Mental Health Problems and Bullying Victimization Among Sexual

Minority Adolescents in Greek Secondary Schools

Eleni Andreoua , Stefanos Plexousakisb, Maria Georgiadib and Omiros Papadopoulosa
a
Department of Primary education, university of Thessaly, Volos, Greece; bDepartment, of Psychology, university
of crete, rethymno, Greece

ARTICLE HISTORY
ABSTRACT Received 19 August 2021
This study provides the first empirical account of mental health issues among Accepted 1 July 2022
sexual minority adolescents in Greece and the effects on mental health of both KEYWORDS
bullying and victimization in relation to adolescents’ sexual orientation. A Adolescents; school- bullying;
sample of 757 adolescents (M age = 15.98, SD = 0.84) completed self-reported victimization; mental health
scales measuring school bullying victimization experiences, levels of
depression, feelings of loneliness, hopelessness, feeling of belonging in school,
self-esteem, and sense of wellbeing. Statistically significant differences were
observed between heterosexuals and gay adolescents in depression,
loneliness, bullying behavior and school belongingness. Gay adolescents are
more likely to present higher levels of depression. Furthermore, sexual
orientation was also found to be significant moderator of the effect of bullying
victimization on loneliness. Bullying was associated with low sense of school
belonging and victimization with depressive symptomatology, loneliness and
low sense of school belonging and self-esteem. Students’ self-esteem and
school belongingness were found to have a protective role against loneliness,
depression and hopelessness. The findings of the current study provide
valuable information to school psychologists, teachers, policy makers, and
other professionals whose goals are to enhance adolescent functioning and
adaptation. It is suggested that intervention strategies designed to promote
resilience should incorporate sexual orientation issues.

Introduction
Over the last two decades extensive literature has investigated the differences in mental health of
adolescents of different sexualities and the mechanisms that may lead to such differences. Lesbian,
gay, and bisexual (LGB) youth seem to be at high risk for a range of mental health problems
(Lucassen et al., 2014; Perales et al., 2020; Wilson & Cariola, 2020). For instance, research has found
that non-heterosexual youth have higher levels of depression, loneliness, suicidality and substance use
(Lucassen et al., 2017; Marshal et al., 2011; Mongelli et al., 2019; Westefeld et al., 2001),
victimization from their peers (Hong & Espelage, 2012; Yang et al., 2020) and bully behavior (Kurki-
Kangas et al., 2019) than heterosexual youth. Research has also found that bisexual youth score
higher than gay male, lesbian female and heterosexual youth in perceived stress (Gisladottir et al.,
2018), alcohol-use problems (Talley et al., 2014), self-harm, suicidality and impulsivity (Liu &
Mustanski, 2012).

CONTACT eleni andreou elandr@uth.gr Department of Primary education, university of Thessaly, argonafton & filellinon,
Volos 38221, Greece. © 2022 Taylor & francis Group, llc
400 E. ANDREOU ET AL.
Many factors contribute to the mental health problems of LGB youths, especially during
adolescence. Adolescence is a critical developmental stage, with heightened effects of stress related to
identity issues on mental health (Sigfusdottir et al., 2017). Identity issues in adolescence occur during
the course of biological changes, and changes in family relationships and peer social networks
(Graber & Archibald, 2001; McClintock & Herdt, 1996). In addition to the stressors associated with
normative adolescent development, LGB youths face specific stressors, related to their sexual
orientation such as disclosing sexual orientation, being ridiculed by others, and peer-acceptance
(Wagaman et al., 2020).
Moreover, adolescents included in sexual minority’s categories consists a group, which is
vulnerable from the nature of homophobic school bullying phenomena creating a general negative
atmosphere against them. Muñoz-Plaza et al. (2002) report characteristically that school classes are
synonymous with a homophobic institution. For many youths school life is synonymous with
rejection, isolation, discrimination and maltreatment (Moyano & Sánchez- Fuentes, 2020).
Homophobic bullying could be defined as the bullying behaviors which are motivated from
prejudices against real or perceived sexual identity or orientation and it takes place through verbal,
physical, relational bullying accompanied or coming with the use of terms like gay, lesbian and others
nicknames by perpetrators (Sterzing et al., 2014). Homophobic bullying could be divided into two
major categories (Ganson & Nagata, 2021; Johns et al., 2019). The first form is related to the general
homophobic atmosphere in school hiding aggressiveness toward gay people in school context (Johns
et al., 2019). School climate creates an indirect latent culture, which argues that youth should be
heterosexual and explicitly masculine or feminine with serious emotional consequences for youth
involved. The second form of homophobic bullying is referred to direct victimization of gay and
bisexual students (Burk et al., 2018; Camodeca et al., 2019) and could take the form of spreaded
rumors, isolation, mobile messages, threatening sights, verbal harassment as well as physical abuse
(Yang et al., 2020).
Many studies investigated the effects of homophobic bullying in the context of minority stress
theory (Meyer, 2003) which suggests that the increased prevalence of mental health issues
experienced by LGB youth is due to the increased level of social stress, including stigma,
discrimination, prejudice and victimization. D’Urso and Pace (2019) reports that homophobic
incidents in school are systematic and long-term and carried out from group peers, while Camodeca et
al. (2019) point out that victimization from homophobic bullying is not restricted in sexual minorities
but it could create a hostile school climate for all students, through the perpetuation and maintenance
of the traditional gender role models.
Although there is an increasing recognition of school homophobic bullying as a major problem for
the public health, very few studies have been conducted in relation to traditional or general bullying
and sexual orientation. General bullying refers to persistent physical or psychological harassment of
one individual by another accompanied by intention to harm and a power imbalance (Nansel et al.,
2001). While it is well documented that homophobic bullying has harmful effects on LGB adolescent
it is not clear yet whether bullying victimization has the same effects for heterosexual and sexual
minority groups. LGB youth experience disproportionate rates of bullying compared to their
heterosexual peers (Gower et al., 2018) and are more likely to get involved in school bullying
incidents both as victims and perpetrators (Eisenberg et al., 2015). In a recent study with 3934 high
school students in China, Yang et al. (2020), found out that bisexual groups were at higher risk from
heterosexual groups for becoming victims in all forms of bullying and develop depression and anxiety
symptoms. Similar findings with Yang et al. (2020) were reported from Kahle (2020) and Elipe et al.
(2018) but to the best of our knowledge the moderating role of sexual orientation in the relationship
between bullying/victimization and adolescents’ mental health has not investigated yet. Given the
vulnerability of sexual minority adolescents, it is possible that the some abusive behaviors have more
severe effects on their mental health, especially in Greece where gender and sexual orientation issues
are not addressed by educational institutions.
Moreover, it should be noted that Greece has historically pursued an intolerant approach to LGBT
civil and human right’s issues (Giannou & Ioakimidis, 2020). Proposals for ensuring equality in civil
partnerships became a law as late as in 2015 and only after the country’s conviction by the European
Court of Human Rights. Moreover, Greece ranks highest among European countries on negative
 ThE JOURNAL OF GENETIc PSychOLOGy
401
attitudes toward LGBT people. Only 53% of Greeks indicate an acceptance of same-sex identities,
making it the lowest in the European Union (European Union Agency for Fundamental Rights, 2013).
Harassment and verbal insults are commonly experienced by sexual minority people, including
adolescents and young adults (Halkitis et al., 2018). In 2013, among 18 to 24 year-olds, 97% reported
having witnessed harassment of students perceived to be LGBT at school and 76% of that age group
reported having experienced negative comments or poor conduct at school because of being LGBT.
These conditions result in 92% of LGBT adolescents and children who fear that disclosing their
sexual identities would be detrimental to their health and well-being (European Union Agency for
Fundamental Rights, 2013).

The present study

Although studies related to LGB mental health and involvement in bully/victim incidents are
accumulative, there are no studies on the relationship between adolescents’ sexual orientation and
mental health in Greece and as far as we know no study on bullying victimization in Greek schools
addresses LGB issues. Due to the lack of correct sex education and the fact that different sexual
orientation is not yet acknowledged as much as in other countries (Bejakovich & Flett, 2018; Giannou
& Ioakimidis, 2020) many sexual minority youth groups are under great psychological pressure in
school. For that reason, we compared youth of different sexualities according to eight variables, six
pertaining to adolescents’ mental health and two pertaining to their bullying victimization
experiences. We defined mental health according to the dual continua model (Keyes, 2002, 2005;
Tudor, 1996). This model states that positive and negative aspects of mental health are related but
distinct. Accordingly, we focused on three positive aspects of mental health, namely, general well-
being, self-esteem, and school belongingness and on three negative aspects of mental health, namely,
loneliness, depression and hopelessness.
The role of sexual orientation in the relationship between bullying/victimization and adolescents’
mental health is also examined in order to shed light on specific associations concerning the interplay
between sexual orientation and mental health issues during adolescence. The aims of the study are as
follows:

1. to explore possible differences between adolescents of different sexualities regarding levels of

depression, feelings of loneliness, hopelessness, feeling of belonging in school, self-esteem,
sense of wellbeing, and bullying victimization experiences,
2. to examine the relationship of bullying victimization with dimensions of adolescents’ mental
health (depression, feelings of loneliness, hopelessness, feelings of belonging in school, self-
esteem and sense of well-being), and
3. to investigate the potential moderator role of sexual orientation (gay versus heterosexual) on
the effects of both bullying, self-esteem and school belonging on loneliness, depression and
hopelessness.

Method
Participants
The sample consisted of 757 secondary education students aged from 15 to 18 (M = 15.98, SD = .84
years), from public schools located in west Thessaloniki in northern Greece. (1 st, 2nd, and 3rd Grade of
Lyceum). Sample size was estimated a priori using G Power version 3.1 (Faul et al.,
2007). The analysis indicates that a sample size of 685 would be sufficient to detect significant direct
and indirect associations with a power of 0.80 and an alpha of 0.05. (Total population of the area of
west Thessaloniki was 6225 students). The majority were girls (n = 412, 54.4%) and 345 (45.6%)
were boys. 274 students (36.2%) were attending the 4 th high school class, 270 (35.8%) the 5 th grade
and 213 (28.1%) the 6th grade.
402 E. ANDREOU ET AL.
Measures
All measures were translated by a bilingual (Greek-American English) translator in order to guarantee
linguistic and cultural equivalence. The translated versions were then submitted to a panel of two
experts in the area of Developmental Psychology, who confirmed their face validity. Α full description
of the validation process of the translated measures used in this study and their psychometric
properties are available in Vleioras et al. (2022).

Sexual orientation
In line with the best practices for asking questions about sexual orientation in adolescents (Sexual
Minority Assessment Research Team (SMART), 2009), the participants responded to four questions,
two tapping on sexual behavior (‘Have you ever had a romantic relationship with a person of female
gender (girl)? … of male gender (boy)?’) and two on sexual preference (‘Have you ever wanted to
have a romantic relationship with a person of female gender (girl)? of male gender (boy)?’).
Participants answered ‘yes’ or ‘no’ to all questions, allowing them to express attraction for and sexual
behavior with either, both or neither sex. Sex assigned at birth was used to determine whether the
answers described heterosexual or gay sexual orientation.

Bullying/victimization
School bullying and victimization were assessed by the University of Illinois Aggression Scales
(Espelage & Holt, 2001). It consists of three subscales (bullying, victimization, physical violence) of
totally 18 questions. The first subscale refers to the participation of the perpetrator and consists of 9
questions. The second subscale examines incidents of students’ victimization by his/her peers with 4
questions, while the third subscale consists of 5 questions concerning the involvement of the
participant in incidents of physical violence. We did not use the last scale because it was irrelevant to
the hypotheses of the study. Students were asked to state the frequency of their participation in
bullying incidents responding to a 5- point Likert type scale (Never/1 or twice/3 or 4 times/5 or 6
times/7 times or more). Example items are ‘I teased some students’ (bully behavior) and ‘Other
students teased me’ (peer victimization).
Scores ranged between 0 − 36 for the perpetrator subscale, and 0 − 16 for the victim subscale with
higher scores showing higher levels of self-reported participation in various incidents. These
subscales have demonstrated good internal consistency in the past (Cronbach’s alpha = .88 and .89,
respectively, Birkett et al., 2009). The internal reliability of the subscales in the present sample was
also good (Cronbach’s alpha = .80 and .74 and Greatest lower bound = .84 and .81, for bully
penetration and peer victimization, respectively).

Depression
Depressive symptoms were explored by The Adolescent Depression Rating Scale (Revah-Levy et al.,
2007). The scale consists of 10 questions, which explore the existence of depressive symptoms during
the last two weeks. An example item is ‘I have trouble thinking’. The participants use a dichotomous
scale (True/Not true) to report whether each of the statements describes them. The internal reliability
of the scale in the study of Revah-Levy et al., 2007 was adequate with Cronbach’s alphas ranging
from .74 to .79 and acceptable in the present study (Cronbach’s alpha = .69, Greatest lower bound
= .74).
Hopelessness
Students’ hopelessness was assessed by the Beck’s Hopelessness Scale (Beck et al., 1974). This scale
consists of 20 statements regarding attitudes toward short term or long term future. An example item
is ‘My future seems dark to me’. The participants use a dichotomous scale (True/ Not true) to report
whether each statement described them in the course of last week. The internal reliability of the scale
 ThE JOURNAL OF GENETIc PSychOLOGy
403
was good in the past (Cronbach’s alpha = .82, Bonanno & Hymel, 2010) and adequate in the present
study (Cronbach’s alpha = .79, Greatest lower bound = .85).

