Qualitative Research

American Journal of Health Promotion

2020, Vol. 34(3) 285-293
“I Don’t Feel Like the Odd One”: Utilizing ª The Author(s) 2019
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Content Analysis to Compare the Effects sagepub.com/journals-permissions

DOI: 10.1177/0890117119885517
journals.sagepub.com/home/ahp
of Social Media Use on Well-Being Among
Sexual Minority and Nonminority
US Young Adults

César Escobar-Viera, MD, PhD1 , Ariel Shensa, MA1, Megan Hamm, PhD1,
Eleanna M. Melcher, BPhil1, Daniel I. Rzewnicki, MPH1, James E. Egan, PhD, MPH1,
Jaime E. Sidani, PhD1, and Brian A. Primack, MD, PhD2

Abstract
Purpose: Although there is evidence of associations between social media (SM) use and mental well-being among the general
population, these associations among lesbian, gay, and bisexual (LGB) persons are poorly understood. This study compared the
influence of SM experiences on mental well-being between LGB and non-LGB persons.
Design and Setting: Online cross-sectional survey.
Participants: National sample of 2408 US adults aged 18 to 30 years.
Method: We asked participants to provide examples of when SM affected their well-being separately in good and bad ways. We
coded, summed, and used rate ratios (RRs) to compare responses of LGB and non-LGB individuals. Thematically similar codes
were described and grouped into categories.
Results: Most responses described positive SM effects. However, of 6 codes that were significantly more frequent among LGB
respondents, only social capital (RR ¼ 1.58, 95% confidence interval [CI], 1.17-2.12) described a positive effect. Five codes
described negative effects of SM for LGB users: negative emotional contagion (RR ¼ 1.28, 95% CI, 1.04-1.58), comparison with
others (RR ¼ 1.28, 95% CI, 1.01-1.62), real-life repercussions (RR ¼ 1.86, 95% CI, 1.18-2.94), envy (RR ¼ 2.49, 95% CI, 1.48-4.19),
and need for profile management (RR ¼ 2.32, 95% CI, 1.07-5.03).
Conclusion: These findings suggest that, for LGB persons, gaining social capital from SM is valuable for establishing and main-
taining connections. Increased negative SM experiences may pose a risk for the mental well-being of LGB individuals.

Keywords
LGBT, young adults, social media, content analysis, mental health

Purpose
Social media (SM) comprises a diverse set of online platforms
for virtual communication. Social media use is ubiquitous;
about 90% of US persons aged 18 to 29 years have at least 1
account.1 Social media has changed the nature of social rela-
tionships among youth, leading researchers to investigate the
mental health impacts of SM on young adults.
For lesbian, gay, and bisexual (LGB) persons, SM is now a
primary mode of socializing,2-4 perhaps to compensate for per-
ceived limited availability of off-line connections, social cap-
ital, resources, and support.5 This is especially true for LGB
young adults who live in geographically isolated areas or have
unsupportive families or environments.6,7
Although the volume of SM use (ie, total time of usage and
frequency of checks) does not seem to vary significantly
between LGB and non-LGB youth,4,6 previous quantitative
research suggests that motivation, characteristics, quality,
stressors, and outcomes associated with SM use may differ
1
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
2
College of Education and health Professions, University of Arkansas
Fayetteville, Fayetteville, AR, USA
Corresponding Author:
César Escobar-Viera, University of Pittsburgh, 230 McKee Place, Pittsburgh,
PA 15213, USA.
Email: escobar-viera@pitt.edu
286 American Journal of Health Promotion 34(3)

