PRB

Youth in the United States who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) face widening health disparities compared with their straight or cisgender peers, and LGBQ young adults experience more psychological distress and suicidal thinking than older generations of LGBQ Americans, recent studies show.¹ (Responses from transgender participants were examined separately.)

“We are at a critical moment,” says Jessica Fish of the University of Maryland Population Research Center, who studies mental health and social support among young LGBTQ people.

A backlash is underway in the wake of rapid social progress that included the legalization of same-sex marriage in 2015, she explains. Over the past two years, state lawmakers inundated legislatures with proposals (including more than 300 bills in early 2022) designed to limit LGBTQ rights, such as bans on classroom discussions and books about LGBTQ people and requirements that teachers out LGBTQ students to their parents.²

“LGBTQ, especially transgender and gender diverse, youth are hearing arguments against the legitimacy of their lived experience,” says Fish. “The message being sent is that they don’t belong. It doesn’t matter whether these bills are enacted or not, the public discourse alone is harmful to LGBTQ youth.”

For evidence, Fish points to a study supported by the University of Texas at Austin Population Research Center documenting an uptick in homophobic bullying in California schools while Proposition 8, a voter referendum to restrict marriage to heterosexual people, was under discussion in 2008.³

LGBTQ youth are on a collision course, between normal adolescent development and the social changes of the last few decades, Fish and coauthor Stephen Russell of the University of Texas at Austin argue in a recent paper.⁴

“With increased visibility, acceptance, and policy progress, youth have felt more comfortable disclosing their sexual orientation earlier than previous generations. More are coming out in their early teens rather than 20s,” Fish says (see figure). “While this is a developmentally appropriate age to be understanding their sexuality, they are financially dependent on their parents, who may or may not be supportive.”

FIGURE. LGBQ Young Adults Come Out to Friends and Family at Younger Ages Than Older Generations

Average age when each generation reached key milestone

Note: Data are from the Generation Study, collected between 2016 and 2018, and do not include transgender youth and young adults.

Source: Meg D. Bishop et al., “Sexual Identity Development Milestones in Three Generations of Sexual Minority People: A National Probability Sample,” Developmental Psychology 56, no. 11 (2020): 2177-93.

In addition, prejudice is high among their high school peers. For many young people, more complex thinking about fairness and discrimination develops in later adolescence, Fish and Russell note.

Most legal progress “has been in areas that benefit adults rather than youth: marriage, parenting, military service, and employment protections,” the researchers write. “For [LGBTQ] youth there is a different story: There remains no U.S. federal nondiscrimination or anti-bullying protection based on sexual and gender minority status.”

States have been implementing LGBTQ protections in a scattershot way and these policies have not been uniformly enforced, according to Fish.

“Inequalities, prejudice, and discrimination are vexingly persistent,” Fish and Russell say.

 30% of LGBQ Young Adults Have Attempted Suicide in Their Lifetimes

LGBQ young adults (ages 18 to 25) experience greater psychological distress and suicidal behavior than older LGBQ people, findings from the Generations Study supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) show.⁵

Between 2016 and 2018, the research team surveyed a representative sample of LGBQ people in the United States from three age groups—young (ages 18 to 25), middle (34 to 41), and older (52 to 59)—to assess how stress, identity, and connectedness with the LGBTQ community differed among the three generations. Researchers expected that younger LGBQ people would fare better in terms of stress and mental health outcomes than their older peers, who came of age in more hostile social and legal environments for LGBQ people.

However, results showed that young LGBQ people experienced high or the highest levels of everyday discrimination, psychological distress, and internalized homophobia. For example, 30% of young LGBQ adults reported at least one suicide attempt in their lifetimes, compared to 24% of the middle cohort and 21% of the older cohort.

“This is an alarming figure,” the researchers write, noting that the share of young people ages 18 to 24 who have attempted suicide in the overall population is less than 4%.

“The findings remind us that LGBT equality remains elusive,” says the study’s principal investigator, Ilan H. Meyer of the Williams Institute at the University of California, Los Angeles. “The persistence of cultural ideologies, such as homophobia and heterosexism, continue to result in rejection and violence against sexual minorities in the United States.”

The study found that younger LGBQ adults showed more extreme experiences of victimization in a shorter timespan than the middle and older cohorts:

• More than one-third (37%) of young LGBQ adults experienced being hit, beaten, physically attacked, or sexually assaulted.
• Almost half (46%) had someone threaten them with violence.
• Nearly three out of four (72%) young LGBQ adults were verbally insulted or abused.

Young LGBQ adults had higher levels of psychological distress, including symptoms of depression and anxiety, compared with the two older cohorts. However, young LGBQ people also reported the highest levels of connection to the LGBT community and were more likely to say their sexual identity is central to who they are, compared with their older peers.

School and Community Groups Can Provide Valuable Support and Build Resilience

Not only do LGBTQ teenagers face a much higher risk of suicide and mental health problems than their heterosexual and cisgender peers, but they are also more likely to binge drink and smoke—disparities that are “heading in the wrong direction” by widening in recent years, Russell and Fish report.⁶

The stress of experiencing bullying, discrimination, and victimization, and living with stigma may be driving these differences. Substance use may be a response to stressful life events and discrimination, Fish explains.