Loneliness
Feelings of loneliness were explored using the Revised UCLA Loneliness Scale (Russell, 1996,
version 3). The scale consists of 20 questions, which explore the degree of loneliness the individual
experiences because of the lack of social interactions. An example item is, ‘I lack companionship’.
The participants use a 4-point Likert-type scale (ranging from 1 = ‘Never’ to 4 = ‘Always’) to
describe the frequency at which each of the statements describes them. An example item is, ‘I lack
companionship’. This scale demonstrated very good internal reliability in the past (Cronbach’s alpha
= .89, Russell, 1996) and in the present study (Cronbach’s alpha = .89, Greatest lower bound = .92).

Well-being
Students’ well-being was assessed by the WHO-5 Well-Being Index (WHO , 1998). The scale
consists of 5 statements measuring feelings of well-being during the last two weeks and has been
found to have excellent internal consistency (Cronbach’s alpha = .91) in adolescents aged 12–18 years
elsewhere (Andreou et al., 2020). An example item is, ‘I have felt cheerful and in good spirits’. The
participants use a 6-point Likert-type scale (ranging from 0 = ‘At no time’ to 5 = ‘All of the time’) to
describe the extent to which each statement held for them in the past two weeks. The internal
reliability of the scale in the current study was good (Cronbach’s alpha = .75, Greatest lower bound
= .79).

Self-esteem
The Rosenberg’s self-esteem scale (Rosenberg, 1965) was used to assess students’ global self-esteem.
An example item is, ‘I feel that I have a number of good qualities’. The participants use a 4-point
Likert-type scale (ranging from 1 = ‘Strongly agree’ to 4 = ‘Strongly disagree’) to describe how they
have viewed themselves in the last month. The internal reliability of the scale in the present sample
was good (Cronbach’s alpha = .81, Greatest lower bound = .86) and adequate in Rosenberg’s study
(Cronbach’s alpha = .77, Rosenberg, 1965).

School belonging
To assess feelings of belonging in school the 18-item Psychological Sense of School Membership
Scale (Goodenow, 1993) was used. This scale demonstrated very good internal reliability in the past
(Cronbach’s alpha = .88, Goodenow, 1993). The participants use a dichotomous scale (True/ Not true)
to report whether each statement is representative for them. An example item is, ‘The teachers here
respect me’. The scale score was ranged from 0 to 18, with higher score indicating perception of more
positive atmosphere in school and higher feeling of belonging in school community. The internal
validity of the scale was satisfactory (Cronbach’s alpha = .76, Greatest lower bound = .81).

Procedure
All procedures performed were in accordance with the ethical standards of the institutional research
committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical
standards.
Informed consent was obtained from all participants’ parents. Questionnaires were distributed by
one of the researchers and completed by students of four general Lyceums in the area of west
Thessaloniki. The distribution took place inside classrooms during prescheduled teaching hours.
Primary consent to carry out the study was obtained from the Greek Ministry of Education. We also
sought permission from local school authorities and finally from schools’ directors. We asked class
404 E. ANDREOU ET AL.
teachers to ensure adolescents that all responses would be confidential, so they could feel secure and
confident about their participating.
The data collection took place between September 2018 and February 2019, with the questionnaire
taking about 20 minutes to complete.

Data analyses
Students’ answers were used to assign participants to four sexuality groups (gay and lesbian
adolescents, heterosexuals, bisexuals and those who didn’t report a preference) on the basis of both
criteria (sexual attraction and sexual behavior). Most children reported being heterosexual (n = 583,
77.0%), 11 (1.5%) gay male or lesbian female, 20 (2.6%) bisexual and 143 (8.8%) reported absence
of sexual behavior.
Statistical analyses were performed using the Statistical Package for the Social Science Version 24
(Howitt & Cramer, 2010). Differences in mental health and bullying victimization experiences
between youth of different sexualities were investigated in a series of ANOVAs with Welch’s robust
test in order to account for differences in group variances. Multiple post-hoc comparisons between
groups were also performed using the Bonferroni test. Correlations between study variables were
assessed by calculating Pearson correlation coefficients.
In order to investigate the effects of bullying victimization, school belonging and self-esteem and
sexual behavior on the levels of loneliness, depression and hopelessness we performed three separate
multiple linear regression models. Independent variables that were used in each model were bullying
victimization, school belonging and self-esteem and sexual orientation (encoded as 1= heterosexual
versus 2 = gay/lesbian adolescents). Bisexual sexual orientation and absence of sexual behavior were
omitted from all regression analysis. Dependent variables were loneliness, depression and
hopelessness. Potential multi-collinearity of independent variables was assessed by calculating the
mean Variance of Inflation (VIF). All models were also checked for normality and homoscedasticity
of residuals by plotting them against a normal kernel density plot and plotting them against their
predicted values. In order to investigate the potential moderation effect of sexual orientation on each
one of the independent variables we additionally performed nine multiple regression models (three
extra models for each dependent variable). In each of these models we used the same set of
independent variables as above (i.e. bullying victimization, school belonging and self-esteem and
sexual behavior) but sexual orientation was used as a moderator on one-toone of the other
independent variables (three separate models per dependent variable). For simplicity reasons we
present only the extra moderation terms for each dependent variable and not the whole models (i.e.
sexual orientation X bullying victimization, sexual orientation X school belonging and sexual
orientation X self-esteem). These results are embedded in Tables 3–5 the main model. R2 change was
calculated for every model and is presented as a footnote on each table. For the moderation analyses
we used the PROCESS Macro for SPSS version 3.4 by Hayes (2018). (Y was set to dependent
variable, X was set to the moderated independent variable, W was the moderator variable and the
remaining variables were set as covariates).

Results
Differentiation of sexuality groupings
Analyses of variance were applied to examine differences between adolescents of different sexualities
regarding levels of depression, feelings of loneliness, hopelessness, feeling of belonging
Table 1. Mean score (s.D.) on the six dimensions of mental health and bullying/victimization for each of the four groups.
absence of sexual
heterosexual Gay Bisexual behavior
Depression 2.25b (1.96) 5.08acd (2.78) 2.61b (2.33) 2.71b (2.73)
hopelessness 6.59b (3.76) 7.75a (4.50) 6.26 (3.70) 6.98 (3.40)
loneliness 39.91 (8.78) 47.8 (11.2) 40.61 (9.67) 43.21 (10.5)
 ThE JOURNAL OF GENETIc PSychOLOGy
405
school belonging 13.2bc (3.35) 9.67ad (3.58) 11.3a (3.66) 12.8b (3.97)
self-esteem 21.20d (4.65) 20.15 (5.82) 20.45 (4.60) 19.2a (5.59)
Well-being 12.71 (4.58) 11.52 (5.65) 13.11 (4.38) 12.23 (6.28)
Victimization 2.94 (2.87) 2.92 (3.45) 4.17 (3.88) 2.50 (2.84)
Bullying 5.44 (5.13) 9.00d (5.75) 5.04 (4.24) 4.12b (4.81)
a
indicates a significant difference (p<.05) from the heterosexual group;
b
indicates a significant difference (p<.05) from the group of gay male and female adolescents; cindicates a
significant difference (p<.05) from the bisexual group. dindicates a significant difference (p<.05) from the
group with absence of sexual behavior (2-tailed tests).