across groups of young SM users. For example, gay, bisexual, impacts health outcomes among young adults. In 2018, we
and other men who have sex with men report using SM to make commissioned Qualtrics Sampling Services to recruit an online
new friends, reconnect with friends, and connect with the gay sample of 2408 US adults aged 18 to 30 years, reflective of the
community.8 Compared with non-LGB peers, LGB college 2010 US Census in terms of key sociodemographic factors. For
students use SM for social communication, identity explora- recruitment, a combination of demographic screening ques-
tion, identity expression, and finding romantic partners. Per- tions and recruitment quotas that best reflect the population
ceived social support on SM was associated with a decrease in makeup of the United States was used (eg, age, race, ethnicity).
loneliness among LGB youth.9 However, LGB individuals are Participants received financial incentives, depending on the
more likely to report being victimized and cyberbullied on SM agreement between each participant and Qualtrics.
than their non-LGB peers.10
Previous qualitative studies have explored the nature and
quality of SM experience for LGB individuals. For example,
SM may provide lesbian mothers and young men who have sex
Method
with men a space to disclose experiences, build a supportive Data Collection
community, and combat isolation, as well as afford a sense of
We used Qualtrics software20 to create an online survey com-
anonymity, removing some of the dangers of stigma and rejec-
patible with smartphones, laptops, and desktop computers. The
tion.11,12 Moreover, for young gay and bisexual men in small
survey was available for 30 days and it contained questions
cities, SM provides a venue to connect with others, a way to
related to demographics, SM usage, contextual variables, and
feel “like they belong.”13
mental health. Surveys contained an open-ended question that
On the other hand, previous research has pointed out the
asked, “In 4 or 5 sentences, please tell us your stories about the
potential role of SM as an amplifier of inequalities for sharing
ways in which SM has had a (1) positive and (2) negative effect
and understanding public health information.14 Specifically,
on your life.” This question was presented near the end of the
LGB youth have expressed the need to balance the positive
survey, and respondents were able to freely type responses.
and negative aspects of SM use. For example, some LGB youth
Responses provided the qualitative data for this analysis.
have conveyed concerns about the uncertainty and lack of
Recruitment and survey procedures were approved by the
accountability of SM-only connections.5,12 Also, although some
[redacted] institutional review board.
LGB youth living in large urban areas identify affirming
We assessed sexual orientation with the question ”Do you
responses from SM contacts, negative experiences like homo-
consider yourself to be” and 6 options: (1) exclusively hetero-
phobic/transphobic comments seem to be pervasive.15 However,
sexual or straight, (2) mostly heterosexual or straight, (3) bisex-
none of these studies compared the SM experience of LGB
ual, (4) mostly gay or lesbian, (5) exclusively gay or lesbian, or
youth with that of their heterosexual counterparts. In order to
(6) queer. We considered “mostly heterosexual” as a separate
understand potential risk and protective factors for the mental
sexual orientation category from heterosexual because previ-
health of young LGB individuals, it is important to compare the
ous research showed this group to be at risk for mental health
quality of SM experiences between LGB and non-LGB youth.
concerns.21-24 Therefore, for analysis purposes, participants
Minority stress theory posits that sexual minority individu-
who identified as “exclusively heterosexual or straight” were
als are exposed to unique stressors, including discrimination
categorized as “non-LGB” and the other 5 categories were
and social rejection. This exposure may be associated with
combined into the “LGB” group. Given that the larger study
internalized homonegativity and identity concealment, but
was focused in recruiting a sample that would resemble the US
social support from within LGB communities can help buffer
population as closely as possible, the mostly gay or lesbian,
the impact of these factors on mental health outcomes.16 These
exclusively gay or lesbian, and queer categories were too small
stressors may explain some disparities in depression and other
(n ¼ 38, n ¼ 89, and n ¼ 15, respectively) to analyze
negative mental health outcomes among LGB individuals.17-19
separately.
However, there is a paucity of evidence on how group-specific
risk and protective factors behave on SM, how they interact
with each other, and the resulting effects on mental health. To
investigate these potential effects of SM on mental health, first
Analysis Strategies
we sought to answer how SM experience differs between LGB A rigorous hybrid approach to code development may start
and non-LGB youth. To do this, we used qualitative data from a with an initial set of codes based on previously existing knowl-
national sample of US young adults to compare self-reported edge about the phenomena and then seek feedback from the
positive and negative SM experiences between LGB and non- data to supplement with newly developed codes that are related
LGB participants. to the experience under study (ie, directed content analysis
approach).25 For this study, the central unit of analysis was the
survey participant. Because each respondent was able to pro-
Design, Setting, and Participants vide only 1 response (regardless of whether the response cov-
This content analysis was part of an online national study that ered only positive SM experiences or only negative or both),
used quantitative and qualitative data to examine how SM use the number of participants and responses are the same.
Escobar-Viera et al.
