B. N.

(1999). International affective picture system (IAPS): Technical manual and affective ratings.

43.

Lee

Ostergard

R. L.

(2017). Measuring discrimination against LGBTQ people: A cross-national analysis. Human Rights Quarterly, 39(1), 37–72. https://doi.org/10.1353/hrq.2017.0001

44.

Logan

G. D.

(1994). On the ability to inhibit thought and action: A users' guide to the stop signal paradigm. In Dagenbach

Carr

T. H.

(Eds.), Inhibitory processes in attention, memory, and language (pp. 189–239). Academic Press.

45.

Masten

A. S.

Burt

K. B.

Roisman

G. I.

Obradović

Long

J. D.

Tellegen

(2004). Resources and resilience in the transition to adulthood: Continuity and change. Development and psychopathology, 16(4), 1071–1094.

46.

McCann

Brown

(2018). The inclusion of LGBT+ health issues within undergraduate healthcare education and professional training programmes: A systematic review. Nurse Education Today, 64, 204–214. https://doi.org/10.1016/j.nedt.2018.02.028

47.

Meyer

I. H.

(2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674

48.

Miyake

Friedman

N. P.

(2012). The nature and organization of individual differences in executive functions: Four general conclusions. Current Directions in Psychological Science, 21(1), 8–14. https://doi.org/10.1177/0963721411429458

49.

Moore

Camacho

Spencer-Suarez

K. N.

(2021). A mixed-methods study of social identities in mental health care among LGBTQ young adults of color. American Journal of Orthopsychiatry, 91(6), 724–737. https://doi.org/10.1037/ort0000570

50.

Musser

E. D.

Backs

R. W.

Schmitt

C. F.

Ablow

J. C.

Measelle

J. R.

Nigg

J. T.

(2011). Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). Journal of Abnormal Child Psychology, 39(6), 841–852. https://doi.org/10.1007/s10802-011-9499-1

51.

Muthén

L. K.

Muthén

B. O.

(1998-2017). Mplus user’s guide. 8th ed. Muthén & Muthén.

52.

Narrow

W. E.

Clarke

D. E.

Kuramoto

S. J.

Kraemer

H. C.

Kupfer

D. J.

Greiner

Regier

D. A.

(2013). DSM-5 field trials in the United States and Canada, Part III: Development and reliability testing of a cross-cutting symptom assessment for DSM-5. American Journal of Psychiatry, 170(1), 71–82. https://doi.org/10.1176/appi.ajp.2012.12071000

53.

Nolen-Hoeksema

(2012). Emotion regulation and psychopathology: The role of gender. Annual review of clinical psychology, 8(1), 161–187.

54.

Pederson

Knudson

Haggerty

Padrón

K. M.

(2025). White paper: Gender affirming care in college health. Journal of American college health, 73(2), 419–425.

55.

Porges

S. W.

(2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. WW Norton & Company.

56.

Puckett

J. A.

Cleary

Rossman

Mustanski

Newcomb

M. E.

(2018). Barriers to gender-affirming care for transgender and gender nonconforming individuals. Sexuality Research and Social Policy: Journal of NSRC: SR & SP, 15(1), 48–59. https://doi.org/10.1007/s13178-017-0295-8

57.

Reisner

S. L.

Conron

K. J.

Baker

Herman

J. L.

Lombardi

GenIUSS Group . (2015). “Counting” transgender and gender-nonconforming adults in health research: Recommendations from the gender identity in US surveillance group. Transgender Studies Quarterly, 2(1), 34–57.

58.

Robe

Păsărelu

C. R.

Dobrean

(2021). Exploring autonomic regulation in children with ADHD with and without comorbid anxiety disorder through three systematic levels of cardiac vagal control analysis: Rest, reactivity, and recovery. Psychophysiology, 58(9), Article e13850. https://doi.org/10.1111/psyp.13850

59.

Rodriguez-Seijas

Morgan

T. A.

Zimmerman

(2021). Is there a bias in the diagnosis of borderline personality disorder among lesbian, gay, and bisexual patients? Assessment, 28(3), 724–738. https://doi.org/10.1177/1073191120961833

60.

Russell

S. T.

Fish

J. N.

(2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual review of clinical psychology, 12(1), 465–487.

61.

Salsman

J. M.

Victorson

Choi

S. W.

Peterman

A. H.

Heinemann

A. W.

Nowinski

Cella

(2013). Development and validation of the positive affect and well-being scale for the neurology quality of life (Neuro-QOL) measurement system. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 22(9), 2569–2580. https://doi.org/10.1007/s11136-013-0382-0

62.

Schmiedek

Lövdén

Lindenberger

(2014). A task is a task is a task: Putting complex span, n-back, and other working memory indicators in psychometric context. Frontiers in Psychology, 5, 1475. https://doi.org/10.3389/fpsyg.2014.01475

63.

Schutte

N. S.

Manes

R. R.

Malouff

J. M.

(2009). Antecedent-focused emotion regulation, response modulation and well-being. Current Psychology, 28(1), 21–31. https://doi.org/10.1007/s12144-009-9044-3

64.

Sheppes

Suri

Gross

J. J.

(2015). Emotion regulation and psychopathology. Annual Review of Clinical Psychology, 11, 379–405. https://doi.org/10.1146/annurev-clinpsy-032814-112739

65.