Table 2. correlations between variables (n = 757).

1 2 3 4 5 6 7 8

Victimization –

Bullying .08* –

Depression .09** .06 –

hopelessness .04 .01 .23** –

loneliness .16** .01 -.20** .07* –

school belonging -.18** - .19** -.13** ,04 -.13** –

self-esteem -.15** -.03 ,06 .05 .02 .07* –

Well-being .01 -,00 -.17** .04 .06 .17** .02 –

Note. 1. Victimization, 2. Bullying, 3. Depression 4. Hopelessnes, 5. Loneliness, 6. School belonging, 7. Self-esteem, 8. Well-
being.
**
p < .01. *p
< .05.

in school, self-esteem, sense of wellbeing, and bullying victimization experiences. Mean scores on
each of the six dimensions of adolescents’ mental health in each of the four sexuality groups
(heterosexuals, gay male and female adolescents, bisexuals and those who didn’t report a preference)
are shown in Table 1. No significant difference was found between the four sexuality groups on
‘Hopelessness’ [Welch’s F(3,32.77)= .69, p=.55], ‘Self-esteem’[Welch’s F(3,32.56)= 2.59, p=.07],
‘Well-being’[Welch’s F(3,32.64)= .005, p=.99] and ‘Victimization’ [Welch’s F(3,32.28)= 1.10,
p=.259]. Gay male and female adolescents tended to score higher that other groups on
‘Depression’[Welch’s F(3,32.44)= 4.67, p=.00], ‘Loneliness[Welch’s F(3,32.51)= 5.42, p=.00],’ and
‘Bullying’ scales[Welch’s F(3,32.72)= 3.93, p=.02],’ and lower on ‘School Belongingness’ Welch’s
F(3,32.75)= 6.53, p=.00]. Bonferroni post-hoc tests revealed significant differences on ‘Depression’,
‘Loneliness’ and ‘School Belongingness’ only between gay male and female adolescents and
heterosexuals and on ‘Bullying’ only between gay male and female adolescents and those who didn’t
report any sexual preference.

Associations between study variables

Pearson correlation coefficients were calculated to assess associations between bullying/victimization
and the other study variables. These correlations are shown in Table 2.
Higher scores on Victimization were associated with higher scores on Bullying Behavior and on
Depression scales and lower scores on School Belongingness and Self-esteem scales. Higher scores
406 E. ANDREOU ET AL.
on Bullying Behavior Scale were also associated with lower scores on school belongingness scale.
Higher scores on Depression scale were associated with higher scores on Hopelessness scale and
lower scores on Loneliness, School belongingness, and Well-being scales. Higher scores on
Hopelessness scale were associated with higher scores on Loneliness scale, while low scores on
Loneliness scale were associated with higher scores on School belongingness scale. Higher
Table 3. results from the multiple linear regression using Loneliness as dependent variable and Bullying victimization, school
belonging, self-esteem and sexual orientation as independent variables.
independent variables B p-value 95% confidence interval
Bullying victimization −0.906 0.118 −0.204 to 0.023
school belonging −0.753 <0.0001 −0.936 to −0.568
self esteem −0.612 <0.0001 −0.742 to −0.482
Gayl sexual orientation 4.911 0.031 0.462 to 9.360
Moderation terms
sexual orientation on Bullying1 1.713 0.009 0.414 to 3.010
sexual orientation on school belongning2 −0.083 0.896 −1.337 to 1.169
sexual orientation on self-esteem3 0.611 0.121 −0.161 to 1.382
Mean Vif 1.12; F(4,687) = 64.62; adjusted R2 = 0.269; p < 0.0001.
1 2
R change 0.0069; F = 6.7096 on 687 d.f. p = 0.009.
2 2
R change 0.0001; F = 0.0172 on 687 d.f. p = 0.896. 3R2
change 0.0025; F = 2.4154 on 687 d.f. p = 0.121.

Table 4. results from the multiple linear regression using Depression as dependent variable and Bullying victimization, school
belonging, self-esteem and sexual orientation as independent variables.
independent variables B p-value 95% confidence interval
Bullying victimization −0.001 0.849 −0.028 to 0.023
school belonging −0.136 <0.0001 −0.176 to −0.939
self esteem −0.139 <0.0001 −0.169 to −0.111
Gay sexual orientation 2.211 <0.0001 1.211 to 3.213
Moderation terms
sexual orientation on Bullying1 −0.007 0.959 −0.307 to 0.292
sexual orientation on school belongning2 0.021 0.886 −0.309 to 0.267
sexual orientation on self-esteem3 0.608 0.501 −0.116 to 0.238
Mean Vif 1.12; F(4,687)=60.43; adjusted R2=0.2560; p < 0.0001.
1 2
R change 0.0001; F = 0.0026 on 687 d.f. p = 0.959.
2 2
R change 0.0005; F = 0.4534 on 687 d.f. p = 0.501.
3 2
R change 0.0001; F = 0.0206 on 687 d.f. p = 0.886.

scores on School belongingness scale were also associated with higher scores on Self-esteem and
Well-being scales.