Our codebook development used a hybrid approach of
inductive and deductive coding to provide meaning to concepts
not yet clearly articulated in existing theoretical frameworks.26
First, 3 noncoding authors developed a tentative list of codes
based on previous qualitative research on positive and negative
SM experiences and our own research questions. Two coders
independently coded a 20-response subsample, followed by
discussions between noncoding authors and each coder to con-
dense similar codes. To increase the credibility of our process,
we integrated feedback from 2 qualitative research experts. We
completed our codebook with 23 unique codes: 13 derived
using a deductive approach from our previous work and
hypotheses, 10 derived based on the data used for this analysis.
Next, we conducted 2 rounds of coding tests. For each itera-
tion, coders independently coded 20 response subsamples.
After each iteration, we assessed inter-rater reliability, which
was excellent (k ¼ .90).27 Subsequently, coders coded the
remaining 2348 responses, selecting multiple codes if a
response met the criteria for more than 1 code. After each
iteration, conflicts and discrepancies were resolved one on one
with the first author and each coder.
For this content analysis, we focused on quantitative descrip-
tions of the data and qualitative examples that represent these
codes. We summed the counts for each code from the responses
of both non-LGB and LGB participants. Then, we computed rate
ratios (RRs) and 95% confidence intervals (CIs) to determine
whether there were significance differences in the occurrence of
each code between LGB and non-LGB respondents. Using RR
accounted for the difference in number of individuals in the LGB
and non-LGB groups (n ¼ 417 and n ¼ 1598, respectively).
Statistical significance was set at P < .05. These analyses were
conducted using Stata 15.28 Finally, we grouped codes into
larger code categories for interpretation. Coding and qualitative
analyses were conducted using Nvivo 12.29
Results
Sample
After removing nonrespondents from the qualitative item, our
final sample comments on either or both the positives and
negatives of SM consisted of 2015 responses, 20.7% from LGB
participants. This is similar to rates found in previous research
in which the “mostly heterosexual” category was grouped with
other LGB minorities.21,24 Table 1 describes respondents’
demographic characteristics; there were group differences in
terms of sex, education, employment, income, and relationship
status.
Code Frequencies and RRs
Table 2 displays code definitions, frequencies, and RR. Of 23
final codes, we categorized 10 as positive effects of SM: social
connectedness, long-distance connections, positive emotional
contagion, social capital, positive personal interactions, infor-
mational support, SM emotional support, membership, identity
287
formation, and positive body image. Conversely, 11 codes were
considered negative: negative emotional contagion, negative
personal interactions, comparison with others, bullying, nega-
tive body image, unmet expectations, real-life repercussions,
jealousy/envy, fear of missing out, social isolation, and profile
management. Two codes—no negative characteristics and no
positive characteristics—described neither positive nor nega-
tive attributes; thus, we categorized them as “informational
purpose” codes.
Overall code count was 4732, of which 49.2% were related to
positive SM effects, 38.3% to negative SM effects, and 12.5% to
informational purpose. Most codes identified in responses
described positive SM effects from both non-LGB and LGB
participants (49.5% and 48.4%, respectively). However, a size-
able minority of codes described a negative SM effect among
responses of both groups (non-LGB 36.7% and LGB 43.6%).
Specifically, we identified 4 larger code categories that encom-
passed similar characteristics of the SM experience, detailed
below. For conciseness, we provide quote examples only for
codes for which frequency was significantly different between
responses of LGB and non-LGB respondents. Examples for
remaining codes are available upon request.
A place to form and maintain connection with others. Three codes
about positive SM effects related to the ability of users to
establish new connections (social capital) and maintain old
ones, whether with people living physically close (social con-
nectedness) or afar (long-distance connections). Within this
category, only the code “social capital” was more frequent
among LGB participants compared to non-LGB counterparts
(n ¼ 65, RR ¼ 1.58, 95% CI, 1.17-2.12).
On the one hand, both LGB and non-LGB participants saw
the value of SM in helping form new connections: “ . . . I am
also able to meet and communicate with people I would’ve
never met without social media. Social media has changed
my life. It has helped me in a lot of ways . . . ” (male, LGB,
22). SM “helped me to connect with people around me that I
otherwise wouldn’t have known” (female, non-LGB, 20).
On the other hand, LGB participants also highlighted the
possibility of increasing their social capital as an intermediate
step in building more meaningful relationships and increasing
their sense of belonging in the LGB community:
SM allowed for me to have a supportive community when I needed
it most. The people I know online, they have provided me with
more support than my own family. The community I’ve found
through social media serves as a welcome escape from my personal
struggles in real life. (female, LGB, 23)
SM helped me meet new people. I’ve met people I’d never have
known about before. I don’t feel like the odd one out when I talk
about my strange interests. (male, LGB, 28).
Conductor of potential protective factors for mental health. Seven of
the positive codes about SM (membership, emotional support,
informational support, positive personal interactions, positive
emotional contagion, identity formation, and positive body
288 American Journal of Health Promotion 34(3)

