PONE-D-25-05634The Relationship between family environments growing up and behavioral health among LGBTQ+ adults: The mediating role of internalized homonegativityPLOS ONE

Dear Dr. Chiang,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.<article class="text-token-text-primary w-full" data-scroll-anchor="false" data-testid="conversation-turn-2" dir="auto">

The reviewers agree that the paper makes a valuable contribution. To strengthen the manuscript further, it would be appropriate to further incorporate relevant minority stress and microaggression literature and addressing analytical gaps, particularly concerning gender identity, sexual orientation subgroups, and the role of age in the context of your study. Furthermore, please review comments form Reviewer 1 around clarifying methodological aspects, particularly around scale scoring and variable definitions. It is also important to consider expanding the introduction and discussion to include global disparities, school-based supports, and the context of COVID-19.

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Additional Editor Comments:

An important aspect that I found that was not addressed is the potential intersectional influence of race, ethnicity,and immigrant background on the mediating role of internalised homonegativity and behavioural health outcomes. Your sample presents significant demographic diversity and includes these variables in regression models, but further interpretation of how these intersecting identities may compound or mitigate the impact of familial homophobia and internalised stigma could provide valuable insights. If this is beyond the scope of your research, this should be discussed clearly as to why.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:  This well-structured and insightful study explores the relationship between family environments growing up and behavioral LGBTQ+ adults with the mediation of internalized homonegativity. This research appears highly relevant and opens avenues for future investigations in other settings.

I support the publication of this manuscript with minor revisions:

1. Manuscript:

• Please ensure that page numbers and/or line numbers are correctly indicated.

2. Introduction:

• Be more precise when you used “world” in the sentence “Even though societies adopt more policies protecting LGBTQ+ rights and discussing LGBTQ+ issues openly more than before, heteronormativity and cisnormativity remain dominant in the world and affect social systems and LGBTQ+ people’s health and development (Mills-Koonce et al., 2018; Van Bergen et al., 2021). Maybe you talk about countries. It could be interesting to add that some of them criminalize LGBTQ+ people. Please detail in which ways it impact heath and development of LGBTQ+ people.

• Add reference for : “IH is also considered a consequence of heteronormative societal beliefs and affects one’s behavioral Health »

• In the Family Environments for LGBTQ+ section

o Maybe you could add a subsection title as “Social environment” for first paragraph as a broader picture or modify the section by “Social and Family Environments for LGBTQ+”

o “Despite important findings about influences of family and caregiver interactions with LGBTQ+ children’s behavioral health outcomes, existing studies largely focus on individual-level factors (e.g., caregiver factors).” Please add examples of individual level factors and references

3. Methods:

• Please define precisely which scores are calculated for each scale. For example, you add final scores ranged from 5 to 25 for Homophobic messages received from family. Add for others scales and add these informations in table 1 for each scale result to understand your results.

• Openly LGBTQ+ people in family or not :

o How do you define family to answer this question : When you were growing up, how many openly LGBTQ+ people were there in your family?”

o Response options were 0, 1 or 2, 3 or 4, or 5 or more. Given the response distribution, this variable was recoded 0 (0) and 1 (1 or more). Give example for this variable recoding. By the way, it is not defined in results section.

• Data analysis : did you think of a correction for multiple models applied to data ?

4. Results:

• Range for scales in table 1 (see method section)

• Openly LGBTQ+ people in family or not : not define (see method section)

• Pages 13-14 : please put table in one page

5. Discussion:

• You discussed results about having openly LGBTQ+ family member in page 17 but don’t mentioned it in limitations. Please discussed this definition of family and variable recoding

• Please discussed study context of covid and potential implications of this specific period in your study. For example responses of participants if they coming back to their family and locked with them in that period.

Reviewer #2:  This paper offers a useful contribution to the research literature on the antecedents of mental health issues experienced by LGBTQ+ people in familial homophobia, and in particular, how internalized homophobia mediates this relationship. There remain a few questions that should be addressed to shape up the paper into final form:

While the review of the research literature covers many relevant studies, there needs to be some reference to the “minority stress” and homophobic “micro-aggression” research literatures which consolidate many of these findings around a few central concepts.

Some analytical questions:

• While the study reports demographic rates for cis-gender/trans and sexual identities, there is curiously no mention of adult gender identity distinguishing men and women. Was gender used in the analysis? Were there any gender differences in either the familial or mental health variables? Related to this, gay and lesbian cannot simply be treated as a single unitary identity. Were there any differences between gay and lesbian categories? Also, what is the gender breakdown of bi/pansexual respondents? Given that the majority of the sample identified as bi/pansexual and had significantly higher rates of anxiety and depression, did gay, lesbian, or trans people present different profiles regarding IH or indicators of familial homophobia?

• Given that increasing age was associated with lower anxiety/depression (in accord with other studies) and age can be associated with sexual identity, particularly bisexual identity, was age controlled for in reporting rates of anxiety or depression? In other words, how much of these bisexual rates are accounted for by age?

In the Implications section, which gestures in the direction of “inclusive practices in therapy, support programs, and educational initiatives [that] would help mitigate the negative impacts of childhood environmental homophobia,” it should be noted that there is significant research on the supportive effects of Gay/Straight Alliances (or equivalent) and anti-bullying programs in schools in improving the lives of LGBTQ+ youth.

Editorial notes:

• intro: should be “Trevor Project”

• family environment section: should be “health outcomes in adulthood have been under-researched”

• p 15 should be “LGBTQ+ people in one’s family did”

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Reviewer #1: No

Reviewer #2: Yes:  Barry D Adam

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The Relationship between family environments growing up and behavioral health among LGBTQ+ adults: The mediating role of internalized homonegativity

PONE-D-25-05634R1

Dear Dr. Chiang,

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Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All feedback from the reviewers has been addressed sufficiently.

Reviewers' comments: