As rates of mental health problems rise among adolescents in the United States, new research offers surprising insights into how social factors are influencing trends for LGBTQ+ youth, who are particularly vulnerable to the harmful effects of discrimination.
Psychology professor Phil Hammack, director of the Sexual and Gender Diversity Laboratory at the University of California, Santa Cruz, led a study that combined survey data, interviews, and ethnographic field notes to analyze the mental health outcomes of LGBTQ+ youth in some of California’s most and least supportive communities for sexual and gender diversity.
The results showed remarkably little variation in outcomes between communities over the 2015-2017 study period. Overall, 41% of LGBTQ+ teens surveyed reported clinically relevant depressive symptoms, compared to a 10% rate for the same symptoms among all California youth, as estimated in previous epidemiological studies.
“It was really surprising that the level of community support for sexual and gender diversity didn’t seem to make a huge difference to these youth’s mental health, given the strikingly different levels of LGBTQ resources and visibility that the communities we studied had. ‘ said Hamack. “When we first looked at our survey results, we were so shocked that we repeated the analysis several times, just to be sure.”
Stigma and mental health impacts stretch across communities
Specifically, the study focused on comparing the Bay Area and California’s Central Valley, regions with higher and lower levels of support for sexual and gender diversity, according to an 8-factor community climate assessment conducted by the research team. Differences between regions included the proportion of LGBTQ+ supportive businesses and religious and political affiliations, the proportion of same-sex households, and the availability of LGBTQ+ resources and celebrations.
The research team surveyed 314 teenagers in these regions to get a sense of how they perceived their community, the types of stigma and discrimination or support and belonging they experienced, and the occurrence of depressive symptoms. The survey results were supplemented with depth and context from 28 interviews with regional LGBTQ+ youth leaders and observations from ethnographic fieldwork in each community.
Results showed that youth in the Bay Area perceived their communities as more supportive as LGBTQ+ people, while youth in the Central Valley perceived their communities as less supportive. Youth in the Central Valley also reported experiencing more anti-LGBTQ+ remarks and felt higher levels of stigma, while youth in the Bay Area felt more empowered. But the statistically significant differences in youth scores ended there.
In all communities, in addition to high rates of depressive symptoms, the researchers found that 41% of all youth surveyed had experienced targeted victimization, such as bullying, related to their LGBTQ+ identity and 59% had experienced discrimination. Adolescents said they believe bullying, internalized stigma, concealing one’s identity and fear of rejection contribute to symptoms of depression in young members of the LGBTQ+ community, and these symptoms often manifest as anxiety and depression, as well as self-harm.
The prevalence of these challenges in communities is of concern from a public health perspective, Hammack says. For decades, researchers have documented a wide range of differences in health outcomes between LGBTQ+ individuals who face social stigma because of their gender and sexual identity and cisgender heterosexual individuals who do not. Higher rates of mental health problems like depression and stress are associated with other health problems like early mortality and cardiovascular disease.
Uncover possible causes and solutions
The persistence of these disparities despite significant efforts to address them in some communities may indicate the need for further systemic change to support Generation Z youth, who identify as members of the LGBTQ+ community more frequently than any previous generation.
“Our results suggest that the health disparities that we have observed for many years still exist for Gen Z and that a well-resourced community is not enough to mitigate the negative effects of broader social stigma,” he said. “It’s easy to fall into the illusion that if we can only create a safe bubble in our community, everything will be fine, but the reality is that we live in a larger culture that harbors oppressive, biased notions of gender and sexuality is still out there, and if anything, those ideas have been encouraged in recent years.”
The research team also documented another trend in in-depth interviews with LGBTQ+ teens that may help explain some of the missing disparities in mental health outcomes across communities. Adolescents’ perceptions of the level of support in their community seemed to influence expectations of what life as an LGBTQ+ person would be like in that community. Teens in lower support communities had low expectations about how they would be treated and expressed optimism that things would get better, while teens in higher support communities had high expectations that were sometimes not met.
“Teens in the Bay Area expected LGBTQ issues to become part of the formal school curriculum and they expected teachers to get pronouns right, but teens in the Central Valley didn’t expect those things, so they didn’t miss it that much, they didn’t.” to have,” Hammack explained. “This speaks to how experience translates into mental health through how we interpret our surroundings and construct our expectations. In this case, differing expectations can actually offset the impact of differing material support in these communities.”
The study also uncovered some community resources that teens found particularly helpful, including mental health services, online and in-person support resources, and social peer support. And teenagers recommended that mental health providers receive more training on cultural literacy related to sexual and gender diversity. Many said they were disappointed with counselors who didn’t seem to understand LGBTQ+ identities or terminology. Hammack says training for psychologists and psychiatrists could help address this problem.
Overall, however, he believes the study shows the importance of increasing efforts to support LGBTQ+ throughout society.
“Young people are looking to adults to change the culture,” Hammack said. “Teenagers have higher expectations of adults, schools and society, and we’re not meeting them. It’s not just about small aspects of the local environment. We need a major fundamental change in our culture so that the stigma can be broken down. Otherwise, we will continue to see major mental health challenges and inequalities.”