Table 1. Participant Characteristics and Bivariate Associations With Sexual Orientation (N ¼ 2015)a.

Sexual Orientation

Sociodemographic Characteristic Whole Sample Non-LGB (79.3%) LGB (20.7%) P Valueb

Age group .99

18-24 18.5 79.3 20.6
25-30 81.5 79.3 20.7
Sex <.001
Male 52.7 49.8 37.9
Female 47.3 50.2 62.1
Race .11
White, non-Hispanic 68.5 68.8 67.6
Black, non-Hispanic 7.5 7.7 6.9
Hispanic 14.2 13.2 17.8
Asian 8.6 9.1 6.7
Otherd 1.2 1.2 1.2
Education .01
High school or less 13.3 12.5 16.5
Some college or technical school 30.8 30.1 33.4
College graduate 33.9 34.3 32.5
Graduate school 21.9 23.1 17.6
Employment status .004
Employed 75.6 76.7 71.9
Homemaker 6.1 5.6 7.7
Student 12.4 12.6 11.3
Unemployed 5.9 5.1 9.1
Annual household income <.001
<$25 000 15.5 14.6 19.0
$25 000-<$50 000 27.3 25.9 33.0
$50 000-<$75 000 23.0 23.1 22.7
$75 000 or above 34.2 36.4 25.3
Relationship status <.001
Single 42.1 41.8 43.2
Member of unmarried couple 26.4 24.6 33.1
Married 31.5 33.6 23.7
Living situation .21
By myself 17.6 17.8 17.0
Parent or guardian 20.4 19.5 24.0
Significant other 46.7 47.5 43.7
Othere 15.3 15.2 15.3
a
Includes individuals who responded to open-ended questions.
b
P value derived from w2 tests for categorical variables.
c
Column and row totals may not equal 100 due to rounding.
d
Includes individuals who self-identified as American Indian/Native Alaskan, Native Hawaiian/Pacific Islander, or Other, non-Hispanic.
e
Included friends and acquaintances.

image) described experiences in which respondents perceived
support, felt a sense of belonging to a community, or had plea-
surable interactions over SM. The most frequently occurring
code in this category was positive emotional contagion. We
found no significant difference in code counts between
responses of non-LGB and LGB participants.
On SM, several LGB identity-related stress processes may occur.
Five codes described negative SM experiences that might be
perceived by the individual as related to their sexual minority
identity (eg, LGB). Of these, negative emotional contagion
(n ¼ 125, RR ¼ 1.28, 95% CI, 1.04-1.58), real-life
repercussions (n ¼ 29, RR ¼ 1.86, 95% CI, 1.18-2.94), and
profile management (n ¼ 11, RR ¼ 2.32, 95% CI, 1.07-5.03)
were significantly more frequent among LGB individuals. Two
codes—bullying and negative personal interactions—were not sig-
nificantly different between groups.
Negative Emotional Contagion
Both non-LGB and LGB respondents expressed their concerns
about the pervasive and sometimes contagious negativity on SM.
For example: “When I read things happening to children. Some
sort of abuse. Also, shootings and killings. Makes me very sad”
(female, non-LGB, 29). “There is just so much negativity going
Escobar-Viera et al. 289

Table 2. Code Counts and Rate Ratios Comparing the Responses of Non-LGB and LGB Participants’ Responses to Open-Ended Question
About Social Media Experiences (N ¼ 2015).