Multiple linear regression analyses

Results from the multiple linear regression presented in Table 3 indicated that School belonging and
Self-esteem were inversely associated with the levels of Loneliness (b= −0.753; 95% CI from −0.936
to −0.568; p < 0.0001 and b= −0.612; 95% CI from −0.742 to −0.482; p < 0.0001 respectively). On
the other hand, being gay/lesbian was found to increase the levels of Loneliness (b = 4.911; 95% from
0.462 to 9.360; p = 0.031).
Sexual orientation seems to be a statistically significant moderator with gay/lesbian sexual
orientation enhancing the effect of bullying victimization on the levels of Loneliness (B = 1.713; p =
0.009; R- change 0.0069). Sexual orientation does not have a significant moderation role on the
influence of school belonging or self-esteem on the levels Loneliness.
Results from the multiple linear regression presented in Table 4 indicated that School belonging
and Self-esteem were inversely associated with the levels of Depression (b= −0.136; 95% CI from
 ThE JOURNAL OF GENETIc PSychOLOGy
407
−0.176 to −0.939; p < 0.0001 and b= −0.139; 95% CI from −0.169 to −0.111; p < 0.0001
respectively). On the other hand, being gay/lesbian was found to increase the levels of Depression (b
= 2.211; 95% from 1.211 to 3.213; p < 0.0001).
Sexual orientation does not have a significant moderation role on the influence of bullying
victimization, school belonging or self-esteem on the levels of Depression (p > 0.05 on all
interactions).
Results from the multiple linear regression presented in Table 5 indicated that School belonging
and Self-esteem were inversely associated with the levels of Hopelessness (b= −0.224; 95%
Table 5. results from the multiple linear regression using Hopelessness as dependent variable and Bullying victimization,
school belonging, self-esteem and sexual orientation as independent variables.
independent variables B p-value 95% confidence interval
Bullying victimization −0.031 0.205 −0.079 to 0.017
school belonging −0.224 <0.0001 −0.302 to −0.146
self esteem −0.309 <0.0001 −0.364 to −0253
Gay sexual orientation 0.151 0.874 −1.729 to 2.033
Moderation terms
sexual orientation on Bullying1 −0.329 0.254 −0.984 to 0.237
sexual orientation on school belongning2 0.176 0.526 −0.368 to 0.719
sexual orientation on self-esteem3 0.104 0.544 −0.231 to 0.438
Mean Vif 1.12; F(4,687) = 60.26; adjusted R2 = 0.2555; p < 0.0001.
1 2
R change 0.0014; F = 1.3041 on 687 d.f. p = 0.254.
2 2
R change 0.0004; F = 0.4026 on 687 d.f. p = 0.526. 3R2
change 0.0004; F = 0.3687 on 687 d.f. p = 0.544.

CI from −0.302 to −0.146; p < 0.0001 and b= −0.309; 95% CI from −0.364 to −0253; p < 0.0001,
respectively).
Sexual orientation does not have a significant moderation role on the effect of bullying
victimization, school belonging or self-esteem on the levels of Depression.

