XV Issue I
The Online Publication of Undergraduate Studies was initiated in 2010 by undergraduate students in the Department of Applied Psychology, NYU Steinhardt. The ideas and opinions contained in this publication solely reflect those of the authors and not New York University. All work is licensed under the Creative Commons Attribution Noncommercial No Derivative Works License. To view a copy of this license, visit http://creativecommons.org
Volume XV Issue I | Spring 2024
Editors-in-Chief
Smrithi Venkatraman
Stacey Zhu
Contributing Writers
Danny Blakeman
Sibing Chen
Chieh-Ting Joyce Cheng
Sophie Dahan
Deru Fu
Yuchen (Rainie) Li
Casey Nordberg
Andre Robbins
Ella Trager
Bonita Wankhade
Carol Wu
Siyi Wu
Creative Director
Shirley Cajamarca
Layout & Design Coordinators
Shirley Cajamarca
Aahana Katneni
Faculty Mentor
Dr. Adina R. Schick
Special Thanks
Bethanie Railling
Dr. Linnie Green
Department of Applied Psychology
NYU Steinhardt
07 Danny Blakeman
The Complexities of Family Rejection for LGBTQ Homeless Youth
13 Ella Trager
Young Adult Team Sports: Social Connectedness and Depressive Symptoms
24 Chieh-Ting Joyce Cheng
Fearfully and Wonderfully Made: Religiosity, Identity, and Belongingness Among LGBTQ+ Christian Young Adults
32 Casey Nordberg and Siyi Wu
Use of Music Therapy to Promote Social Skills and Reduce Externalizing Behaviors in Children with Communication Difficulties
48 Yuchen (Rainie) Li and Sophie Dahan
Exploring the Role of Chinese Immigrant Parents in Supporting Primary School Students after COVID-19’s Remote Learning
56 Sibing Chen, Deru Fu, and Carol Wu
Navigating Social Support for Chinese College Students Following School Bullying
Interviews
67 Bonita Wankhade
Queerness and Mental Health Among South Asian Youth: An Interview with Dr. Katya Viswanadhan
70 Andre Robbins
The Intersection of Spirituality and Psychology: An Interview with Dr. Andrew Newberg
Welcome to the latest edition of the Online Publications of Undergraduate Studies (OPUS), proudly presented by the Applied Psychology Department at New York University. As always, we are thrilled to showcase the scholarly endeavors of our peers, providing a platform for their insightful research and meaningful contributions to the field of psychology.
In this issue, we delve into a myriad of topics that touch upon the complexities of human development and experience. Our talented contributors have explored diverse themes, including mental health and wellness, social and parental support, religiosity, sexuality, and ability. The articles shed light on crucial issues affecting various communities, such as college students, immigrant parents, children with communication difficulties, and LGBTQ+ youth. We invite you to immerse yourselves in the wealth of knowledge presented within these pages.
We express our heartfelt appreciation to the authors for their dedication and passion demonstrated in the creation of these illuminating articles. Thanks to our layout team, Aahana Katneni and Shirley Cajamarca, for their outstanding work in designing this issue. Their creativity brings this publication to life, and we are immensely grateful for their contributions.
We also extend our gratitude to faculty advisor, Bethanie Railing, for her guidance and encouragement throughout this process. Lastly, we would like to extend a special thank you to the co-directors of the Applied Psychology department, Dr. Adina Schick and Dr. Linnie Green, for their support. Namely, this issue would not have been achievable without Dr. Schick’s support.
We hope that this issue of OPUS inspires meaningful dialogues and encourages deeper exploration into the diverse landscape of psychology. Thank you for joining us on this journey of exploration and discovery.
Warm regards,
Smrithi Venkatraman & Stacey Zhu 2023-2024 Editors-in-Chief
Online Publications of Undergraduate Studies (OPUS)
NYU Applied Psychology Department
Smrithi Venkatraman Stacey Zhu
Danny Blakeman
Youth homelessness poses serious threats to physical and mental health, with LGBTQ youth facing higher percentages of homelessness, due to stigma and discrimination, as compared to their heterosexual and cisgender peers (Choi et al., 2015; Durso & Gates, 2012; Ecker, 2016; Medlow et al., 2014; Meyer, 2015; Rhoades et al., 2018; Robinson, 2018; Shelton et al., 2018). Specifically, while LGBTQ youth only comprise 5 to 8% of all U.S. adolescents, they represent 40% of the total population of homeless youth (Choi et al., 2015; Durso & Gates, 2012). One of the leading pathways to homelessness for LGBTQ youth is family rejection: a large percentage of LGBTQ homeless youth report being kicked-out of their home or choosing to leave their home due to disapproval of their sexual orientation or gender identity (Bhandal & Horwood, 2001; Castellanos, 2016; Choi et al., 2015; Côté & Blais, 2021; Durso & Gates, 2012; Ecker, 2016; Rhoades et al., 2018; Robinson, 2018; Schmitz et al., 2018; Shelton et al., 2018). Family rejection has been attributed to religious and socio-cultural beliefs regarding non-heterosexual identity (Castellanos, 2016; Macedo & Sivori, 2019; Robinson, 2018; Schmitz et al., 2018), as well as pre-existing family stressors, such as poverty (Castellanos, 2016; Clatts et al., 2005; Kane, 2012; Robinson, 2018; Schmitz et al., 2018). As such, this literature review aims to answer the question: What are the effects of family rejection on LGBTQ homeless youth, and how is it shaped by religious and socio-cultural beliefs and family stressors?
Homeless youth include 12-18 year-olds who have left their family home and are without income, residence, or social support (Ecker, 2016; Gaetz et al., 2014). For LGBTQ homeless youth, family rejection is one of the most prevalent contributing factors (Choi et al., 2015; Cochran et al., 2002; Côté & Blais, 2021; Durso & Gates, 2012; Ecker, 2016; Rhoades et al., 2018; Robinson, 2018; Schmitz et al., 2018; Shelton et al., 2018). Youth who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) are a significantly marginalized demographic with higher rates of homelessness than that of the larger population of American youth (Choi et al., 2015; Durso & Gates, 2012; Ecker, 2016; Rhoades et al., 2018; Robinson, 2018; Shelton et al., 2018). Youth whose caregivers react negatively to their LGBTQ identity are often kicked out of their home, which increases the likelihood of homelessness (Durso & Gates, 2012; Rhoades et al., 2018; Robinson, 2018). These negative responses occur after the sexual orientation of LGBTQ youth becomes apparent to their families, either by a parent’s perception of non-heterosexual behaviors, such as gender-divergent appearance or mannerisms,
or by the process of publicly identifying as LGBTQ, referred to as “coming out” (Bhandal & Harwood, 2021; Castellanos, 2016; Cohen & Stein, 1986; Keuroghlian et al., 2014; Robinson, 2018; Rosario et al., 2012). Coming out often results in longterm contentious parental relationships and lack of supportive families, which impedes the youth’s ability to exit homeless or return home, resulting in LGBTQ youth staying homeless longer than their heterosexual counterparts (Choi et al., 2015; Cochran et al., 2002; Cote & Blais, 2020; DeChants et al., 2022; Ecker, 2016; Roe, 2016; Sharek et al., 2018; Shelton et al., 2018).
At the same time, some LGBTQ youth run away or voluntarily leave home because of unsafe living conditions, increased familial conflict, and poor mental health due to abusive and homophobic and/or transphobic (i.e., emotional disgust towards LGBTQ people) parental behavior (Choi et al., 2015; Cochran et al., 2002; DeChants et al., 2022; McCurdy & Russell, 2023; Ryan et al., 2010; Sharek et al., 2018). Running away from home is particularly dangerous, as LGBTQ homeless has been associated with high rates of violent physical and sexual assaults, worse physical health, intimate partner violence, substance abuse, sexual exploitation, and early death (Cochran et al., 2002; Côté & Blais, 2023; Davis & Anderson, 2021; Durso & Gates, 2012; Morton et al., 2018). Not surprisingly, LGBTQ youth who experience family rejection report higher levels of depressive symptoms, self harm, suicidality, and further disconnection from familial relationships (Davis & Anderson, 2021; DeChants et al., 2022; Rhoades et al., 2018; Ryan et al., 2009; Schmitz et al., 2018). Therefore, some LGBTQ youth find that homelessness is preferable to the abuse they sustained at their parent’s home (Côté & Blais, 2021; DeChants et al., 2022; Ecker, 2016; Keuroghlian et al., 2014; McMann, 2022; Schmitz et al., 2018).
When LGBTQ youth do receive parental acceptance, it serves as a protective factor against homelessness and abusive behavior (Davis & Anderson, 2021; Green et al., 2021; Grossman et al. 2019; McCurdy & Russell, 2023; Roe, 2016; Ryan et al., 2010; Schmitz et al., 2018; Shilo & Savaya, 2011). In fact, LGBTQ adolescents report that receiving verbal support from their parents about their identity is essential for their wellbeing (Choi et al., 2015; Roe, 2016; Schmitz et al., 2018). Nevertheless, while active parental acceptance of sexual and gender identity is one of most commonly reported needs, all too often it is lacking (Choi et al., 2015; Durso & Gates, 2012; Ecker, 2016; Robinson, 2018; Roe, 2016; Ryan et al., 2010; Shilo & Savaya, 2011), as a result of religious beliefs, cultural beliefs, and low socioeconomic status.
Religious and Socio-cultural Beliefs
Notably, family rejection is influenced by certain social
beliefs (Bhandal & Horwood, 2021; Castellanos, 2016; Côté & Blais, 2021; Macedo & Sivori, 2019; Robinson, 2018; Schmitz, 2018), including religious beliefs, which regard homosexuality as a sin that results in expulsion from the family home (Macedo & Sivori, 2019; Roe, 2016; Robinson, 2018; Ryan et al., 2018). Religious parents may require their LGBTQ children to attend conversion therapy, an intervention that intends to ‘correct’ an individual’s deviation from heterosexuality (Castellanos, 2016; Haldeman, 2002; Macedo & Sívori, 2019; Roe, 2016; Ryan et al., 2018). LGBTQ youth who are subjected to religious conversion therapy report depressive symptoms and were twice as likely to have attempted suicide (DeChants et al., 2022; Green et al., 2020; Rhoades et al., 2018; Ryan et al., 2009; Schmitz et al., 2018). Further challenges facing this demographic includes parental verbal abuse (e.g., being told they were “going to hell,” quoting condemning passages from the Bible), threats of abandonment, and physical violence (Castellanos, 2016; Côté & Blais, 2021; Macedo & Sivori, 2019; Robinson, 2018; Roe, 2016). Furthermore, religious affiliation is often salient to the identity of some LGBTQ youth prior to the rejection, causing feelings of family betrayal and the guilt of sin, contributing to their decision to leave home (Castellanos, 2016; McGraw et al., 2023).
Additional socio-cultural beliefs, such as compulsory heterosexuality (i.e., any other sexual identity is considered a deviation from the norm), influence parents’ disapproval of their LGBTQ child’s identity, often resulting in rejection from the family home (Bhandal & Horwood, 2021; Katz, 2007; Rich, 1998; Robinson, 2018; Schmitz et al., 2015). However, some LGBTQ youth speculate that their parents’ hostile attitudes are rooted in fear for their vulnerability, maintaining that the hostility is a misguided attempt to protect them from further marginalization (Robinson, 2018; Schmitz et al., 2015). While the motivation to police their child’s sexual orientation and gender identity might be indicative of their intention to protect their children, abusive language and actions remain the same, which perpetuates a homophobic and transphobic narrative in the family (Robinson, 2018; Schmitz et al., 2015). The impact of socio-cultural beliefs on family rejection appears to be greater for families struggling with pre-existing stressors (Clatts et al., 2005; Kane, 2012; Schmitz, 2018). For example, lower socioeconomic status is associated with higher rates of family rejection for LGBTQ youth (SES; Castellanos, 2016; Clatts et al., 2005; Robinson, 2018; Schmitz, 2018).
Family stressors contribute to family rejection, as the challenge of accepting the LGBTQ identity of their child adds another layer of difficulty to their already stressful daily lives (Robinson, 2018; Schmitz et al., 2018). Specifically, when families deal with higher levels of poverty, substance abuse, housing instability, or employment difficulties, these challenges further complicate their ability to accept their child’s non-heterosexual identity (Castellanos, 2016; Robinson, 2018; Schmitz et al., 2018). Additionally, housing instability for this demographic
can be generational, wherein some youth report their family’s own history of homelessness, combined with rejection, was a contributing factor to their homeless experience (Schmitz et al., 2018; Shelton et al., 2018). Since people from racial minority groups are overrepresented in the homeless population (Fusaro et al., 2018), children from these families are also more likely to face homelessness (Shelton et al., 2018).
Additionally, racial discrimination can influence how a parent responds to their child’s LGBTQ identity (Robinson, 2018). Racial minorities are more likely to be denied housing, live in poverty, and receive fewer job offers (Quillian et al., 2018a; Quillian et al, 2018b). These structural barriers interfere with parents’ ability to meet the needs of their families, perpetuating a higher degree of familial stressors among communities of color (Houghtaling et al., 2024; Robinson, 2018; Schmitz et al., 2018). Because of this, many LGBTQ homeless youth of color believe that their parent’s rejection is caused by their anxiety about future marginalization that they will face as racial and sexual minorities (Robinson, 2018; Schmitz et al., 2015). Therefore, LGBTQ youth of color are particularly vulnerable to experiencing homeless and family rejection because of their identity as compared to their white counterparts.
Poverty also limits access to LGBTQ educational programs and therapy for families (Robinson, 2018; Schmitz et al., 2018). These programs are more available to middle class families who experience lower financial pressures due to shorter work hours and increased access to transportation (Castellanos, 2016; Robinson, 2018). With greater access to such resources, middle class parents of LGBTQ youth are less likely to reject their children due to their sexual orientation or gender identity (Kane, 2012; Schmitz et al., 2018). These findings illustrate how poverty-related stressors increase family rejection due to various economic barriers, without simply conflating low SES and discriminatory beliefs (Castellanos, 2016; Kane, 2012; Robinson, 2018). Early family support has been shown to reduce adverse experiences for LGBTQ youth, however, SES status adds a secondary layer (Rhoades et al., 2018; Schmitz et al., 2018). In these ways, the constraints of low SES can perpetuate prejudiced socially held beliefs in these communities and contribute to homelessness for LGBTQ youth.
The deleterious effects of family rejection on the experience of LGBTQ homeless youth presents an urgent need to promote acceptance of LGBTQ identities and reduce the prejudiced beliefs and family stressors that hinder inclusivity. LGBTQ youth are disproportionately represented in the homeless youth population, with family rejection being a leading cause of homelessness for this demographic (Choi et al., 2015; Durso & Gates, 2012; Ecker, 2016; Rhoades et al., 2018; Robinson, 2018; Schmitz et al., 2018; Shelton et al., 2018). LGBTQ youth advocates suggest the implementation of LGBTQ educational resources and therapy for parents and families (Ecker, 2016; Shelton el al., 2018). However, not all families choose to or are
able to access these kinds of resources (e.g., due to lower SES) therefore posing a barrier in the provision of LGBTQ education. LGBTQ homeless youth suggest these programs should be designed by LGBTQ staff from diverse backgrounds and should feature practitioners who are specifically trained to address the needs of LGBTQ youth and their families (Abramovich, 2016; Ecker, 2016; Keuroghlian et al., 2014; McCann & Brown, 2019; Shelton et al., 2018). Since family reunification is not possible for all who are affected by rejection, LGBTQ homeless youth express the desire for dedicated LGBTQ-only youth shelters with similarly identified staff (Ecker, 2016; Keuroghlin et al., 2014). Because LGBTQ youth disproportionately experience homelessness with high rates of family rejection, homeless services should make efforts to be appropriately equipped to serve this population (Choi et al., 2015; Durso & Gates, 2012; Ecker, 2016; Rhoades et al., 2018; Robinson, 2018; Schmitz et al., 2018; Shelton et al., 2018). Moreover future research should continue to probe by studying religious and socio-cultural factors along with family stressors (Castellanos, 2016; Robinson, 2018; Schmitz, 2018), as well as explore what protective factors might exist to mitigate preventable adversities that have a negative impact on LGBTQ youths’ emotional and physical wellbeing.
Abramovich, A. (2016). Preventing, reducing and ending LGBTQ2S youth homelessness: The need for targeted strategies. Social Inclusion, 4(4), 86–96. https://doi. org/10.17645/si.v4i4.669
Bhandal, J., & Horwood, M. (2021). The LGBTQ+ Youth Homelessness Report 2021. [Data set]. AKT. https://www. akt.org.uk/youth-homelessness-report-2021
Castellanos, H. D. (2015). The role of institutional placement, family conflict, and homosexuality in homelessness pathways among Latino LGBT Youth in New York City. Journal of Homosexuality, 63(5), 601–632. https://doi.org/ 10.1080/00918369.2015.1111108
Choi, S. K, Wilson, B. D. M., Shelton, J. & Gates, G. J. (2015). Serving our youth 2015: The needs and experiences of lesbian, gay, bisexual, transgender, and questioning youth experiencing homelessness. The Williams Institute with True Colors Fund. https://escholarship.org/uc/ item/1pd9886n
Clatts, M. C., Goldsamt, L., Yi, H., & Viorst Gwads, M. (2005). Homelessness and drug abuse among young men who have sex with men in New York City: A preliminary epidemiological trajectory. Journal of Adolescence, 28, 201–214. https://www.doi.org/10.1016/j. adolescence.2005.02.003
Cochran, B. N., Stewart, A. J., Ginzler, J. A., & Cauce, A. M. (2002). Challenges faced by homeless sexual minorities: Comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. American Journal of Public Health, 92(5), 773–777. https://doi.org/10.2105/AJPH.92.5.773
Cohen, C. J., & Stein, T. S., (1986). Reconceptualizing individual psychotherapy with gay men and lesbians. In C. J. Cohen & T. S. Stein (Eds.), Contemporary perspectives on psychotherapy with lesbians and gay men (pp. 27–54). Springer.
Côté, P., & Blais, M. (2023). ‘I didn’t want to be noticed’: Discrimination and violence among LGBTQ+ youth experiencing homelessness. Journal of LGBTQ Youth, 21(1), 180–199. https://doi.org.10.1080/19361653.2023.2 185337
Côté, P., & Blais, M. (2021). The least loved, that’s what I was: A qualitative analysis of the pathways to homelessness by LGBTQ+youth. Journal of Gay & Lesbian Social Services, 33(2), 137–156. https://doi.org/10.1080/10538720.2020.1 850388
Davis, K. C., & Anderson, J. L. (2020). The role of perceived parental acceptance-rejection on personality psychopathology in sexual orientation minority young adults. Journal of Child and Family Studies, 30(1), 276–291. https://doi.org/10.1007/s10826-020-01858-3
DeChants, J. P., Shelton, J., Anyon, Y., & Bender, K. (2022). “It kinda breaks my heart”: LGBTQ young adults’ responses to family rejection. Family Relations, 71(3), 968–986. https://doi.org/10.1111/fare.12638
Durso, L. E., & Gates, G. J. (2012). Serving our youth: Findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of becoming homeless. The Williams Institute with True Colors Fund and The Palette Fund. https://escholarship.org/uc/item/80x75033
Ecker, J. (2016). Queer, young, and homeless: A review of the literature. Child & Youth Services, 37(4), 325–361. https:// doi.org/10.1080/0145935X.2016.1151781
Fusaro, V. A., Levy, H. G., & Shaefer, H. L. (2018). Racial and ethnic disparities in the lifetime prevalence of homelessness in the United States. Demography, 55(6), 2119–2128. https://doi.org/10.1007/s13524-018-0717-0
Gaetz, S., O’Grady, B., Buccieri, K., Karabanow, J., & Marsolais, A. (2014). Introduction. In S. Gaetz, B. O’Grady, K. Buccieri, J. Karabanow, & A. Marsolais (Eds.), Youth homelessness in Canada: Implications for police and practice (pp. 1–14). Canadian Homelessness Outreach Network, The Homeless Hub.
Green, A. E., Price-Feeney, M., Dorison, S. H., & Pick, C. J. (2020). Self-reported conversion efforts and suicidality among US LGBTQ youths and young adults, 2018. American Journal of Public Health, 110(8), 1221–1227. https://doi.org/10.2105/ajph.2020.305701
Haldeman, D. C. (2002). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33(3), 260–264. https://doi.org/10.1037//0735-7028.33.3.260
Hill, D. B., & Willoughby, B. L. B. (2005). The development of and validation of the genderism and transphobia scale. Sex Roles, 53(7–8), 531–544. https://doi.org/10.1007/ s11199-005-7140-x.
Houghtaling, L. M., Simon, K., Gower, A. L., McCurdy, A., Rider, G. N., Russel, S. T., & Eisenberg, M. E. (2024). Unaccompanied unstable housing among racially, ethnically, sexually, and gender diverse youth: Intersecting identities bearing the greatest burden. American Journal of Orthopsychiatry, 94(3), 311–321. https://doi.org/10.1037/ort0000725
Kane, E.W. (2012). The gender trap. NYU Press.
Katz, J. N. (2007). The invention of heterosexuality. University of Chicago Press.
Keuroghlian, A. S., Shtasel, D., & Bassuk, E. L. (2014). Out on the street: A public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. American Journal of Orthopsychiatry, 84(1), 66–72. https://doi.org/10.1037/h0098852
Macedo, C. M. R., & Sívori, H. F. (2019). The sexual diversity debate in Brazilian psychology: Professional regulation at stake. Psicologia: Ciência e Profissão, 39(spe3). https://doi. org/10.1590/1982-3703003228496
McCann, E., & Brown, M. (2019). Homelessness among youth who identify as LGBTQ+: A systematic review. Journal of Clinical Nursing, 28(11–12), 2061–2072. https://doi.
org/10.1111/jocn.14818
McCurdy, A. L., & Russell, S. T. (2023). Perceived parental social support and psychological control predict depressive symptoms for lesbian, gay, bisexual, transgender, queer, or questioning youth in the United States. Child Development, 94(3), 691–705. https://doi. org/10.1111/cdev.13894
Medlow, S., Klineberg, E., Steinbeck, K. (2014). The health diagnoses of homeless adolescents: A systematic review of the literature. Journal of Adolescence, 37(5), 531–542. https://doi.org/10.1016/j.adolescence.2014.04.003
Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209–213. https://doi.org/10.1037/sgd0000132
Morton, M. H., Samuels, G. M., Dworksy, A. & Patel, S. (2018). Missed opportunities: LGBTQ youth homeless in America Chapin Hall at the University of Chicago. https://www. chapinhall.org/wp-content/uploads/VoYC-LGBTQ-BriefFINAL.pdf
Murphy, J., & Hardaway, R. (2017a). LGBTQ adolescents of color: Considerations for working with youth and their families. Journal of Gay & Lesbian Mental Health, 21(3), 221-227. https://doi.org/10.1080/19359705.2017.1320741
Quillian, L., Lee, J. J., Honore, B. (2020a). Racial discrimination in the U.S. housing and mortgage lending markets: A quantitative review of trends, 1976-2016. Race and Social Problems, 12, 13–18. https://doi.org/10.1007/s12552-01909276-x
Quillian, L., Lee, J. J., & Oliver, M. (2020b). Evidence from field experiences in hiring shows substantial additional racial discrimination after callback. Social Forces, 99(2), 732–759. https://doi.org/10.1093/sf/soaa026
Rhoades, H., Rusow, J. A., Bond, D., Lanteigne, A., Fulginiti, A., & Goldbach, J. T. (2018). Homelessness, mental health and suicidality among LGBTQ youth accessing crisis services. Child Psychiatry & Human Development, 49(4), 643–651. https://doi.org/10.1007/s10578-018-0780-1
Rich, A. (1998). Compulsory heterosexuality and lesbian existence. In R. Parker & P. Aggleton (Eds.), Culture, society, and sexuality. (pp. 631–660). Routledge. Robinson, B. A. (2018). Conditional families and lesbian, gay, bisexual, transgender, and queer youth homelessness: Gender, sexuality, family instability, and rejection. Journal of Marriage and Family, 80(2), 383–396. https://doi. org/10.1111/jomf.12466
Roe, S. (2016). “Family support would have been like amazing.” The Family Journal, 25(1), 55–62. https://doi. org/10.1177/1066480716679651
Rosario, M., Schrimshaw, E. W., & Hunter, J. (2012). Risk factors for homelessness among lesbian, gay, and bisexual youths: A developmental milestone approach. Children and Youth Services Review, 34(1), 186–193. https://doi. org/10.1016/j.childyouth.2011.09.016
Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino Lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352. https://doi.org/10.1542/ peds.2007-3524
Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT Young Adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205–213. https://doi. org/10.1111/j.1744-6171.2010.00246.x
Schmitz, R. M., & Tyler, K. A. (2018). The complexity of family reactions to identity among homeless and college lesbian, gay, bisexual, transgender, and queer young adults. Archives of Sexual Behavior, 47(4), 1195–1207. https://doi. org/10.1007/s10508-017-1014-5
Sharek, D., Huntley-Moore, S., & McCann, E. (2018). Education needs of families of transgender young people: A narrative review of international literature. Issues in Mental Health Nursing, 39(1), 59–72. https://doi.org/10.10 80/01612840.2017.1395500
Shelton, J., DeChants, J., Bender, K., Hsu, H., Maria, D. S., Petering, R., Ferguson, K., Narendorf, S., & BarmanAdhikari, A. (2018). Homelessness and housing experiences among LGBTQ young adults in seven U.S. cities. Cityscape, 20(3), 9–34. https://www.jstor.org/ stable/26524870
Shilo, G., & Savaya, R. (2011). Effects of family and friend support on LGB youths’ mental health and sexual orientation milestones. Family Relations, 60(3), 318–330. https://doi.org/10.1111/j.1741-3729.2011.00648.x
The Trevor Project (2022). U.S. adult’s personal knowledge and comfort with LGBTQ identities. [Data set]. The Trevor Project. https://www.thetrevorproject.org/wp-content/ uploads/2022/03/Embargoed-MC-Polling-Data_3.31.22. pdf
Weinberg, G. H. (1972). Society and the healthy homosexual. St. Martin’s Press.
In 2023, a nationally representative survey revealed that 29% of young adults experience depressive symptoms, which is more than any other age group (Making Caring Common, 2023). Depression also stands as one of the leading causes of death by suicide in young adulthood (Centers for Disease Control and Prevention [CDC], 2022; National Institute of Mental Health [NIMH], 2023). In recent years, pharmacological and psychological treatments for depressive symptoms have taken precedence, overlooking alternative treatment methods (Blumenthal et al., 2007; Thapar et al., 2022). One such treatment, exercise, has been investigated as an effective adjunct treatment for depression that produces psychological gains similar to those of psychotherapy (Craft & Landers, 1998; Kramer, 2020; Meyer et al., 2016; Xie et al., 2021). Specifically, engagement in team sports offers unique mental health benefits to adolescents and older adults (Andersen et al., 2019; Mikkelsen et al., 2017; Pharr et al., 2019; Pluhar et al., 2019). What is largely understudied, however, is the relation between team sport engagement and depressive symptoms in young adults.
Young Adult Mental Health and Exercise
Symptoms of depression include, but are not limited to, feelings of hopelessness, anxiety, low mood, and lack of interest (5th ed.; DSM-5; American Psychiatric Association, 2013) and are most likely to reach their peak in young adulthood (Institute of Medicine [IOM] & National Research Council [NRC], 2015). During this critical period for identity development between the ages of 18 and 30, individuals typically enter the workforce, form new relationships, and move from home, while simultaneously navigating risk factors for depression (e.g., drugs and alcohol; Colarusso, 1991; Dodemaide et al., 2022; Rindfuss, 1991). As a result, young adults are more susceptible to developing depressive symptoms than the general population (Arnett, 2000; Cunningham & Duffy, 2019; Dodemaide, 2022; Matud et al., 2020; Parker et al., 2004; Rindfuss, 1991). The past decade alone has seen unprecedented levels of young adult anxiety, depression, and suicide (National Institute of Mental Health, 2023), intensifying the growing mental health crisis (Cohen et al., 2021; Fusar-Poli et al., 2021; Gruber et al., 2023; Jureqicz, 2015).
Depressive symptoms have traditionally been combated using behavior modification, psychotherapy, psychiatric care, and medication (Marks, 2017; Musyimi et al., 2018; Thapar et al., 2022). Unfortunately, many young adults do not seek such care due to their cost and inaccessibility and/or cultural stigma surrounding mental health (Handy et al., 2022; Parker & Paterson, 2015; Xie et al., 2021). In recent years, nontraditional
forms of treatment for young adults with depressive symptoms have emerged, such as peer counseling, online communities (e.g., apps, social media groups), and psychoeducation (ConejoCerón et al., 2020; Marks, 2017; Marshall et al., 2020). Additional suggestions for coping with symptoms include taking breaks from social media, connecting with others, and meditating (CDC, 2022; Haslam et al., 2015; Huberty et al., 2021). Another method of decreasing symptoms of depression exists, though it is frequently underestimated: exercise (Craft, 2005; Mikkelsen et al., 2017; Morres et al., 2018; Stathopoulou et al., 2006).
“Exercise” is commonly confused with “physical activity.” However, exercise entails fixed bodily movement intended to maintain fitness levels, while physical activity is an umbrella term used to describe any bodily movement that results in energy expense (Caspersen et al., 1985; Singh et al., 2023). The relation between exercise and depression has been extensively researched in recent decades, revealing its effectiveness as a treatment for depression in young adults (Byrne & Byrne, 1993; Everson et al., 2008; Stathopoulou & Powers, 2006; Sundgot-Borgen et al., 2002; Qiu et al., 2019). Not only is exercise an established adjunct treatment for depression, but it also provides a cost-effective and accessible option for those who cannot afford or might not want traditional treatments (Czosnek et al., 2019; Kramer, 2020; Xie et al., 2021).
Various components of exercise have been examined, such as duration, mode, and intensity, each of which may uniquely influence young adult depression (Craft, 2005; Craft & Perna, 2004; Everson et al., 2008; Stanton & Reaburn, 2014). For instance, exercise interventions lasting at least nine weeks are most effective in depression treatment (Craft, 2005; Perraton & Kumar, 2010; Stanton & Reaburn, 2014). Additionally, both anaerobic (e.g., running, walking, swimming, cycling) and aerobic (e.g., sprinting, weightlifting, interval training) exercise significantly decrease stress and anxiety, though reduction may be moderately enhanced in anaerobic exercise (Elzanaty et al., 2021; Gaudlitz et al., 2014; Kianian et al., 2018; Martinsen et al., 1989; Morres et al., 2018; Taliaferro et al., 2009). Furthermore, depressive symptoms are significantly lower across varying levels of exercise intensity (i.e., light, moderate, heavy; Meyer et al., 2016; Mikkelsen et al., 2019), with no heightened effect of one over another.
Exercise increases endorphin action, body temperature, mitochondrial function, mTOR signaling, neurotransmitter levels, and HPA axis regulation, thereby enhancing selfperception, self-esteem, and mood states, which are related to depressive symptoms (Angelopoulos, 2001; Craft & Perna, 2004; Everson et al., 2008). Notably, these effects have significant
benefits on young adults diagnosed with clinical depressive symptoms (Silveira et al., 2013; Wegner et al., 2014). Exercise may also encourage skill mastery, thereby increasing self-efficacy, or one’s confidence in their ability to successfully complete a given task, which is negatively associated with depression (Bandura & Adams, 1997; Craft, 2005; Mikkelsen et al., 2017). Additionally, exercise offers a distraction from extraneous stressors, thus supporting the distraction theory of depression (Craft, 2005; Lopez et al., 2006; Mikkelsen et al., 2017; NolenHoeksema, 1991). That is, participants may be distracted from stress by increased heart rate, muscle awareness, or merely by a need to focus on completing a movement effectively. Ultimately, any form of exercise can bring about these physiological and psychological shifts, though prior literature reveals enhanced benefits in team sports (Andersen et al., 2019; Mikkelsen et al., 2017; Pharr et al., 2019; Pluhar et al., 2019).