Non-LGB, LGB, Rate Ratio

Code Definition n ¼ 1598 n ¼ 417 (95% CI)a

Positive social media effects

Social connectedness Social media (SM) helps people to stay in touch and/or interact with loved 597 153 0.98 (0.81-1.17)
ones and community.
Long-distance SM helps to keep in touch with connections that otherwise would be lost. 336 98 1.10 (0.88-1.39)
connections
Positive emotional SM content that negatively influences a user’s emotional status. 345 74 0.80 (0.62-1.04)
contagion
Social capital SM helped the participant to create new connections and meeting new 154 65 1.58 (1.17-2.12)b
people.
Informational support Participant mentions SM as source of people or resources for obtaining 120 43 1.41 (0.99-2.01)
useful information.
Positive personal SM exchanges that users find uplifting and stimulating. 106 26 0.95 (0.61-1.47)
interactions
Emotional support Participant mentions SM as a source of people to talk to about one’s 88 33 1.27 (0.83-1.93)
problems and feel appreciated.
Membership SM provides a way for individuals to join groups and feel like they belong. 56 18 1.18 (0.69-2.03)
Identity formation SM allows users to explore their identity and other individual 4 5 4.04 (0.98-16.65)
characteristics.
Positive body image SM user’s feelings of being satisfied with their body, weight, or appearance. 8 1 0.36 (0.04-3.05)
Negative social media effects
Negative emotional SM content that negatively influences a user’s emotional status. 374 125 1.28 (1.04-1.58)b
contagion
Negative personal SM exchanges that make people stressed, sad, depressed, upset, or angry. 310 81 1.01 (0.79-1.29)
interactions
Comparison with SM content (eg, accomplishments) causes one to compare one’s life or body 276 98 1.28 (1.01-1.62)b
others to that of others.
Bullying Situations or interactions in which participant was called out, harassed, or 82 31 1.36 (0.89-2.09)
insulted on SM.
Negative body image SM user’s feelings of being dissatisfied with their body, weight, or 79 21 0.85 (0.52-1.38)
appearance.
Social isolation SM may make users feel like they have poor to no contact with society. 66 23 1.33 (0.82-2.16)
Real-life For participants who felt SM usage is related to real-life adverse events in 58 29 1.86 (1.18-2.94)b
repercussions their lives.
Envy SM may be a vehicle for jealousy or envy between couples and friends. 37 26 2.49 (1.48-4.19)b
Unmet expectations On SM, some persons may find unfulfilled their expectations of finding 26 11 1.45 (0.70-3.00)
support, fun, friends, and so on.
Fear of missing out On SM, users may experience a constant fear of missing out on the fun they 21 9 1.93 (0.87-4.32)
could be having.
Profile management SM allows people the ability to edit and manage how they present 17 11 2.32 (1.07-5.03)b
themselves.
Informational purpose codes
No negative Any response expressing no negative SM experiences. 330 49 0.56 (0.41-0.76)b
characteristics
No positive Any response expressing no positive SM experiences. 176 36 0.79 (0.55-1.49)
characteristics
Abbreviations: CI, confidence interval; LGB, lesbian, gay, and bisexual.
a
Comparing nonheterosexual versus heterosexual participant.
b
P < .05.