Skinta

M. D.

(2020). Contextual behavior therapy for sexual and gender minority clients: A practical guide to treatment. Routledge.

66.

Slavich

G. M.

Roos

L. G.

Mengelkoch

Webb

C. A.

Shattuck

E. C.

Moriarity

D. P.

Alley

J. C.

(2023). Social Safety Theory: Conceptual foundation, underlying mechanisms, and future directions. Health Psychology Review, 17(1), 5–59. https://doi.org/10.1080/17437199.2023.2171900

67.

Sloan

Hall

Moulding

Bryce

Mildred

Staiger

P. K.

(2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review, 57, 141–163. https://doi.org/10.1016/j.cpr.2017.09.002

68.

Sutter

Perrin

P. B.

(2016). Discrimination, mental health, and suicidal ideation among LGBTQ people of color. Journal of Counseling Psychology, 63(1), 98–105. https://doi.org/10.1037/cou0000126

69.

Thayer

J. F.

Lane

R. D.

(2009). Claude Bernard and the heart–brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience & Biobehavioral Reviews, 33(2), 81–88. https://doi.org/10.1016/j.neubiorev.2008.08.004

70.

Tombaugh

T. N.

(2004). Trail making test A and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists, 19(2), 203–214. https://doi.org/10.1016/S0887-6177(03)00039-8

71.

Urben

Constanty

Lepage

Rosselet Amoussou

Durussel

Turri

Wouters

Mürner-Lavanchy

Plessen

K. J.

(2022). The added value of a micro-level ecological approach when mapping self-regulatory control processes and externalizing symptoms during adolescence: A systematic review. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-01972-1

72.

Valentine

S. E.

Shipherd

J. C.

(2018). A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clinical psychology review, 66, 24–38.

73.

Vazzana

Bandinelli

Lauretani

Volpato

Lauretani

Di Iorio

Abate

Corsi

A. M.

Milaneschi

Guralnik

J. M.

Ferrucci

(2010). Trail Making Test predicts physical impairment and mortality in older persons. Journal of the American Geriatrics Society, 58(4), 719–723. https://doi.org/10.1111/j.1532-5415.2010.02780.x

74.

Verbruggen

Aron

A. R.

Band

G. P.

Beste

Bissett

P. G.

Brockett

A. T.

Boehler

C. N.

Chamberlain

S. R.

Chambers

C. D.

Colonius

Colzato

L. S.

Corneil

B. D.

Coxon

J. P.

Dupuis

Eagle

D. M.

Garavan

Greenhouse

Heathcote

Huster

R. J.

(2019). A consensus guide to capturing the ability to inhibit actions and impulsive behaviors in the stop-signal task. Elife, 8, Article e46323. https://doi.org/10.7554/eLife.46323

75.

Victor

S. E.

Klonsky

E. D.

(2016). Validation of a brief version of the difficulties in emotion regulation scale (DERS-18) in five samples. Journal of psychopathology and Behavioral Assessment, 38, 582–589.

76.

Wagaman

M. A.

Keller

M. F.

Cavaliere

S. J.

(2016). What does it mean to be a successful adult? Exploring perceptions of the transition into adulthood among LGBTQ emerging adults in a community-based service context. Journal of Gay & Lesbian Social Services, 28(2), 140–158. https://doi.org/10.1080/10538720.2016.1155519

77.

Watson

O’Hara

M. W.

Naragon-Gainey

Koffel

Chmielewski

Kotov

Ruggero

C. J.

(2012). Development and validation of new anxiety and bipolar symptom scales for an expanded version of the IDAS (the IDAS-II). Assessment, 19(4), 399–420. https://doi.org/10.1177/1073191112449857

78.

Watson

O'Hara

M. W.

Simms

L. J.

Kotov

Chmielewski

McDade-Montez

E. A.

Gamez

Stuart

(2007). Development and validation of the inventory of depression and anxiety symptoms (IDAS). Psychological Assessment, 19(3), 253–268. https://doi.org/10.1037/1040-3590.19.3.253

79.

Weiss

N. H.

Forkus

S. R.

Contractor

A. A.

Dixon-Gordon

K. L.

(2020). The interplay of negative and positive emotion dysregulation on mental health outcomes among trauma-exposed community individuals. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 219–226. https://doi.org/10.1037/tra0000503

80.

Wickens

C. M.

Sandlin

J. A.

(2010). Homophobia and heterosexism in a college of education: A culture of fear, a culture of silence. International Journal of Qualitative Studies in Education, 23(6), 651–670. https://doi.org/10.1080/09518390903551035

81.

Wike

Tomlinson

C. A.

Wagaman

Matijczak

Murphy

Watts

O’Connor

McDonald

(2023). The role of thwarted belongingness on the relationship between microaggressions and mental health for LGBTQ+ emerging adults. Journal of Youth Studies, 26(2), 286–303. https://doi.org/10.1080/13676261.2021.2010687

82.

Zhang

Verhaeghen

Cerella

(2012). Working memory at work: How the updating process alters the nature of working memory transfer. Acta Psychologica, 139(1), 77–83. https://doi.org/10.1016/j.actpsy.2011.10.012

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