Town, Rosa Elizabeth; (2023) More Than the Self: Understanding How LGBTQ+ Adolescents Self-Manage Their Emotional Health. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Epidemiological studies show that emotional problems are rising amongst adolescents in the UK. LGBTQ+ adolescents have higher prevalence of emotional problems than their non-LGBTQ+ peers, yet they are less likely to access specialist mental health services. Self-management, or strategies or techniques that do not involve a professional, may be a preferred source of support for this minoritised group. However, there is a lack of research on how self-management could benefit LGBTQ+ adolescents, as well as what they already perceive themselves to be doing to self-manage their emotional health (if anything). Using a mixed methods approach, this thesis aimed to understand factors affecting LGBTQ+ adolescents’ self-management of emotional problems. Study One was a scoping literature review investigating the concepts of self-management, self-help, and self-care in the context of adolescents with emotional problems. Whilst self-help was the most frequently mentioned term, overlap was clear between the definitions and descriptions of all three concepts. Literature involving adolescents from marginalised groups (such as those identifying as LGBTQ+) was lacking. Study Two was a qualitative investigation of LGBTQ+ adolescents’ experiences and perceptions of self-managing their emotional health. Participants reported a range of barriers and facilitators to self-management (e.g., ‘Wanting To Wallow’, ‘Fear of Judgment’, ‘Importance of Social Motivation and Support’, ‘Asking for Help and Showing Vulnerability’). Specific self-management strategies were identified (e.g., ‘Speaking to or Meeting Up With Friends or a Partner’, ‘Distraction’, ‘Exercise’, ‘Listening to or Playing Music’). These findings highlighted the importance of outness, minority stress, and the LGBTQ+ community in participants’ emotional health self-management. Expanding on the findings of Study Two, Study Three used a quantitative survey design to investigate self-management as a mediator or moderator of the relationship between minority stress, outness, anxiety, and depression. From a sample of 3,541 LGBTQ+ adolescents, findings indicated that self-management significantly moderated the relationship between minority stress and depression, but not anxiety. Additionally, self-management significantly mediated the relationship between outness and depression. Study Four consisted of qualitative focus groups with LGBTQ+ adolescents to unpick and reflect on the main survey findings using an explanatory sequential mixed methods study design. Resulting themes were divided into those which supported, challenged, or expanded on the survey findings, as well as those relating to self-management more generally. Findings broadly supported the findings of Study Three and provided further contextual information about participants’ experiences of outness and minority stress. Implications for policy and intervention development drawing from the results of all four studies are discussed, including recommendations for targeted self-management programmes for LGBTQ+ adolescents’ emotional health and implications for future research.

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