on all the time. A lot of it is important but horrible, but a lot of it
is generally horrible. It’s a real drain” (female, LGB, 28).
However, LGB participants also mentioned the negativity of
certain content affected them because it seemed to specifically tar-
get sexual minorities, generating or increasing negativity and anger:
Seeing some extreme views has made me less optimistic about the
future. Hearing people say that I should be attacked, not have work,
etc. has made me less likely to want to share my opinions. Social
media’s polarizing influence has made me afraid to talk to friends
about some things. (male, LGB, 26)
290
Reading people’s negative/hateful/ignorant/incorrect comments on
social media really makes me angry/upset. I get really fired up and
want to fight back with them (which in the past I have). (female,
LGB, 24)
Real-Life Repercussions
While both non-LGB and LGB respondents described reper-
cussions in everyday life from SM experiences, non-LGB par-
ticipants described SM’s complication of romantic
relationships and friendships: “It’s terrible. I am constantly
checking in . . . I’ve found out a lot through social media from
past guys I’ve dated and now I check constantly regarding
current relationships and it ruins the relationship because of
lack of trust [ . . . ]” (female, non-LGB, 27).
Social media is addicting. I have friends that sit around during their
free time and look at it nonstop. It has definitely affected my
friendships in a negative way. My friends will often pay more
attention to their phones than to me. (female, non-LGB, 24)
LGB participants described consequences related to being
accidentally outed on SM and dealing with family rejection
and/or workplace discrimination: “I became outed by changing
my status on Myspace [ . . . ]. It caused issues with my mother
and sister [ . . . ]. That caused me to delay actually coming out
(in person) to my whole family until I was about 24” (male,
LGB, 26). “Social media caused the majority of my family to
go after me for my political views and homosexuality. [ . . . ] I
never post anything on my own because I’m afraid of people’s
reactions” (female, LGB, 21).
I get judged for certain things I say and people can make rude nasty
responses. I had to use a picture of my cat [for my profile picture]
because a potential employer viewed my Facebook page and didn’t
give me an interview based off my Facebook page. (female, LGB, 28)
Profile Management
Most of the profile management-coded responses commented
on the pressure and negative effect of editing profile photos:
“Too many people Photoshop their photos and pose to make
themselves look more attractive. Those standards tend to have a
negative effect on a lot of individuals” (female, non-LGB, 20).
However, for some LGB participants, this pressure was on
the content, words, and ideas they share on SM, to the point of
sometimes feeling socially isolated:
I would say before social media and having exposure to lots of
followers for my costuming, I didn’t care that much about how I
looked. But I have to be very attentive now about what I write
that’s publicly visible, and what I have to filter for only friends/
family, which makes me feel like a self-imposed isolation or
silence about my views, in order not to stir the water with my
followers/supporters/fans. (female, LGB, 29)
American Journal of Health Promotion 34(3)
Worsening feelings of disconnect. The final category included 6
codes encompassing negative SM experiences that may generate
or maintain a feeling of disconnect from others. Unlike the codes
from the previous category, respondents did not report a perception
of the experience being related to their sexual identity; whereas 4 of
these codes (fear of missing out, negative body image, unmet
expectations, and social isolation) showed no frequency difference
between groups, “comparison with others” (n ¼ 98, RR ¼ 1.28,
95% CI, 1.01-1.62) and “envy” (n ¼ 26, RR ¼ 2.49, 95% CI, 1.48-
4.19) were more frequent among LGB participants.
Despite the difference in frequency, responses of both non-
LGB and LGB participants were similar for both these codes.
Regarding “comparison with others,” participants expressed how
SM makes them feel like their lives are worse or less successful
than others’: “I have high school friends that I am not friends with
anymore. I compare myself to them. Like they have more friends
than me or they are having a better time than I am” (female, non-
LGB, 20). “Seeing others post about their family, friends, and
success makes me feel inferior” (male, LGB, 26).
In terms of the “envy” code, participants also expressed how
seeing other people’s lives portrayed on SM makes them feel jea-
lous, sometimes generating negative feelings toward those people
or themselves: “I tend to feel jealous of a lot of people I see on
social media. It makes me dislike people” (male, LGB, 30). “I have
always had trouble with the way I see myself weight-wise. When I
go on social media and see pictures of girls who are skinnier and in
better shape, it makes me jealous” (female, non-LGB, 19).
Finally, among the 2 informational codes, responses of LGB
participants expressed the absence of negative SM experiences
much less frequently than non-LGB respondents (n ¼ 49, RR ¼
0.56, 95% CI, 0.41-0.76).
Conclusion
Content analysis of open-ended responses in a national online
survey found that although the majority of codes from both
non-LGB and LGB young adults were positive regarding the
effect of SM on participants’ lives, a sizable minority high-
lighted negative effects. Six codes were significantly more
frequent among LGB respondents: 1 reflected positive effects
(social capital) and 5 described negative effects of SM (nega-
tive emotional contagion, comparison with others, real-life
repercussions, envy, and need for profile management). One
informational code was less frequent among LGB respondents
(no negative characteristics).
Our work has identified areas that are important to study
when trying to understand the impact of SM on the well-being
of LGB persons. Future research could seek to expand minority
stress theory with constructs that capture the SM experience of
LGB individuals. Most codes were positive toward SM expe-
rience across both non-LGB and LGB participants. Both
groups thought SM was good at helping them to feel appre-
ciated, supported, and like they belong. Social media was also
described as positive for individual identity development.
These findings support and extend those of previous qualitative
research regarding the positive impact of SM on the lives of
Escobar-Viera et al.
LGB persons.11-13 Specific to our study, LGB participants
highlighted using SM to increase their social capital, establish
new connections, and develop these into significant friend-
ships/romantic relationships. Although there is evidence to
support the value of SM-gained social capital in improving
psychological well-being,30,31 studies of LGB youth are lim-
ited. It is possible that increasing one’s social capital may be
harder in real life for LGB persons than for others, especially in
conservative areas.7 Our qualitative findings partially support
this argument: LGB respondents from our sample thought of
increasing one’s social capital via SM as a way to develop
fulfilling relationships. Future research should consider the
effect of social capital on the well-being of LGB youth in a
more nuanced way. For example, examining how familial net-
works and nonfamilial identity-based SM networks reinforce or
buffer environmental stressors. Previous research suggested
social capital derived on SM from intimate SM contacts might
be responsible for this potential positive effect.31 Conversely,
social capital derived on SM from acquaintances may be more
like distant friends, but it might provide additional information
on shared challenges, which may be enriching for young LGB
individuals who are seeking reaffirming connections. These are
questions to address with extensive qualitative studies with
diverse LGB participants.
Nearly 40% of our code frequency count covered negative
SM experiences. Importantly, in responses of LGB partici-
pants, our content analysis found 5 of these codes more fre-
quently, including “negative emotional contagion.” Previous
research found emotional contagion can occur on SM and that
amount of positive SM posts seen might have a protective
effect on mental health among the general population.32 Unfor-
tunately, our findings suggest that LGB youth might see or
interact with more negative SM content in the form of news,
comments, and status updates that target sexual orientation.
This could negatively affect LGB youths’ mood, well-being,
and perception of the world. Our findings expand the literature
about the potential negative aspects of SM among LGB indi-
viduals, adding everyday life consequences of SM interac-
tions.15 Indeed, LGB participants reported more “real-life
repercussions” from their engagement with SM, including con-
flicts with family, friends, and co-workers, after being acciden-
tally outed on SM. Potentially related, the “profile
management” code was also more frequent in responses of
LGB participants. The LGB persons might feel compelled to
exert tighter control of profile settings on their SM platforms,
attempting to compartmentalize their contacts, and perhaps
part of their lives, to avoid an information overspill that could
lead to real-life consequences, such as the ones our participants
reported. These findings complement and extend those of pre-
vious research conducted among lesbian and bisexual
women.11,33 Future research should look into negative emo-
tional contagion spread through SM, real-life repercussions
of SM interactions, and profile management on SM as potential
sources of targeted stress for LGB youth.
Our work also adds to the literature on the impact of SM on
the well-being of LGB individuals. We found that LGB youth’s
291
responses contained “comparison with others” and “envy”
more frequently than non-LGB persons. Both constructs have
been associated with negative mental health, either by generat-
ing or increasing an already existing feeling of disconnection
with others. In our data, “comparison with others” invariably
described the comparing of oneself with someone whom one