Discussion
The main aim of this study was to investigate mental health issues that adolescents in Greece may
have in relation to their sexual orientation. Consistent with past research, participants with LG
identities had higher levels of depression and loneliness than those identifying as heterosexual
(Lucassen et al., 2014; Mongelli et al., 2019; Westefeld et al., 2001). It should be noted, however that
there are studies, which show that bisexuals are at greater risk of poor mental health than gay male
and female adolescents (e.g. Gisladottir et al., 2018; King et al., 2008; Marshal et al., 2011). It is also
likely that these findings are a peculiarity of the Greek socio-cultural context, in which bisexuality
may be seen as part of the transition toward becoming gay male or lesbian female (Garr-Schultz &
Gardner, 2019).
Moreover, gay male and female adolescents were similar with other groups on the levels of
hopelessness, general well-being and victimization, but they had higher scores on bullying behavior
than those without sexual orientation and lower scores on school belonging than heterosexuals. Also
they presented higher levels of depression and loneliness and lower levels of school belonging.
School belonging may be particularly crucial to the psychosocial adjustment of sexual minority
students (Galliher et al., 2004). Researchers have documented that, for sexual minority youth, school
environments, at best, foster not belonging, but invisibility, and, at worst, peer harassment and
bullying (Bontempo & D’Augelli, 2002; Camodeca et al., 2019). Increased involvement of gay male
and female adolescents in bullying in the role of the perpetrator has also been observed in other
studies (Eisenberg et al., 2015; Kurki-Kangas et al., 2019). Bullying perpetration among gay male and
female adolescents has been attributed to elevated subjection to bullying (Berlan et al., 2010), when
aggressive behavior would be coping mechanism, or self-protective behavior hiding the perpetrator’s
408 E. ANDREOU ET AL.
own vulnerability (Eisenberg et al., 2015). It is also possible that factors related to school climate,
such as sense of belonging to the school community and school connectedness contribute to bullying
perpetration.
Regarding the relationship of bullying victimization with dimensions of adolescents’ mental health
the results of our analysis indicated that bullying is inversely associated with the sense of school
belonging and victimization with depressive symptomatology, loneliness and low sense of school
belonging and self-esteem. These results are generally in accordance with relevant literature, which
emphasizes the connection between bullying/victimization and mental health (e.g. Andreou et al.,
2020; Cunningham, 2007; Kosciw et al., 2018; Narayanan & Betts, 2014). They also pinpoint the role
that school belongingness play in both bullying and victimization. High levels of school
belongingness seem to enhance positive emotions, such as happiness and contentment, whereas low
or a lack of belongingness is often associated with negative experiences, including depression,
loneliness and bullying victimization (Arslan, 2021; Osterman, 2000).
We can assume that bullying behavior consists a risk factor for adolescents that may lead to the
emergence of negative consequences on mental health directly or indirectly through the moderating
role of sexual orientation. Our results agree with previous findings, which highlight the ‘traumatic’
effect of bullying behaviors (Plexousakis et al., 2019), and the risk factor of sexual orientation as a
destabilizing factor both socially and psychologically (Burk et al., 2018; Galliher et al., 2004;
Lucassen et al., 2014). Our research is also congruent with previous studies, which indicate that gay
male and female students involved in bullying behaviors are at high risk to exhibit various mental
health issues (Wilson & Cariola, 2020).
Victimization also consists a major risk factor for adolescent students who are very likely to
exhibit ‘traumatic’ feelings of depression and anxiety (Plexousakis et al., 2019). Our findings are
congruent with previous studies which indicate that sexual minorities youth are at higher risk to
exhibit mental health issues like depression, anxiety, low-self-esteem, sense of not belonging in
school context (Gisladottir et al., 2018, Lucassen et al., 2014; Mongelli et al., 2019) and victimization
from their peers (Yang et al., 2020).
It is quite plausible that various factors contribute to the emergence of mental health problems of
youth who belong in sexual minorities during adolescence that consists a critical developmental state
with additional stress and anxiety because of possible difficulties arising from adjustment issues,
relationship issues, family relationships and peer social support (Graber & Archibald, 2001;
McClintock & Herdt, 1996). Many adolescents disclosing their sexual orientation are being ridiculed
by their peers and they are feeling excluded and being scapegoated causing enormous stress
(Wagaman et al., 2020). It is also understood that sexual minorities adolescents are exposed to a
general negative atmosphere that make them vulnerable to demonstrate various negative emotions
worsening their mental health (Muñoz-Plaza et al., 2002).
In our study gay male and female adolescents are more likely to present higher levels of
depression. Furthermore, gay sexual orientation was also found to be significant moderator of the
effect of bullying victimization on loneliness. Loneliness and social dissatisfaction have been among
the most well-documented adverse affective outcomes of peer rejection and victimization (Andreou et
al., 2015). Additionally, victimization is considered to have a possible negative impact on children’s
trust in their peers and sense of safety in school. Therefore, victimization experiences among gay
students may lead to withdrawal from peer interactions and from the social and academic activities.
This, in turn, could reinforce loneliness and social dissatisfaction and lead to depression (Galanaki &
Vassilopoulou, 2007). Within this context, the role of self-esteem in conjunction with school
belongingness is crucial, as the results of all our multiple regression analyses suggest. Given that both
self-esteem and the need to belong are considered fundamental psychological constructs associated
with a variety of important adolescent school-based and quality-of-life outcomes (Arslan, 2021), our
findings support the importance of promoting inclusive practices at school and enabling adolescents
to find ways to improve the feelings of connectedness and raise their self-esteem.
The findings of this study expands previous knowledge on risk and protective factors associated
with adolescents’ mental health, suggesting a complex interplay between sexual orientation and
mental health during adolescence and promotes understanding of adaptation issues that sexual
 ThE JOURNAL OF GENETIc PSychOLOGy
409
minorities face in Greek secondary schools. Therefore, they should be interpreted within the context
of school atmosphere as a risk or protective factor for sexual minority students who experience
aggressiveness (Ganson & Nagata, 2021; Johns et al., 2019) with serious emotional consequences for
their mental health both directly to them or indirectly from the negative even aggressive school
environment (Burk et al., 2018; Camodeca et al., 2019; Yang et al., 2020). We can assume that sexual
minority students experience enormous social stress through stigma, prejudice and finally
victimization (Meyer, 2003) ending in the perpetuation of traditional gender sex roles which causing
major distress in their attempt for sexual expression. (Bacchini et al., 2021; D’Urso & Pace, 2019;
Camodeca et al., 2019).
Given the fact that, as our results indicate, gay male and female adolescents have much more
possibilities to be involved in bullying incidents, it is of great importance that anti-bullying programs
should consider the protective role of supportive school environments, which promote such a safe and
respectful climate where all students have the opportunity to thrive and achieve their academic and
personal goals regardless of sexual orientation.
Despite the strengths of this study, there are some significant limitations. For instance, we relied
solely on self-reports and only students aged 15 to 18 from urban schools were tested. Moreover,
group administration in the school classrooms may have affected the responses in some questions,
such as the sexuality questions. In our study, bisexuals are underrepresented and that poses a certain
limitation to the interpretation of our results. Finally, because of the restricted numbers, in this study,
it was not possible to take into account other factors (such as gender) that may affect the interplay
between sexuality and mental health or bullying victimization experiences. Future studies, could look
at rural schools, younger adolescents and differences between male and female students. Longitudinal
studies are also needed to determine causal relationships between bullying victimization and LGB
mental health.
Nevertheless, the findings of the current study provide valuable information to school
psychologists, teachers, policy makers, and other professionals whose goals are to enhance adolescent
functioning and adaptation. Anti-bullying interventions designed to promote resilience should aim at
increasing students’ access to appropriate information about issues related to sexual orientation, and at
explicitly dealing with behaviors and attitudes related to aggression and discrimination.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors
Eleni Andreou is a Professor of Educational Psychology in the Department of Primary Education, University of
Thessaly, Volos, Greece. Research interests: school bullying, inclusive education, psychological well-being of children
and adolescents.
Stefanos Plexousakis is a research assistant in the Department of Psychology, University of Crete, Rethymno, Greece.
Research interests: trauma, psychotherapy, bullying, developmental disorders, implementation of intervention
programs.
Georgiadi Maria is a research assistant in the Department of Psychology, University of Crete, Rethymno, Greece.
Research interests: school inclusion of children with disabilities, children’s chronic illnesses, psychological well-being,
students with special educational needs, developmental disorders, implementation of intervention programs.
Omiros Papadopoulos is a research assistant in the Department of Primary Education, University of Thessaly, Volos,
Greece. Research interests: school bullying, school inclusion of children with disabilities, psychological well-being of
children and adolescents.
410 E. ANDREOU ET AL.
ORCID
Eleni Andreou http://orcid.org/0000-0002-5692-9017
References
Andreou, E., Didaskalou, E., & Vlachou, A. (2015). Bully/victim problems among Greek pupils with special
educational needs: Associations with loneliness and self-efficacy for peer interactions. Journal of Research in
Special Educational Needs, 15(4), 235–246. doi:10.1111/1471-3802.12028
Andreou, E., Roussi-Vergou, C., Didaskalou, E., & Skrzypiec, G. (2020). School bullying, subjective well‐being, and
resilience. Psychology in the Schools, 57(8), 1193–1207. doi:10.1002/pits.22409
Arslan, G. (2021). School belongingness, well-being, and mental health among adolescents: Exploring the role of
loneliness. Australian Journal of Psychology, 73(1), 70–80. doi:10.1111/ajpy.12274
Bacchini, D., Esposito, C., Affuso, G., & Amodeo, A. L. (2021). The Impact of personal values, gender stereotypes, and
school climate on homophobic bullying: A multilevel analysis. Sexuality Research and Social Policy, 18(3), 598–
514. doi:10.1007/s13178-020-00484-4
Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale.
Journal of Consulting and Clinical Psychology, 42(6), 861–865. doi:10.1037/h0037562
Bejakovich, T., & Flett, R. (2018). Are you sure?: Relations between sexual identity, certainty, disclosure, and
psychological well-being. Journal of Gay & Lesbian Mental Health, 22(2), 139–161. doi:10.1080/19359705.201
8.1427647
Berlan, E. D., Corliss, H. L., Field, A. E., Goodman, E., & Austin, S. B. (2010). Sexual orientation and bullying among
adolescents in the growing up today study. The Journal of Adolescent Health, 46(4), 366–371. doi:10.1016/j.
jadohealth.2009.10.015
Birkett, M., Espelage, D. L., & Koenig, B. W. (2009). LGB and questioning students in schools: The moderating effects
of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence,
38(7), 989–1000. doi:10.1007/s10964-008-9389-1
Bonanno, R. A., & Hymel, S. (2010). Beyond hurt feelings: Investigating why some victims of bullying are at greater
risk for suicidal ideation. Merrill-Palmer Quarterly, 56(3), 420–440. doi:10.1353/mpq.0.0051
Bontempo, D. E., & D’Augelli, A. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay,
or bisexual youths’ health risk behavior. The Journal of Adolescent Health, 30(5), 364–374. doi:10.1016/ S1054-
139X(01)00415-3
Burk, J., Park, M., & Saewyc, E. M. (2018). A media-based school intervention to reduce sexual orientation prejudice
and its relationship to discrimination, bullying, and the mental health of lesbian, gay, and bisexual adolescents in
western Canada: A population-based evaluation. International Journal of Environmental Research and Public
Health, 15(11), 2447. doi:10.3390/ijerph15112447
Camodeca, M., Baiocco, R., & Posa, O. (2019). Homophobic bullying and victimization among adolescents: The role
of prejudice, moral disengagement, and sexual orientation. European Journal of Developmental Psychology, 16(5),
503–521. doi:10.1080/17405629.2018.1466699
Cunningham, J. N. (2007). Level of bonding to school and perception of the school environment by bullies, victims,
and bully/victims. The Journal of Early Adolescence, 27(4), 457–478. doi:10.1177/0272431607302940
D’Urso, G., & Pace, U. (2019). Homophobic bullying among adolescents: The role of insecure-dismissing attachment
and peer support. Journal of LGBT Youth, 16(2), 173–191. doi:10.1080/19361653.2018.1552225
Eisenberg, M. E., Gower, A. L., McMorris, B. J., & Bucchianeri, M. (2015). Vulnerable bullies: Perpetration of peer
harassment among youths across sexual orientation, weight, and disability status. American Journal of Public
Health, 105(9), 1784–1791. doi:10.2105/AJPH.2015.302704
Elipe, P., de la Oliva Muñoz, M., & Del Rey, R. (2018). Homophobic bullying and cyberbullying: Study of a silenced
problem. Journal of Homosexuality, 65(5), 672–686. doi:10.1080/00918369.2017.1333809
Espelage, D. L., & Holt, M. K. (2001). Bullying and victimization during early adolescence. Journal of Emotional
Abuse, 2(2-3), 123–142. doi:10.1300/J135v02n02_08
European Union Agency for Fundamental Rights. (2013). European Union lesbian, gay, bisexual, and transgender
survey: Main results. Retrieved from http://fra.europa.eu/en/publication/2013/eu-lgbt-survey-europeanunion-lesb
ian-gay-bisexual-and-transgender-survey-results.
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for
the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. doi:10.4236/
psych.2015.64033
Galanaki, E., & Vassilopoulou, H. D. (2007). Teachers’and children’s loneliness: A review of the literature and
educational implications. European Journal of Psychology of Education, 22(4), 455–475. https://www.jstor.org/
stable/23421518. doi:10.1007/BF03173466
Galliher, R. V., Rostosky, S. S., & Hughes, H. K. (2004). School belonging, self-esteem, and depressive symptoms in
adolescents: An examination of sex, sexual attraction status, and urbanicity. Journal of Youth and Adolescence,
33(3), 235–245. doi:10.1023/B:JOYO.0000025322.11510.9d
 ThE JOURNAL OF GENETIc PSychOLOGy
411
Ganson, K. T., & Nagata, J. M. (2021). Gender and sexual orientation bullying victimization are associated with gun
carrying among adolescent boys. Child and Adolescent Social Work Journal, 38, 631–640. doi:10.1007/ s10560-020-
00689-x
Garr-Schultz, A., & Gardner, W. (2019). “It’s just a phase”: Identity denial experiences, self-concept clarity, and
emotional well-being in bisexual individuals. Self and Identity. https://doi.org/10.1080/15298868.2019.1625435.
Giannou, D., & Ioakimidis, V. (2020). Neither invisible nor abnormal!’ Exploring the invisibility and pathologisation of
LGBT people in the Greek National Health System. Critical Social Policy, 40(3), 370–388.
doi:10.1177/0261018319840187
Gisladottir, B., Gronfeldt, B., Kristjansson, A. L., & Sigfusdottir, I. D. (2018). Psychological well-being of sexual
minority young adults in iceland: Assessing differences by sexual attraction and gender. Sex Roles, 78(11-12), 822–
832. doi:10.1007/s11199-017-0847-7
Goodenow, C. (1993). The psychological sense of school membership among adolescents: Scale development and
educational correlates. Psychology in the Schools, 30(1), 79–90. doi:10.1002/1520-6807(199301)30:1 < 79 ::AID-
PITS2310300113 > 3.0.CO;2-X
Gower, A. L., Forster, M., Gloppen, K., Johnson, A. Z., Eisenberg, M. E., Connett, J. E., & Borowsky, I. W. (2018).
School practices to foster LGBT-supportive climate: Associations with adolescent bullying involvement. Prevention