Team sports are characterized by player socialization and interaction toward a common goal (e.g., softball, soccer, hockey, football, rugby, basketball; Pharr et al., 2019). They are not only defined by, but contingent upon, interpersonal relationships, unlike other forms of exercise, thus serving as an effective outlet for young adults experiencing depressive symptoms (Andersen et al., 2019; Armstrong & Oomen-Early, 2009). More specifically, team sport members often report feelings of camaraderie, collective solidarity, friendships, social skills, social engagement, and social bonding, in conjunction with decreased depressive symptoms (e.g., worry, anxiety, hopelessness, low mood; Andersen et al., 2019; Armstrong & Oomen-Early, 2009; Eime et al., 2013; Fleury & Lee, 2006; Hoye et al., 2012; Marsters et al., 2020). Thus, team sports complement the physiological benefits of exercise, serving as an added protective factor against depressive symptoms.
Participating in team sports provides distinct mental health advantages over individual exercise by integrating physiological and psychological mechanisms, along with a crucial element for young adult mental well-being: social connectedness (Andersen et al., 2019; Armstrong & Oomen-Early, 2009; Marsters et al., 2020; Pluhar et al., 2019; Wickramaratne et al., 2022). Social connectedness, or one’s identification and sense of belonging with a group, encapsulates two primary dimensions: social networks (i.e., the number of individuals and frequency of interactions in a social circle) and social support (i.e., the amount of empathy circulated among the group; Haslam et al., 2015; Herbison et al., 2019). Unfortunately, attrition rates from team sports peak around age 17 just before entering young adulthood, a time when individuals are most in need of social support (Enoksen, 2011; Villatte et al., 2022). Attrition rates may stem from young adults’ reported lack of time and access to participate in sports (IOM & NRC, 2015; Sáez et al., 2021). In fact, approximately 48% of male and 23% of female young adults play sports, both individual and team, compared to nearly 60% and 55% of male
and female adolescents who play team sports, demonstrating a lack of opportunity for young adults’ social connectedness (Deng & Fan, 2022; Harvard T. H. Chan School of Public Health, 2015). Both social networks and support may reduce symptoms of depression by decreasing loneliness, social anxiety, and increasing senses of belonging, motivation, self-esteem, and social acceptance (Armstrong & Oomen-Early, 2009; Eime et al., 2013; Haverfield et al., 2019; Hoffman et al., 2021; Ozbay et al., 2007; Pluhar et al., 2019; Wickramaratne et al., 2022). Such outcomes can be understood using a social ecological model of change framework, which underscores the importance of communities and interpersonal relationships in mental health and well-being (Fleury & Lee, 2006; Martino et al., 2015). Various theories further attest to the negative relationship between social connectedness and depressive symptoms. Notably, Bowlby’s attachment theory provides a conceptualization of depressive symptoms as expressions of disrupted relational bonds, which social connectedness may mend (Ozbay, 2007; Wickramaratne et al., 2022). Additionally, emerging physiological theories of social connectedness describe its ability to buffer mal psychosomatic effects of stress and depression (Haslam et al., 2015; Ozbay et al., 2007).
Most research on team exercise and depressive symptoms focuses on adolescents, since opportunities for organized sports are most commonly presented in school or as extracurricular activities (Kanters et al., 2013). Such opportunities are thus not as frequently offered to young adults, which may explain the lack of research focusing on team sports as an adjunct treatment for young adult depression (Deng & Fan, 2022; Harvard T. H. Chan School of Public Health, 2015; IOM & NRC, 2015; Sáez et al., 2021). Ultimately, young adult engagement in team sports as a protective factor against depressive symptoms is largely understudied (Blumenthal et al., 2007; Thapar et al., 2022; Townsend & McWhirter, 2011). Therefore, the current study aimed to address the impact of team sports on mental health through the following question: How do team sports relate to young adults’ social connectedness and depressive symptoms?
Five young adults participated in this qualitative study (see Table 1). EN identifies as a 30-year-old White cisgender male playing recreational soccer through a New York City public league; DL identifies as a 21-year-old African American cisgender male playing intramural basketball at his university; SN identifies as a 27-year-old Latinx/White female playing recreational kickball through a public league in New York City; OM identifies as a 21-year-old White cisgender female playing Division III soccer at her college; CL identifies as a 20-yearold Asian cisgender female playing pickup basketball at her university.
Participants partook in semi-structured interviews lasting approximately 45 minutes. Interviews for DL, SN, and CL took place in person while those for OM and EN were conducted via zoom. Broadly, interview questions addressed basic demographic information, details about participants’ chosen sport, reasons for joining and continuing to play their sport, expectations, and outcomes. Follow-up questions were asked for clarification and to further probe responses. Interviews were audio-recorded and later transcribed verbatim.
Transcribed interviews were coded using a grounded theory approach (Corbin & Strauss, 1990). First, the research question was subdivided into the following elements to simplify the coding process: young adult involvement in team sports, social connectedness, and depressive symptoms. Then, a codebook was created where different colors represented those three elements, or codes. Approximately 20% of the data were then read closely with the codes in mind and data were highlighted appropriately, according to the codebook. It is important to note that data were coded at a phrase-level, meaning each phrase was examined mutually exclusive from one another. Thus, one sentence may contain one code, multiple codes, or zero codes. As different themes emerged from the data, they were added to the codebook. Next, the established coding system was applied to the remaining data, through an iterative process through which codes were modified, added, and removed as necessary (see Appendix A for an in-depth explanation of each code).
Four major codes emerged from the data: social support, social networking, physical health, and mental health, each with multiple sub-codes (see Appendix A). Social support encapsulates mentions of empathy, connectedness, and/or belongingness in the group. Social networking, on the other hand, includes references to interactions with others, making friends, and social circles (Haslam et al., 2015). Physical health is self-explanatory, though examples of this code include participants enjoying team sports due to endurance, muscular, or cardiovascular fitness outcomes. Lastly, acknowledgements of loneliness, motivation, self-esteem, stress, pressure, and pleasure were coded as mental health outcomes.
Of the five participants interviewed, 100% addressed social support as a reason for joining and continuing to play their team sport. Notably, all participants stated at least three times that social support from their team members decreased loneliness, making it the first of two main reasons for both joining and continuing to play their team sport. For instance, EN articulated, “playing recreational soccer is far better than going to the gym by myself or running because the support from teammates makes me feel like I belong to something greater, it adds meaning.”
Furthermore, he said, “Having friendships helps counter the loneliness epidemic because I feel close to my teammates even though we haven’t had a lot of in-depth conversations. It’s just the camaraderie of being on a team and working together.”
Social support manifested in two ways: feeling connected to others and feeling a sense of belongingness. Connection refers to an emotional tie with other team members, whereas belongingness suggests feelings of being accepted, valued, and included within the team. OM, for instance, expressed feeling connected to her teammates because she spends over 30 hours a week with them in-season, which “makes [her] feel less alone.” However, unlike other participants, she did not feel a sense of belongingness with her teammates during the first two years of her collegiate soccer career. She explained that her teammates were “constantly competing to be the best,” upperclassmen showed “hatred towards the underclassmen,” and there was a “lack of camaraderie.” As such, she felt increasingly stressed and withdrawn.
Equally important to social support was the opportunity to build social networks through engaging in team sports. Namely, 100% of the participants explained that their experiences playing team sports revolve around making new friends, which brings them joy. For instance, DL stated, “Not only does basketball give me exercise, but it also allows me to spend time with people and make friends. Sometimes I play video games, study, or eat lunch with the new friends I’ve made, which gives me energy and makes me feel valued.” Similarly, EN explained that sometimes he and his teammates will “go out for dinner and drinks after a game which feels nice, especially as someone who is a little socially awkward because I know we can talk about the game.” SN also claimed, “It’s really fun to go see my kickball friends after the game, catch up with them, and make even more new friends that are not in the same career field as I am.” One participant, however, had a negative experience playing collegiate soccer. OM reported,
I didn’t know anyone when I first joined the team, and the older girls were very cliquey. I felt a little bit on the outs because there were such intense power dynamics that made everyone have built up hatred towards each other, which felt really lonely and just kind of depressing.
Once OM became an upperclassman on the team, though, these feelings dissipated.
In addition to social connectedness, participants derived physical health benefits from engaging in team sports. 80% of the participants acknowledged the exercise component as a positive outcome at least four times, making physical health the second main reason for joining and continuing to play team sports. For instance, DL joined intramural basketball to “keep health and overall stamina in check to stay in shape.” He continues to engage with the team because “it gives him a place to exercise and spend time with friends at the same time,
which puts him in a good mood.” Additionally, EN joined his soccer team “to get the endorphin high of exercising because it feels magical, especially when it’s with other people.” Lastly, CL claimed that pick-up basketball has reaped “very good physical health benefits.” Without it, she said, “she’d be super lazy and probably lack self-esteem.”
Uniquely, OM did not report joining collegiate soccer for the physical health benefits. Rather, she felt it would be a place to “show off skills” she had been working towards since preadolescence and that doing so gives her “an energy boost.” Interestingly, when asked about how team sports have impacted her health, OM immediately stated, “It’s taken a toll on my shins and my hip and I feel the need to push myself despite being in pain because there is so much pressure to do well, which probably affects my mental health.” Only one other participant, EN, noted the potential for injuries in team sports. Again, OM deviated from the other recreational-sport athletes in that she has experienced negative physical health outcomes, like injuries. While EN also noted he had been injured before, OM spent more time elaborating on its detrimental effect to not just her physicality, but her mental health as well. She also noted that she has been “one of the lucky ones,” and “if you asked some other players on the team, they would have worse stories, which is probably more representative of the collegiate athlete life at large.”
Also relevant to participants’ experiences with engaging in team sports are mental health outcomes. 100% of participants reported at least one mental health benefit, such as enjoying playing a sport they love, unleashing competitive urges, releasing stress, and increasing motivation. For instance, 80% of participants joined their team sport because of the pure enjoyment they got from playing it during childhood and adolescence. CL, for example, joined her team sport with the “goal to just play basketball because it’s so fun and makes everyone happy.” OM and EN also noted that they “grew up playing soccer,” so they felt intrinsically motivated to continue. 60% of participants acknowledged external motivation as a source of decreasing depressive symptoms. For instance, EN claimed, “Sometimes, it’s what I look forward to the most that week because I know I will be able to release stress, talk to friends, and get exercise.” Similarly, SN explained that knowing she had kickball scheduled for Thursdays inspired her to “eat properly and mentally prepare to socialize the night before,” which solidified a routine for her and increased motivation.
40% of participants attributed their motivation to accountability fostered by team members. Namely, EN stated, “It’s easier to get off the couch from being lazy when you know someone is counting on you to play the game, and I am always so glad that I got up.” Similarly, SN stated, “We bonded after the first game, the 12 of us, so I feel like because of that we were more willing to go back because we’re more invested in the relationships.” She continued to say, “Sometimes I fall into a flaky mental health pattern and say no to things but since this is a commitment and people count on me, I actually want to pull
myself together and nourish myself enough to socialize.”
100% of participants felt their sport allowed them to release stress. Namely, DL explained that playing intramural basketball “feels relaxing and cathartic, it releases stress because [he is] not thinking about anything other than the game.” Similarly, EN called soccer an “emotional regulation mechanism”; OM said soccer is a “place to run around and not think about the stress of school or what’s happening in the world, it’s just a place to unplug for a few hours”; CL called basketball “a de-stressor, a place to go when I need to get my mind off things and expend energy,” and SN said,
We rarely talk about work when we’re together at kickball so when I come back to work the next day, I feel refreshed. Also, during the game I feel less stressed because I am thinking about the strategies I will use to kick the ball and stuff, rather than the stress of work.
Once again differing from recreational athletes, OM reported feeling heightened levels of stress during her first two years at college, which is not surprising given that freshmen and sophomore collegiate athletes are at a higher risk of developing depressive symptoms than their upper-class counterparts, likely because they are still learning to navigate the social, academic, and psychological stressors associated with collegiate athletics (Valster et al., 2022; Weber et al., 2023; Yang et al., 2007).
Young adult engagement in team sports combines physiological and psychological benefits with social connectedness, highlighting its role in depressive symptomatology reduction. Extensive research has investigated the role of team sports in adolescence and adulthood, though little attention has been paid to young adulthood, a phase when loneliness levels reach their peak (Andersen et al., 2019; Armstrong & Oomen-Early, 2009; Marsters et al., 2020; Pluhar et al., 2019). It is, thus, crucial to examine the role of team sports as one potential outlet for young adults to feel socially connected as a means of protecting against depressive symptoms.
Major themes identified as influencing young adults’ engagement were social connectedness and health and wellbeing. Within both themes, subthemes emerged: social support, social networking, mental health, and physical health. The prevalence of these themes is not surprising given that research highlights similar outcomes in adolescents and older adults who play team sports (Andersen et al., 2019; Craft & Perna, 2004; Deng & Fan, 2022; Mikkelsen et al., 2017; Pluhar et al., 2019).
Participants’ reported positive mental health outcomes in relation to feeling socially connected through their team sport, which falls in line with research identifying social connectedness as a significant protective factor from depressive symptomatology in young adulthood (Armstrong & Oomen-Early, 2009; Eime et al., 2013; Haslam et al., 2015; Haverfield et al., 2019; Liu et al., 2022; Martino et al., 2015; Wickramaratne et al., 2022). Interestingly, one non-recreational team sport athlete, OM, differed from
other recreational-athlete participants in feeling isolated. This is not surprising, given that non-recreational collegiate sports can spur “exclusive competition,” where individuals work towards winning, professional recruitment, or increased playing time. This weakens elements of belongingness that are found in most recreational or “inclusive competition” spaces where the main goal is often to have fun, exercise, or make friends (Bollók et al., 2011; Lozano-Sufrategui et al., 2017, p. 307; Pluhar et al., 2019). While no individual-sport athletes were interviewed for this study, these results are also consistent with literature that compares team sports with individual sports, where team sports are more protective of developing depressive symptoms because they promote interpersonal connections and empathy (Eime et al., 2013; Hoye et al., 2015; Marsters et al., 2020; Wickramaratne et al., 2022). Furthermore, findings reveal that young adults often play team rather than individual sports because they anticipate receiving greater mental health benefits from building social connections (Bollók et al., 2011). Such findings are pertinent to research, or lack thereof, regarding team sports as protective factors for young adult depressive symptoms.
Participants of this study also reported physical and mental health as both motivational factors and outcomes from engaging in team sports. Such findings are not surprising given the breadth of literature on health benefits of exercise (Caspersen et al., 1985; Everson et al., 2008; Folkins & Sime, 1981; Qiu et al., 2019; Venet-Kelma et al., 2023). Moreover, these results align with previous findings that indicate young adults primarily engage in team sports to enhance physical health (Bollók et al., 2011). Results, as such, also support self-efficacy theory, which posits that achieving skill mastery leads to increased self-esteem and decreased depressive symptoms (Bandura & Adams, 1997; Mikkelsen et al., 2017). Lastly, these results further corroborate existing literature on the distraction theory of depression, which posits distraction from active ruminations as effective tools in elevating mood (Lopez et al., 2006; Mikkelsen et al., 2017; NolenHoeksema, 1991). Such benefits contribute to the validity and effectiveness of team sport engagement as a means of combating young adult depression.
In sum, team sports may ameliorate depressive symptoms in young adults by way of increasing social connectedness and health and wellbeing (Boone and Leadbeater, 2006; Eime et al., 2013; Hoye et al., 2015; Marsters et al., 2020; Pluhar et al., 2019; Sabiston et al., 2016; Wickramaratne et al., 2022). Namely, four broad themes were identified as reasons for joining and continuing participation in team sports, including social support, social networking, physical health, and mental health. Interestingly, participants identified alleviation of depressive symptoms as stemming from social support and physical activity more than any other factor in team sports.
Notable differences were also observed between participants who played college division sports and nondivision sports, though such findings should be interpreted
with caution as only one participant played non-recreationally. These results suggest that collegiate athletes suffer from unique stressors, unlike non-recreational athletes, which aligns with research indicating that collegiate athletes place more emphasis on competition, and they experience more depressive symptoms attributed to substantial pressures to perform (Lower & Turner, 2016; Martindale et al., 1990; Madrigal & Robbins, 2020; Sutcliffe & Greenberger, 2020). Such findings also shed light on rapidly increasing rates of depression and anxiety in collegiate athletes, indicating an urgent need for sports psychologists in the collegiate athlete space, in addition to coaching methods focused on social connectedness (Carr & Davidson, 2014; Jones et al., 2022; Sutcliffe & Greenberger, 2020; Valster et al., 2022).
In fact, a mere 9% of Division I athletic departments employ at least two mental health providers (Jones et al., 2022). Again, the push for research and practice in sports psychology must be addressed to combat rates of depression and anxiety in collegiate athletes, or any non-recreational sport at large. Suffice it to say, future research should investigate how recreational and nonrecreational young adult athletes differ across levels of social connectedness and depressive symptoms.
To extend future research and practice, researchers may consider exploring the relation between young adult engagement in team sports, social connectedness, and depressive symptoms using a quantitative approach. Future research may also consider identifying barriers and motivators for participation in young adult team sports across genders, socioeconomic statuses, cultural backgrounds, and type of sport played (Bollók et al., 2011; Wickramaratne et al., 2022). This research is particularly pertinent for mental health practitioners working with clients uninterested in traditional depression treatments, such as psychotherapy or medication. Namely, team sports encapsulate a unique interaction between social benefits and exercise, both of which are negatively associated with depressive symptoms in young adults (Cohen et al., 2021; Stathopoulou et al., 2006; Townsend & McWhirter, 2011). Ultimately, this qualitative study is a first step in uncovering the relation between young adult engagement in team sports, social connectedness, and depressive symptoms.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). https:// doi.org/10.1176/appi.books.9780890425596
Andersen, M. H., Ottesen, L. & Thing, L. F. (2019). The social and psychological health outcomes of team sport participation in adults: An integrative review of research. Scandinavian Journal of Public Health, 47(8), 832–850. https://doi. org/10.1177/1403494818791405
Angelopoulos, T. (2001). Beta-endorphin immunoreactivity during high-intensity exercise with and without opiate blockade. European Journal of Applied Physiology, 86(1), 92–96. https://doi.org/10.1007/s004210100501
Armstrong, S., & Oomen-Early, J. (2009). Social connectedness, self-esteem, and depression symptomatology among collegiate athletes versus nonathletes. Journal of American College Health, 575(5), 521–526. https://doi.org/10.3200/ JACH.57.5.521-526
Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003066X.55.5.469
Bandura, A., & Adams, N. E. (1997). Analysis of self-efficacy theory of behavioral change. Cognitive Therapy and Research, 1(4), 287–310. https://doi.org/10.1007/ BF01663995
Bettmann, J. E. (2006). Using attachment theory to understand the treatment of adult depression. Clinical Social Work Journal, 34(4), 531–542. https://doi.org/10.1007/s10615005-0033-1
Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M., Watkins, L., Hoffman, B. M., Barbour, K. A., Herman, S., Craighead, W. E., Brosse, A. L., Waugh, R., Hinderliter, A., & Sherwood, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine, 69(7), 587–596. https://doi.org/10.1097/ PSY.0b013e318148c19a
Bollók, S., Takás, J., Kalmár, Z., & Dobay, B. (2011). External and internal sport motivations of young adults. Biomedical Human Kinetics, 3, 101–105. https://doi.org/10.2478/ v10101-011-0022-5
Boone, E. M., & Leadbeater, B. J. (2006). Game on: Diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports. Journal of Research on Adolescence, 16(1), 79–90. https://doi.org/10.1111/j.15327795.2006.00122.x
Byrne, A., & Byrne, D. G. (1993). The effect of exercise on depression, anxiety and other mood states: A review. Journal of Psychosomatic Research, 37(6), 565–574. https:// doi.org/10.1016/0022-3999(93)90050-p
Capel, T., Schnittert, J. F., Snow, S., & Vyas, D. (2015). Exploring motivations of young adults to participate in physical activities. Association for Computing Machinery, 1409–1414. https://doi.org/ 10.1145/2702613.2732800
Carr, C., & Davidson, J. (2014). The psychologist perspective. In G. T., Brown (Ed.), Mind, body and sport: Understanding
and supporting student-athlete mental wellness (pp. 17–20). National Collegiate Athletic Association. https://www. naspa.org/images/uploads/events/Mind_Body_and_ Sport.pdf
Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports, 100(2), 126–131.
Centers for Disease Control and Prevention. (2022, April 29). Taking care of your mental health. https://www.cdc.gov/ emotional-wellbeing/features/how-right-now.htm
Centers for Disease Control and Prevention. (2022, November 2). Risk and protective factors. https://www.cdc.gov/ suicide/factors/index.html
Cohen, K. A., Stiles-Shields, C., Winquist, N., & Lattie, E. G. (2021). Traditional and nontraditional mental healthcare services: Usage and preferences among adolescents and younger adults. Journal of Behavioral Health Services & Research, 48, 537–553. https://doi.org/10.1007/s11414020-09746-w
Colarusso, C. A. (1991). The development of time sense in young adulthood. The Psychoanalytic Study of the Child 46(1), 125–144. https://doi.org/10.1080/00797308.1991.1 1822361
Conejo-Cerón, S., Bellón, J. Á., Motrico, E., Campos-Paíno, H., Martín-Gómez, C., Ebert, D. D., Buntrock, C., Gili, M., & Moreno-Peral, P. (2020). Moderators of psychological and psychoeducational interventions for the prevention of depression: A systematic review. Clinical Psychology Review, 79, 1–19. https://doi.org/10.1016/j.cpr.2020.101859
Corbin, J., & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13(1), 3–21. https://doi.org/10.1007/ BF00988593
Craft, L. L., (2005). Exercise and clinical depression: Examining two psychological mechanisms. Psychology of Sport and Exercise, 6(2), 151–171. https://doi.org/10.1016/ j.psychsport.2003.11.003
Craft, L. L., & Landers, D. M. (1998). The effect of exercise on clinical depression and depression resulting from mental illness: A meta-analysis. Journal of Sport & Exercise Psychology, 20(4), 339–357.
Craft, L. L., & Perna, F. M. (2004). The benefits of exercise for the clinically depressed. The Primary Care Companion to the Journal of Clinical Psychiatry, 6(3), 104–111. https://doi. org/10.4088/pcc.v06n0301
Cunningham, A., & Duffy, A. (2019). Investing in our future: Importance of postsecondary student mental health research. The Canadian Journal of Psychiatry, 64(2), 79–81. https://doi.org/10.1177/0706743718819491
Czosnek, L., Lederman, O., Cormie, P., Zopf, E., Stubbs, B., & Rosenbaum, S. (2018). Health benefits, safety and cost of physical activity interventions for mental health conditions: A meta-review to inform translation efforts. Elsevier BV.
https://doi.org/10.1016/j.mhpa.2018.11.001
Deng, Y., & Fan, A. (2022). Trends in sports participation in adolescents: Data from a large-scale sample in the US adolescents. Frontiers in Public Health, 10, https://doi. org/10.3389/fpubh.2022.960098
Dodemaide, P., Merolli, M., Hill, N., & Joubert, L. (2022). Do social media impact young adult mental health and wellbeing? A qualitative study. The British Journal of Social Work, 52(8), 4664–4683. https://doi.org/10.1093/bjsw/ bcac078
Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., & Payne, W. R. (2013). A systematic review of the psychological and social benefits of participation in sport for adults: Informing development of a conceptual model of health through sport. The International Journal of Behavioral Nutrition and Physical Activity, 10(98), 1–14. https://doi. org/10.1186/1479-5868-10-135
Elzanaty, M. Y., Gamal, M. M., Ahmed, G. M., Rahman, A. M. A., & Tawfik, R. M. (2021). Effect of aerobic versus anaerobic exercise on quality of life in stroke patients. International Journal of Human Movement and Sports Sciences. https:// doi.org/10.13189/saj.2021.090632
Enoksen, E. (2011). Drop-out rate and drop-out rate reasons among promising Norwegian track and field athletes: A 25 year study. Scandinavian Sport Studies Forum, 2, 19–43.
Everson, E. S., Daley, A. J., & Ussher, M. (2008). The effects of moderate and vigorous exercise on desire to smoke, withdrawal symptoms and mood in abstaining young adult smokers. Mental Health and Physical Activity, 1(1), 26–31. https://doi.org/10.1016/j.mhpa.2008.06.001
Fleury, J., & Lee, S.M. (2006). The social ecological model and physical activity in African American women. American Journal of Community Psychology, 37, 129–140 (2006). https://doi.org/10.1007/s10464-005-9002-7
Folkins, C. H., & Sime, W. E. (1981). Physical fitness training and mental health. The American Psychologist, 36(4), 373–389. https://doi.org/10.1037//0003-066x.36.4.373
Fusar-Poli, P., Correll, C. U., Arango, C., Berk, M., Patel, V., & Ioannidia, J. P. A. (2021). Preventative psychiatry: A blueprint for improving the mental health of young people. World Psychiatry, 20(2), 200–221. https://doi.org/10.1002/ wps.20869
Gaudlitz, K., Plag, J., Dimeo, F., & Ströhle, A. (2014). Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depression and Anxiety, 32, 221–228. https://doi.org/10.1002/da.22337
Gruber, J., Hinshaw, S. P., Clark, L. A., Rottenberg, J., & Prinstein, M. J. (2023). Young adult mental health beyond the COVID-19 Era: Can enlightened policy promote long-term change? Policy Insights from the Behavioral and Brain Sciences, 10(1), 75–82. https://doi. org/10.1177/23727322221150199
Handy, A., Mangal, R., Stead, T.S., Coffee, R. L., Jr., & Ganti, L. (2022). Prevalence and impact of diagnosed and
undiagnosed depression in the United States. Cureus, 14(8), 1–5. https://doi.org/10.7759/cureus.28011
Harvard T. H. Chan School of Public Health. (2015). Sports and health in America. https://media.npr.org/documents/2015/ june/sportsandhealthpoll.pdf
Haslam, C., Cruwys, T., Haslam, S. A., & Jetten, J. (2015). Social connectedness and health. Encyclopedia of Geropsychology, 1–10. https://doi.org/10.1007/978-981-287-080-3_46-2
Haverfield, M. C., Ilgen, M., Schmidt, E., Shelley, A., & Timko, C. (2019). Social support networks and symptom severity among patients with co-occurring mental health and substance use disorders. Community Mental Health Journal, 55(5), 768–776. https://doi.org/10.1007/s10597019-00396-7
Herbison, J. D., Vierimaa, M., Côté, J., Martin, L. J. (2019). The dynamic nature of connection and its relation to character in youth sport. International Journal of Sport and Exercise Psychology, 17(6), 568–577.
Hoye, R., Nicholson, M., & Brown, K. (2015). Involvement in sport and social connectedness. International Review for the Sociology of Sport, 50(1), 3–21. https://doi.org/10.3200/ JACH.57.5.521-526
Huberty, J., Puzia, M. E., Green, J., Vlisides-Henry, R. D., Larkey, L., Irwin, M. R., & Vranceanu, A. M. (2021). A mindfulness meditation mobile app improves depression and anxiety in adults with sleep disturbance: Analysis from a randomized controlled trial. General Hospital Psychiatry, 73, 30–37. https://doi.org/10.1016/ j.genhosppsych.2021.09.004
Institute of Medicine & National Research Council. (2015). Investing in the health and well-being of young adults. National Academies Press. https://www.ncbi.nlm.nih.gov/ books/NBK284787/pdf/Bookshelf_NBK284787
Jones, M., Zakrajsek, R., & Eckenrod, M. (2022). Mental performance and mental health services in NCAA D1 athletic departments. Association for Applied Sport Psychology, 2(1), 4–18. https://doi.org/10.55743/000010
Jurewicz, I. (2015). Mental health in young adults and adolescents: Supporting general physicians to provide holistic care. Clinical Medicine, 15(2), 151–154. https:// doi.org/10.7861/clinmedicine.15-2-151
Kanters, M. A., Bocarro, J. N., Edwards, M. B., Casper, J. M., & Floyd, M. F. (2013). School sport participation under two school sport policies: Comparisons by race/ethnicity, gender, and socioeconomic status. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 45, 113–121. https://doi.org/10.1007/s12160012-9413-2
Kianian, T., Kermansaravi, F., Saber, S., & Aghamohamadi, F. (2018). The impact of aerobic and anaerobic exercises on the level of depression, anxiety, stress and happiness of non-athlete male. Zahedan Journal of Research in Medical Sciences, 20(1), 1–6. https://doi.org/10.5812/zjrms.14349
Kramer, A. (2020). An overview of the beneficial effects of exercise on health. Advances in Experimental Medicine and
Biology, 1228, 3–22. https://doi.org/10.1007/978-981-151792-1_1
Liu, S. R., Davis, E. P., Palma, A. M., Sandman, C. A., & Glynn, L. M. (2022). The acute and persisting impact of COVID-19 on trajectories of adolescent depression: Sex differences and social connectedness. Journal of Affective Disorders, 299, 246–255. https://doi.org/10.1016/j.jad.2021.11.030
Lopez, C. M., Driscoll, K. A., & Kistner, J. A. (2009). Sex differences and response styles: Subtypes of rumination and associations with depressive symptoms. Journal of Clinical Child and Adolescent Psychology, 38(1), 27–35. https://doi.org/10.1080/15374410802575412
Lower, L. M., & Turner, B. A. (2016). Examination of the 3x2 achievement goal model in collegiate recreation: Comparison across sport programs. Journal of Amateur Sport, 2(2), 75–102. https://doi.org/10.17161/jas.v0i0.5689
Lozano-Sufrategui, L., Pringle, A., Carless, D., & McKenna, J. (2017). ‘It brings the lads together’: A critical exploration of older men’s experiences of a weight management programme delivered through a Healthy Stadia project. Sport in Society, 20(2), 303–315. https://doi.org/10.1080/17 430437.2016.1173912
Madrigal, L., & Robbins, J. E. (2020). Student-athlete stress: An examination in United States collegiate athletics. Journal for the Study of Sports and Athletes in Education, 14(2), 123–139. https://doi.org/10.1080/19357397.2020.1774261
Making Caring Common. (2023). On edge: Understanding and preventing young adults’ mental health challenges. https:// mcc.gse.harvard.edu/reports/on-edge
Marks, S. (2017). Psychotherapy in historical perspective. History of the Human Sciences, 30(2), 3–16. https://doi. org/10.1177/0952695117703243
Marshall, J. M., Dunstan, D. A., & Bartik, W. (2020). Clinical or gimmickal: The use and effectiveness of mobile mental health apps for treating anxiety and depression. The Australian and New Zealand Journal of Psychiatry, 54(1), 20–28. https://doi.org/10.1177/0004867419876700
Marsters, C., Tiatia-Seath, J., & Shiu, R. N. (2020). Social connectedness and mental wellbeing for young pacific rugby union and rugby league players: A qualitative study. The International Journal of Sport and Society, 11(4), 55–76. https://doi.org/10.18848/2152-7857/CGP
Martindale, E., Devlin, A. S., & Vyse, S. A. (1990). Participation in college sports: Motivational differences. Perceptual and Motor Skills, 71(3), 1139–1150. https://doi.org/10.2466/ PMS.71.8.1139-1150
Martino, J., Pegg, J., & Frates, E. P. (2015). The connection prescription: Using the power of social interactions and the deep desire for connectedness to empower health and wellness. American Journal of Lifestyle Medicine, 11(6), 466–475. https://doi.org/10.1177/1559827615608788
Martinsen, E. W., Hoffart, A., & Solberg, O. (1989). Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. Comprehensive
Psychiatry, 30(4), 324–331. https://doi.org/10.1016/0010440x(89)90057-6
Matud, M. P., Díaz, A., Bethencourt, J. M., & Ibáñez, I. (2020). Stress and psychological distress in emerging adulthood: A gender analysis. Journal of Clinical Medicine, 9(9), 2859. https://doi.org/10.3390/jcm9092859
Mikkelsen, K., Stojanovska, L., Polenakovic, M., Bosevski, M., & Apostolopoulos, V. (2017). Exercise and mental health. Maturitas, 106, 48–56. https://doi.org/10.1016/j. maturitas.2017.09.003
Morres, I. D., Hatzigeorgiadis, A., Stathi, A., Comoutos, N., Arpin-Cribbie, C., Krommidas, C., & Theodorakis, Y. (2019). Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety, 36(1), 39–53. https://doi.org/10.1002/da.22842
Musyimi, C. W., Mutiso, V., N., Loeffen, L., Krumeich, A., & Ndetei, D. M. (2018). Exploring mental health practice among traditional health practitioners: A qualitative study in rural Kenya. BMC Complementary and Alternative Medicine, 18(1), 1–10. https://doi.org/10.1186/s12906018-2393-4
National Institute of Mental Health. (2023, March). Mental illness .https://www.nimh.nih.gov/health/statistics/ mental-illness
National Institute of Mental Health. (2023, September). Depression .https://www.nimh.nih.gov/health/topics/ depression
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi. org/10.1037//0021-843x.100.4.569
North, T. C., McCullagh, P., & Tran, Z. V. (1990). Effect of exercise on depression. Exercise and Sport Sciences Reviews, 18, 379–415.
