Figure 1 outlines the study selection process according to a PRISMA flowchart. The initial search identified 5,433 articles. Of these, 1,329 duplicates were removed. Next, 4,104 unique titles and abstracts were screened. This screening resulted in a total of 385 articles that were selected for full-text review. Of these 385 articles, 356 articles were excluded based on the exclusion criteria, resulting in 29 articles that met the inclusion criteria. The full-text review revealed that four of the 29 articles meeting inclusion criteria were analyses of the same study dataset (Caba et al., 2022, 2023; McKay & Watson, 2020; Rentería et al., 2022). Table 1 includes key attributes of the articles included in the review.

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Diagram

Table 2 provides a summary of study and participant characteristics. The dataset that was used in four articles is included in Table 2 only once (Caba et al., 2022, 2023; McKay & Watson, 2020; Rentería et al., 2022), yielding a study sample size of 26. All articles were published between 2008 and 2023. Of the 26 studies, 17 (65.3%) were conducted in the United States. The remaining nine were conducted in Canada, Australia, China, Malta, the Philippines, and the United Kingdom. Two studies were conducted in multiple countries (i.e., the United States and Canada, and the United States, Canada and Israel).

Sample sizes ranged from n = 6 to 11,225. Regarding gender identity, all studies included participants who identified as men/boys in their sample, and all articles except two included participants who identified as women/girls. Many studies included trans youth (38.4%) or gender non-binary/non-confirming youth (23.0%). Regarding sexual orientation, over half of studies included participants who identified as bisexual/pansexual (76.9%), gay (76.9%), or lesbian (65.3%). Fewer than half included participants who identified as queer (32.3%), asexual (23.0%) and less than 10% of articles included participants who identified as heterosexual (7.6%), homosexual (7.6%), questioning (7.6%), or same-sex attracted (3.8%). Participant ages ranged from 12 to 26 years old. In just over half of articles (53.8%), samples were predominantly White. Few articles reported samples that were predominantly Asian (11.5%) (D’amico et al., 2015; King, 2008; Wei & Liu, 2019), Latino (11.5%) (Burdick & Nicholus, 2022; Lozano et al., 2021; Russell et al., 2014), or African American (3.8%) (Feinstein et al., 2019).

All articles were published between 2008 and May 2023, with data collection occurring as early as 2004. Among the 26 studies with unique datasets, 42.3% were quantitative, 42.3% were qualitative, and 15.3% were mixed-methods. The majority of studies (88.4%) were cross-sectional, and few were longitudinal studies (Feinstein et al., 2019; Kiekens & Mereish, 2022; Little et al., 2023). Two articles (7.6%) were dyadic, including parents/caregivers and youth (D’Amico & Julien, 2012; Lozano et al., 2021).

Across studies, many different terms and labels were used to describe the diverse sexual orientations and gender identities included across samples. For ease of interpretation, the label LGBTQ + is used when describing results of the studies reviewed. For specific sample descriptions, including sexual orientations and gender identities, see Table 1.

Table 3 summarizes components of the DPM and moderators of disclosure processes. The following sections summarize and synthesize the literature reviewed in each of the four components of the DPM as well as moderators of the disclosure. Although all articles evaluated at least part of the DPM (decision-making, disclosure events, mediating processes, outcomes) only one study used the DPM as an explicit guiding framework (Feinstein et al., 2019).

More than half of articles (51.7%) highlighted avoidance goals, or reasons against disclosure. These included: sexual and gender minority stigma (e.g., homophobia, heterosexism, heteronormativity), fear and concern of rejection or loss of family financial support, a desire to not offend or make family members feel uncomfortable, shame and guilt, and social isolation (Carpineto et al., 2008; D’Amico & Julien, 2012; Du Bois et al., 2022; King, 2008; Lozano et al., 2021; Mollet, 2023; Sammut et al., 2021). Fear of negative reactions was sometimes based on negative past experiences. For instance, the risk of data leakage when disclosing private information and heteronormative expectations in the health care system can increase the fear of negative reactions from the health care providers. (Burdick & Nicholus, 2022). About a third of articles (34.4%) highlighted approach goals, or reasons for disclosure. These included: a desire to live honestly or authentically, self-protection, identity management, and building a sense of community belonging (Burdick & Nicholus, 2022; Carpineto et al., 2008; Du Bois et al., 2022; Gioia et al., 2021; Little et al., 2023; Lozano et al., 2021; Mollet, 2023; Price & Prosek, 2020; Sammut et al., 2021; Wei & Liu, 2019).