Science, 19(6), 813–821. doi:10.1007/s11121-017-0847-4
Graber, J. A., & Archibald, A. B. (2001). Psychosocial change at puberty and beyond: Understanding adolescent
sexuality and sexual orientation. In A. R. D’Augelli & C. J. Patterson (Eds.), Lesbian, gay and bisexual identities
and youth: Psychological perspectives (pp. 3–26). New York: Oxford University Press.
Halkitis, P. N., Valera, P., & Kantzanou, M. (2018). Deterioration in social and economic conditions in Greece impact
the health of LGBT populations: A call to action in the era of Troika. Psychology of Sexual Orientation and Gender
Diversity, 5(4), 503–507. doi:10.1037/sgd0000317
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based
approach (2nd ed.). New York: Guilford Press.
Hong, J. S., & Espelage, D. L. (2012). A review of research on bullying and peer victimization in school: An ecological
system analysis. Aggression and Violent Behavior, 17(4), 311–322. doi:10.1016/j.avb.2012.03.003
Howitt, D., & Cramer, D. C. (2010). Introduction to SPSS in psychology. London, UK: Pearson Education Limited.
Johns, M. M., Poteat, V. P., Horn, S. S., & Kosciw, J. (2019). Strengthening our schools to promote resilience and health
among LGBTQ Youth: Emerging Evidence and research priorities from the state of LGBTQ youth health and
wellbeing symposium. LGBT Health, 6(4), 146–155. doi:10.1089/lgbt.2018.0109
Kahle, L. (2020). Are sexual minorities more at risk? Bullying victimization among lesbian, gay, bisexual, and
questioning youth. Journal of Interpersonal Violence, 35(21-22), 4960–4978. doi:10.1177/0886260517718830
Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and
Social Behavior, 43(2), 207–222. doi:10.2307/3090197
Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of
health. Journal of Consulting and Clinical Psychology, 73(3), 539–548. doi:10.1037/0022-006X.73.3.539
King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of
mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70.
doi:10.1186/1471-244X-8-70
Kosciw, J. G., Greytak, E. A., Zongrone, A. D., Clark, C. M., & Truong, N. L. (2018). The 2017 national school climate
survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. Gay, Lesbian
and Straight Education Network (GLSEN).
Kurki-Kangas, L., Marttunen, M., Fröjd, S., & Kaltiala-Heino, R. (2019). Sexual orientation and bullying involvement
in adolescence: The role of gender, age, and mental health. Journal of School Violence, 18(3), 319–332.
doi:10.1080/15388220.2018.1488136
Liu, R. T., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth.
American Journal of Preventive Medicine, 42(3), 221–228. doi:10.1016/j.amepre.2011.10.023
Lucassen, M., Stasiak, K., Samra, R., Frampton, C., & Merry, S. N. (2017). Sexual minority youth and depressive
symptoms or depressive disorder: A systematic review and meta-analysis of population-based studies. The
Australian and New Zealand Journal of Psychiatry, 51(8), 774–787. doi:10.1177/0004867417713664
Lucassen, M., Clark, T., Moselen, E., & Robinson, E. (2014). Youth’12 the health and wellbeing of secondary school
students in New Zealand: Results for young people attracted to the same sex or both sexes. The University of
Auckland. https://www.fmhs.auckland.ac.nz/assets/fmhs/facult.
Marshal, M., Dietz, L., Friedman, M., Stall, R., Smith, H., McGinley, J., & Brent, D. ( 2011). Suicidality and depression
disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health,
49(2), 115–123. doi:10.1016/j.jadohealth.2011.02.005
McClintock, M. K., & Herdt, G. (1996). Rethinking puberty: The development of sexual attraction. Current Directions
in Psychological Science, 5(6), 178–183. doi:10.1111/1467-8721.ep11512422
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. doi:10.1037/0033-2909.129.5.674
412 E. ANDREOU ET AL.
Mongelli, F., Perrone, D., Balducci, J., Sacchetti, A., Ferrari, S., Mattei, G., & Galeazzi, G. ( 2019). Minority stress and
mental health among LGBT populations: An update on the evidence. Minerva Psichiatrica, 60(1), 27–50.
doi:10.23736/S0391-1772.18.01995-7
Moyano, N., & Sánchez-Fuentes, M. M. (2020). Homophobic bullying at schools: A systematic review of research,
prevalence, school-related predictors and consequences. Aggression and Violent Behavior, 53, 101441.
doi:10.1016/j.
avb.2020.101441
Muñoz-Plaza, C., Quinn, S. C., & Rounds, K. A. (2002). Lesbian, gay, bisexual and transgender students: Perceived
social support in the high school environment. The High School Journal, 85(4), 52–63. doi:10.1353/hsj.2002.0011
Nansel, T. R., Overpeck, M., Pilla, R. S., Ruan, W. J., Simons-Morton, B., & Scheidt, P. (2001). Bullying behaviors
among US youth: Prevalence and association with psychosocial adjustment. JAMA, 285(16), 2094–2100.
doi:10.1001/jama.285.16.2094
Narayanan, A., & Betts, L. R. (2014). Bullying behaviors and victimization experiences among adolescent students:
The role of resilience. The Journal of Genetic Psychology, 175(1-2), 134–146. doi:10.1080/00221325.2013.834290
Osterman, K. F. (2000). Students’ need for belonging in the school community. Review of Educational Research, 70(3),
323–367. doi:10.3102/00346543070003323
Perales, F., Campbell, A., & Johnson, S. (2020). Mental-health disparities between heterosexual and sexual minority
adolescents: Examining the role of informant discrepancies. Journal of Adolescence, 79, 122–127.
doi:10.1016/j.adolescence.2020.01.006
Plexousakis, S. S., Kourkoutas, E., Giovazolias, T., Chatira, K., & Nikolopoulos, D. (2019). School bullying and post-
traumatic stress disorder symptoms: The role of parental bonding. Frontiers in Public Health, 7, 75.
doi:10.3389/fpubh.2019.00075
Revah-Levy, A., Birmaher, B., Gasquet, I., & Falissard, B. (2007). The Adolescent Depression Rating Scale (ADRS): A
validation study. BMC Psychiatry, 7(2), 2. doi:10.1186/1471-244X-7-2
Rosenberg, M. (1965). Society and the adolescent self-image. New Jercey: Princeton University Press.
Russell, D. W. (1996). UCLA loneliness scale (Version 3): Reliability, validity, and factor structure. Journal of
Personality Assessment, 66(1), 20–40. doi:10.1207/s15327752jpa6601_2
Sigfusdottir, I. D., Kristjansson, A. L., Thorlindsson, T., & Allegrante, J. P. (2017). Stress and adolescent well-being:
The need for an interdisciplinary framework. Health Promotion International, 32(6), 1081–1090. doi:10.1093/
heapro/daw038
Sexual Minority Assessment Research Team (SMART). (2009). Best practices for asking questions about sexual
orientation on surveys. Los Angeles, California: The Williams Institute.
Sterzing, P. R., Auslander, W. F., & Goldbach, J. T. (2014). An exploratory study of bullying involvement for sexual
minority youth: Bully-only, victim-only, and bully-victim roles. Journal of the Society for Social Work and Research,
5(3), 321–337. doi:10.1086/677903
Talley, A. E., Hughes, T. L., Aranda, F., Birkett, M., & Marshal, M. P. (2014). Exploring alcohol-use behaviors among
heterosexual and sexual minority adolescents: Intersections with sex, age, and race/ethnicity. American Journal of
Public Health, 104(2), 295–303. doi:10.2105/AJPH.2013.301627
Tudor, K. (1996). Mental health promotion: Paradigms and practice. London: Routledge.
Vleioras, G., Andreou, E., & Papadopoulos, O. (2022). Differences in mental health and bullying victimization
experiences between youth of different sexualities: A Bayesian perspective. Journal of Aggression, Maltreatment &
Trauma, 31(2), 149–118. doi:10.1080/10926771.2021.1970670
Wagaman, M. A., Watts, K. J., Lamneck, V., D’Souza, S. A., McInroy, L. B., Eaton, A. D., & Craig, S. (2020).
Managing stressors online and offline: LGBTQ + Youth in the Southern United States. Children and Youth Services
Review, 110, 104799–104710. doi:10.1016/j.childyouth.2020.104799
Westefeld, J., Maples, M., Buford, B., & Taylor, S. (2001). Gay, lesbian, and bisexual college students. Journal of
College Student Psychotherapy, 15(3), 71–82. doi:10.1300/J035v15n03_06
WHO (1998). Wellbeing measures in primary health care/the DEPCARE Project. WHO Regional Office for Europe.
Wilson, C., & Cariola, L. A. (2020). LGBTQI + youth and mental health: A systematic review of qualitative research.
Adolescent Research Review, 5(2), 187–211. doi:10.1007/s40894-019-00118-w
Yang, M., Wu, F., Liu, Q., Yang, Z., Lai, X., & Liu, X. (2020). School bullying victimization and emotional problems
in relation to sexual orientation among high school students in china a cross-sectional study. Research Square.
doi:10.21203/rs.3.rs-60041/v1
Copyright of Journal of Genetic Psychology is the property of Taylor & Francis Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.