Ozbay, F., Johnson, D. C., Dimoulas, E., Morgan, C. A., Charney, D., & Southwick, S. (2007). Social support and resilience to stress: From neurobiology to clinical practice. Psychiatry, 4(5), 35–40.
Parker, G., & Paterson, A. (2015). Differentiating ‘clinical’ and ‘non-clinical’ depression. Acta Psychiatrica Scandinavica, 131(6), 401–407. https://doi.org/10.1111/acps.12385
Parker, J. D. A., Summerfeldt, L. J., Hogan, M. J., & Majeski, S. A. (2004). Emotional intelligence and academic success: examining the transition from high school to university. Personality and Individual Differences, 36(1), 163–172. https://doi.org/ 10.1016/S0191-8869(03)00076-X
Perraton, L. G., Kumar, S., & Machotka, Z. (2010). Exercise parameters in the treatment of clinical depression: a systematic review of randomized controlled trials. Journal of Evaluation in Clinical Practice, 16(3), 597–604. https:// doi.org/10.1111/j.1365-2753.2009.01188.x
Pharr, J. R., Lough, N. L., & Terencio, M. A. (2019). Health and sociodemographic differences between individual and
team sport participants. Sports (Basel), 7(6), 1–9. https:// doi.org/10.3390/sports7060150
Pluhar, E., McCracken, C., Griffith, K. L., Christino, M. A., Sugimoto, D., & Meehan, W. P., III. (2019). Team sport athletes may be less likely to suffer from anxiety or depression than individual sport athletes. Journal of Sports Science and Medicine, 18(3), 490–496.
Qiu, Fanghui, Peng, W., Li, M., Zhang, L., Zhu, H., Tan, X., Li, H., & Zhang, J. (2019). Effects of physical exercise on negative emotional susceptibility in young adult females: An eventrelated potential study. Brain Research, 1–7. https://doi. org/10.1016/j.brainres.2019.146382
Rindfuss, R. R. (1991). The young adult years: Diversity, structural change, and fertility. Demography, 28(4), 493–512. https://doi.org/10.2307/2061419
Sabiston, C. M., Jewett, R., Ashdown-Franks, G., Belanger, M., Brunet, J., O’Loughlin, E., & O’Loughlin, J. (2016). Number of Years of Team and Individual Sport Participation During Adolescence and Depressive Symptoms in Early Adulthood. Journal of Sport & Exercise Psychology, 38(1), 105–110. https://doi.org/10.1123/jsep.2015-0175
Sáez, I., Solabarrieta, J., & Rubio, I. (2021). Reasons for sportsbased physical activity dropouts in university students. International Journal of Environmental Research and Public Health, 18(11), 5721. https://doi.org/doi: 10.3390/ ijerph18115721
Silveria, H., Moraes, H., Oliveira, N., Coutinho, S. F., Laks, J., & Deslandes, A. (2013). Physical exercise and clinically depressed patients: A systematic review and metaanalysis. Neuropsychobiology, 67(2), 61–68. https://doi. org/10.1159/000345160
Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O’Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C. E., & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine, 57(18), 1203–1209. https://doi.org/10.1136/bjsports-2022-106195
Stanton, R., & Reaburn, P. (2014). Exercise and the treatment of depression: A review of the exercise program variables. Journal of Science and Medicine in Sport, 17(2), 177–182. https://doi.org/10.1016/j.jsams.2013.03.010
Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A. J., & Otto, M. W. (2006). Exercise interventions for mental health: A quantitative and qualitative review. Clinical Psychology: Science and Practice, 13(2), 179–193. https:// doi.org/10.1111/j.1468-2850.2006.00021.x
Sundgot-Borgen, J., Rosenvinge, J. H., Bahr, R., & Schneider, L. S. (2002). The effect of exercise, cognitive therapy, and nutritional counseling in treating bulimia nervosa. Medicine & Science in Sports & Exercise, 34(2), 190–195. https://doi.org/10.1097/00005768-200202000-00002
Sutcliffe, J. H., & Greenberger, P. A. (2020). Identifying psychological difficulties in college athletes. The Journal of
Allergy and Clinical Immunology: InPractice, 8(7), 2216–2219. https://doi.org/10.1016/j.jaip.2020.03.006
Taliaferro, L. A., Rienzo, B. A., Pigg, R. M., Jr, Miller, M. D., & Dodd, V. J. (2009). Associations between physical activity and reduced rates of hopelessness, depression, and suicidal behavior among college students. Journal of American College Health, 57(4), 427–436. https://doi.org/10.3200/ JACH.57.4.427-436
Thapar, A., Eyre, O., Patel, V., & Brent, D. (2022). Depression in young people. The Lancet, 400, 617–631. https://doi. org/10.1016/S0140-6736(22)01012-1
Townsend, K. C., & McWhirter, B. T. (2011). Connectedness: A review of the literature with implications for counseling, assessment, and research. Journal of Counseling & Development, 83(2), 191–201. https://doi. org/10.1002/j.1556-6678.2005.tb00596.x
Valster, K., Cochrane-Snyman, K., Jones, K., & Smith, D. (2022). Mental health prevalence in NCAA division III collegiate athletes. Journal of Athlete Development and Experience, 4(1), 37–55. https://doi.org/10.25035/jade.04.01.04
Venet-Kelma, L., Morvan, Y., Romain, A. J., Mendy, M., Meslier, M., Thoisy, I., Mulin, E., Chirio-Espitalier, M., Dadi, G., Moualla, M., Amado, I., & Kern, L. (2023). Effect of an adapted physical activity program on stress, anxiety, depression in patients with schizophrenia: Study protocol of a randomized-controlled trial. European Archives of Psychiatry and Clinical Neuroscience. https://doi. org/10.1007/s00406-023-01689-5
Villatte, A., Piché, G., & Benjamin, S. (2022). Perceived support and sense of social belonging in young adults who have a parent with a mental illness. Frontiers in Psychiatry, 12, 1–15. https://doi.org/10.3389/fpsyt.2021.793344
Wegner, M., Helmich, I., Machado, S., Nardi, A. E., AriasCarrion, O., & Budde, H. (2014). Effects of exercise on anxiety and depression disorders: Review of meta-analyses and neurobiological mechanisms. CNS & Neurological Disorders: Drug Targets, 13(6), 1002–1014. https://doi.org/ 10.2174/1871527313666140612102841
Wickramaratne, P. J., Yangchen, T., Lepow, L., Parta, B. G., Glicksburg, B., Talati, A., Adekkanattu, P., Euijung, R., Biernacka, J. M., Charney, A., Mann, J. J., Pathak, J., Olfson, M., & Weissman, M. M. (2022). Social connectedness as a determinant of mental health: A scoping review. PLoS ONE, 17(10), 1–30. https://doi.org/10.1371/journal. pone.0275004
Xie, Y., Wu, Z., Sun, L., Wang, G., Xiao, L., & Wang, H. (2021). The effects and mechanisms of exercise on the treatment of depression. Frontiers in Psychiatry, 12, 1–16. https://doi. org/10.3389/fpsyt.2021.705559
Yang, J., Peek-Asa, C., Corlette, J., Cheng, G., Foster, D., & Albright, J. (2007). Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes. Clinical Journal of Sports Medicine, 17(6), 481–487. https://doi.org/10.1097/JSM.0b013e31815aed6b
Code
Social Support
Connection with others
Sense of belonging
Social Networking
Commitment to friends
Socializing with others
Making new friends
Socially ostracizing
Physical Health
Physical activity
Skill mastery
Injuries
Mental Health
Intrinsic motivation
Competitive outlet
Stress relief
Extrinsic motivation
Pressure
Example quote
“Being around like-minded people who enjoy the same sport makes me feel connected” (EN)
“It gives me a sense of belongingness, like I have a group” (OM)
“I continue to show up because of my commitment to my friends, I know they are counting on me” (SN)
“It’s a good time to socialize with others without having to put in a lot of work” (CL)
“It’s introduced me to a lot of people on campus” (DL)
“Sophomore year was my least favorite because I knew no one and everyone was very cliquey” (OM)
“The physical activity allows me to stay in shape” (CL)
“Gives me the opportunity to show off my skills” (OM)
“It’s taken a toll on my shins and my hip” (OM)
“I grew up playing soccer and I just love the sport; it would be weird to stop playing it” (EN)
“It gives me a competitive outlet” (EN)
“It’s a de-stressor, if I’m feeling stressed I will go play basketball” (CL)
“Gives me something to look forward to during the week” (SN)
“It was stressful because everyone was competing for a lot of playing time and there was pressure to perform well” (OM)
Religiosity, which includes religious affiliation, belief, and practice, serves as a protective factor against mental health issues. Extant literature demonstrates that religiosity is negatively associated with depression and suicidality among both adolescents and adults (Cotton et al., 2005; Stack & Kposowa, 2016; Taliaferro et al., 2009; Wong et al., 2009). However, it is unclear whether these results can be generalized to marginalized populations, such as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth. LGBTQ+ individuals are at high risk for psychological distress due to identity-based stressors (Hatzenbuehler et al., 2011; Mays et al., 2007; Meyer, 2003; Plöderl & Tremblay, 2016). For instance, queer youth are four times more likely than their heterosexual and cisgender peers to attempt suicide (Johns et al., 2020). Likewise, in 2022, 67% and 54% of LGBTQ+ youth reported symptoms of anxiety and depression, respectively (The Trevor Project, 2023). While religiosity benefits the general population by providing a sense of community and belonging (Taliaferro et al., 2009; Wong et al., 2006), many religious groups do not affirm LGBTQ+ identities, thereby causing social isolation and identity conflict among queer people (Rodriguez, 2009; Sherry et al., 2010). Results from prior studies examining the effects of religiosity on mental health issues and suicide related behaviors among LGBTQ+ populations are inconclusive (Blosnich et al., 2020; Dyer, 2022; Lefevor et al., 2022, 2021; Lytle et al., 2015, 2018; Oh et al., 2022; Park & Hsieh, 2023). Thus, the effects of religiosity on the psychological well-being of LGBTQ+ people is unclear.
Existing literature indicates that belongingness to religious communities confers mental health benefits for LGBTQ+ individuals (Boppana & Gross, 2019; Gandy et al., 2021; Hamblin & Gross, 2013; Kravolec et al., 2014; Lease et al., 2005; Rodriguez et al., 2013; Rosenkrantz et al., 2016; Schuck & Liddle, 2001; Yarhouse & Carrs, 2012). For instance, religious LGBTQ+ individuals derive healing, inclusion, acceptance, sense of deeper purpose in life, and strength to cope with prejudice from engaging with their faith communities (Gandy et al., 2021; Rosenkrantz et al., 2016; Schuck & Liddle, 2001). Greater belongingness to one’s religious community is also associated with less suicidal ideation (Kravolec et al., 2014). Furthermore, most queer people who have attempted suicide have sought pastoral counselling afterwards (Barnes & Meyer, 2012; Gibbs & Goldbach, 2015; Kralovec et al., 2014; Lease et al., 2005; Meyer et al., 2015; Saewyc et al., 2009). This suggests that LGBTQ+ individuals utilize religious communities as a source of connection during vulnerable moments of need.
However, although religious communities can provide community and social support, LGBTQ+ people often feel excluded on account of their queer identities (Beagan & Hattie, 2015; Pew Research Center, 2013; Schuck & Liddle, 2001). When asked about their perceptions of the attitudes of six major American religious groups towards queer people, LGBTQ+ adults express significant concern. Namely, around 80% view Islam, Mormonism, and Catholicism as unfriendly toward queer individuals; 73% view evangelical Protestantism as unfriendly; and around 45% view Judaism and mainline Protestantism as unfriendly (Pew Research Center, 2013). Additionally, 29% of LGBTQ+ adults report that they have personally “been made to feel unwelcome at a place of worship or religious organization” (Pew Research Center, 2013, para. 4). Religious communities also tend to center around heterosexual families, thereby ignoring the needs of LGBTQ+ people (Schuck & Liddle 2001). Queer individuals’ understanding of religion as generally unfriendly toward them is not unfounded, as 48% of American adults state that their religious beliefs conflict with homosexuality (Pew Research Center, 2014).
Because of their complex intersectional identities, LGBTQ+ people of faith especially struggle with belongingness. Many religious groups are not affirming of queer identities, and LGBTQ+ spaces are commonly hostile toward organized religion (Haldeman, 2002; Sherry et al., 2010; Subhi & Geelan, 2012). As a result, queer religious individuals experience loneliness, exclusion, and ostracization (Beagan & Hattie, 2015). Given that social isolation is the strongest and most reliable predictor of suicide related behaviors (Van Orden et al., 2010), religious LGBTQ+ people could be at particularly high risk for suicide because they struggle to connect with religious and queer communities alike (Haldeman, 2002; Sherry et al., 2010; Subhi & Geelan, 2012). Therefore, identifying strategies that help LGBTQ+ individuals feel a sense of belonging in their communities, whether religious or otherwise, is essential for improving mental health outcomes in this marginalized population.
Of the 51% of American LGBTQ+ adults who are religiously affiliated, 30% state that their religious beliefs conflict with their queer identities (Pew Research Center, 2013). Since conflict between religious beliefs and sexual orientation is associated with higher levels of depression, suicidality, and internalized homophobia (Coyle & Rafalin, 2000; Ganzevoort et al., 2011; Gibbs & Goldbach, 2015; Levy & Reeves, 2011; Wolkomir, 2011), around one-third of religious LGBTQ+ people
may suffer from serious psychological distress. However, while LGBTQ+ people who leave their religious communities in an attempt to resolve conflict between their religious beliefs and queer identities exhibit lower levels of internalized homophobia, they also struggle with higher levels of suicidal ideation and worse mental health (Dahl & Galliher, 2009; Gibbs & Goldbach, 2015). When individuals leave their religious communities, they lose a significant portion of their social network, leading to these negative psychological consequences (Beagan & Hattie, 2015). This indicates that resolving identity conflict without attending to lack of belongingness is likely insufficient for improving mental health outcomes.
Although approximately one-third of religiously affiliated LGBTQ+ adults experience conflict between their religious beliefs and queer identities (Pew Research Center, 2013), Christians are more likely than members of other religious groups to struggle with integrating their religious and queer identities (Beagan & Hattie, 2015; Schuck & Liddle, 2001). Christians experience high rates of identity conflict because many Christian denominations understand homosexuality as sinful (Beagan & Hattie, 2015; Richards & Bergin, 2000; Schuck and Liddle, 2001; Sherry et al., 2010; Subhi & Geelan, 2012). In particular, seven scriptural passages are frequently cited to condemn same-sex relationships (Moon, 2002; Schuck and Liddle, 2001; Yip 1997). Thus, biblical hermeneutics determine how Christians perceive LGBTQ+ identity: for example, Christians who strictly interpret scripture in a literal sense view queerness as “unnatural” or against God’s will (Moon, 2002; Rodriguez, 2009). Fundamentalist and socially conservative Christian communities present LGBTQ+ and Christian identities as mutually exclusive, leading to identity conflict and anxiety among queer Christians (Rodriguez, 2009; Sherry et al., 2010). As a result, LGBTQ+ Christians suffer from a myriad of negative emotional and psychological consequences, including guilt, shame, self-loathing, hopelessness, depression, and suicidality (Beagan & Hattie, 2015; Shallenberger, 1996; Schuck & Liddle, 2001; McMinn, 2005; Murr, 2013). Many fear committing sin and going to hell, as well as rejection by their religious communities (Beagan & Hattie, 2015; Murr, 2013; Schuck & Liddle, 2001). Despite these challenges, Christianity remains the most common religion among LGBTQ+ people: 42% of religiously affiliated queer adults identify as Christian (Pew Research Center, 2013). Therefore, due to their sizable population and greater inclination toward identity conflict (Beagan & Hattie, 2015; Schuck & Liddle, 2008), queer Christians should serve as the starting point for further research on the effects of religiosity among LGBTQ+ individuals.
Existing literature suggests that a variety of different tools can help religious LGBTQ+ Christians integrate their religious and queer identities, as well as achieve a sense of belonging to their religious communities (Beagan & Hattie, 2015; Dahl and Galliher, 2009; Murr, 2013; Schuck & Liddle, 2001). While few
LGBTQ+ Christians choose to leave behind religion entirely in order to resolve identity conflict, most eventually return to their religious communities after coming out or join queer-affirming denominations of their childhood faith tradition (Schuck & Liddle, 2001). Studying scripture and theology also appears to be an important tool for identity integration, as it provides LGBTQ+ Christians with contextualized and nuanced understandings of their religions’ teachings regarding gender and sexuality (Beagan & Hattie, 2015; Dahl and Galliher, 2009; Schuck & Liddle, 2001). Specifically, LGBTQ+ Christians participating in qualitative studies emphasize the ambiguity of biblical teachings on queer identities, as well as issues of translation and interpretation (Beagan & Hattie, 2015; Schuck & Liddle, 2001).
Engaging in religious ritual could also help reduce suicide related behaviors among LGBTQ+ people. Frequency of service attendance is associated with less suicidal ideation in the general population (Taliaferro et al., 2009), but this relationship is conditional among queer individuals. Among LGBTQ+ Christians whose churches reject queer identities, frequency of service attendance is positively associated with anxiety, depression, and internalized homophobia, all of which increase one’s risk of suicide related behaviors. In contrast, among LGBTQ+ Christians whose churches affirm queer identities, frequency of service attendance is negatively associated with depression and internalized homophobia (Boppana & Gross, 2019; Hamblin & Gross, 2013). Affiliation with queer-affirming religious communities is also related to higher self-esteem in LGBTQ+ populations (Lease et al., 2005; Rodriguez et al., 2013; Yarhouse & Carrs, 2012). Religiosity serves as a protective factor against psychological distress and provides mental health benefits for LGBTQ+ Christians only when they engage with affirming churches (Boppana & Gross, 2019; Hamblin & Gross, 2013; Lease et al., 2005; Rodriguez et al., 2013; Yarhouse & Carrs, 2012), which indicates that acceptance of queer identity has a positive impact on the well-being of queer individuals. This potentially obscures whether religiosity in and of itself can be advantageous for LGBTQ+ people, or if religious communities must also be queer-affirming in order for them to benefit.
Research demonstrates that conflict between one’s queer identity and religious beliefs is common among LGBTQ+ people, particularly Christians (Beagan & Hattie, 2015; Boppana & Gross, 2019; Hamblin & Gross, 2013; Pew Research Center, 2013; Schuck & Liddle, 2001; Sherry et al., 2010), which leads to increased risk of suicide related behaviors and other mental health issues (Coyle & Rafalin, 2000; Ganzevoort et al., 2011; Gibbs & Goldbach, 2015; Levy & Reeves, 2011; Wolkomir, 2011). Several studies suggest that identity integration and belongingness can be achieved through forming supportive social networks, engaging in religious education, and participating in religious rituals in queer-affirming environments (Beagan & Hattie, 2015; Boppana & Gross, 2019; Dahl and Galliher, 2009; Hamblin & Gross, 2013). However, more research is needed to
substantiate the effectiveness of these strategies, as extant studies contain several oversights. Most notably, existing research that addresses religiosity among LGBTQ+ people rarely hones in on a particular religious and/or denominational affiliation, thereby homogenizing the experiences of members from disparate faith traditions (e.g., Dyer, 2022; Lytle et al., 2015; Oh et al., 2022; Schuck et al., 2001). Since different religious groups, including across denominations within the same religion, hold diverse views on same-sex relationships (Pew Research Center, 2014), disregarding denominational differences likely obscures the results of previous studies. Given that 42% of religious LGBTQ+ adults identify as Christian (Pew Research Center, 2013), the current study will focus on Christians and clearly delineate denominational affiliations. The following question will be examined: How do LGBTQ+ Christian young adults navigate their queer identities in relation to their religious beliefs and communities?
Four Christian young adults who identify as LGBTQ+ and are active members of their religious communities participated in this qualitative study. All participants were graduate or undergraduate students, ranging from ages 20-23. They are members of Canterbury Downtown (the campus ministry of the Episcopal Diocese of New York in lower Manhattan) or affiliates of the Multifaith Advisory Council of the Center for Global Spiritual Life at New York University, and attend church every week and engage in daily ritual practices. Participants represented a variety of queer identities. Using pseudonyms, they identified as the following: Finn (he/him) is Catholic and bisexual; Marie (they/them) is a non-denominational Christian and non-binary lesbian; Daniel (he/they) is Unitarian Universalist, Episcopal, transgender, and bisexual; and Charlotte (she/her) is Episcopal and bisexual.
Semi-structured 30-minute interviews were conducted with each participant, focusing on the formation of LGBTQ+ identity in relation to Christian beliefs and belongingness as a queer person in Christian communities. Three out of four participants were interviewed in-person; the fourth was interviewed over Zoom. Brief notes regarding recurring themes discussed by participants were taken during the interviews. All interviews were audio recorded and later transcribed using the software Otter AI.
Interview transcripts were coded at the sentence level using grounded theory. Each sentence received no code, one code, or multiple codes. The researcher began by reading one interview transcript using open coding, noting common ideas that the participant mentioned. Then, the researcher read the same transcript again using axial coding, grouping together similar
codes into broader themes. Finally, the developing coding system was used to analyze the other three transcripts, during which codes were added and removed based on their high and low frequencies of occurrence, respectively.
Four main themes emerged from the data, each of which were then subdivided into three to five codes. See Appendix A for descriptions of themes and codes.
Two of the participants were taught to be affirming of LGBTQ+ people by their childhood Christian communities. For example, Charlotte noted that growing up in the Episcopal Church, she learned that queerness is not a sin and that God loves everyone equally. Another participant was taught to be tolerant toward LGBTQ+ individuals: Finn, who was raised Catholic, learned that being LGBTQ+ in and of itself is not wrong, but expressions of queer identity are sinful. In contrast, three participants were taught by certain Christian communities that they interacted with to be unaccepting toward LGBTQ+ individuals. For instance, Marie, who was raised in a nondenominational evangelical church in Georgia, received negative messaging about queer identity throughout their childhood: “I was taught that [queerness] was a sin, and that I was going to go to hell… it’s a sin like lying… all sins [are] equal because at the end of the day, we are all sinners and need redemption.” Marie’s explanation highlights how evangelicals understand queerness to be a choice, which renders it punishable; therefore, one must seek forgiveness from God in order to be freed from one’s queerness.
Interestingly, three out of four participants learned different teachings regarding LGBTQ+ identity from the various Christian communities that they were either members of or proximate to. For example, Finn received different types of negative messaging about LGBTQ+ people from his childhood Catholic parish and evangelical groups in his home state of Texas:
I had been very familiar with the stance on same-sex marriage when it came to the evangelical church. And so I think that it made things worse, because it was very much like no, being queer is entirely a sin, is entirely a choice, and you will go to hell for it. It’s sort of this idea that you could be almost cured from your homosexuality.
Finn expressed that both Catholic and evangelical teachings influenced his understanding of his own queer identity. Specifically, the Catholic Church condemns same-sex relationships but not necessarily gay people, whereas most evangelicals believe that queerness is sinful in and of itself; the negative view of LGBTQ+ people that Finn adopted from his Catholic faith was compounded by more extreme evangelical influences. However, despite most participants encountering messages about LGBTQ+ identity in multiple Christian settings, three out of four participants also stated that it was not a frequent
topic of conversation in church. While churches evidently hold strong opinions about queerness, it was often avoided in conversation: for instance, as Marie explained, certain parishes assume that LGBTQ+ people do not exist in their midst, leading to silence on this subject. The diversity of teachings on queerness that participants learned from various Christian communities highlights the impact of denominational differences.
Two out of four participants have previously experienced identity conflict: they originally struggled to internally reconcile their LGBTQ+ identities with their Christian beliefs. For instance, throughout his childhood, Daniel did not believe that it was possible to be a faithful Christian as a queer person due to unaccepting teachings that he had learned. As a result, he suffered from internalized transphobia for several years and thought that he should be “stronger than [his] gender dysphoria” in order to live a morally “better life.” This illustrates how Daniel believed that his gender identity needed to be corrected according to his religious beliefs, rendering him initially unable to embrace being transgender.
Another participant, Marie, compartmentalized their queer and Christian identities. They grew up and continue to attend non-denominational churches that are unaccepting of queer identities. Interestingly, Marie noted that they never experienced identity conflict: “I think [queer and Christian] identities aren’t mutually exclusive. So it was, to other people, perhaps strange, but it was never like a personal thing.” While Marie did not struggle with identity conflict, they also did not achieve identity integration, as they do not openly identify as lesbian or nonbinary at church and often keep their Christian faith concealed in queer spaces. Marie’s experience illustrates that attending churches that are unaccepting toward LGBTQ+ people is not necessarily associated with identity conflict. However, their choice to remain a member of a Christian community that is unaccepting of LGBTQ+ people also prevents them from openly integrating their religious and queer identities.
In contrast, Charlotte has always experienced identity integration because she was raised in the Episcopal Church, which is affirming of LGBTQ+ people. She shared that her mother, who is an Episcopal priest, and her father, who is a New Testament scholar, taught her to normalize LGBTQ+ identity: “I always grew up with gay people leading church and teaching and… with the idea that God made us all how we’re supposed to be and that there’s nothing wrong with being gay and God loves you just as much.” Charlotte exemplifies that not all Christians struggle to reconcile their queer and Christian identities. She also explicitly related learning to be affirming of LGBTQ+ people to her experience of identity integration, which suggests that queer-affirming Christian teachings can positively influence identity formation. Daniel, Finn, and Charlotte all claimed that the Christian teachings on queerness that they were taught throughout their formative years shaped their identity formation, thereby establishing a plausible connection between
these two themes.
All four participants felt a sense of belonging to their current congregations through shared religious practices. For instance, Marie noted that they regularly attend non-denominational churches because they enjoy the Pentecostal and charismatic influences on their worship, such as lack of structure and style of music included. Marie occasionally attends Episcopal services because of the LGBTQ+ community that exists within the Episcopal Church, but they dislike its emphasis on liturgy and ritual. Therefore, while the Episcopal Church affirms their queer identity, Marie does not feel a sense of religious connection in this denomination.
All participants except Marie have formed peer and mentor relationships with other LGBTQ+ Christians through their congregations; Finn, Daniel, and Charlotte all currently belong to parishes that are affirming of LGBTQ+ people. (Although the Catholic Church as a whole is not affirming of queer individuals, Finn’s specific Catholic parish is welcoming toward them.) While Marie does not have LGBTQ+ connections through their church, they reported feeling a sense of belonging through sharing the same ethnic and cultural background as other congregation members. This illustrates that various facets of identity can serve as sources of belongingness in Christian communities, and non-affirming churches do not necessarily prevent queer people from forming social connections.
Two out of four participants noted that LGBTQ+ representation in church protected them from experiencing identity conflict or helped them achieve identity integration. Both Charlotte and Daniel grew up with openly queer clergy in their congregations, which conveyed to them that queer people can fully partake in religious rituals, including serving as leaders. Similarly, three out of four participants also emphasized the importance of religious authorities affirming their queer identities. Charlotte, as well as Daniel and Finn when they became members of parishes that are affirming of LGBTQ+ people, were explicitly instructed by priests and scholars that queer people can live faithfully as Christians and be righteous in God’s sight without ridding themselves of their queerness. Learning queer-affirming teachings from religious authorities provided participants with a sense of confidence in their identities as LGBTQ+ Christians, thereby helping them embrace both their queerness and religiosity.
Additionally, three out of four participants shared that studying scripture, theology, and history was crucial for experiencing identity integration and belongingness to their Christian communities. Both Charlotte and Finn expressed that reading scripture from a historical-critical perspective allowed them to appropriately contextualize passages in the Bible that discuss same-sex relationships. For instance, Finn demonstrated extensive knowledge of biblical passages that are frequently
employed by Christians to condemn homosexuality: Sodom and Gomorrah… was a misinterpretation, but even if it was true, the reality is, the Old Testament isn’t applied to [Christians]... When Christ was crucified, the Old Covenant was null and void—essentially, it was fulfilled. [Christians] can eat pork and we can wear different fabrics. In the New Testament, the fact that Jesus Christ never… talked about homosexuality at all… A lot of what Paul said was mistranslated… biblical analysis helped in that regard. Finn attributed his acceptance of his bisexuality to his knowledge of scripture, theology, and history, clearly exemplifying how religious studies can aid LGBTQ+ Christians in navigating the controversy that surrounds their identities. Furthermore, all four participants held positive beliefs about God that helped them personally come to terms with their identity as queer Christians. Daniel and Charlotte highlighted God’s unconditional love for all people, while Finn and Marie emphasized their trust in God as the provider of justice and peace. In particular, Finn boldly stated that “Christ was and is for the marginalized. That includes LGBT people.” Despite the current teachings of the Catholic Church, Finn believes that God ultimately supports LGBTQ+ people because he conceptualizes God as someone who stands with the oppressed. The positive characteristics that all four participants attributed to God strongly suggests that one’s conceptualization of God impacts one’s understanding of queer identity. In fact, in certain cases, one’s personal beliefs about God can hold greater significance than official doctrine.
The current study indicates that LGBTQ+ Christian young adults navigate their queer identities in relation to their Chrisian beliefs and communities by attempting to integrate their queer and Christian identities, as well as finding various sources of belongingness to their religious communities. Findings corroborated existing research that portrays many churches as unaccepting toward LGBTQ+ people (Beagan & Hattie, 2015; Dahl & Galliher, 2009; Murr, 2013; Pew Research Center, 2014; Schuck & Liddle, 2001; Sherry et al., 2010), as most participants have encountered such communities. However, results did not reflect previous studies that portray all LGBTQ+ Christians as having experienced identity conflict at some point in their lives (Beagan & Hattie, 2015; Murr, 2013; Schuck & Liddle, 2001; Sherry et al., 2010), since half of the participants in the current study did not struggle with identity conflict. Additionally, in contrast to findings from extant literature, the majority of participants claimed that LGBTQ+ identity was not frequently discussed in their childhood Christian communities.
The results of the current study suggest that churches do not necessarily need to be affirming of LGBTQ+ Christian young adults in order for them to feel a sense of belonging, but do need to be affirming in order for them to achieve identity integration. Therefore, churches that affirm queer identities should provide
more mental health benefits. The lack of a consistent association between teachings on LGBTQ+ identity and identity formation among queer Christians could be attributed to participants receiving messages about queer identity from sources outside of one’s own church, as well as personally holding strong positive beliefs about God despite what one’s church may officially teach. Moreover, different facets of identity, including religion, culture, and queerness, can all serve as points of connection between LGBTQ+ Christian young adults and their congregations. The current study suggests that Christian communities, particularly those that are affirming of queer identities, have the potential to improve mental health outcomes among LGBTQ+ Christian young adults. As such, religiosity should support, rather than hinder, the well-being of queer populations. These results can help psychologists and mental healthcare providers better understand the unique challenges that queer Christians face, as well as priests and pastors (or religious leaders more broadly) who wish to create more welcoming and inclusive environments for queer youth.
Notwithstanding its contributions, there are also several limitations to the current study, including a small sample size and use of convenience sampling. For instance, all of the participants are students at New York University and reside in New York City, which are relatively socially progressive environments. All four participants were also raised in the southern United States; the geographic location of their upbringings could have contributed toward both their experiences with Christian communities and their perceptions of queer identity. The current study should be replicated with a larger sample within and across different religious groups and denominational affiliations. Additionally, future research should explore how culture/ethnicity impact identity and belongingness among religious LGBTQ+ young adults, as well as consider influences from online religious communities, especially since they have been popularized by the recent COVID-19 pandemic. The potential mental health benefits that LGBTQ+ Christian young adults can derive from their religious communities illustrate the need for further research on the complex intersection of religiosity and queer identity.