thinks is better off (ie, upward comparison). This form of social
comparison has been consistently described as a risk factor for
negative mental health outcomes.34-37 In addition, “envy” was
also coded more frequently in the responses of our LGB parti-
cipants. Previous research found that jealousy and envy on SM
may behave as potential mediators in the relationship between
SM use and negative mental health outcomes.38,39 Future quan-
titative research that looks at understanding SM use among
LGB youth should consider these as potential factors that may
influence mental health outcomes.
Interestingly, the “no negative characteristics” was the only
code found significantly less frequently in the responses of
LGB participants. Essentially, this means that compared to
non-LGB respondents, LGB respondents expressed much less
frequently that they did not have a negative SM experience.
This is not surprising, given that several codes that describe a
negative SM experience were more frequent in responses of
LGB individuals. Previous research has reported no significant
difference in amounts of SM use between non-LGB and LGB
populations.4,6 In light of our findings, future qualitative
inquiry should explore the complexities of why the majority
of LGB individuals, given the otherwise significant number of
negative SM experiences in their lives, keep using SM as a
medium to connect with others and seek support.
Limitations
Our work has some limitations. First, among demographic
characteristics, ages 25 to 30 years were overrepresented. This
is important because younger individuals are recognized as
heavy SM consumers. Second, our data did not contain geo-
graphic location of respondents, which could have been poten-
tially useful to understand some SM experiences in the context
of more conservative versus more liberal environments. Future
qualitative research should focus on a more diverse sample of
sexual minority groups. Third, instead of suitable measures,
such as Krippendorff a,40we chose Cohen k for determining
inter-rater reliability. We did this given k common usage in the
health research field and because the excellent agreement
between our coders was well above any threshold for potential
concern regarding reliability.41 Fourth, because of subsample
sizes, we were limited in our ability to compare codes and RRs
between the 3 main sexual minority groups. Fifth, because of
the way we coded the “no negative characteristics” code, we
were unable to determine whether participants were providing
a thoughtful answer to the question. Finally, in this research, we
used minority stress theory16 to contextualize our findings. At
this time, we did not seek to, nor ask the appropriate questions
that could inform further theory development. Nonetheless, our
findings unveiled aspects of the SM experience that are
292
SO WHAT?
Research conducted in the past 10 to 12 years suggests
that social media (SM) may play a role in mental well-
being, but group-specific factors have been understudied.
For lesbian, gay, and bisexual (LGB) minorities, we know
very little in terms of whether and how SM use is related
to mental health outcomes. This is important, given well-
known mental health disparities for this population.
Although more study is needed, our finding suggests that,
among LGB persons, SM experiences may have an effect
on individuals’ well-being. Clinicians and mental health
practitioners may want to consider incorporating con-
versations about behaviors and experiences on SM with
their LGB patients. Topics such as whether they feel an
impact of SM on their daily lives might provide valuable
insight on their social behaviors and availability of
resources and support.
Our findings show that, for LGB individuals, gaining
social capital online has potential ramifications for their
ability of establishing and maintaining meaningful connec-
tions. These findings call for further research on the
value of social capital gained through online platforms for
one’s mental well-being, especially among minority popu-
lations with less ability to make these gains in the off-line
world.
However, for the negative SM experiences, LGB indi-
viduals describe more real-life repercussions and these
repercussions seem to impact their family dynamics and/
or relationships in the workplace. These experiences
may pose a distinct risk for the mental health and well-
being of minority individuals and require more research
efforts to thoroughly characterize and subsequently
measure them, accounting for the increasing diversity
of the US population.
potentially unique to LGB persons. In-depth qualitative inquiry
will aid in understanding the meaning and effects of SM experi-
ences on the well-being of this population.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This study
was funded by the National Institute of Health Disparities and Minor-
ity Health (K99-MD012813) and the Fine Foundation (Grant number
171R32SM-2018).
ORCID iD
César Escobar-Viera https://orcid.org/0000-0002-1031-499X
American Journal of Health Promotion 34(3)
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