For example, one U.S. study of nearly 12,000 racially and geographically diverse LGBTQ 13- to-17-year-olds found that they were more likely to binge drink if they had been insulted or threatened with violence because of their sexual orientation. The researchers also identified a link between binge drinking and internalized stigma, that is, teenagers who reported feeling self-critical, being depressed about their sexual orientation, or wishing they were heterosexual at times were more likely to binge drink.⁷

Support can make a difference not just at home but also at school and in the community. Another study using the same data shows that school clubs that provide support for LGBTQ youth appear to buffer the stressors that drive binge drinking. The researchers found that LGBTQ students who were victimized or had depressive symptoms were less likely to binge drink if they participated in Gender and Sexualities Alliances (GSAs) than their peers who did not participate in such clubs.⁸ Early in the COVID-19 pandemic, students were separated from their school support groups and counselors when schools moved online.⁹ Many of these clubs pivoted to online platforms to provide support for LGBTQ youth. The numbers of youth engaging in online support groups increased three-fold and included more rural teenagers who had not previously participated, reported Fish in an interview with PRB.

Community-based organizations that provide LGBTQ-focused support and services could have long-lasting effects on the health of LGBTQ youth, Fish argues.¹⁰ A study by Fish and colleagues based on more than 1,000 LGBTQ youth and young adults ages 15 to 21 showed that ongoing participation in such community organizations was related to less substance use and better self-esteem and mental health.

LGBTQ youth are coming out into a very polarized environment, Fish notes, but they are very resilient.

“Most LGBTQ youth thrive,” Fish and Russell argue.

“Naming vulnerability and discrimination in the lives of youth is not the same as perpetuating it,” they write. “Rather it affords the potential for adults and institutions that support youth—and youth themselves—to understand and identify those vulnerabilities and accept responsibility for addressing them.”

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of Maryland (R24 HD041041), University of Texas, Austin (5P2CHD042849-18), and University of California, Los Angeles (R24 HD041022). Rachel Dowd of the Williams Center at the University of California, Los Angeles contributed to this piece.

References

[1] Stephen T. Russell and Jessica N. Fish, “Sexual Minority Youth, Social Change, and Health: A Developmental Collision,” Research in Human Development 16, no. 1 (2019): 5-20; Jessica N. Fish, Meg D. Bishop, and Stephen T. Russell, “Developmental Differences in Sexual Orientation and Gender Identity-Related Substance Use Disparities: Findings From Population-Based Data,” Journal of Adolescent Health 68, no. 6 (2021): 1162-9; Eric K. Layland et al., “Suicide Attempt Rates and Associations with Discrimination Are Greatest in Early Adulthood for Sexual Minority Adults Across Diverse Racial and Ethnic Groups,” LGBT Health 7, no. 8 (2020): 439-47; and Ilan H. Meyer et al., “Minority Stress, Distress, and Suicide Attempts in Three Cohorts of Sexual Minority Adults: A U.S. Probability Sample,” PLoS ONE 16, n. 3 (2021): e0246827.

[2] Kelsey Butler, “Anti-LGBTQ Proposals Are Flooding U.S. State Legislatures at a Record Pace,” Bloomberg, April 8, 2022, https://www.bloomberg.com/news/articles/2022-04-08/mapping-the-anti-lgbtq-proposals-flooding-u-s-state-legislatures.

[3] Mark L. Hatzenbuehler et al., “Proposition 8 and Homophobic Bullying in California,” Pediatrics 143, no. 6 (2019).

[4] Russell and Fish, “Sexual Minority Youth, Social Change, and Health: A Developmental Collision.”

[5] Ilan H. Meyer et al., “Minority Stress, Distress, and Suicide Attempts in Three Cohorts of Sexual Minority Adults: A U.S. Probability Sample,” PLoS ONE 16, no. 3 (2021): e0246827. This research data set focuses on LGBQ only but mentions the LGBT population as a whole when speaking generally.

[6] Jessica N. Fish et al., “Cigarette Smoking Disparities Between Sexual Minority and Heterosexual Youth,” Pediatrics 143, no. 4 (2019): e20181671; Russell and Fish, “Sexual Minority Youth, Social Change, and Health: A Developmental Collision”; Fish, Bishop, and Russell, “Developmental Differences in Sexual Orientation and Gender Identity-Related Substance Use Disparities: Findings From Population-Based Data”; and Ryan J. Watson et al., “Sexual and Gender Minority Youth Alcohol Use: Within-Group Differences in Associations with Internalized Stigma and Victimization,” Journal of Youth and Adolescence 48, no. 12 (2019): 2403-17.

[7] Watson et al., “Sexual and Gender Minority Youth Alcohol Use: Within-Group Differences in Associations with Internalized Stigma and Victimization.”

[8] V. Paul Poteat, Jessica N. Fish, and Ryan J. Watson, “Gender-Sexuality Alliances as a Moderator of the Association Between Victimization, Depressive Symptoms, and Drinking Behavior Among LGBTQ+ Youth,” Drug and Alcohol Dependence 229, B (2021): 109140.

[9] John P. Salerno et al., “Sexual and Gender Minority Stress Amid the COVID-19 Pandemic: Implications for LGBTQ Young Persons’ Mental Health and Well-Being,” Public Health Reports 135,6 (2020): 721-727.

[10] Jessica N. Fish et al., “LGBTQ Youth-Serving Community-Based Organizations: Who Participates and What Difference Does It Make?” Journal of Youth and Adolescence 48, no. 12 (2019): 2418-31.