Double Minority Youth Mental Health: An investigation of challenges and opportunities to support Chinese sexual/gender minority young people in New Zealand

Abstract

Objectives: Most research on sexual and gender (SG) minority mental health has been conducted with European (White) populations in the United States. Very little is known about the mental health needs and challenges faced by young people who are both ethnic and SG minorities (i.e. those who are not exclusively heterosexual or cisgender) in Western nations. With a focus on Chinese SG minority youth ('double minority youth') in New Zealand (NZ), I explored what might affect their mental health and wellbeing, and opportunities to improve therapeutic practice including psychological therapies, counselling or talking therapies (hereafter 'therapies') for Chinese SG minority youth. Methods: I adopted a three-phase mixed-methods research approach and conducted four studies. In Study One, a secondary analysis of nationally representative Youth2000 survey data was conducted to examine the mental health status of double minority youth, including Chinese SG minority young people. In Study Two, I embarked on a systematic search of 29 international databases to identify the best evidence-based therapeutic practice for Chinese and other East Asian minorities. Study Three involved qualitative interviews with 11 Chinese SG minority youth to explore their views on mental health challenges and support. Study Four involved qualitative interviews with 8 therapists to gather their views on working effectively with these youth. I adopted a general inductive approach to analyse the data of both Study Three and Study Four. Results: SG minority status, minority ethnicity, and female sex were independently associated with a higher risk of depression, suicidality, and poor wellbeing in NZ. Double minority youth reported higher risk than their SG majority peers of the same ethnicity, whereas double minority youth reported lower risk than their NZ European SG minority peers. The review of international literature highlighted the scarcity of published studies in the field. Challenges associated with various forms of oppression, including those relating to their intersecting identities were explored. Culture and community connections, in addition to family and peer support were described as resilience factors. However, stigma and fear of 'losing face', and the lack of cultural competency in therapeutic practice were reported by both youth and therapist participants as barriers to effective mental health support. A range of recommendations to improve mental health support were identified. Conclusion: A set of 'Chinese-SG-minority-specific' recommendations for therapeutic practice emerged, with a strong emphasis on youth development. Holistic clinical assessment, culturally attuned relationship building, and growth in cross-cultural competency as well as supporting healthy identity management are the main tenants of these recommendations for practice. Further research is required which aims to: address the oppression experienced by Chinese SG minority youth and seeks to enhance therapy for Chinese SG minority young people.