Sexual orientation identity change and psychological distress among college students in Suzhou, Jiangsu, China: a longitudinal repeated-measures study

In China, few longitudinal studies have examined sexual orientation identity change and psychological distress during late adolescence. From 2020 to 2021, 481 college students in Suzhou, Jiangsu, China, completed an average of 2.1 follow-up surveys (range: 1-3), yielding 1008 person-periods for potential change. Between any two successive surveys, there were four possible states involving heterosexual (Het) and sexual minority (SM) identity labels: static Het → Het, static SM → SM, Het → SM and SM → Het. Across all follow-up waves, seven distinct participant-level patterns were observed: static heterosexual, static sexual minority, Het → SM, SM → Het, Het → SM → Het, SM → Het → SM and SM → Het → SM → Het. Depressive and anxiety symptoms were assessed with the Patient Health Questionnaire-4. Overall, 13.5% of participants changed their reported sexual orientation identity label at least once. Multiple identity changes occurred in 4.3% of participants. Among men, Het → SM identity label periods were associated with more depressive symptoms and experience of shame/embarrassment compared to static heterosexual periods. Psychological distress associated with sexual orientation identity change likely reflects the heteronormative social environments in which these identity processes unfold, rather than identity fluidity itself.