Barnes, D. M., & Meyer, I. H. (2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. American Journal of Orthopsychiatry, 82(4), 505–515. https://doi.org/10.1111/ j.1939-0025.2012.01185.x
Beagan, B. L., & Hattie, B. (2015). Religion, spirituality, and LGBTQ identity integration. Journal of LGBT Issues in Counseling, 9(2), 92–117. https://doi.org/10.1080/1553860 5.2015.1029204
Blosnich, J. R., Henderson, E. R., Coulter, R. W. S., Goldbach, J. T., & Meyer, I. H. (2020). Sexual orientation change efforts, adverse childhood experiences, and suicide ideation and attempt among sexual minority adults, united states, 2016–2018. American Journal of Public Health, 110(7), 1024–1030. https://doi.org/10.2105/AJPH.2020.305637
Boppana, S., & Gross, A. M. (2019). The impact of religiosity on the psychological well-being of LGBT Christians. Journal of Gay & Lesbian Mental Health, 23(4), 412–426. https:// doi.org/10.1080/19359705.2019.1645072
Coyle, A., & Rafalin, D. (2000). Jewish gay men’s accounts of negotiating cultural, religious, and sexual identity: A qualitative study. Journal of Psychology & Human Sexuality, 12(2), 21–48. https://doi.org/rg/10.1300/J056v12n04_02
Cotton, S., Larkin, E., Hoopes, A., Cromer, B. A., & Rosenthal, S. L. (2005). The impact of adolescent spirituality on depressive symptoms and health risk behaviors. Journal of Adolescent Health, 36(6), 529.e7–529.e14. https://doi. org/10.1016/j.jadohealth.2004.07.017
Dahl, A. L., & Galliher, R. V. (2009). LGBQQ young adult experiences of religious and sexual identity integration. Journal of LGBT Issues in Counseling, 3(2), 92–112. https:// doi.org/10.1080/15538600903005268
Dyer, W. J. (2022). Refining research on the intersection between sexual orientation, suicide, and religiosity. Psychology of Religion and Spirituality, 14(2), 179–188. https://doi. org/10.1037/rel0000451
Gandy, M. E., Natale, A. P., & Levy, D. L. (2021). “We shared a heartbeat”: Protective functions of faith communities in the lives of LGBTQ+ people. Spirituality in Clinical Practice, 8(2), 98–111. https://doi.org/10.1037/scp0000225
Ganzevoort, R. R., van der Laan, M., & Olsman, E. (2011). Growing up gay and religious. conflict, dialogue, and religious identity strategies. Mental Health, Religion, & Culture, 14(3), 209–222. https://doi.org/10.1080/13674670903452132
Gibbs, J. J., & Goldbach, J. (2015). Religious conflict, sexual identity, and suicidal behaviors among LGBT young adults. Archives of Suicide Research, 19(4), 472–488. https://doi.or g/10.1080/13811118.2015.1004476
Haldeman, D. C. (2002). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33(3), 260–264. https://doi.org/10.1037/0735-7028.33.3.260
Hamblin, R., & Gross, A. M. (2013). Role of religious attendance and identity conflict in psychological well-being. Journal
of Religion and Health, 52(1), 817–827. https://doi. org/10.1007/s10943-011-9514-4
Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2011). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health, 100(3), 388–573. https://doi.org/10.2105/ AJPH.2009.168815
Kralovec, K., Fartacek, C., Fartacek, R., & Plöderl, M. (2014). Religion and suicide risk in lesbian, gay and bisexual Austrians. Journal of Religion and Health, 53(1), 413–423. https://doi.org/10.1007/s10943-012-9645-2
Lease, S. H., Horne, S. G., & Noffsinger-Frazier, N. (2005). Affirming faith experiences and psychological health for caucasian lesbian, gay, and bisexual individuals. Journal of Counseling Psychology, 52(3), 378–388. https://doi. org/10.1037/0022-0167.52.3.378
Lefevor, G. T., Park, S. Y., Acevedo, M. J., & Jones, P. J. (2022). Sexual orientation complexity and psychosocial/health outcomes. Journal of Homosexuality, 69(1), 190–204. https://doi.org/10.1080/00918369.2020.1815432
Levy, D. L., & Reeves, P. (2011). Resolving identity conflict: Gay, lesbian, and queer individuals with a Christian upbringing. Journal of Gay & Lesbian Social Services, 23(1), 53–68. https://doi.org/10.1080/10538720.2010.530193
Lytle, M. C., De Luca, S. M., Blosnich, J. R., & Brownson, C. (2015). Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals. Journal of Affective Disorders, 178(1), 39–45. https://doi.org/10.1016/j. jad.2014.07.039
Mays, V. M., Cochran, S. D., Barnes, N., & W. (2007). Race, racebased discrimination, and health outcomes among African Americans. Annual Review of Psychology, 58(1), 201–225. https://doi.org/10.1146/annurev.psych.57.102904.190212
McMinn, L. G. (2005). Sexual identity concerns for Christian young adults: Practical considerations for being a supportive presence and compassionate companion. Journal of Psychology and Christianity, 24(4), 368–377. https://digitalcommons.georgefox.edu/lang_fac/45
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychology of Sexual Orientation and Gender Diversity, 1(S), 3–26. https://doi. org/10.1037/2329-0382.1.S.3
Meyer, I. H., Teylan, M., & Schwartz, S. (2015). The role of helpseeking in preventing suicide attempts among lesbians, gay men, and bisexuals. Journal of Suicide and Life Threatening Behavior, 45(1), 25–36. https://doi.org/10.1111/sltb.12104
Moon, D. (2002). Religious views of homosexuality. In D. Richardson & S. Seidman (Eds.), Handbook of lesbian and gay studies (pp. 313–328). London, UK: Sage.
Murr, R. (2013). “I became proud of being gay and proud of being Christian”: The spiritual journeys of queer Christian
women. Journal of Religion & Spirituality in Social Work, 32(4), 349–372. https://doi.org/10.1080/15426432.2013.83 9241
Oh, H., Goehring, J., Smith, L., Zhou, S., & Blosnich, J. (2022). Sexual minority status, religiosity, and suicidal behaviors among college students in the United States. Journal of Affective Disorders, 305(1), 65–70. https://doi. org/10.1016/j.jad.2022.02.068
Park, K., & Hsieh, N. (2023). A national study on religiosity and suicide risk by sexual orientation. American Journal of Preventive Medicine, 64(2), 235–243. https://doi. org/10.1016/j.amepre.2022.08.020
Pew Research Center. (2013). A Survey of LGBT Americans. https://www.pewresearch.org/social-trends/2013/06/13/ chapter-6-religion/ Pew Research Center. (2014). Religious Landscape Study. https:// www.pewresearch.org/religion/religious-landscape-study/ Plöderl, M., & Tremblay, P. (2016). Mental health of sexual minorities. A systematic review. International Review of Psychiatry, 27(5), 367–385. https://doi.org/10.3109/09540 261.2015.1083949
Richards, P. S., & Bergin, A. E. (2000). Toward religious and spiritual competency for mental health professionals. In P. S. Richards & A. E. Bergin (Eds.), Handbook of psychotherapy and religious diversity (pp. 3–26). American Psychological Association. https://doi.org/10.1037/10347001
Rodriguez, E. M. (2009). At the intersection of church and gay: A review of the psychological research on gay and lesbian Christians. Journal of Homosexuality, 57(1), 5–38. https:// doi.org/10.1080/00918360903445806
Rodriguez, E. M., Lytle, M. C., & Vaughan, M. D. (2013). Exploring the intersectionality of bisexual, religious/spiritual, and political identities from a feminist perspective. Journal of Bisexuality, 13(3), 285–309. https://doi.org/10.1080/15299 716.2013.813001
Rosenkrantz, D. E., Rostosky, S. S., Riggle, E. D. B., & Cook, Jennifer R. (2016). The positive aspects of intersecting religious/spiritual and LGBTQ identities. Spirituality in Clinical Practice, 3(2), 127–138. http://dx.doi.org/10.1037/ scp0000095
Saewyc, E. M., Homma, Y., Skay, C. L., Bearinger, L. H., Resnick, M. D., & Reis, E. (2009). Protective factors in the lives of bisexual adolescents in North America. American Journal of Public Health, 99(1), 110–117. https://doi.org/10.2105/ AJPH.2007.123109
Schuck, K. D., & Liddle, B. J. (2001). Religious conflicts experienced by lesbian, gay, and bisexual individuals. Journal of Gay & Lesbian Psychotherapy, 5(2), 63–82. https://doi.org/10.1300/J236v05n02_07
Shallenberger, D. (1996). Reclaiming the spirit: The journeys of gay men and lesbian women toward integration. Qualitative Sociology, 19, 195–215. https://doi.org/10.1007/ BF02393418
Sherry, A., Adelman, A., Whilde, M. R., & Quick, D. (2010). Competing selves: Negotiating the intersection of spiritual and sexual identities. Professional Psychology: Research and Practice, 41(2), 112–119. https://doi.org/10.1037/a0017471
Stack, S., & Kposowa, A. J. (2016). Culture and suicide acceptability: A cross-national, multilevel analysis. The Sociological Quarterly, 57(1), 282–303.
Subhi, N., & Geelan, D. (2012). When Christianity and homosexuality collide: Understanding the potential intrapersonal conflict. Journal of Homosexuality, 59(10), 1382–1402. https://doi.org/10.1080/00918369.2012.72463 8
Taliaferro, L. A., Rienzo, B. A., Pigg, R. M., Miller, M. D., & Dodd, V. J. (2010). Spiritual well-being and suicidal ideation among college students. Journal of American College Health, 58(1), 83–90. https://doi.org/10.3200/ JACH.58.1.83-90
Trevor Project, The. (2023). 2023 U.S. national survey on the mental health of LGBTQ young people. https://www. thetrevorproject.org/survey-2023/
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. https://doi.org/10.1037/a0018697
Wolkomir, M. (2011). Wrestling with the angels of meaning: The revisionist ideological work of gay and ex-gay Christian men. Society for the Study of Symbolic Interaction, 24(4), 391–508. https://doi.org/10.1525/si.2001.24.4.407
Wong, Y. J., Rew, L., & Slaikeu, K. D. (2009). A systematic review of recent research on adolescent religiosity/spirituality and mental health. Issues in Mental Health Nursing, 27(2), 161–183. https://doi.org/10.1080/01612840500436941
Yarhouse, M. A., & Carrs, T. L. (2012). MTF transgender Christians’ experiences: A qualitative study. Journal of LGBT Issues in Counseling, 6(1), 18–33. https://doi.org/10. 1080/15538605.2012.649405
Yip, A. K. T. (1997). Attacking the attacker: Gay Christians talk back. British Journal of Sociology, 48, 113–127. https://doi. org/10.2307/591913
Description of Themes and Codes
Themes Codes
Christian Teachings on Queerness: various types of messages that participants learned about LGBTQ+ identity from the Christian communities with which they interacted.
Affirming Teachings: queerness does not conflict with religious beliefs or prevent one from being in right relationship with God
Tolerant Teachings: queer identity and action are viewed as separate issues (i.e., experiencing same-sex attraction is not sinful, but acting on such desires is)
Unaccepting Teachings: queerness is sinful according to religious beliefs and one cannot be in right relationship with God as a queer person
Multiple Teachings: participants received different messages about queer identity from more than one Christian community
Lack of Discussion: queer identity was not frequently discussed in one’s church
Identity Formation: degree to which participants have been able to achieve a coherent and continuous sense of self
Identity Integration: participants view their Christian and queer identities as fully compatible
Identity Compartmentalization: participants separate their Christian and queer identities (e.g., not publicly identifying as LGBTQ+ at church)
Identity Conflict: participants view their Christian and queer identities as irreconcilable with one another
Sources of Belongingness: factors that create a sense of connection between participants and their current Christian communities
Tools for Improving Identity and Belongingness: methods that participants have utilized to successfully integrate their queer and Christian identities and/or establish a sense of belonging to their churches
Religious Connection: shared religious beliefs and practices between participants and other congregation members
LGBTQ+ Connection: participants have established peer and/or mentor relationships with other LGBTQ+ Christians at their churches
Cultural/Ethnic Connection: participants share the same ethnic or cultural background as other congregation members
LGBTQ+ Representation in the Church: participants have seen queer Christian laypeople and clergy practicing their faith and serving as religious leaders, respectively
Affirmation of Queer Identities by Religious Authorities: clergy and scholars explicitly state that LGBTQ+ people are full members of their communities (e.g., they are given equal access to all rites, such as baptism, ordination, and marriage) and do not have to change their queer identities to be in right relationship with God
Religious Studies: learning about scripture, theology, and ecclesiastical history
Strong Positive Beliefs about God: participants view God as a source of love, justice, protection, and/or peace
Externalizing behavior can put children at risk for marked deficits in social skills such as internalizing rules, regulating emotions, developing empathy, and problem solving (Eisenberg et al., 2010; Wakschlag et al., 2012). Moreover, externalizing behaviors are highly prevalent in children with disorders that impact verbal communication (Kanne & Mazurek, 2010; Parkes & McCusker, 2008; van Gameren-Oosterom et al., 2011; Volker at al., 2009). This poses a significant barrier for those children to receive treatment as they navigate interventions targeting behavioral issues and social skills development, which typically involve verbal components (Kamps et al., 1992; Rao et al., 2008). However, music therapy may be a helpful alternative compared to traditional treatment modalities for children with externalizing behaviors, as it utilizes music as an additional mode of communication between the client and therapist through reciprocal musical interaction (Krøier et al., 2021). Supporting its use as a behavioral intervention, music therapy has also been shown to reduce children’s problem behaviors (de Mers et al., 2009; Govindan et al., 2020; Ye et al., 2021). Yet few studies, to date, have examined how music therapy reduces externalizing behaviors and promotes social skills for children with verbal communication difficulties.
Externalizing behavior is defined as antisocial behavior characterized by aggression, delinquency, and hyperactivity (Liu, 2004). Children who exhibit externalizing behaviors are often isolated by their peers and viewed unfavorably by their teachers (Mulvey et al., 2017; Samek & Hicks, 2014), which exacerbates their existing symptoms and creates a vicious cycle of exclusion, poor social skills, and externalizing behaviors (Hukkelberg et al., 2019; Meier et al., 2006; Mulvey et al., 2017; Rubin et al., 2006). If left unaddressed, the negative impacts of externalizing behaviors and social skills deficits can persist into adolescence and adulthood, impacting various domains of professional, social and psychological well-being (Aunola et al., 2000; Erskine et al., 2016; Faraone et al., 2015; Lujiten et al., 2021; Narusyte et al., 2017; Sourander et al., 2007; Sun et al., 2019). To help children with externalizing behaviors improve their social skills, intervention programs foster positive social interactions while simultaneously reducing problematic behaviors (Hukkelberg et al., 2019; Smith et al., 2022). For example, social problemsolving curricula and social competence interventions in school settings have been shown to reduce externalizing behaviors and increase problem-solving (Malti et al., 2011; Van Loan et al., 2018). In addition, Social Skills Training (SST) interventions that focus on social emotional development are also effective
in reducing problem behaviors compared to other behavioral interventions in early childhood education and parental training programs (Malti et al., 2011; Schindler et al., 2015).
SST interventions encourage the acquisition of new social skills, enhancement of existing social skills, and the practice of skill generalization to a wide range of situations (Bellini & Peters, 2008; Rao et al., 2008; Yizengaw, 2022). Specifically, SST enhances communication skills that contribute to socialemotional reciprocity, or mutual initiation and response in a social interaction between two or more people (Reichow, 2012; Yizengaw, 2022). These include nonverbal communication skills, such as use of facial expressions and eye contact, as well as verbal communication skills such as taking turns in the conversation, giving and receiving compliments, addressing others, asking and answering questions, and disclosing information (Kamps et al., 1992; Rao et al., 2008).
SST interventions can promote these skills in various ways, but they traditionally involve trainers explaining verbal skills in a didactic manner, practicing verbal skills with children through role-play, and modeling nonverbal skills for children to imitate (Kamps et al., 1992; Rao et al., 2008). This is followed by a feedback component where children are given the opportunity to use skills with their peers and are positively reinforced, or rewarded, by trainers when they engage successfully (Kamps et al., 1992; Rao et al., 2008). These techniques draw from social learning theory, which describes learning as observing others’ behavior and adjusting one’s own behavior in response to rewards and consequences (Bandura, 1977). Thus, when children observe trainers modeling social skills and are rewarded for successfully applying skills with their peers, they are more likely to exhibit positive social skills post-intervention (Bandura, 1977; Kamps et al., 1992; Rao et al., 2008).
Despite the effectiveness of SST in promoting social skills, some children who display externalizing symptoms do not possess the verbal skills necessary to engage in the role-play and didactic components of SST. For example, children with developmental disabilities, including autism spectrum disorder (ASD), cerebral palsy (CP), and down syndrome (DS) are more likely to experience delays in language development and to exhibit externalizing behavior and social functioning difficulties than their typically developing peers (Buckley, 1993; Filipe et al., 2022; Hughes et al., 2023; Kanne & Mazurek, 2010; Mason-Apps et al., 2018; Mei et al., 2015; 2016; 2020; Parkes & McCusker, 2008; van Gameren-Oosterom et al., 2011; Volker at al., 2009).
Some adaptations of social skills programs employ alternative methods of communication, such as hand gestures or picture communication cards, in order to address comorbid communication difficulties (Gordon et al., 2011; Kroeger et al., 2007). While these adaptations have been found to facilitate children’s communication to request objects in order to fulfill basic needs (e.g. presenting a card with the word “lunch” on it to people when they want to eat), they have not made significant advancements in children’s social communication with peers, as they provide limited options to communicate in a way that establishes a back-and-forth, expressive interaction (Gordon et al., 2011; Kroeger et al., 2007). However, recent research suggests that music therapy can be used to reduce externalizing behaviors (Moore & Hanson-Abromeit, 2018; Porter et al., 2017; Ye et al., 2021) and promote children’s social interactions, nonverbal communication (Geretsegger et al., 2022; Pater et al., 2022), and emotion regulation.
Improvisational music therapy has been found to be particularly helpful for children who have difficulty expressing themselves verbally (Edgerton, 1994; Geretsegger et al., 2014). Improvisational music therapy is non-verbal, subject to personal interpretation, and less socially intimidating compared to traditional therapeutic approaches, since children can freely explore various instruments with music therapists supporting and mirroring their actions without requiring verbal interaction (Ghasemtabar et al., 2015; Srinivasan & Bhat, 2013). These qualities make music therapy an appealing approach for the diverse population of children who exhibit externalizing behaviors, especially those with difficulty in verbal communication (Ghasemtabar et al., 2015; Kim, 2013). Music therapy gives children with communication difficulties an alternative way to practice social-emotional reciprocity (Ghasemtabar et al., 2015; Swanson, 2020; Thompson & Gold, 2013; Yizengaw, 2022), and provides unlimited options for them to express themselves through their musical engagement, which other non-verbal adaptations to SST interventions lack (Gordon et al., 2011; Kroeger et al., 2007).
The use of music as a therapeutic medium can create unique opportunities for social skill-building through musical elements that serve several therapeutic functions (Bharathi et al., 2015; Eren, 2015; Swanson, 2020). For example, harmony and rhythm, such as suspenseful chords or deliberate musical pauses, can be used to cue children’s speech and movement, providing structure for them to engage in turn-taking and collaborative work (Swanson, 2020). Dynamics and pitch can be used to match, respond to, and engage clients. For example, if a therapist wanted to help a client regulate the force they use to hit a drum, they could first match the volume that the client uses, and then lower and raise the volume of their own playing to help the client hit the drum softer or harder (Swanson, 2020). Melody, instrumentation, and timbre can also be used to facilitate
emotional perception through creating a sensory experience (Hailstone et al., 2006). If the therapist wanted to help a client process a sad emotion, for example, they may improvise a song in a minor key to match the client’s mood.
Typically, the therapeutic process involves the initiation of a musical stimulus from the therapist, and a gauge of how much the client reciprocates (Ghasemtabar et al., 2015; Thompson & Gold, 2013). Through successful reciprocal musical interaction with a therapist, children develop generalizable skills to interact with others, including teamwork, collaboration, listening, turn-taking, emotion regulation, and sharing (Ghasemtabar et al., 2015; Swanson, 2020; Thompson & Gold, 2013). As music activates reward centers and triggers dopamine release in the brain (Salimpoor et al., 2015), it can also be used as a positive reinforcer to reward prosocial behavior, while problem behaviors are discouraged through the cessation of music (Friedman & Pfiffner, 2020). This aligns with other treatments for externalizing behavior, in which the use of contingent positive reinforcement as a motivator has predicted the decrease of problematic behaviors and increase of positive behaviors (Friedman & Pfiffner, 2020).
Music therapy interventions have been successful in both reducing children’s externalizing behaviors and promoting their social skills (Ghasemtabar et al., 2015; Ye et al., 2021). Children with social skills deficits demonstrated significantly improved social skills, social functioning, and decreased antisocial behaviors after a music therapy intervention (Chong et al., 2010; Gooding, 2011). Music therapy interventions have also been effective for promoting prosocial behaviors of children with ASD, suggesting that it may be useful when working with clients with other developmental disorders which impact language abilities (Ghasemtabar et al., 2015; Ye et al., 2021). Children with ASD displayed significantly more initiation of interaction, compliant responses, and joyful responses, as well as less antisocial, aggressive externalizing behaviors after music therapy intervention (Kim et al., 2009; Mayer-Benarous et al., 2021). After a group music therapy intervention, children with ASD also showed greater attention span, longer eye contact with peers, sustained social interactions, and less resistance in interaction compared to a control group (Eren, 2015; LaGasse, 2014).
A wealth of previous quantitative research has demonstrated the efficacy of using music therapy to reduce externalizing behaviors and promote social skills in diverse populations. (Gooding, 2011; Kim et al., 2009; Moore & HansonAbromeit, 2018; Porter et al., 2016; Ye et al., 2021). Additionally, qualitative studies have explored the use of music therapy to promote communication in various populations that experience language difficulties (Holck, 2004; Knapik-Szweda, 2019; Perry, 2003). However, there is a lack of qualitative research that examines the use of music therapy techniques to promote social skills while also reducing externalizing behavior in children
with communication difficulties. Thus, to fill this gap in the literature, this qualitative study sought to answer the question: How can music therapy be used to promote social skills and reduce externalizing behaviors in children with communication difficulties?
Participants
Previously recorded sessions of four clients at the Nordoff Robbins Center for Music Therapy at New York University were reviewed. The first client, A, was a four-year-old Asian girl who is visually impaired and non-verbal. The second client, B, was a five-year-old Asian boy diagnosed with autism spectrum disorder (ASD). The third client, C, was a seven-year-old Caucasian girl diagnosed with ASD and processing delays. The last client, D, was a fourteen-year-old African American boy diagnosed with Down Syndrome. All participants exhibited externalizing behaviors and difficulties with verbal communication.
To control for changes in children’s behavior and music therapists’ techniques over the course of treatment, three sessions were reviewed per child, including their first session, a midpoint session, and their final or most recent session. Each session was 30 minutes in length, and took place in a music room which included a piano, guitar, drum set, and instruments selected by the therapists based on children’s personalities and developmental levels. For instance, children who liked to play drums were offered percussive instruments such as desk bells and xylophones, and the use of bulky instruments such as rain sticks was carefully evaluated and discussed prior to the session to ensure children’s and therapists’ safety. There was also a closet full of musical instruments which, depending on their age and behavior, some children were allowed to explore in the sessions. Each session involved two clinicians including a main therapist and a co-therapist. The primary responsibility of the main therapist was to observe the children and make musical decisions including the genre of music, tempo, dynamics, and incorporation of improvisation techniques to respond to children’s behaviors. The primary responsibility of the cotherapist was to use behavioral and musical techniques to support children in the process of music making while reporting additional information about the child (e.g., physical condition, facial expressions) to the main therapist when necessary.
A narrative transcription style, whereby researchers watched the recorded sessions and manually transcribed children’s behaviors and therapist’s techniques, was used to capture the data. Then, researchers used a grounded theory approach to generate two codebooks, one that identified themes related to children’s behavior, and one that identified themes in therapists’ techniques. Researchers separately reviewed 25% of the data (four sessions, one from each child) and developed codes
for both of these codebooks based on patterns they observed in the data. Then, they condensed individual codes into broader themes and subthemes. To establish reliability, discrepancies between each researcher’s coding system were discussed and a consensus was reached. Researchers then used the established codebooks to code the remaining data, as well as to re-code the 25% of the data which was used to develop the system.
The first set of codes highlighted the techniques used by therapists in session. Three broad themes were identified: initiation, instruction, and responses to the child. Therapists varied their use of techniques within each of these themes, which allowed researchers to later identify subthemes including musical, verbal, behavioral initiations and instructions. In addition, therapists’ use of child-centered techniques, response to antisocial behaviors, and physical proximity are identified as subthemes under the theme responses to the child. In the second set of codes, researchers recognized prosocial and antisocial behavior as themes within children’s behaviors. Subthemes including positive engagement, independent engagement, and rule following were identified under the theme positive engagement, and subthemes including externalizing behaviors, emotional dysregulation, and disengagement were identified under the theme of antisocial behavior. Based on the type of behavior children exhibited in sessions, researchers were able to determine which therapeutic techniques were most helpful in treatment. After the coding process was completed, the researchers identified trends between themes in both codebooks by analyzing which therapeutic practices were used to respond to various child behaviors, and how children subsequently responded to the therapeutic practices.
Three prominent themes emerged as the result of the first set of analysis: initiation, instruction, and responses to the child. Therapists initiated interactions when their behavior was not preceded by a related child behavior, or when introducing a new concept, such as a new musical theme or a different topic of conversation. When instructing children, therapists used direct or indirect prompts to elicit specific behaviors from children. Finally, therapists responded to children when their techniques addressed a preceding child behavior.
Under each theme, subthemes emerged based on how the therapists communicated with children. Within the initiation theme, these included musical initiation, verbal initiation, and behavioral initiation. Musical initiation involved the therapist playing an instrument, singing, or speaking rhythmically to initiate an interaction with the child (see Appendix A). In one of client A’s sessions, therapists initiated musically by singing, “hello” and the child’s name to welcome her in. Verbal initiation involved the therapist speaking to the child. The therapist initiated an interaction verbally in a session with client D, asking him, “Did you go to summer camp?” Lastly, behavioral
initiation involved use of non-verbal cues and physical contact (see Appendix A). For example, a therapist tapped client A’s leg in a session, initiating the interaction physically.
Similarly, emergent sub-themes for “therapists instructing” included musical instructions, verbal instructions, and physical instructions. Musical instructions included the use of music to cue a child’s behavior, and the incorporation of verbal instructions into a song. In one session, therapists used musical instructions to prompt client B to count the strings on a guitar by singing, “How many strings do you see? I see…” and pausing, cueing client B to finish the song. Verbal instructions consisted of therapists delivering instructions through directive statements, questions, or more general statements (see Appendix A). In the same session, therapists used verbal instructions by telling client B to “count the strings.” Lastly, physical instructions involved therapists’ use of physical signals or guidance to elicit a specific behavior from the child. When client B did not fill in the gap in the song, the therapist instructed him physically by holding his hand to help him pluck the strings.
Under the final theme, “therapist responding,” the subthemes which emerged included therapists’ responses to children’s antisocial behavior, therapists’ use of child-centered techniques, and therapists’ proximity to the child. Therapists used musical, verbal, and behavioral techniques to respond to children’s antisocial behavior. For example, music was used to respond to antisocial behavior in order to redirect a child’s attention. This occurred when client B tried to push over a drum and the therapist offered him a mallet, attempting to distract him from engaging in the disruptive behavior by redirecting his attention to playing music. In the same session, therapists also used verbal intervention when they saw client B trying to push over a drum by saying, “No, we don’t do that.” Therapists’ behavioral techniques for preventing children’s engagement in aggressive or disruptive behavior included intervening physically and ignoring antisocial behavior by not exhibiting any response (see Appendix A). Additionally, therapists used child-centered techniques by using musical, verbal, or behavioral interactions to respond to their children’s interests and encourage their engagement. For example, when client B played the chimes, the therapists used musical reciprocity to respond by playing high, quick notes on the piano to create a similar sound. In a different session, when client D said, “The water”, the therapist used a child-centered technique by repeating him verbally.
The second set of analysis focused on children’s behavior, with prominent themes of prosocial behaviors and antisocial behaviors emerging during the coding process. Prosocial behaviors refer to children’s successful engagement in sessions, emphasizing children’s social engagement with the therapists. Antisocial behaviors referred to children’s maladaptive responses in sessions, including externalizing behaviors and disengagement.
Children demonstrated prosocial behaviors through
positive engagement with the therapists, independent engagement, following instructions, and adaptively responding to negative stimuli, which emerged as subthemes in the data (see Appendix B). Children engaged positively with the therapists by initiating interactions, responding to the therapists, moving closer to the therapists, maintaining eye contact, and exhibiting positive affect (see Appendix B). For example, client A engaged positively with a therapist who was bouncing her up and down in his lap by laughing, displaying positive affect. Children engaged independently in sessions when exhibiting musical or behavioral engagement without interacting with the therapists (see Appendix B). Children followed instructions by complying with therapists’ instructions and internalizing rules. For instance, client B internalized rules by repeating, “That’s not nice” and “we don’t broke the drums” after the therapists responded to him knocking drums over. Finally, children’s adaptive responses to negative stimuli included children’s emotional and behavioral regulation (see Appendix B). Children exhibited emotional regulation when they had an appropriate reaction to something in the environment that could be perceived as distressing. For example, client D demonstrated emotion regulation when he accidentally knocked an instrument over, creating a startling noise, and he remained calm and apologized. Children engaged in behavioral regulation when correcting accidental behaviors without instruction from therapists and waiting patiently during transitional moments in sessions (see Appendix B).
Children’s antisocial behaviors fell into subthemes of externalizing behaviors, emotional dysregulation, and disengagement. Children exhibited externalizing behaviors when they acted out in a way that disrupted their environment and/or others around them through aggressive, delinquent, and hyperactive behaviors. For example, client D demonstrated aggression by threatening to slap one of the therapists. In another session, client C exhibited hyperactivity when she ran around the music room and climbed on chairs and instruments. Emotional dysregulation occurred when children had an emotional outburst that appeared disproportionate to the stimulus they were reacting to. For example, client C exhibited difficulty regulating anger when she screamed at the therapists for playing the guitar. Lastly, children’s disengagement included children ignoring a therapist’s attempt to engage by remaining unresponsive to a question or instruction, and children’s withdrawal from engagement (see Appendix B).
While musical, verbal, and behavioral techniques were all used in the sessions, children were most responsive to therapists’ musical techniques across the board.
On average, when therapists initiated musical interactions, children responded musically, behaviorally, or verbally 60% of the time, and responded antisocially 17% of the time. In contrast, when therapists initiated interactions verbally or behaviorally, children only responded musically, behaviorally, or verbally 47% of the time, and exhibited antisocial responses 42% of the time.
Children’s use of music to respond to the therapists also varied greatly depending on how the therapist initiated the interaction. When therapists initiated interaction with children musically, children responded musically 50% of the time, compared to 14% of children’s responses being musical when the therapist chose to start the interaction verbally or behaviorally.
This trend of increased responsiveness to musical techniques continued with how children responded to therapists’ instructions. Children followed musically-delivered instructions 80% of the time, whereas they followed verbal instructions 53% of the time, and physical instructions 19% of the time. Thus, it appears that when therapists initiate interactions or give instructions musically, children exhibit better response and compliance.
Music techniques also appeared to be the most successful in therapists’ child-centered techniques, with 73% of children’s responses to therapists’ musical reciprocity falling under the “social skills” theme, as opposed to only 45% of children’s responses to therapist praise, and 64% of children’s responses to therapists’ verbal or behavioral responses to child behavior.
Utilizing music and music-related therapeutic techniques also led to better compliance and internalization of rules when therapists intervened in children’s externalizing behavior. When therapists used music to redirect children’s attention or regulate their negative emotions and behaviors, 38% and 44% of the responses respectively were related to rule internalization and compliance. In comparison, only 25% and 37% of the responses were instances of compliance and rule internalization when therapists intervened verbally or physically in children’s antisocial behaviors.