Several articles (17.2%) explored the disclosure decision-making process in general, or whether the decision-making process led to disclosing sexual orientation and gender identity or not. Although these articles did not explicitly describe participants’ goals for disclosure (as framed by the DPM), they did report on associations between the decision-making process and disclosure (Grafsky, 2018; Grafsky et al., 2018; McInroy et al., 2021; Reyes et al., 2023; Toft, 2020). For example, one article reported relationship dynamics and the youth’s expectations of the disclosure outcome are factors that influence the decision of whether or not to disclose (Grafsky, 2018).

A few articles (24.13%) specifically considered the first experience of disclosure; however, no studies focused exclusively on the first disclosure among LGBTQ + youth. Furthermore, the majority of articles (58.62%) explored disclosure among LGBTQ + youth as a process rather than a singular event, and a few studies (6.89%) even considered disclosure over time.

Regarding reactions to disclosure, many articles reported a mix of positive and negative (41.3%), several reported mostly negative (17.2%), and few reported mostly positive (6.8%). Articles describing mixed reactions to LGBTQ + youth disclosure documented reactions ranging from rejection to unconditional support (Morgan et al., 2022; Roe, 2017). Initial reactions to first disclosures were often characterized as negative, however, responses and reactions from these initial disclosure recipients improved over time (Grafsky, 2018; Lozano et al., 2021; Morgan et al., 2022; Sammut et al., 2021).

Negative reactions to youth disclosure included emotional reactions, such as shock, uncertainty, doubt, disappointment, anger, anxiety, grief, and loss; disbelief, denial, and ignoring the disclosure; attempts to change participants’ sexual orientation; as well as rejection and withdrawal of financial and emotional support (Burdick & Nicholus, 2022; D’Amico & Julien, 2012; D’amico et al., 2015; McInroy et al., 2021; Morgan et al., 2022; Pollitt et al., 2017; Roe, 2017; Sammut et al., 2021). Homophobia, heterosexism, stigma, religion, lack of information, and poor communication were described as profound barriers to positive reactions and support for LGBTQ + youth disclosure (King, 2008; Little et al., 2023; Morgan et al., 2022; Roe, 2017; Sammut et al., 2021).

Positive reactions to youth disclosure included expressions of unconditional love and acceptance; encouragement and affirmation of youth identity; expression of a desire for youth to be happy; openness and involvement; and financial and emotional support including support for the child’s romantic relationships (Carpineto et al., 2008; D’Amico & Julien, 2012; Lozano et al., 2021; Price & Prosek, 2020; Reyes et al., 2023; Roe, 2017). Approximately half (41.3%) of the articles reported that LGBTQ + youth experienced social support following disclosure (Burdick & Nicholus, 2022; Carpineto et al., 2008; Kiekens & Mereish, 2022; King, 2008; Little et al., 2023; Morgan et al., 2022; Pollitt et al., 2017; Price & Prosek, 2020; Reyes et al., 2023; Roe, 2017; Sammut et al., 2021); however, at least one study found no association between outness and social support (Wei & Liu, 2019). Although LGBTQ + youth reported wanting to receive explicit, or verbalized support, most support received was characterized as implicit (e.g., non-verbal expressions, and supportive behaviors) (Lozano et al., 2021; Roe, 2017).

The final component of the DPM, outcomes of disclosure, were reported in the majority of included articles (62.1%). Outcomes may include social support, alleviation of inhibition, and changes in social information. Outcomes could be immediate or long-term outcomes at the individual, dyadic, and social contextual levels. The majority of studies (90%) were cross-sectional; however, retrospective studies provided a valuable perspective by evaluating the long-term outcomes of disclosure. Approximately 20% of articles described long-term outcomes of disclosure (Caba et al., 2022; D’amico et al., 2015; Feinstein et al., 2019; Little et al., 2023; McKay & Watson, 2020; Russell et al., 2014), and an additional 24.1% described short-term or more immediate outcomes (Caba et al.,