The findings of the current study build upon previous research, showing that music therapy is an effective approach to promote social skills and reduce externalizing behaviors (Eren, 2015; Ghasemtabar et al., 2015; Yum et al., 2020), and reveal how music is used as an alternative method of communication to elicit more positive social engagement from children in improvisational music therapy.
Children’s increased musical responses to therapists’ use of musical initiating suggests that music is a more accessible communication tool than verbal or behavioral techniques. Using social learning theory to interpret the therapeutic interactions, when therapists initiate an interaction in a given manner, they also simultaneously model how the child should respond (Bandura, 1977). Thus, if a therapist initiates an interaction verbally, a child would be most likely to respond verbally. However, likely due to these children’s impaired verbal abilities, the therapist’s verbal initiation is much more likely to elicit an antisocial response. Conversely, when the therapists initiate musically, children are far more likely to respond musically and far less likely to respond antisocially. This aligns with previous literature which has described music therapy as a “less intimidating” approach, and points to music as the preferred method of communication
for these children (Ghasemtabar et al., 2015; Srinivasan & Bhat, 2013).
These findings support the importance of reciprocal musical interaction asserted in previous literature, particularly for those with limited verbal abilities (Ghasemtabar et al., 2015; Swanson, 2020). By providing an easier communication method, music therapists are better able to have the reciprocal interactions necessary to build rapport with verbally-impaired children. This can precipitate the development of children’s social skills by providing a valuable social connection (Ghasemtabar et al., 2015; Swanson, 2020; Thompson & Gold, 2013) and simulating a back-and-forth interaction akin to a conversation, similar to role-play methods in more traditional social skills interventions (Kamps et al., 1992; Rao et al., 2008).
This study also provides more support for how the unique properties of music can be helpful in the therapeutic setting. Children’s increased compliance, internalization of rules, and improved emotional and behavioral regulation in response to musical techniques demonstrates how music can be a helpful tool for behavior management (Cheong et al., 2016; Yinger & Gooding, 2014). In addition to decreasing externalizing and antisocial behavior, musical techniques successfully facilitate positive social skills, including children’s independent engagement, positive engagement with therapists, and adaptive responses to negative stimuli. This is also supported by previous findings that music therapy facilitates engagement, positive behaviors, and stress management (de Witte et al., 2020; Perkins et al., 2020; Robb, 2000).
The present study found that musical techniques decrease externalizing behaviors and promote social skill in children with verbal difficulties by establishing a connection between the child and therapist, and leveraging unique musical properties to deliver more successful instructions and responses to children’s behavior. However, due to limitations related to varying specificity in the researchers’ session transcriptions, the researchers were not able to effectively examine how these practices evolved over the course of treatment. Thus, future research should explore how techniques of therapist initiation, instruction, and response evolve as children progress through treatment, and how children’s responses to such techniques may shift as well. Additionally, as the population for this study was limited to children with communication difficulties, future research should examine how treatment techniques may vary for reduction of externalizing behavior and promotion of social skills in children with typical verbal abilities.
The current study also provides insight on effective social skills and behavioral interventions for children with externalizing disorders, and emphasizes how music therapy can help children of various verbal ability levels to build social skills and connections. With this, future clinical research and practice should aim to incorporate music therapy techniques into other therapeutic interventions for children with communication difficulties as a means of increasing opportunities for social skills development and improving behavior.
Acknowledgement:
We would like to express our gratitude to XingYe Mao for his contribution during the early stages of the project. We also want to thank Zachary Kandler, Mariana Aslan, and the clinicians, staff, and clients at Nordoff-Robbins Center for Music Therapy at New York University for allowing us to observe footage of their sessions to generate data for this research.
American Music Therapy Association. (2005). AMTA Official Definition of Music Therapy. https://www.musictherapy. org/about/musictherapy/
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. https://doi. org/10.1176/appi.books.9780890425596
American Psychological Association. (n.d.). APA dictionary of psychology. American Psychological Association. https:// dictionary.apa.org/
Aunola, K., Stattin, H., & Nurmi, J. (2000). Adolescents’ achievement strategies, school adjustment, and externalizing and internalizing problem behaviors. Journal of Youth and Adolescence, 29, 289306. https://doi. org/10.1023/A:1005143607919
Baker, J. A., Grant, S., & Morlock, L. (2008). The teacher-student relationship as a developmental context for children with internalizing or externalizing behavior problems. School Psychology Quarterly, 23(1), 3–15. https://doi. org/10.1037/1045-3830.23.1.3
Bandura, A. J. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
Bellini, S., & Peters, K. J. (2008). Social skills training for Youth with autism spectrum disorders. Child and Adolescent Psychiatric of North America, 17(4), 857–873. https://doi. org/10.1016/j.chc.2008.06.008
Bharathi, G., Venugopal, A., & Vellingiri, B. (2019). Music therapy as a therapeutic tool in improving the social skills of autistic children. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 55(1). https://doi.org/10.1186/s41983-0190091-x
Birnbaum, J. C. (2014). Intersubjectivity and Nordoff-Robbins Music therapy. Music Therapy Perspectives, 32(1), 30–37. https://doi.org/10.1093/mtp/miu004
Bornstein, M. H., Hahn, C. S., & Suwalsky, J. T. (2013). Language and internalizing and externalizing behavioral adjustment: developmental pathways from childhood to adolescence. Development and Psychopathology, 25(3), 857–878. https:// doi.org/10.1017/S0954579413000217
Buckley, S. (1993). Language development in children with Down Syndrome - Reasons for optimism. Down Syndrome Research and Practice, 1(1), 3–9. https://doi.org/10.3104/ reviews.5
Burke, J. D., Hipwell, A. E., & Loeber, R. (2010). Dimensions of oppositional defiant disorder as predictors of depression and conduct disorder in preadolescent girls. Journal of the American Academy of Child and Adolescent Psychiatry, 49(5), 484–492. https://doi.org/10.1016/j.jaac.2010.01.016
Campbell, S. B. (2006). Maladjustment in preschool children: A developmental psychopathology perspective. In K. McCartney & D. Phillips (Eds.), Blackwell handbook of early childhood development (pp. 358–377). Blackwell Publishing Inc.
Cheong, C. Y., Tan, J. A., Foong, Y. L., Koh, H. M., Chen, D. Z., Tan, J. J., Ng, C. J., & Yap, P. (2016). Creative music therapy
in an acute care setting for older patients with delirium and dementia. Dementia and Geriatric Cognitive Disorders Extra, 6(2), 268–275. https://doi.org/10.1159/000445883
Chong, H. J., & Kim, S. J. (2010). Education-oriented Music Therapy as an after-school program for students with emotional and behavioral problems. The Arts in Psychotherapy, 37(3), 190–196. https://doi.org/10.1016/j. aip.2010.03.004
de Mers, C. L., Tincani, M., van Norman, R. K., & Higgins, K. (2009). Effects of music therapy on young children’s challenging behaviors: A case study. Music Therapy Perspectives, 27(2), 88–96. https://doi.org/10.1093/ mtp/27.2.88
Demirtaş-Zorbaz, S., & Ergene, T. (2019). School adjustment of first-grade primary school students: Effects of family involvement, externalizing behavior, teacher and peer relations. Children and Youth Services Review, 101, 307–316. https://doi.org/10.1016/j.childyouth.2019.04.019
de Witte, M., Pinho, A. D. S., Stams, G. J., Moonen, X., Bos, A. E. R., & van Hooren, S. (2022). Music therapy for stress reduction: A systematic review and meta-analysis. Health Psychology Review, 16(1), 134–159. https://doi.org/10.108 0/17437199.2020.1846580
Edgerton, C. L. (1994). Effect of improvisational music therapy on the communicative behaviors of autistic children. Journal of Music Therapy, 31(4), 31–62. https://doi. org/10.1093/jmt/31.1.31
Eisenberg, N., Spinrad, T. L., & Eggum, N. D. (2010). Emotion-related self-regulation and its relation to children’s maladjustment. Annual Review of Clinical Psychology, 6, 495–525. https://doi.org/10.1146/annurev. clinpsy.121208.131208
Eren, B. (2015). The use of music interventions to improve social skills in adolescents with autism spectrum disorders in integrated group music therapy sessions. Social and Behavioral Sciences, 197, 207–213. https://doi. org/10.1016/j.sbspro.2015.07.125
Erskine, H. E., Norman, R. E., Ferrari, A. J., Chan, G. C. K., Copeland, W. E., Whiteford, H. A., & Scott, J. G. (2016). Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 55(10), 841–850. https://doi. org/10.1016/j.jaac.2016.06.016
Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J., Tannock, R., & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, Article 15020. https://doi.org/10.1038/ nrdp.2015.20
Filipe, M. G., Cruz, S., Veloso, A. S., & Frota, S. (2022). Early predictors of language outcomes in Down Syndrome: A mini-review. Frontiers in Psychology, 13. https://doi. org/10.3389/fpsyg.2022.934490
Friedman, L. M., & Pfiffner, L. J. (2020). Behavioral interventions. The Clinical Guide to Assessment and Treatment of Childhood Learning and Attention Problems, 149–169. https://doi.org/10.1016/b978-0-12-815755-8.00007-1
Georgiades, S., Szatmari, P., Duku, E., Zwaigenbaum, L., Bryson, S., Roberts, W., Fombonne, E., Mirenda, P., Smith, I., Vaillancourt, T., Volden, J., Waddell, C., & Thompson, A. (2010). Phenotypic overlap between core diagnostic features and emotional/behavioral problems in preschool children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 41(10), 1321–1329. https:// doi.org/10.1007/s10803-010-1158-9
Geretsegger, M., Fusar-Poli, L., Elefant, C., Mossler, K. A., Vitale, G., & Gold, C. (2022). Music therapy for autistic people. Cochrane Database of Systematic Reviews, 5. https://doi. org/10.1002/14651858.CD004381.pub4
Ghasemtabar, S. N., Hosseini, M., Fayyaz, I., Arab, S., Naghashian, H., & Poudineh, Z. (2015). Music therapy: An effective approach in improving social skills of children with autism. Advanced Biomedical Research, 4, 157. https:// doi.org/10.4103/2277-9175.161584
Gooding L. F. (2011). The effect of a music therapy social skills training program on improving social competence in children and adolescents with social skills deficits. Journal of Music Therapy, 48(4), 440–462. https://doi.org/10.1093/ jmt/48.4.440
Gordon, K., Pasco, G., McElduff, F., Wade, A., Howlin, P., & Charman, T. (2011). A communication-based intervention for nonverbal children with autism: What changes? Who benefits? Journal of Consulting and Clinical Psychology, 79(4), 447–457. https://doi.org/10.1037/a0024379
Govindan, R., Kommu, J. V., & Bhaskarapillai, B. (2020). The effectiveness of nurses implemented music add-on therapy in children with behavioral problems. Indian Journal of Psychological Medicine, 42(3), 274–280. https://doi. org/10.4103/ijpsym.ijpsym_240_19
Hailstone, J. C., Omar, R., Henley, S. M., Frost, C., Kenward, M. G., & Warren, J. D. (2009). It’s not what you play, it’s how you play it: Timbre affects perception of emotion in music. Quarterly Journal of Experimental Psychology, 62(11), 2141–2155. https://doi.org/10.1080/17470210902765957
Holck, U. (2004). Turn-taking in music therapy with children with communication disorders. British Journal of Music Therapy, 18(2), 45–54. https://doi. org/10.1177/135945750401800203
Hughes, M. M., Shaw, K. A., DiRienzo, M., Durkin, M. S., Esler, A., Hall-Lande, J., Wiggins, L., Zahorodny, W., Singer, A., & Maenner, M. J. (2023). The prevalence and characteristics of children with profound autism, 15 Sites, United States, 2000-2016. Public Health Reports, 138(6), 971–980. https:// doi.org/10.1177/00333549231163551
Hukkelberg S., Keles, S., Ogden, T., & Hammerstorm, K. (2019). The relation between behavioral problems and social competence: A correlational meta-analysis. BMC
Psychiatry, 19, 354. https://doi.org/10.1186/s12888-0192343-9
Kamps, D. M., Leonard, B. R., Vernon, S., Dugan, E. P., Delquadri, J. C., Gershon, B., Wade, L., & Folk, L. (1992). Teaching social skills to students with autism to increase peer interactions in an integrated first-grade classroom. Journal of Applied Behavior Analysis, 25(2), 281–288. https://doi.org/10.1901/jaba.1992.25-281
Kanne, S. M., & Mazurek, M. O. (2011). Aggression in children and adolescents with ASD: Prevalence and risk factors. Journal of Autism and Developmental Disorders, 41(7), 926–937. https://doi.org/10.1007/s10803-010-1118-4
Kim, J. (2013). Music therapy with children who have been exposed to ongoing child abuse and poverty: A pilot study. Nordic Journal of Music Therapy, 24(1), 27–43. https://doi. org/10.1080/08098131.2013.872696
Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13(4), 389–409. https://doi.org/10.1177/1362361309105660
Knapik-Szweda, S. M. (2019). The significance of the process of music therapy for children with multiple social and communication disabilities: Case studies. Voices: A World Forum for Music Therapy, 19(1). https://doi.org/10.15845/ voices.v19i1.2732
Krøier, J. K., Stige, B., & Ridder, H. M. (2021). Non-verbal interactions between music therapists and persons with dementia. A qualitative phenomenological and arts-based inquiry. Music Therapy Perspectives, 39(2), 162–171.
Kroeger, K. A., Schultz, J. R., & Newsom, C. (2007). A comparison of two group-delivered social skills programs for young children with autism. Journal of Autism and Developmental Disorders, 37(5), 808–817. https://doi.org/10.1007/s10803006-0207-x
LaGasse A. B. (2014). Effects of a music therapy group intervention on enhancing social skills in children with autism. Journal of Music Therapy, 51(3), 250–275. https:// doi.org/10.1093/jmt/thu012
Liu J. (2004). Childhood externalizing behavior: Theory and implications. Journal of Child and Adolescent Psychiatric Nursing: Official Publication of the Association of Child and Adolescent Psychiatric Nurses, 17(3), 93–103. https://doi. org/10.1111/j.1744-6171.2004.tb00003.x
Lujiten, C. C., van de Bongardt, D., Jongerling, J., & Nieboer, A. P. (2021). Associations between adolescents’ internalizing problems and well-being: Is there a buffering role of boys’ and girls’ relationships with their mothers and fathers? BMC Public Health, 21(1). https://doi.org/10.1186/s12889021-11920-4
Malti, T., Ribeaud, D., & Eisner, M. P. (2011). The effectiveness of two universal preventive interventions in reducing children’s externalizing behavior: A cluster randomized controlled trial. Journal of Clinical Child and Adolescent Psychology, 40(5), 677–692. https://doi.org/10.1080/15374
416.2011.597084
Mason-Apps, E., Stojanovik, V., Houston-Price, C., & Buckley, S. (2018). Longitudinal predictors of early language in infants with Down Syndrome: A preliminary study. Research in Developmental Disabilities, 81, 37–51. https:// doi.org/10.1016/j.ridd.2017.12.021
Mayer-Benarous, H., Benarous, X., Vonthron, F., & Cohen, D. (2021). Music therapy for children with autistic spectrum disorder and/or other neurodevelopmental disorders: A systematic review. Frontiers in Psychiatry, 12. https://doi. org/https://doi.org/10.3389/fpsyt.2021.643234
Mei, C., Reilly, S., Reddihough, D., Mensah, F., Pennington, L., & Morgan, A. (2016). Language outcomes of children with cerebral palsy aged 5 years and 6 years: A population-based study. Developmental Medicine and Child Neurology, 58(6), 605–611. https://doi.org/10.1111/dmcn.12957
Mei, C., Fern, B., Reilly, S., Hodgson, M., Reddihough, D., Mensah, F., & Morgan, A. (2020). Communication behaviours of children with cerebral palsy who are minimally verbal. Child: Care, Health and Development, 46(5), 617–626. https://doi.org/10.1111/cch.12792
Meier, C. R., Diperna, J. C., & Oster, M. M. (2006). Importance of social skills in the elementary grade. Education and Treatment of Children, 29(3), 409–419.
Moore, K. S., Hanson-Abromeit, D. (2018). Feasibility of the musical contour regulation facilitation (MCRF) intervention for preschooler emotion regulation development: A mixed methods study. Journal of Music Therapy, 55(4), 408–438. https://doi.org/10.1093/jmt/ thy014
Mulvey, K. L., Boswell, C., & Zheng, J. (2017). Causes and consequences of social exclusion and peer rejection among children and adolescents. Report on Emotional & Behavioral Disorders in Youth, 17(3), 71–75.
Narusyte, J., Ropponen, A., Alexanderson, K., & Svedberg, P. (2017). Internalizing and externalizing problems in childhood and adolescence as predictors of work incapacity in young adulthood. Social Psychiatry and Psychiatric Epidemiology, 52(9), 1159–1168. https://doi.org/10.1007/ s00127-017-1409-6
Parkes, J., & McCusker, C. (2008). Common psychological problems in cerebral palsy. Pediatrics and Child Health, 18(9), 427–431. https://doi.org/10.1016/j.paed.2008.05.012
Pater, M., Spreen, M., & van Yperen, T. (2022). Music therapy for children on the autism spectrum: Improved social interaction observed by multiple informants across different social contexts. Nordic Journal of Music Therapy, 32(1), 29–47. https://doi.org/10.1080/08098131.2022.2046 628
Perkins, R., Mason-Bertrand, A., Fancourt, D., Baxter, L., & Williamon, A. (2020). How participatory music engagement supports mental well-being: A metaethnography. Qualitative Health Research, 30(12), 1924–1940. https://doi.org/10.1177/1049732320944142
Porter, S., McConnell, T., McLaughlin, K., Lynn, F., Cardwell, C., Braiden, H. J., Boylan, J., & Holmes, V. (2017). Music therapy for children and adolescents with behavioral and emotional problems: A randomized controlled trial. The Journal of Child Psychology and Psychiatry, 58(5), 586–594. https://doi.org/10.1111/jcpp.12656
Rainey Perry, M. M. (2003). Relating improvisational music therapy with severely and multiply disabled children to communication development. Journal of Music Therapy, 40(3), 227–246. https://doi.org/10.1093/jmt/40.3.227
Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills training for children with Asperger’s Syndrome and high functioning autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38, 353–361. https://doi.org/10.1007/s10803-007-0402-4
Reichow, B., Steiner, A. M., & Volkmar, F. (2012). Social skills group for people aged 6 to 21 with autism spectrum disorders (ASD). Campbell Systematic Reviews, 8(1), 1–76. https://doi.org/10.1002/14651858.CD008511.pub2
Robb, S. L. (2000). The effect of therapeutic music interventions on the behavior of hospitalized children in isolation: Developing a contextual support model of music therapy. Journal of Music Therapy, 37(2), 118–146. https://doi. org/10.1093/jmt/37.2.118
Roberts, J. E., Price, J., & Malkin, C. (2007). Language and communication development in Down syndrome. Mental Retardation and Developmental Disabilities Research Reviews, 13(1), 26–35. https://doi.org/10.1002/mrdd.20136
Rubin, K. H., Bukowski, W. M., & Parker, J. G. (2006). Peer Interactions, Relationships, and Groups. In N. Eisenberg, W. Damon, & R. M. Lerner (Eds.), Handbook of child psychology: Social, emotional, and personality development (pp. 571–645). John Wiley & Sons, Inc.
Salimpoor, V. N., Zald, D. H., Zatorre, R. J., Dagher, A., & McIntosh, A. R. (2015). Predictions and the brain: How musical sounds become rewarding. Trends in Cognitive Sciences, 19(2), 86–91. https://doi.org/10.1016/j. tics.2014.12.001
Samek, D. R., & Hicks, B. M. (2014). Externalizing disorders and environmental risk: Mechanisms of gene-environment interplay and strategies for intervention. Clinical Practice, 11(5), 537–547. https://doi.org/10.2217/CPR.14.47
Schindler, H. S., Kholoptseva, J., Oh, S. S., Yoshikawa, H., Duncan, G. J., Magnuson, K. A., & Shonkoff, J. P. (2015). Maximizing the potential of early childhood education to prevent externalizing behavior problems: A meta-analysis. Journal of School Psychology, 53(3), 243–263. https://doi. org/10.1016/j.jsp.2015.04.001
Smith, T. E., Thompson, A. M., & Maynard, B. R. (2022). Self‐management interventions for reducing challenging behaviors among school‐age students: A systematic review. Campbell Systematic Reviews, 18(1). https://doi. org/10.1002/cl2.1223
Sourander, A., Jensen, P., Davies, M., Niemelä, S., Elonheimo,
H., Ristkari, T., Helenius, H., Sillanmäki, L., Piha, J., Kumpulainen, K., Tamminen, T., Moilanen, I., & Almqvist, F. (2007). Who is at greatest risk of adverse long-term outcomes? The Finnish from a boy to a man study. Journal of the American Academy of Child and Adolescent Psychiatry, 46(9), 1148–1161. https://doi.org/10.1097/ chi.0b013e31809861e9
Srinivasan, S. M., & Bhat, A. N. (2013). A review of “Music and movement” therapies for children with autism: Embodied interventions for multisystem development. Frontiers in Integrative Neuroscience, 7. https://doi.org/10.3389/ fnint.2013.00022
Sun, S., Kuja-Halkola, R., Faraone, S. V., D’Onofrio, B. M., Dalsgaard, S., Chang, Z., & Larssonm, H. (2019). Association of psychiatric comorbidity with the risk of premature death among children and adults with attentiondeficit/hyperactivity disorder. JAMA Psychiatry, 76(11), 1141. https://doi.org/10.1001/jamapsychiatry.2019.1944
Swanson, A. L. (2020). Music therapy in schools: Stimulating the mind and body to create positive change. In C. Maykel & M. A. Bray (Eds.), Promoting mind–body health in schools: Interventions for mental health professionals (pp. 233–244). American Psychological Association. https://doi. org/10.1037/0000157-016
Thompson, G. A., McFerran, K. S., & Gold, C. (2013). Family‐centered music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomized controlled study. Child: Care, Health and Development, 40(6), 840–852. https://doi.org/10.1111/ cch.12121
Trevarthen, C., & Malloch, S. N. (2000). The dance of wellbeing: Defining the musical therapeutic effect. Nordic Journal of Music Therapy, 9(2), 3–17. https://doi. org/10.1080/08098130009477996
Van Loan, C. L., Garwood, J. D., Smith, S. W., & Daunic, A. P. (2018). Take charge! A randomized controlled trial of a social problem-solving curriculum to support students with emotional and behavioral disorders. Journal of Emotional and Behavioral Disorders, 27(3), 143–153. https://doi.org/10.1177/1063426617754083
van Gameren-Oosterom, H. B., Fekkes, M., Buitendijk, S. E., Mohangoo, A. D., Bruil, J., & Van Wouwe, J. P. (2011). Development, problem behavior, and quality of life in a population based sample of eight-year-old children with Down syndrome. PLOS One, 6(7). https://doi.org/10.1371/ journal.pone.0021879
Volker, M. A., Lopata, C., Smerbeck, A. M., Knoll, V. A., Thomeer, M. L., Toomey, J. A., & Rodgers, J. D. (2009). BASC-2 PRS Profiles for students with high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(2), 188–199. https://doi.org/10.1007/s10803009-0849-6
Wakschlag, L. S., Henry, D. B., Tolan, P. H., Carter, A. S., Burns, J. L., & Briggs-Gowan, M. J. (2012). Putting theory to the
test: Modeling a multidimensional, developmentally-based approach to preschool disruptive behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 51(6), 593–604. https://doi.org/10.1016/j.jaac.2012.03.005
Ye, P., Huang, Z., Zhou, H., & Tang, Q. (2021). Music-based intervention to reduce aggressive behavior in children and adolescents. Medicine, 100(4). https://doi.org/10.1097/ md.0000000000023894
Yinger, O. S., & Gooding, L. (2014). Music therapy and music medicine for children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 23(3), 535–553. https://doi.org/10.1016/j.chc.2013.03.003
Yizengaw, S. S. (2022). Effect of social skills training on interpersonal interactions of children with autism: An interventional research. International Journal of Developmental Disabilities, 68(6), 858–866. https://doi.org /10.1080/20473869.2021.1902730
Yum, Y. N., Lau, W. K., Poon, K., & Ho, F. C. (2020). Music therapy as social skill intervention for children with comorbid ASD and ID: Study protocol for a randomized controlled trial. BMC Pediatrics, 20(1), 545. https://doi. org/10.1186/s12887-020-02454-6
Zatorre, R. J., & Salimpoor, V. N. (2013). From perception to pleasure: Music and its neural substrates. Proceedings of the National Academy of Sciences, 110, 10430–10437. https:// doi.org/10.1073/pnas.1301228110
Therapeutic Practices Codebook
Themes
Therapist initiates interaction with the child
Subthemes
Musical initiation
Codes
Therapist initiates musical interaction
Therapist instructs the child
Verbal Initiation
Behavioral Initiation
Behavioral instruction
Therapist initiates verbal interaction
Therapist initiates behavioral interaction
Modeling
Definitions
Therapist plays an instrument, sings, or speaks rhythmically to the child
Therapist speaks to the child
Therapist uses non-verbal cues and physical contact with the child
Therapist demonstrates behavior for the child to mimic
Indirect physical instructions
Use of physical guidance to direct the child
Verbal instruction
Direct verbal instruction
Indirect verbal instruction
The therapist uses physical cues to invite the child to engage in a specific manner
The therapist uses handover-hand instruction or physically guides the child to engage in a specific manner
The therapist uses a directive statement to deliver an instruction
Therapist delivers instruction in the form of a question, a general statement, or including themselves in the subject of the sentence
Examples
The therapist sings, “Hello” as client A walks into the room.
The therapist says, “I see cars on your shirt” to client B.
The therapist touches client A’s leg.
After client B picks up the cabasa, the therapist also picks up the cabasa and begins to play it
The co-therapist holds the tambourine for client B to play
The co-therapist holds client B’s fingers to guide him to strum the guitar.
The therapist tells client B, “tap on the instrument”
The therapist asks client B “Do you know how to stop?”
The therapist tells client D, “it’s time to say goodbye”
The therapist tells client B, “let’s close it”
Musical instruction
Therapist’s instructions are delivered through music
The therapist delivers an instruction by singing it or incorporating it into a song.
The therapist makes a song about closed doors when client A tries to open the door during the session
Therapist responds to the child’s behavior
Child-centered techniques
Musical cue
Therapist responds verbal or behaviorally to the child’s behavior
Therapist leaves an intentional musical gap for the child to fill
The therapist uses their voice and body language to react to or mimic a child’s behavior, and repeat speech and behaviors that the child has responded to well
The therapists sing, “How many strings do you see? I see…” and wait for client B to count.
The therapist hits his thigh after client A does.
Responses to children’s antisocial behaviors
Musical reciprocity
Praise
The therapist uses music to respond to the child’s musical, behavioral, or verbal engagement
Verbal or nonverbal praise
Use of music to redirect the child’s attention
Use of music to regulate the child’s negative emotion or behavior
Ignoring the child’s behavior
In response to the child’s antisocial behavior, the therapist begins to play a new song or offers the child an instrument to redirect their attention.
The therapist uses music to facilitate a change of mood when the child exhibits a negative emotion or behavior.
The therapist asks, “is that a song?” in response to client D repeating a phrase. The therapist tickles the client A’s leg after seeing her display positive affect in response to this
The therapist plays the same tune that client B sang on the piano.
“Thank you for your music”
Nodding, giving a thumbs-up
The therapist offers client B a mallet as she sees him trying to push over a drum.
The therapist plays calm, slow music after client B breaks the wind chime.
The therapist does not respond musically, behaviorally, or verbally, or otherwise give attention to child’s antisocial behavior. When client C attempts to hit the therapist with something, the therapist stands still and does not react.
Therapist’s proximity to the child
Physical intervention
The therapist intervenes physically to stop the child’s antisocial behaviors or correct disruptions to the environment caused by the child’s antisocial behavior.
The therapist holds client B’s arm to prevent him from pushing over a cymbal. The therapist picks up the drum after client B knocks it over.
Verbal intervention
Far proximity
Close proximity
The therapist intervenes verbally to stop the child’s antisocial behaviors.
The therapist says, “No, we don’t do that” as client B tries to push a drum over.
The therapist moves further away from the child. The therapist lets go of client B’s hands
The therapist moves closer to the child, or follows the child closely as they move around the room.
The therapist keeps her arms very close to client B during the session
Themes
Subthemes
Prosocial behavior Child engages positively with the therapist
Codes
Musical response
Verbal or behavioral response
Definitions
The child responds musically after the therapist initiates.
Musical initiation
Verbal or behavioral initiation
The child responds verbally or behaviorally after the therapist initiates.
Examples
Moving closer
Eye contact
Positive affect
Child engages independently
Independent musical engagement
The child initiates interaction with the therapist using music.
The child initiates interaction with the therapist by talking to them or using non-verbal, non-musical behavior.
The child moves closer to the therapist.
The child looks at the therapist.
The child demonstrates positive affect by laughing or smiling, not coinciding with antisocial behavior.
The child engages in musical behavior independently- not as a response to therapists’ initiation, and not as a way of initiating an interaction with the therapist.
Client D plays the drum to the same rhythm as the song the therapist is playing.
Client A spins faster as the therapist plays faster music.
The therapist asks, “How was your summer?” and client D responds, “good”.
Client D picks up the cabasa, shows the therapist, and sings “that’s a cabasa”.
Client D stops playing the drum and says, “I’m done”.
Client A walks over to the therapist.
Client A turns toward the therapist and looks at her.
Client A laughs as she spins to the music.
Client B plays the drum alone, turned away from the therapists.
Client C colors independently. Child Behavior Codebook
Independent behavioral engagement
The child engages in non-musical behavior independently.
Antisocial behavior
Child follows therapists’ instructions Compliance
Child responds adaptively to a negative stimulus
Internalizing rules
Emotion regulation
The child responds to any of the codes under the “therapist instructs the child” theme by doing what the therapist prompted.
Client B puts away the bells after the therapist sings, “the bells go back in the box”.
Client B takes the mallet that the therapist offered and begins to play the drum.
Client D stops touching the microphone to his mouth after the therapist says, “don’t touch it on your lips”.
The child demonstrates knowledge of rules by repeating rules verbally/ musically or acknowledging whether a behavior was appropriate.
The child remains calm when exposed to a potentially distressing stimulus.
Client B says, “that’s not nice” after knocking over the drums
Externalizing behaviors
Problem solving
Patience
Aggressive behaviors
The child corrects a mistake without prompting from the therapists, or takes it upon themselves to adjust elements of their environment for greater ease.
The child waits calmly during transitions or adjustments by the therapists.
Behaviors intended to cause physical or psychological harm to the self or others.
Client D knocks over a drum accidentally and remains calm.
Client D drops a mallet on the floor and picks it up without prompting from the therapists.
Client D sits patiently while the therapists move the piano.
Client C tries to hit the therapist with the piano cover cloth.
Delinquent behaviors
Hyperactive behaviors
Rule-breaking and protesting behaviors.
Excessive restlessness, spontaneous gross motor activity.
Client D knocks over the drums.
Client C runs around the room and climbs on chairs.
Emotional dysregulation
Difficulty with emotion regulation
Disengagement
The child has an emotional outburst which appears disproportionate to the stimulus they are reacting to.
Emotion incongruence A positive emotion coinciding with a negative behavior.
Ignoring a therapist’s attempt to engage
Withdrawal or self-isolation
The child does not have any response to a therapist’s verbal, behavioral, or musical attempt to engage with them.
Client C screams at the therapist after the therapist begins to play guitar.
Client B laughs as he runs around the room knocking over instruments.
The co-therapist asks, “do you want to try some bells?” and client C does not respond.
The therapists begin to play a new song and client A does not react.
The child withdraws from engaging with the therapists and/or behaves in a way that makes it difficult for the therapist to engage them.
Client A lies on the floor with her head in her hands
Research has shown that there are a range of barriers that may restrict a parent’s ability to be involved in their child’s life, including insufficient communication between parents and schools, logistical challenges, and cultural disparities. These barriers can lead to disadvantages to the child’s academic success, further emphasizing the importance of parental involvement (Baker et al., 2016; Ribeiro et al., 2021). While these challenges are not exclusive to any cultural or ethnic group, Chinese immigrant parents require particular attention because of the unique obstacles they face, such as language barriers and unfamiliarity with the U.S. school system (Yamamoto et al., 2022; Zhong & Zhou, 2011). Additionally, parents face temporal challenges given current events. For example, the effects of the COVID-19 pandemic contributed to the barriers parents face by increasing their concerns regarding technical difficulties and financial struggles (Antony-Newman, 2019; Ribeiro et al., 2021). Therefore, understanding the various cultural complexities that Chinese immigrant parents face is crucial when addressing their school involvement levels as well as providing proper academic support.
Parental involvement is a multifaceted construct that describes the ways in which parents support their children’s learning and development allowing them to succeed in their academics (Jensen & Minke, 2017). It is important to note that parental involvement evolves as children age. While much of the literature on parental involvement hones in on children in their early childhood years, as children grow up parental involvement can look different depending on developmental stages (Nurhayati, 2021). Two notable types of parent involvement are school-based engagement and home-based engagement (Jensen & Minke, 2017; Yamamoto et al., 2022; Zhong & Zhou, 2011). School-based engagement focuses on a parent actively volunteering and attending school events, and home-based engagement includes a parent who monitors their child’s school work from home (Barge & Loges, 2003; Hornby & Lafaele, 2011; Jensen & Minke, 2017; Yamamoto et al., 2022; Zhong & Zhou, 2011). Ultimately, it is crucial for parents to balance both types of engagement to contribute to a child’s academic success (Barge & Loges, 2003; Hornby & Lafaele, 2011; Jensen & Minke, 2017; Yamamoto et al., 2022; Zhong & Zhou, 2011). Irrespective of the type of parental involvement, when parents dedicate more time to their child’s learning, there are positive academic, social, and emotional outcomes (Jensen & Minke, 2017).
Various factors contribute to parental involvement, including Baumrind’s parenting styles (i.e. authoritarian,
authoritative, and permissive). The parenting styles incorporate different levels of parental involvement and demandingness: authoritarian parents encompass a demanding and imprisoning outlook, authoritative parents maintain a warmhearted, involved, and consistently firm demeanor, and permissive parents tend to take on a lenient and inaccessible parenting role (Baumrind, 1971). The differing parenting styles show that parents can be more or less involved in one’s child’s educational experiences. Therefore, the range of parenting styles directly distinguishes the various levels of parental involvement, ultimately shaping academic performance (Ishak et al., 2012; Pinquart, 2016).
Expanding upon the intricate nature of parental involvement, it is crucial to explore the influence of culture on parental involvement in education, specifically within the context of Chinese immigrant parents (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011). Culture plays a vital role in parental involvement given that ethnic and racial minorities make up over 30% of the United States population (Malone, 2015). The diverse population is causing more cultural differences among students and creating more challenges for both parents and educators (Malone, 2015). With their unique culture, values, and beliefs, Chinese immigrant parents play a distinctive role in their children’s education (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011). To many Chinese immigrant parents, education is a way of obtaining high social status, personal achievement, wealth, and a promising future. Thus, they tend to hold high expectations for their children’s education, specifically high academic achievement (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011). In other words, they believe that education is the most effective way to overcome barriers, like future employment challenges, and therefore, that parents must proactively be involved in their children’s learning (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011). Furthermore, per Confucian values, traditionally held educational values in Chinese culture, rather than accrediting their children’s academic success solely to their children’s effort, many Chinese parents consider it as a representation of their worth and the family’s honor (Xiong et al., 2021; Yamamoto et al., 2022). This perspective emphasizes a profound commitment to their children’s education, as high academic achievement is not just a personal pursuit but also serves to strengthen the family’s standing and the parents’ esteem within their community (Xiong et al., 2021; Yamamoto et al., 2022). Therefore, Chinese parents often exhibit a higher level
of parental involvement than their Western counterparts (Xiong et al., 2021; Zhong & Zhou, 2011). This heightened involvement is rooted in the cultural significance placed on academic achievement as a means of enhancing a family’s reputation, social status, and honor, and it persists even after immigration to North America (Xiong et al., 2021; Zhong & Zhou, 2011).
As mentioned earlier, there are two types of parental engagement, home-based engagement, such as homework supervision, and school-based engagement, which includes parent-teacher meetings (Barge & Loges, 2003; Hornby & Lafaele, 2011; Jensen & Minke, 2017; Yamamoto et al., 2022; Zhong & Zhou, 2011). While Chinese immigrant parents recognize the importance of school-based involvement in their children’s learning, they encounter myriad challenges as many immigrants are unfamiliar with the American educational system and the English language (Yamamoto et al., 2022; Zhong & Zhou, 2021). Despite these initial challenges, Chinese immigrant mothers who participate more in American culture, like attending Thanksgiving more often or having higher English language proficiency, tend to employ a more authoritative parenting style, which is closely associated with high parental involvement (Vu et al., 2019; Xia et al., 2020). However, difficulty understanding school culture and not being able to communicate with their child’s teachers due to the language barrier relates to a concentration on supporting their children’s learning at home, with relatively less engagement in school-related activities (Yamamoto et al., 2022; Zhong & Zhou, 2011). Additionally, Chinese immigrant parents perceive difficulties in finding and maintaining a job in a foreign country due to anticipated discrimination (Yamamoto et al., 2022; Zhong & Zhou, 2011). Therefore, they tend to invest more in their work commitments than school-based involvement, especially for low socioeconomic status (SES) families (Yamamoto et al., 2022; Zhong & Zhou, 2011). Although Chinese immigrant parents value their children’s education and diligence, language barriers, the depletion of time and energy from work responsibilities, and unfamiliarity with the school system are all significant obstacles that hinder their school-based involvement (Yamamoto et al., 2022; Zhong & Zhou, 2011).
Besides the role of culture, it is essential to recognize the unprecedented and profound impact brought about by the COVID-19 outbreak on the field of education (FontenelleTereshchuk, 2021; Garbe et al., 2020; Ribeiro et al., 2021). As schools in the United States were physically shut down and classes were shifted to remote learning, parents were pushed into a multifaceted and central role in their children’s education (Becker et al., 2020; Fontenelle-Tereshchuk, 2021; Garbe et al., 2020; Nyanamba et al., 2022; Ribeiro et al., 2021). Primary school students specifically, those with younger age and less autonomy, were put at risk of less in-person social interaction, reduced teachers’ support, and increased mental well-being problems, which required more involvement from their parents
(Fontenelle-Tereshchuk, 2021; Garbe et al., 2020; Nyanamba et al., 2022; Ribeiro et al., 2021). Particularly, primary schoolers’ courses mainly use play-based methods and social interactions, which is difficult in online learning environments, therefore making parental engagement in the learning process essential (Fontenelle-Tereshchuk, 2021; Garbe et al., 2020).
This rapid transition brought forth numerous challenges that parents had to navigate, including the lack of knowledge and access to the necessary devices for remote learning, as well as logistical barriers (Nyanamba et al., 2022; Ribeiro et al., 2021). Parents began to take responsibility as technological supporters, primary educators, and prominent facilitators for their children (Becker et al., 2020; Garbe et al., 2020). They had to balance these various requirements in addition to their work responsibilities (Becker et al., 2020; Garbe et al., 2020; Nyanamba et al., 2022). In some instances, financial difficulties worsened these challenges, especially for those from low-income families who had little or no experience with remote learning (Becker et al., 2020; Ribeiro et al., 2021).
Despite the significant challenges faced, the pandemic also uncovered opportunities in the form of enhanced parental involvement (Bubb & Jones, 2020; Ribeiro et al., 2021). Parents were aware of the importance of allocating their time to their children and were motivated to participate in their children’s remote learning experiences, especially when they were concerned with their children’s academic progress (Garbe et al., 2020; Nyanamba et al., 2022). Parents assisted children in navigating remote learning in many ways, such as the use of technology, helping to develop study plans, and supervising their children’s studying (Nyanamba et al., 2022; Ribeiro et al., 2021). Importantly, this strengthened parental involvement is beyond the confines of the home (Bubb & Jones, 2020; Ribeiro et al., 2021). Parents began to seek communication with schools and teachers to establish better connections and support for their children (Bubb & Jones, 2020; Ribeiro et al., 2021). This enhanced home-school communication allowed parents to better understand their children’s learning process and opened opportunities for the development of remote learning, like the increasing use of technology in homework for online learning (Bubb & Jones, 2020).
Studies have suggested that Chinese immigrant parents exhibit high parental involvement, especially home-based involvement, and that their involvement rose during the pandemic (Bubb & Jones, 2020; Nyanamba et al., 2022; Ribeiro et al., 2021; Xiong et al., 2021; Zhong & Zhou, 2011). However, since some of the changes implemented during remote learning continue to be in operation, it is unclear how parental involvement has continued to evolve post-pandemic. Therefore, this study aims to enhance the understanding of how culture influences Chinese immigrant parental involvement in remote learning, and examine the enduring impact of this post-pandemic shift, provoking our research question: How are Chinese immigrant
parents involved in their middle childhood children’s remote learning experiences after the COVID-19 pandemic?
This study included six Chinese immigrant mothers aged 34 to 43 with children aged 6 to 11 who currently live in New York City. The participants live across different boroughs: three in Brooklyn, two in Staten Island, and one in Queens. Five of the parents primarily spoke in Mandarin and one parent spoke English fluently. Two of the families’ annual incomes are below $30,000, two are about $40,000, one is about $60,000, and one is unstable. These families immigrated to the United States between 2009 and 2016, all their children were born in the United States and each child primarily speaks English. They all have more than one child. All of the parents’ children obtain one-on-one academic tutoring through a non-profit organization that aims to provide academic and mental support for immigrant families whose parents’ primary language is not English. To ensure anonymity, participants will be referred to as Student Parent 1(SP1), Student Parent 2 (SP2), and so on.
The researchers contacted all the parents through a nonprofit organization in a convenient sampling method and scheduled thirty-minute interviews over Zoom. The semistructured interviews included the following main topics: demographic background, immigration-related information, remote-learning experience, parental involvement, and factors influencing involvement. After interviewing five participants in Mandarin and one in English, one of the researchers, fluent in Mandarin and English, translated the transcripts to allow for accurate translations and proper coding.
The researchers used grounded theory to code the data. The researchers then created individual codebooks by independently examining emerging themes in two out of six of the transcripts— one in English and one translated from Mandarin to English. Following the identification of major themes from the initial two transcripts, the researchers created a merged codebook and continued to code the English versions of the remaining four transcripts. Afterward, the researcher who spoke Mandarin coded one of the interviews in Mandarin to ensure that the translation was accurate and the same themes emerged. The researchers employed this comparative coding approach to ensure that translation does not compromise the precision of the study’s findings and to ensure inter-rater reliability.
Through the coding, four themes emerged through overlapping concepts that surfaced during the interviews. Overall, recurrent ideas mentioned by the participants included the difference between American and Chinese culture when it
comes to education, their concerns surrounding remote learning, ways in which they remain involved in their child’s learning, and strategies they have used to adapt to the new environment and societal norms.
Chinese cultural influence on education is the specific manifestations of cultural values and expectations related to education that form the opinions, behaviors, and participation of Chinese immigrant parents surrounding their children’s learning experiences. This theme includes parental expectations and cultural conflicts.
Parental expectations refer to parents’ desired outcome of their children’s academic performance and general educational journey influenced by Chinese culture. All participants agreed that Chinese culture usually expects children to achieve academic excellence, particularly in grades. Half of the participants indicated that Chinese culture’s emphasis on education is related to their studying expectations of their children. For instance, SP 5 said:
In China, parents really do push their kids to study hard. And of course, they go to Saturday school for a long time. We just let them go to Saturday school. For Max, I do let him learn some coding. Yeah, well, because they don’t know coding.
However, although some participants expressed their wish for children to have good grades, five participants said they did not force their children to achieve academic excellence. SP3 said, “We do encourage them to do their best in school. I tell them that good grades are essential, but I don’t impose excessive expectations.” Moreover, three participants emphasized that they considered children’s happiness as their priority rather than grade, despite their awareness of the culture’s emphasis on academic achievement. SP2 said:
Chinese culture definitely values children’s grades, but I don’t. I just hope he is happy. Because you don’t need to have a very high grade, as long as it’s not too low. If his grade is always high, and when there is a low grade, he will not be happy. I don’t have high requirements. I’m not that kind of parent. I told him no pressure, just learn what you could learn.
Cultural conflicts refer to the disagreements in problemsolving methods between parents with Chinese cultural values and children with a mixture of Chinese and American cultural values that affect parental involvement. Five participants mentioned that they tried to help with their children’s math homework. However, they either could not understand the questions since they were in English or employed a different problem-solving method that their children did not approve of. For example, SP4 mentioned, “If he doesn’t know how to do the math homework, his dad will teach a little bit, but not too much since his dad also cannot understand well.”
These five participants all chose to let the children choose how to learn when there was such a difference. SP2 said, “We
don’t have such a culture conflict. I go with whatever he picks.”
The second emerging theme is parental concerns about remote learning, which is defined as parents’ specific expressions of worry, distress, or difficulties regarding their children’s virtual learning experiences. These concerns include three identifiable elements: language barriers, eyesight concerns, and a child’s attitude.
Five participants expressed worries about the language barrier, the unfamiliarity of English, as a factor that impedes their involvement in their children’s remote learning. For example, SP1 talked about how she was worried that she could not assist in her child’s homework because of her insufficiency in English:
There’s also written material, but it’s all in English, and I can’t understand it. For me, it’s impossible to understand everything in English. Even when I use translation, there are times when I still don’t understand because there is no Chinese word in the questions themselves.
Participants usually do not use English in their daily lives, as mentioned by all participants. Specifically, SP1 said, “ On 8th Avenue, we speak either Mandarin or Cantonese. We don’t speak English.” Although this inadequacy in English affects home-based parental involvement, four parents reported that schools provided translation services when they had concerns and wanted to communicate with teachers, which facilitated their school-based involvement. For instance, SP2 said, “I want to communicate with the teacher. The school will support us and give us translators. There will be three people when we talk: me, the teacher, and the translator since I don’t understand English.”
Four parents also expressed eyesight concerns and worries about children’s eyesights brought on by increased use of electronic devices, after remote learning became prevalent. SP1 said:
I’m just worried about the child’s eyesight. Since the pandemic started, the school has given us an iPad, and many kids are obsessed with it after the pandemic. Sometimes since we don’t understand English, they play games on the iPad, because we don’t understand, they sometimes deceive us. Many parents are worried about this increase in iPad usage. They are addicted to the iPad.
This concern about tablet use made the parents more involved in their children’s remote learning classes since they wanted to ensure that their children were not playing around rather than studying. SP 6 said, “I checked what he was doing from time to time to see if he was using the iPad to study.”
All parents had concerns about their children’s attitudes, specifically children’s remote learning attitudes when they were having online courses or doing homework. SP2 said:
If you sit next to him, he will listen to the teacher, but if you don’t, he will play games. He could not
concentrate for long. He would just end up touching the pencils, rulers, and anything around him. I don’t think he was paying attention to the teacher.
Three parents believed that children’s indolent remote learning attitude is related to their young age. They indicated that as children grow up, they have more self-control and therefore can complete their homework independently. For example, SP 4 said, “This semester is better than the previous one. He has been doing his homework. He has grown up more.”
The next theme that emerged touched upon the different ways in which parents can support their child’s development academically. Among the participants’ responses to their types of involvement, the primary methods included homework help and supervision, serving as the operational definition of this theme. Furthermore, this theme includes parental preference for in-person learning methods. Parents demonstrated that their level of involvement differs depending on whether their child’s learning is in-person or remote.
When trying to find ways to assist children with their homework, SP3 shared, “I bought practice exercises on my own and I follow the exercises to help teach him math. For example, when we’re eating or playing, I’ll talk about counting, just counting some numbers.” In other words, this participant ensured that she was doing as much as she could to promote better learning for her children. Other parents, such as SP6, took a different approach and did not directly assist with homework. Rather, she “only [looks] at their notes. [she doesn’t] actually assist with homework.”
When it came to supervising, all six parents mentioned that they supervise their children as a form of parental involvement. According to all the parents, their way of supervision is sitting directly next to the child during classes and checking in on them frequently when they are doing their work. SP2 shared “I will sit next to him when he is having online classes.” SP5 implied that sitting next to their child was a given. However, she said that it was most important to sit next to the younger children given that they get distracted more easily.
Along with staying involved with their child’s learning, five parents expressed a preference for in-person learning over online learning. SP1 clearly stated her preference for in-person learning by sharing, “We don’t actually have a choice. I don’t like this mode.” She shared that in-person learning is much better because “interaction is actually real.” SP4 expressed a similar opinion and dislike for remote learning. She claimed “I don’t like it, but we don’t have a choice. We have to work too. If he can only study online, it’s easier for all of us. He doesn’t need to commute and everything.” Ultimately, all five parents who preferred inperson learning shared that it has been harder for them to stay involved in their child’s learning given the difficulties their children face during remote learning as well. In other words, just like it’s difficult for students to maintain their attention, it’s harder for parents to stay involved as well.
Ultimately, in response to parental concerns around remote learning, parental struggles to remain involved in their child’s academics, and cultural conflicts being faced, parents had to take certain steps to adapt to their new environments. Five of the parents mentioned turning to their community to seek support when they struggle with numerous barriers such as language obstacles and the new school system. SP1 shared, “We don’t speak English and can’t help our kids. The elementary school teachers helped me.” She also mentioned that she would receive assistance from her nephew who is an older student at the same school as her child. Just like SP1, SP2 also sought assistance from family members. She mentioned that when struggling with technical difficulties, she would turn to her eldest son, and if he was not able to help then she would visit a local library. Moving forward, SP5 explained how in her community there was a parent chat made. She told the interviewer: Especially for Chinese people, you know, some of them don’t know English that much. So, we had to create a parent chat to help with ‘How do you take a picture? How do you do that or submit that?’ We would help each other.
Other parents shared that they were able to get support through translating on the internet, other fellow parents, older siblings, and teachers. Lastly, all parents shared that the organization has been highly helpful given that many of the tutors can assist with various English subjects.
The study explored Chinese immigrant parents’ involvement in their children’s remote learning experiences postCOVID-19. Parents discussed their cultural differences and their role in their child’s educational experiences. Topics discussed in the interviews included the school system, individual challenges, and various ways in which parents sought supportive help. The four emerging themes are (1) Chinese cultural influence on education, (2) parental concerns about remote learning, (3) parental involvement, and (4) parental adaptation. Although all participants acknowledged the expectations for high grades in Chinese culture, differing from previous research (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011), they considered their children’s happiness as the primary educational goal as they were involved in their children’s remote learning experiences. This emphasis on happiness may be influenced by their exposure to American culture over seven years since they all mentioned American cultural emphasis on children’s independence and mental well-being (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011). Therefore, in this study, Chinese cultural emphasis on education did not seem to influence Chinese immigrant’s parental involvement, contrary to the existing literature (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011). However, cultural conflicts in teaching methods hindered home-based parental involvement,
as participants struggled to help with homework in line with teachers’ methods that children expected. Moreover, given that most of the participants moved to the United States during adulthood, they struggled with language barriers and unfamiliarity with the school system (Yamamoto et al., 2022; Zhong & Zhou, 2011). Furthermore, the language barrier not only hindered their ability to maintain school-based involvement, as indicated in previous studies (Yamamoto et al., 2022; Zhong & Zhou, 2021), but it also impeded their home-based involvement, an aspect often overlooked in the existing literature. The reason for having such language difficulty after living in the US for several years may be associated with their geographic locations since most of them lived in areas where most people speak Mandarin. In addition, parents’ reason for high involvement was usually related to their children’s young age and lack of selfcontrol, which aligned with previous researchers’ expectations (Becker et al., 2020; Fontenelle-Tereshchuk, 2021; Garbe et al., 2020; Nyanamba et al., 2022; Ribeiro et al., 2021).
Interestingly enough, another concern mentioned by most parents, their child’s eyesight, was not mentioned in previous literature, which may specifically occur after the pandemic as children’s iPad usage increased dramatically due to the prevalence of remote learning, as mentioned by participants. This concern may be related to their increased involvement in their children’s remote learning since parents may want to ensure that their children were using their iPads to study instead of playing games. Additionally, parents’ concern about children’s learning attitudes augmented their home-based involvement. Parents may believe that their frequent involvement can improve children’s attitudes in remote learning settings, which aligned with the existing literature on the positive relationship between parental expectation and involvement (Xiong et al., 2021; Yamamoto et al., 2022; Zhong & Zhou, 2011). Lastly, although participants explicitly stated that their involvement in their children’s remote learning experience was now higher compared to pre-COVID time, they would prefer in-person mode since they did not have enough time to supervise their children all the time. As they got familiar with the online mode, they were less involved than during the pandemic, which was not mentioned in previous literature.
Additionally, the literature highlighted the importance of monitoring and supervising children as a supportive act of parental involvement (Thomas et al., 2015). The results concurred with these findings as all parents mentioned that they supervised their children in different ways. Furthermore, the literature touched upon the differing viewpoints when it came to child autonomy, specifically with homework (Cooper et al., 2000; Vasquez et al., 2015). The results showed that parents took different perspectives when assisting their children with homework, some parents minimized their child’s autonomy, while others let their children do their homework independently. Along with past research, the current study provided significant insight into the challenges and unique barriers faced by Chinese immigrant parents in supporting their
children’s remote learning experiences following the COVID-19 pandemic. Implications included the importance of educational systems recognizing families’ cultural differences and addressing language barriers. By recognizing cultural differences, schools can understand better the needs of students from different cultural backgrounds, therefore improving their school experiences. Moreover, by addressing language barriers, like hiring translators, schools can ensure effective communication between schools and families and families’ equitable access to educational resources. Overall, future research should delve into the long-term effects of remote learning. Educational support programs targeting immigrant families may be beneficial by addressing language barriers and providing cultural orientation. Future studies can include participants with a more diverse demographic, language proficiencies, and income levels among Chinese immigrant families since this study focuses on immigrant families in New York City with a low SES and existing literature shows that SES and language proficiency are vital factors in immigrant parental involvement (Yamamoto et al., 2022; Zhong & Zhou, 2011).
Antony-Newmann, M. (2019). Parental involvement of immigrant parents: A meta-synthesis. Educational Review, 71(3), 362–381. https://doi.org/10.1080/00131911.2017.14 23278
Baker, T. L., Wise, J., Kelley, G., & Skiba, R. J. (2016). Identifying barriers: Creating solutions to improve family engagement. The School Community Journal, 26(2), 161–184. https:// psycnet.apa.org/record/2016-62234-009
Barge, J. K., & Loges, W. E. (2003). Parent, student, and teacher perceptions of parental involvement. Journal of Applied Communication Research, 31(2), 140–163, https://doi.org/ 10.1080/0090988032000064597
Barger, M. M., Kim, E. M., Kuncel, N. R., & Pomerantz, E. M. (2019). The relation between parents’ involvement in children’s schooling and children’s adjustment: A metaanalysis. Psychological Bulletin, 145(9), 855–890. https:// doi.org/10.1037/bul0000201
Baumrind, D. (1971). Current patterns of parental authority. Developmental Psychology, 4(1, Pt.2), 1–103. https://doi. org/10.1037/h0030372
Becker, S. P., Breaux, R., Cusick, C. N., Dvorsky, M. R., Marsh, N. P., Sciberras, E., & Langberg, J. M. (2020). Remote learning during COVID-19: Examining school practices, service continuation, and difficulties for adolescents with and without attention-deficit/hyperactivity disorder. Journal of Adolescent Health, 67(6), 769–777. https://doi. org/10.1016/j.jadohealth.2020.09.002
Bubb, S., & Jones, M. (2020). Learning from the COVID-19 home-schooling experience: Listening to pupils, parents/ carers and teachers. Improving Schools, 23(3), 209–222. https://doi.org/10.1177/1365480220958797
Cooper, H., Lindsay, J. J., & Nye, B. (2000). Homework in the home: How student, family, and parenting-style differences relate to the homework process. Contemporary Educational Psychology, 25(4), 464–487. https://doi.org/10.1006/ ceps.1999.1036
Cripps, K., & Zyromski, B. (2015). Adolescents’ psychological well-being and perceived parental involvement: Implications for parental involvement in middle schools. Research in Middle-Level Education, 33(4), 1–13. https:// doi.org/10.1080/19404476.2009.11462067
Fontenelle-Tereshchuk, D. (2021). Mental health and the COVID-19 crisis: The hopes and concerns for children as schools re-open. Interchange, 52(1), 1–16. https://doi. org/10.1007/s10780-020-09413-1
Frosch, C. A., Schoppe-Sullivan, S. J., & O’Banion D. D. (2021). Parenting and child development: A relational health perspective. American Journal of Lifestyle Medicine, 15(1), 45–59. https://doi.org/10.1177/1559827619849028
Garbe, A., Ogurlu, U., Logan, N., & Cook, P. (2020). COVID-19 and remote learning: Experiences of parents with children during the pandemic. American Journal of Qualitative Research, 4(3), 45–65. https://doi.org/10.29333/ajqr/8471
Harris, A., & Goodall, J. (2008). Do parents know they matter?
Engaging all parents in learning. Educational Research, 50(3), 277–289. https://doi.org/10.1080/00131880802309424
Hornby, G., & Lafaele, R. (2011). Barriers to parental involvement in education: An explanatory model. Educational Review, 63(1), 37–52. https://doi.org/10.1080/00131911.2010.4880 49
Ishak, Z., Low, S. F., & Lau, P. L. (2012). Parenting style as a moderator for students’ academic achievement. Journal of Science Education and Technology, 21(1), 487–493. https:// doi.org/10.1007/s10956-011-9340-1
Jensen, K. L., & Minke, K. M. (2017). Engaging families at the secondary level: An underused resource for student success. School Community Journal, 27(2), 167–191.
Khajehpour, M., & Ghazvini, S. D. (2011). The role of parental involvement affect in children’s academic performance. Procedia Social and Behavioral Sciences, 15, 1204–1208. https://doi.org/10.1016/j.sbspro.2011.03.263
Malone, D. (2015). Culture: A potential challenge for parental involvement in schools. Delta Kappa Gamma Bulletin; Austin, 82(1), 14–18. http://proxy.library.nyu. edu/login?qurl=https%3A%2F%2Fwww.proquest. com%2Fscholarly-journals%2Fculture-potentialchallenge-parental-involvement%2Fdocview%2F1770514 326%2Fse-2%3Faccountid%3D12768
Nurhayati, S. (2021). Parental involvement in early childhood education for family empowerment in the digital age. Empowerment, 10(1), 54–62. https://doi.org/10.22460/ empowerment.v10i1p54-62.2185.
Nyanamba, J. M., Liew, J., & Li, D. (2022). Parental burnout and remote learning at home during the COVID-19 pandemic: Parents’ motivations for involvement. School Psychology, 37(2), 160–172. https://doi.org/10.1037/spq0000483
Pinquart, M. (2016). Associations of parenting styles and dimensions with academic achievement in children and adolescents: A meta-analysis. Educational Psychology Review, 28(1), 475–493. https://doi.org/10.1007/s10648015-9338-y
Ribeiro, L. M., Cunha, R. S., Andrade e Silva, M. C., Carvalho, M., & Vital, M. L. (2021). Parental involvement during pandemic times: Challenges and opportunities. Education Sciences, 11(6), 302. https://doi.org/10.3390/ educsci11060302
Sartor, C. E., & Youniss, J. (2002). The relationship between positive parental involvement and identity achievement during adolescence. Adolescence, 37(146), 221–234.
Thomas, V., Backer, F. D., Muls, J., & Lombaerts, K. (2019). Middle school student and parent perceptions of parental involvement: Unravelling the associations with school achievement and well being. Educational Studies, 46(4), 404–421. https://doi.org/10.1080/03055698.2019.1590182
Vasquez, A. C., Patall, E. A., Fong, C. J., Corrigan, A. S., & Pine, L. (2016). Parent autonomy support, academic achievement, and psychosocial functioning: A meta-analysis of research. Educational Psychology Review, 28, 605–644. https://doi.
org/10.1007/s10648-015-9329-z
Vu, K. T. T., Castro, K. M., Cheah, C. S. L., & Yu, J. (2019). Mediating and moderating processes in the associations between Chinese immigrant mothers’ acculturation and parenting styles in the United States. Asian American Journal of Psychology, 10(4), 307–315. https://doi. org/10.1037/aap0000150
Wilder, S. (2014). Effects of parental involvement on academic achievement: A meta-synthesis. Educational Review, 66(3), 377–397. https://doi.org/10.1080/00131911.2013.780009
Xia, X., Hackett, R. K., & Webster, L. (2020). Chinese parental involvement and children’s school readiness: The moderating role of parenting style. Early Education and Development, 31(2), 289–307. https://doi.org/10.1080/104 09289.2019.1643439
Xiong, Y., Qin, X., Wang, Q., & Ren, P. (2021). Parental involvement in adolescents’ learning and academic achievement: Cross-lagged effect and mediation of academic engagement. Journal of Youth & Adolescence, 50(9), 1811–1823. https://doi-org.proxy.library.nyu. edu/10.1007/s10964-021-01460-w
Yamamoto, Y., Li, J., & Bempechat, J. (2022). Reconceptualizing parental involvement: A sociocultural model explaining Chinese immigrant parents’ school-based and home-based involvement. Educational Psychologist, 57(4), 267–280. https://doi.org/10.1080/00461520.2022.2094383
Zhong, L., & Zhou, G. (2011). Chinese immigrant parents’ involvement in their children’s school education: High interest but low action. Brock Education, 20(2), 4–21. https://doi.org/10.26522/BROCKED.V20I2.167
School bullying is a prevalent phenomenon in China (Han et al., 2017; Luo et al., 2022; Qiao et al., 2009). While bullying can impact individuals of all ages, adolescents may be particularly vulnerable due to their developmental stage and social dynamics in schools (Han et al; 2017; Luo et al., 2022). Studies have shown that individuals who were bullied during their adolescence have a higher possibility of experiencing mental health problems in the long term (Eyuboglu et al., 2021; Luo et al., 2022). The prolonged exposure to bullying in adolescence is related with an increased risk of internalizing mental health problem such as anxiety disorders and depression in adulthood, even leading to suicidal ideations and attempts (Källmén & Hallgren, 2021; Luo et al., 2022). Furthermore, if these mental health issues persist from adolescence into college, the highly competitive college environment will exacerbate psychological problems with other stressors such as higher workload and living in a new place (Adams & Lawrence, 2011; Brown, 1992; Hubbard et al., 2018; Reid et al., 2016). Previous research has emphasized the role of social support in mitigating the psychological challenges that students being bullied during adolescence may face in their college years (Cheng et al., 2008; Cooley et al., 2014; Duru & Balkis, 2018; Guo et al., 2020). However, there has been insufficient investigation into adolescent school bullying in China and how its long-term effects can be mitigated (Eyuboglu et al., 2021; Han el al, 2017; Luo et al., 2022). Thus, to understand the potential lasting impact of school bullying, it is important to explore how Chinese college students, who experienced bullying during adolescence, navigate social support.
The influence of Chinese culture is an important factor in understanding the prevalence of school bullying in China, particularly the emphasis on academic achievement and parenting styles (Abou-ezzeddine et al., 2007; Huang et al., 2012; Lai et al., 2008). Chinese culture places significant value on academic success, viewing it as a symbol of achievement (Abou-ezzeddine et al., 2007; Huang et al., 2012; Lai et al., 2008). Consequently, Chinese parents, teachers, and school staff often prioritize students’ academic performance over addressing behavioral issues and bullying, allowing these problems to persist (Huang et al., 2012; Wong et al., 2010). Additionally, traditional Chinese values emphasize parents’ responsibility to guide and support their children toward success (Huang et al., 2012; Ma et al., 2018; Wang & Heppner, 2002; Xu et al., 2005). This sense of duty can lead some parents to employ harsh parenting methods such as physical punishment or verbal reprimands (Chao, 1994; Georgiou et al., 2017; Xu et al., 2005; Xu et al., 2009).
These practices can create a hostile and unpredictable family environment, leaving adolescents feeling insecure and more susceptible to social conflicts at school (Georgiou et al., 2017; Xu et al., 2005; Xu et al., 2009). Over time, this may lead them to internalize harsh parental behaviors and react aggressively to peers in school, potentially contributing to increased bullying behaviors among children (Georgiou et al., 2017; Xu et al., 2005; Xu et al., 2009).
School bullying is characterized by deliberate and persistent harm intended to cause discomfort to the victim (Benbenishty & Astor, 2005; Olweus, 2003). It can manifest in various ways, including physical actions like beatings, punches, and kicks, as well as verbal behaviors such as assigning derogatory nicknames and mockery (Benbenishty & Astor, 2005; Olweus, 2003). Additionally, school bullying may involve interpersonal actions such as spreading rumors and social exclusion (Benbenishty & Astor, 2005; Olweus, 2003). Research indicates that all forms of school bullying are prevalent across middle schools and high schools in China, with approximately 11% of Chinese adolescents experiencing one or more forms of bullying (Han et al., 2017; Luo et al., 2022; Qiao et al., 2009). This prevalence among adolescents underscores the need to understand the cultural and social factors contributing to bullying in Chinese schools.
School bullying has long-lasting negative outcomes on adolescents’ personal and academic life (Olweus, 1994; Pescaru & Pescaru, 2022; Reid et al., 2016). Victims may have increased fear of trusting peers and tend to be alone at school, which diminishes their sense of belonging at school (Huang, 2020; Olweus, 1994). The exclusion from school undermines students’ psychological connections with the school community, further leading to their failure to engage in classroom learning and resulting in poor academic performance (Buhs & Ladd, 2001; Huang, 2020; Mundy et al., 2017). The unpleasant and intense school environment also diminishes victims’ learning motivation, which reduces their overall academic success in late adolescence (Pescaru & Pescaru, 2022; Young-Jones et al.,2015). The persistent stress experienced by victims of school bullying can significantly impede their personal development, hindering their ability to form healthy relationships and maintain a positive self-image throughout their lives (Pescaru & Pescaru, 2022; Reid et al., 2016).
Moreover, school bullying has long-lasting negative effects on the psychological well-being of those who are victimized (Arseneault et al., 2009; Chu et al., 2019). Specifically, the
experience of school bullying makes individuals feel helplessness, fear, and loneliness, which decreases their self-esteem (Arseneault et al., 2009; Dervishi, 2019; Pescaru & Pescaru, 2022). These unhealthy emotional states are associated with higher levels of depression and anxiety in college (Arseneault et al., 2009; Holt et al., 2014; Reid et al., 2016). For instance, the lingering effects of school bullying extend into college, where victims may encounter difficulties in adjusting to the academic and social environment (Arseneault et al., 2009; Holt et al., 2014). These challenges, coupled with persistent mental health issues, significantly elevate the likelihood of dropout rates among affected individuals (Arseneault et al., 2009; Holt et al., 2014; Reid et al., 2016). Additionally, adolescents who experience school bullying in high school are at risk for later suicidal thoughts and attempts in general (Corcoran & Graham, 2002; Hawker & Boulton, 2002; Klomek et al., 2011). In fact, victims of school bullying are 1.7 times more likely to attempt suicide compared to their peers (Hinduja & Patchin, 2018).
Social support (i.e., assistance from interpersonal relationships that fosters feelings of care, love, and esteem; Cobb, 1976; Cohen & Wills, 1985; Jacobson, 1986) is positively correlated with mental health improvement and the ability to mitigate psychological issues (Davidson & Demaray, 2007; Fasihi Harandi et al., 2017; Hefner & Eisenberg, 2009). Social support during the college years includes support from mental health services, family, and peers (Cleary et al., 2011; Reid et al., 2016). Strong social support can enhance coping skills and reduce the perceived significance of stressful events, ultimately preventing potential mental health issues (Cohen & Wills, 1985; Davidson & Demaray, 2007; Reid et al., 2016).
Numerous studies have explored how social support can act as a buffer against the psychological challenges faced by college students, including those with histories of being bullied (Fasihi Harandi et al., 2017; Merianos et al., 2013; Reid et al., 2016; Tennant et al., 2015). Its positive impact can be explained by the stress-buffering effect model (Cobb, 1976; Cohen & Wills, 1985), which suggests that strong social support can act as a buffer against adverse mental health consequences stemming from stressful life events (Cobb, 1976; Cohen & Wills, 1985; Reid et al., 2016). These studies support the stress-buffering model by demonstrating that increased social support can shield college students from experiencing elevated anxiety, depressive symptoms, and suicidal thoughts associated with adolescent bullying experiences (Guo et al., 2020; Liu et al., 2016; Reid et al., 2016; Xu et al., 2018). One potential explanation could be that when college students with a history of being bullied face stressors, they may experience pathological mental health disorders, such as depression and anxiety disorders (Cohen & McKay, 2020; Newman et al., 2005; Reid et al., 2016). Receiving social support can provide students with more emotional resources which include self-compassion, confidence, self-care, and resilience, helping them recover from emotional loss and
ultimately improving their mental health outcomes (Cohen & McKay, 2020; Reid et al., 2016). For example, the group counseling service at school increases the self-compassion for victims, which is a form of self-care and protects them from developing self-evaluation anxiety (Chishima et al., 2018; Prastiwi & Mahanani, 2021). The increased self-compassion is associated with positive mental health outcomes, and negatively related with stress and depression (Chishima et al., 2018; Krieger et al., 2013).
Studies have examined the prevalence of adolescent school bullying in China and explored its long-lasting negative impact on the mental health of students that can be carried into college (Da et al., 2023; Fang et al., 2022; Fei et al., 2022; Gorman et al., 2011; Han et al., 2017; Hinduja & Patchin, 2018; Kowalski & Limber, 2013; Turanovic & Siennick, 2022). Strong social support acts as a buffer against adverse mental health consequences, reducing the risk of anxiety, depression, and suicidal thoughts, especially for college students with adolescent experiences of being bullied (Cohen & Wills, 1985; Davidson & Demaray, 2007; Reid et al., 2016). Even though adolescent school bullying is prevalent in China (Luo et al., 2022), there is insufficient research that examines how Chinese college students with a history of adolescent school bullying receive social support. Therefore, the current study investigates the following research question: How do Chinese college students, who experienced bullying during adolescence, receive social support?
The research was conducted on a cohort of eight Chinese college students who experienced bullying during their adolescence. They were recruited by social media groups and referrals from peers. The participants were aged between 18 and 22 years and included 3 males and 5 females. All eight participants were Chinese undergraduates at NYU and were born and raised in China. Among them, some arrived in the U.S. during their college years, while others pursued their high school education in the U.S.. All participants shared experiences of encountering school bullying during their adolescent years. Before the interview, each participant received a consent form outlining the research questions and confidentiality information, and they received a $15 Uber gift card after the interview.
The study was conducted through individual semistructured interviews. The interviews lasted 30 minutes and were conducted via Zoom. Some of the interviews were recorded if the participant gave permission. If they did not give permission, extensive notes were taken during the interview. The interview questions included topics such as demographic information, school experiences, encounters with school bullying, and the social support they have received. Participants had the
option to skip questions or terminate the interview if they felt uncomfortable or chose not to answer.
The study used grounded theory to code the interview data. Initially, one researcher transcribed all the data, followed by collaborative efforts from all researchers to identify commonalities, thus generating draft themes. Then the researchers reviewed the raw data to finalize the themes. To enhance inter-rater reliability, researchers iteratively collaborated, refining the process and formulating four themes and sub-themes.
After interviewing eight Chinese college students who experienced bullying during their adolescence, three sub-themes emerged. They are types of bullying, mental health challenges, and social support. These sub-themes help researchers better understand how social support helps Chinese adolescents navigate school bullying.
All but one participant recounted instances of interpersonal forms of school bullying which is a prevalent form of school bullying. They detailed various forms of mistreatment, such as spreading rumors and social exclusion. Notably, all six female participants faced rumor spreading, particularly of a sexual nature. For instance, one female participant shared her experience during high school, where several girls spread rumors about her being pregnant, leading to her social exclusion. She said, “They said that I am pregnant, but I have never had any sexual activity before. I don’t understand, I just don’t.” Another participant, also a high school student, faced similar false rumors of a sexual relationship with a boy she had never even spoken to.
Among the female participants, two highlighted experiences of severe social exclusion. One of the four Chinese girls in her grade was consistently subjected to eye-rolling and explicit instructions from other girls not to eat lunch with her, resulting in her prolonged isolation during lunchtime. Furthermore, another participant expressed the impact of the false rumors on their social life. She claimed that due to the rumors, her classmates stopped talking with her, resulting in a profound sense of sadness and social exclusion. She said, “Many people didn’t want to talk to me for a long time. I am always questioning what I have done”.
Two forms of mental health challenges emerged from the data: sadness and anxiety. Half of the participants reported feeling isolated at school, leading them to withdraw from social interactions for a long time. Some victims chose to avoid social settings entirely, expressing preference to stay in their rooms, saying things like, “I feel home is actually a safe place for me. For a long time, I didn’t want to go to school.” Additionally, victims of
bullying often experience frustration and confusion, struggling to understand why they are being mistreated. One participant expressed, “I don’t know how to deal with this situation.” These feelings of frustration further contribute to a sense of loneliness, which a participant explained, “I feel like I am always alone at school. I feel very sad.” Another participant who experienced social exclusion from her friends also expressed the feeling of loneliness stating, “For a long time, I felt lonely during lunchtime at school because I had to be alone.”
Some interviewers also reported increased stress and anxiety after experiencing school bullying. One participant who experienced exclusion and isolation from her friends for two years revealed, “I even became very self-conscious about what I do and cared a lot about others’ reactions.” This selfconsciousness always makes me reflect on myself, which makes me feel anxious and stressful.” This feeling persisted for three to four years, extending into her first year in college. Another participant who attended high school in the U.S. was excluded from her classmates in the first year. She explained, “It really stressed me out, and I felt anxious during lunchtime.” According to her experience, the anxiety of getting friends with others lasts for three years and makes it difficult to integrate into college life.
Within the realm of social support, two forms emerged: social support from friends related to positive feelings and social support from family related to mixed feelings.
Three participants mentioned receiving social support from friends. All three had experienced interpersonal forms of school bullying, contributing to their feelings of social isolation and making them seek more friendships in college. For example, one female participant, who struggled with being bullied by the spread of rumors during high school, discussed feeling caught up in negative, long-lasting feelings of isolation in college. She emphasized that spending time with friends and getting “helpful advice” from them made her feel more accompanied and view friends as the most important source of support. Another female participant was bullied through social exclusion by her peers during adolescence, which deprived her of support from friends at that time. This drove her to seek friendship and spend time with friends in companionship to overcome feelings of isolation during college. A male participant who experienced rumors of him being a racist during high school mentioned that he felt that the experience hurt his mental health for a long time and made him less likely to trust strangers and talk with unfamiliar people in college. However, he mentioned that his close friends were “good listeners” who were patient to hear his previous “stressful stories” and always showed support by “standing with [him]” to move forward. Additionally, his friends could provide him with a sense of belonging as he transitioned to college, stating, “I think I’m so glad that I have supportive friends who will stand out at that time just making me feel secure as a newcomer, not to the college, but also to the city.”
Five participants discussed how they navigate support from
family members, including parents and siblings. One female participant, who was bullied by rumors of engaging in sexual activities with other boys in high school, reported feeling positive and reassured about her family support, stating, “I have a really warm family. With them, I am afraid of nothing.” She claimed that her family, including her parents and older brother, always believed in her and supported her in facing school bullying, making her feel that she “always has backup” that continues into college. However, the other four participants all expressed uncertainty or negativity regarding social support from family. All of them noted that, as international students in a U.S. college, their parents were physically distant in China. Consequently, three male participants stated that when confronted with enduring negative emotions, such as anxiety and isolation rooted in past experiences of being bullied, they hesitated to share these challenges with their parents, stating that their parents “cannot help.” Another female participant mentioned that her parents always expected her to remain “quiet” about her negative emotions to avoid “causing any trouble to anyone” as she was in another country, making her feel unsupported or unbacked.
The present study seeks to answer how Chinese college students, who experienced bullying during adolescence, receive social support. By conducting semi-structured interviews with eight Chinese college students, three major themes emerged: type of school bullying, mental health challenges, and social support, followed by several sub-themes (See Table 1). Results suggested that Chinese students who experienced bullying during adolescence may face long-lasting mental health issues that could persist into their college years. Nevertheless, social support received during high school and college can mitigate these mental health challenges.
These interview findings are consistent with previous studies where verbal bullying and interpersonal bullying are found to be more prevalent than physical bullying among Chinese adolescents (Xu et al., 2020; Zhang, 2002; Zhang & Jiang, 2021). Similarly, previous studies have shown that school bullying can lead to long-lasting negative mental health outcomes during adolescence, such as feelings of helplessness, loneliness, and a loss of self-confidence (Dervishi, 2019; Pescaru & Pescaru, 2022). The participants’ constant experience of sadness and anxiety has had a long lasting effect on their college years, which is also consistent with previous research indicating that heightened stress makes it more difficult for victims to integrate into the college (Deroma et al., 2009).
Moreover, the findings show the stress-buffering effect of social support from friends. This differs from previous studies that found that social support from friends did not significantly mitigate negative mental health consequences associated with past histories of being bullied (Davidson & Demaray, 2007; Guo et al., 2020; Reid et al., 2016). Furthermore, past research has shown that family support could buffer against students’ poor mental health outcomes related to past experiences of being
bullied (Davidson & Demaray, 2007; Reid et al., 2016; Shaheen et al., 2019). However, in this study, only one participant consistently felt positively supported and backed whenever she needed help. Other participants were reluctant to rely on parental support when facing negative emotions. These inconsistencies might be attributed to the geographical distance of the current participants from their parents. As all participants are Chinese college students studying in the U.S., they might rely more heavily on their friends as sources of social support.
While the current study has expanded the literature by exploring the emotional impact of school bullying during adolescence on Chinese college students and how they navigate social support, it does have certain limitations. The study utilized convenience sampling, predominantly recruiting Chinese college students from U.S. colleges. Future research should thus further investigate these relations with a larger sample and should expand the focus to include Chinese college students studying in China as well as international students studying in the U.S. from countries other than China. Moreover, researchers might consider using a longitudinal design to better explore the long lasting effects of bullying during the adolescent years.
Overall, the current study has shown that Chinese college students who experienced bullying during adolescence could struggle with long-lasting negative emotions. Therefore it is critical to address school bullying during adolescence and to provide support to college students who have previously experienced bullying. Scaffolding social support from friends may alleviate these negative feelings through the stress-buffering model by providing positive feelings of belongingness and companionship (Cobb, 1976; Cohen & Wills, 1985; Reid et al., 2016). Additionally, colleges could organize more social events to create more opportunities for international college students to make friends and build social support from peers. College counselors should also encourage international students to seek support from their friends in order to better cope with stress and negative feelings, as well as work to develop strategies to improve family support for international students.
Abou‐ezzeddine, T., Schwartz, D., Chang, L., Lee‐Shin, Y., Farver, J., & Xu, Y. (2007). Positive peer relationships and risk of victimization in Chinese and South Korean children’s peer groups. Social Development, 16(1), 106–127. https://doi. org/10.1111/j.1467-9507.2007.00374.x
Adams, F. D., & Lawrence, G. J. (2011). Bullying victims: The effects last into college. American Secondary Education, 40(1), 4–13.
Alharbi, E. S., & Smith, A. P. (2018). Review of the literature on stress and wellbeing of international students in Englishspeaking countries. International Education Studies, 11(6), 22. https://doi.org/10.5539/ies.v11n6p22
Arseneault, L., Bowes, L., & Shakoor, S. (2009). Bullying victimization in youths and mental health problems: ‘Much ado about nothing’? Psychological Medicine, 40(5), 717–729. https://doi.org/10.1017/s0033291709991383
Benbenishty, R., & Astor, R. A. (2005). School violence in context: Culture, neighborhood, family, school, and gender. Oxford University Press.
Brown, R. T. (1992). Helping students confront and deal with stress and procrastination. Journal of College Student Psychotherapy, 6(2), 87–102. https://doi.org/10.1300/ j035v06n02_09
Buhs, E. S., & Ladd, G. W. (2001). Peer rejection as antecedent of young children’s school adjustment: An examination of mediating processes. Developmental Psychology, 37(4), 550–560. https://doi.org/10.1037/0012-1649.37.4.550
Chao, R. K. (1994). Beyond parental control and authoritarian parenting style: Understanding Chinese parenting through the cultural notion of training. Child Development, 65(4), 1111. https://doi.org/10.2307/1131308
Chen, J. K., & Wei, H. S. (2013). School violence, social support and psychological health among Taiwanese junior high school students. Child Abuse & Neglect, 37(4), 252–262. https://doi.org/10.1016/j.chiabu.2013.01.001
Cheng, S. T., Cheung, K. C., & Cheung, C. (2008). Peer victimization and depression among Hong Kong Adolescents. Journal of Clinical Psychology, 64(6), 766–776. https://doi.org/10.1002/jclp.20489
Chishima, Y., Mizuno, M., Sugawara, D., & Miyagawa, Y. (2018). The Influence of Self-Compassion on Cognitive Appraisals and Coping with Stressful Events. Mindfulness, 9(6), 1907–1915. https://doi.org/10.1007/s12671-018-0933-0
Chu, X. W., Fan, C. Y., Lian, S. L., & Zhou, Z. K. (2019). Does bullying victimization really influence adolescents’ psychosocial problems? A three-wave longitudinal study in China. Journal of Affective Disorders, 246, 603–610. https:// doi.org/10.1016/j.jad.2018.12.103
Cleary, M., Walter, G., & Jackson, D. (2011c). “not always smooth sailing”: Mental health issues associated with the transition from high school to college. Issues in Mental Health Nursing, 32(4), 250–254. https://doi.org/10.3109/0 1612840.2010.548906
Cobb, S. (1976). Social support as a moderator of life stress.
Psychosomatic Medicine, 38(5), 300–314. https://doi. org/10.1097/00006842-197609000-00003
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310
Cohen, S., & McKay, G. (2020). Social support, stress and the buffering hypothesis: A theoretical analysis. In Handbook of psychology and health, Volume IV (pp. 253–267). Routledge.
Cooley, J. L., Fite, P. J., Rubens, S. L., & Tunno, A. M. (2014). Peer victimization, depressive symptoms, and rule-breaking behavior in adolescence: The moderating role of peer social support. Journal of Psychopathology and Behavioral Assessment, 37(3), 512–522. https://doi.org/10.1007/ s10862-014-9473-7
Corcoran, K., & Graham, T. C. (2002). In thought, word, and deed: Suicidal behaviors of adjudicated youth. Brief Treatment and Crisis Intervention, 2(3), 233–240. https:// doi.org/10.1093/brief-treatment/2.3.233
Da, Q., Huang, J., Peng, Z., Chen, Y., & Li, L. (2023). Did the prevalence of traditional school bullying increase after COVID-19? Evidence from a two-stage cross-sectional study before and during COVID-19 pandemic. Child Abuse & Neglect, 143, 106256. https://doi.org/10.1016/j. chiabu.2023.106256
Davidson, L. M., & Demaray, M. K. (2007). Social support as a moderator between victimization and internalizing–externalizing distress from bullying. School Psychology Review, 36(3), 383–405. https://doi.org/10.1080/0279601 5.2007.12087930
Deroma, V. M., Leach, J. B., & Leverett, J. P. (2009). The relationship between depression and college academic performance. College Student Journal, 43, 325–334.
Dervishi, E. (2019). School bullying and symptoms of depression. Archives of Psychiatry and Psychotherapy, 21(2), 48–55. https://doi.org/10.12740/app/103658
Duru, E., & Balkis, M. (2018). Exposure to school violence at school and mental health of victimized adolescents: The mediation role of Social Support. Child Abuse & Neglect, 76, 342–352. https://doi.org/10.1016/j.chiabu.2017.11.016
Eyuboglu, M., Eyuboglu, D., Pala, S. C., Oktar, D., Demirtas, Z., Arslantas, D., & Unsal, A. (2021). Traditional school bullying and cyberbullying: Prevalence, the effect on mental health problems and self-harm behavior. Psychiatry Research, 297, 113730. https://doi.org/10.1016/j. psychres.2021.113730
Fang, D., Lu, J., Che, Y., Ran, H., Peng, J., Chen, L., Wang, S., Liang, X., Sun, H., & Xiao, Y. (2022). School bullying victimization-associated anxiety in Chinese children and adolescents: The mediation of resilience. Child and Adolescent Psychiatry and Mental Health, 16(1), 1–7. https://doi.org/10.1186/s13034-022-00490-x
Fasihi Harandi, T., Mohammad Taghinasab, M., & Dehghan Nayeri, T. (2017). The correlation of social support with
Social Support for Chinese College Students
mental health: A meta-analysis. Electronic Physician, 9(9), 5212–5222. https://doi.org/10.19082/5212
Fei, L., Liao, M., Ke, L., Zou, Y., Li, X., Chen, Y., & Zhang, R. (2022). School bullying among Chinese third to fifthgrade primary school students in a cross-sectional study: The protective effect of psychological resilience. PLoS one, 17(12), e0278698. https://doi.org/10.1371/journal. pone.0278698
Georgiou, S. N., Ioannou, M., & Stavrinides, P. (2017). Cultural values as mediators between parenting styles and bullying behavior at school. Social Psychology of Education, 21(1), 27–50. https://doi.org/10.1007/s11218-017-9413-y
Gierczyk, M., & Diao, R. (2021). Socio-educational Contexts of Gāokao Exam: A qualitative retrospective study of how gāokao is perceived by successful exam-takers. International Journal of Chinese Education, 10(2). https:// doi.org/10.1177/22125868211035802
Gorman, A. H., Schwartz, D., Nakamoto, J., & Mayeux, L. (2011). Unpopularity and disliking among peers: Partially distinct dimensions of adolescents’ social experiences. Journal of Applied Developmental Psychology, 32(4), 208–217. https:// doi.org/10.1016/j.appdev.2011.05.001
Gruttadaro, D., & Crudo, D. (2012). College students speak: A survey report on mental health. National Alliance on Mental Illness, 1–24.
Guo, J., Li, M., Wang, X., Ma, S., & Ma, J. (2020). Being bullied and depressive symptoms in Chinese high school students: The role of social support. Psychiatry Research, 284, 112676. https://doi.org/10.1016/j.psychres.2019.112676
Han, Z., Zhang, G., & Zhang, H. (2017). School bullying in urban China: Prevalence and correlation with school climate. International journal of environmental research and public health, 14(10), 1116. https://doi.org/10.3390/ ijerph14101116
Hawker, D. S., & Boulton, M. J. (2002). Twenty Years’ research on peer victimization and psychosocial maladjustment: A meta-analytic review of cross-sectional studies. Annual Progress in Child Psychiatry and Child Development 20002001, 505–534. https://doi.org/10.4324/9780203449523-26
Hefner, J., & Eisenberg, D. (2009). Social support and mental health among college students. American Journal of Orthopsychiatry, 79(4), 491–499. https://doi.org/10.1037/ a0016918
Hinduja, S., & Patchin, J. W. (2018). Connecting adolescent suicide to the severity of bullying and cyberbullying. Journal of School Violence, 18(3), 333–346. https://doi.org /10.1080/15388220.2018.1492417
Holt, M. K., & Espelage, D. L. (2006). Perceived social support among bullies, victims, and bully-victims. Journal of Youth and Adolescence, 36(8), 984–994. https://doi.org/10.1007/ s10964-006-9153-3
Holt, M. K., Greif Green, J., Reid, G., DiMeo, A., Espelage, D. L., Felix, E. D., Furlong, M. J., Poteat, V. P., & Sharkey, J. D. (2014). Associations between past bullying experiences
and psychosocial and academic functioning among college students. Journal of American College Health, 62(8), 552–560. https://doi.org/10.1080/07448481.2014.947990
Huang, H., Hong, J. S., & Espelage, D. L. (2012). Understanding factors associated with bullying and peer victimization in Chinese schools within ecological contexts. Journal of Child and Family Studies, 22(7), 881–892. https://doi. org/10.1007/s10826-012-9647-4
Huang, L. (2020). Exploring the relationship between school bullying and academic performance: The mediating role of students’ sense of belonging at school. Educational Studies, 48(2), 216–232. https://doi.org/10.1080/03055698.2020.17 49032
Hubbard, K., Reohr, P., Tolcher, L., & Downs, A. (2018). Stress, mental health symptoms, and help-seeking in college students. Psi Chi Journal of Psychological Research, 23(4), 293–305. https://doi.org/10.24839/2325-7342.jn23.4.293
Jacobson, D. E. (1986). Types and timing of social support. Journal of Health and Social Behavior, 27(3), 250. https:// doi.org/10.2307/2136745
Källmén, H., & Hallgren, M. (2021). Bullying at school and mental health problems among adolescents: A repeated cross-sectional study. Child and Adolescent Psychiatry and Mental Health, 15(1). https://doi.org/10.1186/s13034-02100425-y
Klomek, A. B., Kleinman, M., Altschuler, E., Marrocco, F., Amakawa, L., & Gould, M. S. (2011). High school bullying as a risk for later depression and suicidality. Suicide and Life-Threatening Behavior, 41(5), 501–516. https://doi. org/10.1111/j.1943-278x.2011.00046.x
Klomek, A. B., Marrocco, F., Kleinman, M., Schonfeld, I. S., & Gould, M. S. (2007). Bullying, depression, and suicidality in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 40–49. https://doi. org/10.1097/01.chi.0000242237.84925.18
Kowalski, R. M., & Limber, S. P. (2013). Psychological, physical, and academic correlates of cyberbullying and traditional bullying. Journal of Adolescent Health, 53(1), S13–S20. https://doi.org/10.1016/j.jadohealth.2012.09.018
Krieger, T., Altenstein, D., Baettig, I., Doerig, N., & Holtforth, M. G. (2013). Self-Compassion in Depression: Associations with Depressive Symptoms, Rumination, and Avoidance in Depressed Outpatients. Behavior Therapy, 44(3), 501–513. https://doi.org/10.1016/j.beth.2013.04.004
Lai, S.-L., Ye, R., & Chang, K.-P. (2008). Bullying in middle schools: An Asian-Pacific Regional Study. Asia Pacific Education Review, 9(4), 503–515. https://doi.org/10.1007/ bf03025666
Lin, M., Wolke, D., Schneider, S., & Margraf, J. (2020). Bullying history and mental health in university students: The mediator roles of social support, personal resilience, and self-efficacy. Frontiers in Psychiatry, 10, 960. https://doi. org/10.3389/fpsyt.2019.00960
Liu, X., Chen, G., Hu, P., Guo, G., & Xiao, S. (2016). Does
perceived social support mediate or moderate the relationship between victimisation and suicidal ideation among Chinese adolescents? Journal of Psychologists and Counsellors in Schools, 27(1), 123–136. https://doi. org/10.1017/jgc.2015.30
Luo, X., Zheng, R., Xiao, P., Xie, X., Liu, Q., Zhu, K., Wu, X., Xiang, Z., & Song, R. (2022). Relationship between school bullying and Mental Health Status of adolescent students in China: A nationwide cross-sectional study. Asian Journal of Psychiatry, 70, 103043. https://doi.org/10.1016/j. ajp.2022.103043
Ma, Y., Siu, A., & Tse, W. S. (2018). The role of High Parental Expectations in adolescents’ academic performance and depression in Hong Kong. Journal of Family Issues, 39(9), 2505–2522. https://doi.org/10.1177/0192513x18755194
Malecki, C. K., Demaray, M. K., & Davidson, L. M. (2008). The relationship among social support, victimization, and student adjustment in a predominantly Latino sample. Journal of School Violence, 7(4), 48–71. https://doi. org/10.1080/15388220801973847
Merianos, A. L., Nabors, L. A., Vidourek, R. A., & King, K. A. (2013). The Impact of Self-esteem and Social Support on College Students’ Mental Health. American Journal of Health Studies, 28(1), 27–34.
Mulder, C. H., & Van der Meer, M. J. (2009). Geographical distances and support from family members. Population, Space and Place, 15(4), 381–399. https://doi.org/10.1002/ psp.557
Mundy, L. K., Canterford, L., Kosola, S., Degenhardt, L., Allen, N. B., & Patton, G. C. (2017). Peer victimization and academic performance in primary school children. Academic Pediatrics, 17(8), 830–836. https://doi.org/10.1016/j. acap.2017.06.012
Newman, M. L., Holden, G. W., & Delville, Y. (2005). Isolation and the stress of being bullied. Journal of Adolescence, 28(3), 343–357. https://doi.org/10.1016/j. adolescence.2004.08.002
Olweus, D. (1994). Bullying at school: Basic facts and effects of a school based intervention program. Journal of Child Psychology and Psychiatry, 35(7), 1171–1190. https://doi. org/10.1111/j.1469-7610.1994.tb01229.x
Olweus, D. (2005). Bullying at school: What we know and what we can do. Blackwell.
Papafratzeskakou, E., Kim, J., Longo, G. S., & Riser, D. K. (2011). Peer victimization and depressive symptoms: Role of peers and parent–child relationship. Journal of Aggression, Maltreatment & Trauma, 20(7), 784–799. https://doi.org/1 0.1080/10926771.2011.608220
Peng, C., Hu, W., Yuan, S., Xiang, J., Kang, C., Wang, M., Rong, F., Huang, Y., & Yu, Y. (2020). Self-harm, suicidal ideation, and suicide attempts in Chinese adolescents involved in different sub-types of bullying: A cross-sectional study. Frontiers in Psychiatry, 11. https://doi.org/10.3389/ fpsyt.2020.565364
Pescaru, C. M., Pescaru, M. (2022). The Phenomenon of Bullying at Early School Age: Social and Psychological Consequences. Revista Universitara Sociologie, 18(3), 276. Prastiwi, S. B., & Mahanani, F. K. (2021). Self-compassion dan subjective Well-Being pada calon Tenaga Kerja Wanita (Tkw). Jurnal Psikologi Ilmiah, 13(2), 120–128. http:// journal.unnes.ac.id/nju/index.php/INTUISI
Qiao, Y. J., Xing, Y., Ji, C. Y., & Zhang, L. (2009). The prevalence of bullying behaviors among urban middle school students in 18 provinces, China. Zhonghua Liuxingbingxue Zazhi, 30(5), 444-447.
Reid, G. M., Holt, M. K., Bowman, C. E., Espelage, D. L., & Green, J. G. (2016). Perceived social support and mental health among first-year college students with histories of bullying victimization. Journal of Child and Family Studies, 25(11), 3331–3341. https://doi.org/10.1007/s10826-0160477-7
Seeds, P. M., Harkness, K. L., & Quilty, L. C. (2010). Parental maltreatment, bullying, and adolescent depression: Evidence for the mediating role of perceived social support. Journal of Clinical Child & Adolescent Psychology, 39(5), 681–692. https://doi.org/10.1080/15374416.2010.50 1289
Shaheen, A. M., Hamdan, K. M., Albqoor, M., Othman, A. K., Amre, H. M., & Hazeem, M. N. (2019). Perceived social support from family and friends and bullying victimization among adolescents. Children and Youth Services Review, 107, 104503. https://doi.org/10.1016/j. childyouth.2019.104503
Tanigawa, D., Furlong, M. J., Felix, E. D., & Sharkey, J. D. (2011). The protective role of perceived social support against the manifestation of depressive symptoms in peer victims. Journal of School Violence, 10(4), 393–412. https://doi.org/ 10.1080/15388220.2011.602614
Tennant, J. E., Demaray, M. K., Coyle, S., & Malecki, C. K. (2015). The dangers of the web: Cybervictimization, depression, and social support in college students. Computers in Human Behavior, 50, 348–357. https://doi.org/10.1016/j. chb.2015.04.014
Turanovic, J. J., & Siennick, S. E. (2022). The Causes and Consequences of School Violence: A Review. National Institute of Justice.
Wang, L. F., & Heppner, P. P. (2002). Assessing the impact of parental expectations and psychological distress on Taiwanese College students. The Counseling Psychologist, 30(4), 582–608. https://doi.org/10.1177/00100002030004006
Wong, D. S., Cheng, C. H., Ngan, R. M., & Ma, S. K. (2010). Program effectiveness of a restorative wholeschool approach for tackling school bullying in Hong Kong. International Journal of Offender Therapy and Comparative Criminology, 55(6), 846–862. https://doi. org/10.1177/0306624x10374638
Xu, Q., Li, S., & Yang, L. (2018). Perceived social support and mental health for college students in Mainland China:
The mediating effects of self-concept. Psychology, Health & Medicine, 24(5), 595–604. https://doi.org/10.1080/1354850 6.2018.1549744
Xu, S., Ren, J., Li, F., Wang, L., & Wang, S. (2020). School bullying among vocational school students in China: Prevalence and associations with personal, relational, and school factors. Journal of Interpersonal Violence, 37(1–2). https:// doi.org/10.1177/0886260520907360
Xu, Y., Farver, J. A., Zhang, Z., Zeng, Q., Yu, L., & Cai, B. (2005). Mainland Chinese parenting styles and parent-child interaction. International Journal of Behavioral Development, 29(6), 524–531. https://doi. org/10.1080/01650250500147121
Xu, Y., Farver, J. A., & Zhang, Z. (2009). Temperament, harsh and indulgent parenting, and Chinese children’s proactive and reactive aggression. Child Development, 80(1), 244–258. https://doi.org/10.1111/j.1467-8624.2008.01257.x
Young-Jones, A., Fursa, S., Byrket, J. S., & Sly, J. S. (2015). Bullying affects more than feelings: The long-term implications of victimization on academic motivation in higher education. Social psychology of education, 18, 185–200.
Zhang, W. (2002). Prevalence and major characteristics of bullying/victimization among primary and junior middle school children. Acta Psychologica Sinica, 34(4), 57–64. https://journal.psych.ac.cn/acps/EN/ Zhang, H., & Jiang, Y. (2021). A systematic review of research on school bullying/violence in mainland China: Prevalence and correlates. Journal of School Violence, 21(1), 48–59. https://doi.org/10.1080/15388220.2021.1985326
Table 1
Theme generated from interviews
Theme Sub-Theme Code
Types of School Bullying Physical actions
Beats and Kicks
Example quotes
“He beated me and told me never to come to the court as it was exclusively reserved for them.”
Verbal behaviors
Insulting words
Interpersonal Forms Spreading rumors “They said that I am pregnant, but I have never had any sexual activity before.”
Social exclusion
Mental Health Challenges Sadness
Feel Isolated
Anxiety
Loneliness
Frustration
“It made me feel like a betrayal. And it was incredibly isolating for me.”
“I feel pretty bad about it because I don’t want to be treated differently.”
“I am alone outside, my family is not around me. I feel very sad.”
“For a whole semester, I was just totally lost. I don’t know what I should do, I don’t know where I should go for lunch.”
“So that made me very frustrated. I kind of like to question myself a lot.”
Self-consciousness “I will be very, very self conscious about what I do. I would like to care a lot about others’ reactions.”
Feeling Stressful
“I feel stressed because it’s only like my first year in high school. So I definitely feel a certain level of stress when I hear people are feeling so offensive about me.”
Social Support
Social Support from Friends related to Positive Feelings
Social Support for Chinese College
Social Support from Family related to Mixed Feelings
Feeling a sense of belonging “I think I’m so glad that I have a supportive friend who will stand out at that time just making me feel secure as a newcomer, not to the school, but also to the city.”
Feeling accompanied “...they’re standing with me and fighting against those bullying.”
Feeling reassured “I have a really warm family. With them, I am afraid of nothing.”
Feeling hesitant “...my parents were in China. So if I share something bad for them, like they cannot help me, you know.”
Bonita Wankhade
Queerness and mental health are both considered taboo subjects in the South Asian community, and those who hold these intersecting identities are faced with considerable challenges. Most notably, queer South Asians are more likely to be disproportionately affected by both external stressors, such as discrimination, and internal stressors, including internalized heterosexism and acculturative stress (Sandil et al., 2014). This combination can increase their likelihood of developing depression, anxiety, PTSD, and suicidal thoughts, particularly for young people (Shaligram et al., 2022). Despite this, LGBTQ+ South Asians have been found to be less likely to access mental health care because of cultural norms that marginalize or entirely erase their identities (Choudhury et al., 2009). As a result, queer South Asian youth report that they are rarely open about their sexuality or gender identity with members of their family and community (Choudhury et al., 2009). To further shed light on the difficulties Queer South Asian youth face in talking about their mental health, seeking mental health care, and coming to terms with their identities, Dr. Katya Viswanadhan (they/them), whose work focuses on genderqueer youth and their experiences with mental health issues (particularly eating disorders), was interviewed.
What is your education and career background? Why did you choose specifically to study youth?
I actually got my master’s in India, where I specialized in clinical psychology. When I realized that I wanted to study more, I went to a doctoral program in Indiana. I soon realized that there was such a need for not only studying the intersection between being South Asian and being queer, but in general, just talking about queerness in people of color. I did my residency at Stanford University, and that was where I had a lot of channels open up for me to learn from and teach a lot of South Asian university students about what it meant to explore their South Asian heritage. I think knowing that children and adolescents are such a vulnerable population piqued my interest. You’re figuring things out in a world where you don’t have as much control, let alone legal authority to make specifically medical decisions for yourself. Often it also coalesces with understanding your body and your sexuality, maybe for the first time. I kind of soon realized that the impact that I wanted to make might necessitate me working with younger and younger populations because really the idea of exploring your gender, your sexuality can start from a very young age. My own journey with gender also influenced this.
How do people typically discuss mental health within a South
Asian cultural context?
Even though a lot of practices that connect mind and body originated in South Asia, like yoga or meditation, I think in our current world, South Asian culture is sometimes quick to negate mental health experiences, as a result of a deep denial of emotional pain and trauma. There’s so much collectivism embedded in our culture. And so if you have a problem, you know you go to your older family members, and they serve as these therapeutic sources. Now that we are spread out internationally and we’re being pushed to seek higher opportunities, we don’t have the access to each other that we used to have. I think that heavily influences the dialogue now with younger generations of South Asians where they’re kind of like, “I need to talk to somebody and my aunt isn’t cutting it.”
What do you think makes it difficult for South Asian youth in particular to open up to their families about their mental health?
The model minority idea really does shape and impact any South Asian kid, as well as Asian youth in general, but I think it’s also self stigma. The mentality is, “I don’t want to necessarily open up or talk about what I’m going through because what if I bring shame to myself or my family? Aren’t I supposed to be performing at a high level?” The language is very much that it’s a white person thing to go to therapy or to open up to your friends about what’s going on at home. It’s kind of built into the fabric of South Asian culture to keep everything at home. And I also think that the belief is that if you talk about it more, the problem is only going to get worse, so it is better to just put your head down and work through it. Even within families, it is common to keep secrets so as to stress someone else out, with the intent of protecting them from your pain. Family secrets are a big barrier to speaking your truth because you think it needs to be a secret and needs to be hidden, which then perpetuates shame and stigma too.
Speaking of speaking your truth, how is queerness perceived in South Asian culture?
It’s so coded. In a lot of Bollywood films there is always a character that is clearly queer, often male, and the idea is making fun of gayness. It’s so interesting because some of our early texts, at least in Hinduism, talk about sexuality of the body as it relates to all genders and about the fact that there’s more than a binary when it comes to gender. So our society has chosen to close doors on freely expressing our truth, which we know is much more than just sex.
What are the challenges that queer South Asian youth face when
they talk to their parents about their identities and try to seek professional help?
I want to be careful to note that all parents are so complex, and I want to be sure not to reduce any parent’s experience or a child’s experience of their parents to this image of an angry, upset, Desi parent. The truth is South Asian youth face similar reactions to any other cultural group with their parents because all parents have to first grieve who they thought their child was. When it comes to South Asian parents, I think there is a cultural script where immediately the parent can be worried because they know that friends or other family members may shun their child. Because at the end of the day, they just want their child to be happy and successful. Being able to ensure that they can at least have a brave space to be able to talk to a parent about that is the first most important piece. But then how a parent responds can really vary. I think for South Asian families, what I often hear is, “We love you and we support you, and we’re not sure that other people will.” So, you know, that theme of family secrecy comes into play and it’s a huge barrier for South Asian kids to come out in the first place.
What benefits do you think queer South Asian youth can get out of accessing mental health care?
I think what therapy can provide to queer South Asian kids is the knowledge that there’s nothing inherently wrong about them. It helps them work through that feeling of hating themselves for something that they think is unacceptable, the truth is that it is acceptable. It helps for them to have that confidence and strength to move around the world where people are homophobic and transphobic, and gives them that inner sense of strength and compassion.
How can the mental health system improve to accommodate different racial and sexual backgrounds?
The first thing that comes to mind for me is representation. We always say “log kya kahenge,” which translates to “what will people say?” If there are people who are gay or queer and open, I think that type of representation can mean so much to South Asian queers, and I think it’s just so liberating to know you’re not alone. I also think, honestly, what is going on right now seems to be working, which is that people are talking about the fact that we need to process our emotions and experiences. People are first realizing that as a society, we need to talk about our emotions. We need to process our traumas. If we can help to dismantle the shame and the stigma that comes with speaking to a therapist, that’s a great start right. The mental health system at large is also so taxed right now because there are so many people who actually do want mental health services and the barriers are significant, like insurance and financial restrictions. If the government could help to subsidize sustained mental health on a larger scale, specifically for people who come from low income backgrounds, that would be a great start. Literacy around what therapy is and how to access it is very important.
Dr. Viswanadhan asserts that the biggest step forward in promoting dialogue about mental health among queer South Asian youth is representation. According to them, it can feel validating and liberating to see other people with the same marginalizations lead happy and successful lives while sustaining their relationships with their families. For transgender youth of color specifically, seeing themselves represented both in popular media and on social media helps them start conversations with family, provides them with role models and mentors, and affirms their right to happiness and fulfillment in their transgender identities (Singh, 2012). Dr. Viswanadhan also asserts that creating a brave space for discussion about queerness and mental health is vital, which is why access to mental health care is valuable in coping with an unsupportive or confused family.
Valuable considerations for mental health practitioners dealing with South Asian queer youth include the fact that their patients face a great deal of disclosure stigma from people within and outside of their culture, as well as the fact that queer South Asian youth are subjected to pathologization more often than their white counterparts (Shaligram et al., 2022). As Dr. Viswanadhan also raises, South Asian culture is deeply rooted in collectivism and filial piety. It follows that interventions for queer South Asian youth must involve building trust with the patient’s family and fostering open dialogue in a safe environment for both parties (Shaligram et al., 2022). Structural and social barriers to mental health care, such as cost and social stigma, also prevent South Asian youth from accessing mental health care. Lowering or subsidizing the cost of mental health care is an important first step to ensuring more young, queer people have access to life-changing and life-saving interventions (Owens et al., 2002). Lastly, removing social stigmas by talking about mental health care can help young people feel more equipped to ask for help when they need it (Owens et al., 2002).
Dr. Katya Viswanadhan (they/them), is a Clinical Assistant Professor in NYU’s Department of Child and Adolescent Psychiatry as well as a care provider and researcher. Their work focuses specifically on genderqueer youth and their experiences with mental health issues, particularly eating disorders.
Interview with Dr. Viswanadhan
Choudhury, P. P., Badhan, N. S., Chand, J., Choksey, R., Husainy, S., Lui, C., & Wat, E. C. (2009). Community alienation and its impact on help-seeking behavior among LGBTIQ South Asians in southern California. Journal of Gay and Lesbian Social Services, 21(2-3), 247–266. https://doi. org/10.1080/10538720902772196
Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., & Ialongo, N. S. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41(6), 731–738. https://doi.org/10.1097/00004583-200206000-00013
Sandil, R., Robinson, M., Brewster, M. E., Wong, S., & Geiger, E. (2014). Negotiating multiple marginalizations: Experiences of South Asian LGBQ individuals. Cultural Diversity and Ethnic Minority Psychology, 21(1), 76–88. https://doi. org/10.1037/a0037070
Shaligram, D., Khan, M., Adiba, A., & Anam, S. (2022). Cultural considerations for working with South Asian youth. Child and Adolescent Psychiatric Clinics of North America, 31(4), 789–803. https://doi.org/10.1016/j.chc.2022.06.006
Singh, A. A. (2012). Transgender youth of color and resilience: Negotiating oppression and finding support. Sex Roles, 68, 690–702. https://doi.org/10.1007/s11199-012-0149-z
Andre Robbins
We live in a time of spiritual fluctuation. Across most of the world, people are becoming less faithful to their traditional belief structures and embracing new ones (Pew Research Center, 2023). This process has been described as “spiritual remixing,” and has been spearheaded by young people’s growing desire to be “decoupled from institutions, from creeds, from metaphysical truth-claims about God . . . [while still seeking] the pillars of what religion always has: meaning, purpose, community, ritual” (Burton, 2022, p. 32). In order to understand this era of spiritual fluctuation, we must consider the social and psychological reasons why spirituality is still being pursued by young people. To provide clarity on this topic, Dr. Andrew Newberg, a psychological researcher whose work focuses on Neurotheology, was interviewed.
Overview of Neurotheology and Dr. Newberg’s Work
What led you to develop an interest in studying spirituality?
Since I was very young, I was always interested in the big questions. I was always intrigued by the fact that people have such strong ideas about the world, when we’re all looking at the same world, arguably. As I got older and went to college, I realized that, while science is terrific for questions about the physical world, there are aspects of those conversations that really do seem to require additional perspectives. Later when I was in medical school, I had two incredible mentors, one who was studying the brain through neuroimaging, and the other who was interested in exploring the relationship between the brain and our spirituality. And so that’s when the proverbial light bulb went off, and I thought, “Gee, if we’re doing all these brain scans for very traditional things like Alzheimer’s and Parkinson’s, why can’t I do a brain scan while somebody’s meditating or praying?” And so that’s when we started to do some of the first research back in the 1990s. And from there it just kept growing.
You are one of the pioneers of the field of neurotheology. How would you define the aims of this field and what it typically studies?
Neurotheology is a field of study that seeks to understand the relationship between the brain and our religious and spiritual selves. That’s the short answer, but I think some more needs to be said. I think for Neurotheology to really work as a field, it needs to be a two way street, which means that it’s not just science looking at religion, it’s not just religion looking at science, but it’s the two of them looking at each other, and looking at ourselves as human beings, with the goal of trying to understand ourselves in terms of how we think about the world.
I get excited about neurotheology because, as I always try
to remind my colleagues, this field really does push the limits of science, in the way that the field is trying to look at something which is very difficult to look at, since religious and spiritual experiences and beliefs are very subjective. Psychology has to deal with the same basic issues, since something like depression cannot be directly assessed in a medical sense, but must be understood through questioning and observation.
Could you shed a little more light on some of the key takeaways from the research you and your colleagues have conducted?
A big part of Neurotheogly is to understand what is going on in the brain. To me, one of the take home messages of the research that I’ve done to date, is that there’s not one part of our brain which is spiritual. It involves many different parts of our brain. And for anyone who has a religious or spiritual belief system, I think that would make sense. Spirituality can evoke all kinds of emotions, thoughts and sensory processes. There are the symbols that you see, the smells that you smell, the songs that you sing during a ceremony. So to me, there are kind of these broad networks of structures in the brain that all can become involved in different ways, depending on the practice, depending on the tradition, depending on the person. And with that point in mind, it’s not just the brain; the brain is connected to the body. And so when you have a spiritual experience, it’s felt all the way through the whole body. So our whole person really is something that can engage in religious and spiritual experiences.
If you’re an atheist or agnostic, you might not even feel that spirituality exists because it can’t be directly observed. Is that an issue you’ve faced in your research?
What I try to emphasize to people is that everyone has a spiritual side. That doesn’t inherently imply a supernatural spiritual side, but even for people who are atheists or agnostics, we all want to feel connected to the world, and we want to feel connected to something greater than the self. Even if they don’t necessarily adhere to a given religious tradition, they might love to listen to Mozart concertos, or love to take walks in the mountains, or go to the ocean, or something else. I think everybody finds the things that ground them and make them feel connected. And that could even mean just being a good person, being a good humanist and taking care of people and taking care of the world.
And with that being said, I think part of what neurotheology brings is, you know, I guess a sense of humility, and an openness and compassion, for the fact that people believe different things than we do. It’s like what I always tell my colleagues: if there’s 8 billion people on the planet, then there’s 8 billion religions. No
and we can either be upset about that, or we can try to embrace and appreciate the differences. So to me from an idealistic perspective, I hope that neurotheology can bring us an ability to be open and to explore what other people are thinking and feeling about the world.
How would you define a spiritual experience?
There does seem to be something that is unique about spiritual experiences that makes them different from everyday experiences. It has to do with the intensity of the experience, the sense of unity and clarity, a sense of surrender, and then ultimately, a sense of transformation. The sort of change that really radically changes the person. When you get all of those kinds of experiences coming together, that’s part of how someone defines an experience as spiritual.
What sort of psychological or cognitive processes are happening in someone’s brain when they are meditating or praying?
One of the areas that we’ve been specifically interested in is the parietal lobe. The parietal lobe is in the back of the brain, and it’s an area that takes in sensory information to help us create a spatial representation of ourselves. And so through the process of meditation, what we think happens is that this area of the brain begins to quiet down. When it shuts down, we lose that sense of self. We lose the boundaries and distinctions between ourselves and others. So that’s why during those practices we tend to feel at one and connected with the universe. Interestingly, at some peak experiences, where you sort of surrender to the process, we actually see frontal lobe activity drop. That was one thing we saw in the Brazilian mediums, they get into a trance state and do a practice called psychography, where they write what the spirits are telling them. They don’t feel like they’re writing, they feel like they’re being told what to write, they’re almost being controlled. And when we did brain scans during this practice we saw their frontal lobe activity actually decrease.
What is happening in someone’s brain when they have an intense spiritual experience, like a near death experience, taking hallucinogenic drugs or having other intense experiences?
When I think about neurotheology, it’s sort of a big jigsaw puzzle with lots of pieces. One piece is that there are many different ways in which people can access these states. I think that ultimately, they’re all accessing the same network of structures, and they all do it a little bit differently. If you take psilocybin, you activate the serotonin system, and this leads to very powerful experiences that have similar effects to mystical experiences that some people have naturally. Psychedelics tend to be a bit more sensorially described, but feelings of connectedness, oneness, loss of the self, many of those are all part of that process. Near death experiences radically alter the brain because the near death state causes changes in blood flow and oxygenation, leading different areas of the brain to start shutting down. And so that’s a harder one to study, because we never know when those experiences
are going to happen. But the main takeaway from our research on this is that there are a few continuums of experience for these practices. There’s a continuum of unity, for example, and a continuum of intensity. So there’s a lot of different ways in which these experiences are perceived by people.
You and your colleagues have made the argument that God will always be with us. What part of your research has led you to that conclusion?
We’ve made the argument that the brain has two very basic functions which are interrelated. There is self maintenance, which is basically survival instincts, the parts that keep us alive and regulated, internally and externally. The brain is also involved with the concept of self transcendence. As we go through our lives, the brain has to keep changing, because we keep changing. You’re still the same person, arguably, when you’re 25 as when you were five, but you are different, and your brain has been along for that whole ride. You have new thoughts and ideas, and you can change religions or political perspectives. All the time the brain continues to adapt and change. What’s interesting is that when we look at religious and spiritual beliefs and practices, they support those two functions very, very well.
Religion and spirituality function in many ways, as a mechanism of self maintenance. Religions provide a sense of life stages, rituals from birth to adulthood, marriage, and death. This structure helps us through our lives. Religion also gives us information on how to be a moral person, how to live our lives, how to create a cohesive community, how to look at the world, even how to look at the seasons, and explore the world and ask questions, and a lot of the things that we need to do in order to survive, and really how to think and to understand the world. All of these things help us survive and maintain our psychological and physical wellbeing.
Religion also helps with self transcendence. In many ways, not only does it usher us through our lives in the context of self transcendence, but it may offer the concept of ultimate self transcendence, feelings of enlightenment and becoming a sort of ultimate version of yourself. And so our argument has been that as long as the brain’s primary goals are self maintenance and self transcendence, since religion seems to map on to that so well, from a neurological perspective it would seem that we would have religion and spirituality with us for a very, very long time, unless the brain undergoes some radical change.
How are certain spiritual practices associated with better health outcomes, either emotionally or cognitively?
Well there’s been a lot of research, hundreds, if not thousands, of articles that have shown that religious and spiritual beliefs and practices tend to be beneficial for people. They tend to be associated with reductions in anxiety and stress and depression. There’s evidence that they help to protect adolescents from suicidality and drug drug use. This may be because religion and spirituality provide a sense of meaning and purpose, which
helps to reduce the weight of stressors.
In a broader sense, what we’ve learned is that these practices affect the brain, not only in the moment that you’re doing a practice, but in the long term as well. The brain is like a muscle, and just like when you lift a weight your muscle becomes bigger and functionally stronger. meditation and prayer practices are kind of like lifting weights for the brain. Our evidence suggests that the brain can become physically bigger and functionally stronger from spiritual practices, the frontal lobes can become more active even at rest, and that helps you concentrate and regulate your emotions better.
Considering your research and some of your findings, what kind of role do you think practices like meditation or other spiritual ideas could play in psychotherapy?
I think there’s a lot of potential for utilizing these practices and approaches in ways that can be very beneficial for people. But these practices ultimately need to be tailored to the given individual. For example, our research shows that doing the Catholic rosary reduces anxiety. But I’m not about to go to a Muslim patient and say, “Hey, you should start doing the rosary, because I have data that shows that it helps.” It’s not gonna make any sense if they don’t know the practice. But maybe there’s a practice that’s part of their tradition that would have a similar effect. Fundamentally, I think it’s important for anybody in the healthcare industry to at least explore the patient’s religious and spiritual beliefs. If they’re coming from a relatively strong one, a sick patient may think that God’s punishing them because of an immoral activity or actions in their past. So there may be a real need to help a person with spiritual issues, if those issues are augmenting their psychological problems. In integrative medicine, we talk about the whole person, made up of our biological, psychological, social, and spiritual needs. Ideally, you want to bring all of those factors together to help heal that person, irrespective of whether they have a biological, spiritual, psychological or social problem. Combining all of that together can be a very, very powerful way of helping people. And that’s ultimately our goal.
My interview with Dr. Newberg was a powerful testament to the role spirituality can play in both our personal lives and the field of psychology. By understanding the many benefits of spirituality which he described, we can begin to understand why today, despite decreasing participation in traditional methods of spiritual practice (Pew Research Center, 2022), personal belief in a higher power and experimentation with new types of spirituality are still popular (Pew Research Center, 2022). Dr. Newberg’s message about the need to integrate biological, psychological, social and needs was particularly resonant. Considering the many benefits of spirituality, it’s integration into psychotherapy may be a powerful way to support individual’s mental health needs, especially if rates of increasingly diverse forms of spirituality continue to increase in younger generations
(Burton, 2022; Pew Research Center, 2022).
Dr. Newberg graduated from Haverford College in 1988 and obtained his M.D. from the University of Pennsylvania in 1993. Since then he has published over one hundred research articles and several books on topics ranging from the brain activity of Buddhist monks to spiritual experiences in space. Today he works as a Professor in the Department of Integrative Medicine at Thomas Jefferson University, and is also an adjunct professor at the University of Pennsylvania and Saybrook University.
Burton, T. I. (2022). Strange rites: New religions for a godless world. PublicAffairs.
Pew Research Center. (2022, September 13). Modeling the future of religion in America. Pew Research Center’s Religion & Public Life Project. https://www.pewresearch.org/ religion/2022/09/13/modeling-the-future-of-religionin-america/#:~:text=The%20Center%20estimates%20 that%20in,Buddhists%20%E2%80%93%20totaled%20 about%206%25.
Pew Research Center. (2023, August 30). Measuring religion in China. Pew Research Center’s Religion & Public Life Project. https://www.pewresearch.org/ religion/2023/08/30/measuring-religion-in-china/#What%E2%80%9Creligion%E2%80%9D-means-in-China
Smrithi Venkatraman
Editor-in-Chief spv3672@nyu.edu
Smrithi Venkatraman (she/her) is a senior majoring in Applied Psychology and minoring in Social and Public Policy and Global and Urban Education Studies (‘24). She currently works as a senior data collector and data manager for RISE Labs at NYU and is finishing her honors thesis on staff burnout and juvenile justice residential facilities. She is passionate about fighting against racial inequity and deconstructing mass incarceration by examining the policies that impact communities of color. After graduation, Smrithi will begin work as a research assistant at Rutgers’ Graduate School of Applied and Professional Psychology.
Stacey Zhu Editor-in-Chief qz1127@nyu.edu
Stacey Zhu (she/her) is a senior majoring in Applied Psychology (‘24). With her international educational experiences, she is interested in the intersection between cultures and mental health. She has worked as a research assistant at NYU ARCADIA for Adolescent Suicide Prevention lab and the Together Growing Strong research team at NYU Langone. Stacey was also the wellness ambassador at NYU Madrid. After graduation, she will be pursuing a master’s degree in human development at Harvard University.
Shirley Cajamarca
Layout & Design Coordinator | Creative Director
sjc725@nyu.edu
Shirley Cajamarca (she/her) is a senior majoring in Applied Psychology (‘24). She is currently a research assistant at the CONNECT Lab, participating in projects that support a special education program. She is grateful for being part of the thriving community that OPUS fosters and has enjoyed working with the team since her junior year. She remains optimistic and excited about her future. Wherever Shirley goes, she promises to always stay gold.
Aahana Katneni
Layout & Design Coordinator
ak9568@nyu.edu
Aahana Katneni (she/her) is a sophomore majoring in Applied Psychology (‘26) and minoring in BEMT and Spanish. She is currently studying abroad at NYU London. She has had the opportunity to spend much of this past semester traveling and experiencing new cultures. She is passionate about the impact of global perspectives on developmental psychology, especially in regards to parenting.
Danny Blakeman
Contributing Writer dab10067@nyu.edu
Danny Blakeman is a senior in Applied Psychology with a minor in Religious Studies. Their life experiences inspired them to pursue an education in mental health services for at-risk gender and sexual minorities. Danny is an intake counselor at The Door, a youth social service organization. Given the frequency of LBGTQ youth seeking crisis services, Danny’s research seeks to examine modes of early intervention for this demographic and will be presenting at NYU’s Social Impact Conference 2024. Danny has also worked as a TA in the Psychology Department at CUNY. They plan to pursue a Master’s in Mental Health Counseling after taking a gap year.
Sibing Chen
Contributing Writer sc8346@nyu.edu
Sibing Chen is a recent graduate with a major in Applied Psychology and a minor in Mathematics. During her undergraduate years, she engaged in extensive research across various labs and actively participated in practical initiatives. Her main focus was on understanding the intricate connection between mental health, emotional development in youth, and the broader ecological systems. Sibing is committed to utilizing sociallevel mechanisms to enhance the effectiveness of culturally adaptable interventions and to contribute to the eradication of social stigma surrounding mental health among the young population.
Contributing Writer cjoycecheng@nyu.edu
Chieh-Ting Joyce Cheng is a senior double majoring in Applied Psychology and Religious Studies (NYU ‘24). Inspired by her work with ARCADIA for Adolescent Suicide Prevention, her research in psychology has focused on mental health among religious LGBTQ+ populations. Joyce is also an aspiring scholar of Christian history and theology: she is currently completing a thesis on gender, ethnicity, and ritual in the authentic Pauline epistles. Post graduation, Joyce will be pursuing a Master in Theological Studies at Harvard with a focus on religion, ethics, and politics, after which she hopes to continue on to doctoral studies.
Sophie Dahan
Contributing Writer
sed514@nyu.edu
Sophie Dahan completed her studies at New York University in December (‘23). She majored in Applied Psychology and minored in Chemistry. In her free time, Sophie works as a communicative habilitation counselor teaching a young man with autism skills to become more independent. Sophie is highly interested in medicine and is planning on beginning her studies at Touro University’s Physician Assistant Program this fall.
Deru Fu
Contributing Writer
df1978@nyu.edu
Deru Fu is a recent graduate of New York University, holding a degree in BS in Applied Psychology and Global Public Health. With a keen focus on enhancing mental health interventions for children and youth, Deru’s research centers on developing specialized community-based care for minority populations. Through rigorous qualitative research and lab work, Deru addresses culturally and age-sensitive issues in pediatric mental health. Deru is dedicated to designing tailored training programs for youth health care professionals, aiming to provide effective treatment plans for minority youths’ traumas, accounting for cultural nuances in the suture. The work bridges academia and practical application, striving for more equitable mental health care for marginalized youth.
Yuchen (Rainie) Li
Contributing Writer yl7127@nyu.edu
Yuchen (Rainie) Li is a senior majoring in Applied Psychology (24). She volunteers at EConnected, providing academic, social, and emotional support to immigrant children and children of immigrants aged from 6 to 18. She has also worked in the Chinese Families Lab as a research assistant gathering qualitative data from interviews. She hopes to pursue a Master’s degree in mental health counseling and become a supportive, empathic, and culturally sensitive mental health counselor who promotes social equity in mental health services.
Casey Nordberg
Contributing Writer cen8850@nyu.edu
Casey Nordberg is a senior earning a B.S. in Applied Psychology (‘24) with a double major in French & Linguistics, and an accelerated M.A. in Counseling for Mental Health and Wellness (‘25). Through her work at Kurtz Psychology Consulting PC, Casey has developed interests in children’s mental health, with a focus on the intersection of mental health and language. She currently works at Fountain House, a nonprofit organization which provides services and community support for people with serious mental illnesses. In the future, Casey hopes to increase access to quality mental healthcare by working with children and families from underserved populations.
Andre Robbins
Contributing Writer ar6783@nyu.edu
Andre Robbins is a senior (24’) pursuing studies in Applied Psychology and History. His professional experience includes serving as an NYU Welcome Leader and working as a tutor for Thinking Caps Group. He has also dedicated his time to volunteering at Williamsburg High School for Arts and Technology. Post-graduation, Andre plans to embark on a gap year as a history teacher before pursuing further academic degrees. Throughout his endeavors, Andre is driven by his passion to facilitate growth and empower individuals to reach their fullest potential.
Ella Trager
Contributing Writer ert4406@nyu.edu
Ella Trager (she/her) is a senior pursuing a BS in Applied Psychology (‘24) and an MA in Counseling for Mental Health and Wellness (‘25). She aspires to become a performance-focused mental health counselor for collegiate and professional athletes. As an athlete herself, she appreciates the mental and physical benefits of engaging in sports while simultaneously recognizing the toll it takes on the mind and body. While she is interested in working with athletes, her ultimate goal is to use an understanding of psychopathology and human behavior to guide all individuals towards becoming the best version of themselves.
Bonita Wankhade
Contributing Writer bw2500@nyu.edu
Bonita Wankhade is a junior at NYU studying Applied Psychology with a minor in Journalism. She is especially interested in how different cultures around the world view mental health, and the intersection between mental health and social justice. Ultimately, she would love to become a professor or an early childhood educator.
Carol Wu
Contributing Writer yw4994@nyu.edu
Carol Wu is a senior NYU student expected to graduate in Spring 2024, specializing in Applied Psychology & Global Public Health. Her academic and research interests lie in the realm of epidemiology, focusing on the study of infectious diseases and improving vaccine accessibility in low- and middleincome countries (LMICs). Carol’s dedication extends beyond the theoretical, aiming to apply her knowledge in practical settings to mitigate health disparities and enhance community wellbeing globally. She is expected to pursue an MPH in Epidemiology at Columbia University, concentrating on infectious diseases and molecular epidemiology. Looking ahead, Carol envisions a dynamic career at the intersection of public health and the private sector, aiming to drive innovation and development within pharmaceutical companies or healthcare consulting. Her ambition is to influence brand and development strategies that promote equitable healthcare solutions and advance global health initiatives.
Siyi Wu
Contributing Writer sw4736@nyu.edu
Siyi Wu is a senior in the Accelerated Master’s Program in Applied Psychology and Counseling for Mental Health and Wellness. Siyi is motivated to advocate for mental health within marginalized communities. His experience of interning in a Chinese hospital, Nordoff-Robbins Music Therapy Center, and serving as a research assistant for the South Asian Muslim American Mental Health research project equip him with a broad and diverse lens about contemporary mental health issues. Siyi’s research interests include mental health, achievement goals, and student academic outcomes. He hopes to pursue an EdD or PhD degree in the future.