1. Introduction
Lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ) youth are a growing population in the United States. The estimated number of LGBQ youth aged 13–17 averages around 9.5%, and the number of transgender youth averages around 0.7% [
1]. Recent news coverage highlights that more young people identify as LGBTQ than ever before, as high as one in six among the Gen Z population [
2,
3]. As a result, society must continue moving towards greater visibility and acceptance, providing better networks of support, and addressing the issues that often plague LGBTQ young people.
Youth who identify as LGBTQ face a myriad of risk factors which are, in turn, associated with a variety of negative health outcomes [
4]. Stigma and discrimination manifest in multiple ways, across different facets of LGBTQ lives [
5,
6]. Institutional discrimination in the most foundational aspects of children’s lives, such as school systems, places of worship, peer groups, the law, and even the family, create uniquely difficult circumstances for LGBTQ youth that often result in (not just physical) violence and victimization [
7]. Lesbian, gay, bisexual, transgender, queer, and/or questioning youth have some of the highest reported rates of victimization, including various types of harassment and bullying, both in person and online, as well as physical assault and sexual violence [
8,
9]. According to the 2021 National School Climate Survey, 76% of LGBTQ students experienced verbal harassment, 31% experienced physical harassment, 13% were physically assaulted, 54% were sexually harassed, and between 30 and 37% of students were harassed online based on their sexual orientation, gender, or gender expression [
8]. Hostile climates and behaviors such as these often produce negative physical, mental, and/or physiological harm among young people experiencing them. Victimization (and bullying in particular) is one of the highest risk factors for poor grades and educational outcomes, truancy, substance use, psychological distress, and even suicide [
10,
11,
12,
13].
A clear risk for poor mental health exists among LGBTQ students because of the many risk factors they face, especially victimization. According to the major trends in the 2015–2019 Youth Risk Behavior Survey data, 60 to 66% of LGB students reported feeling sad or hopeless, compared to 26–32% of heterosexual youth. Lesbian, gay, and bisexual students also had greater chances of being at risk of suicide than heterosexual students, and these also varied by sex. Over half of transgender students (53.1%) reported feeling sad or hopeless almost every day for two weeks or more, which was well above cisgender male and female students. In addition, the report also found that planned suicide attempts were higher among transgender students than cisgender male and female students, with 39.3% of transgender students reporting that they had made a suicide plan within the past year [
14]. There is a clear need for multilevel mechanisms of support for LGBTQ youth.
The National School Climate Survey and other evidence-based research note the need for supportive environments, because they help reduce victimization and equip LGBTQ youth with the proper tools to build resilience and overcome a possible trajectory towards the negative outcomes that may occur as a result of victimization. Protective factors are different characteristics associated with the possible mitigation, or countering, of negative outcomes and risk factors [
15]. Protective factors exist at the individual, community, and familial levels, and are seen as protections against the negative stimuli that young people may encounter. They allow them to succeed ‘despite’ the presence of risk [
15].
The protective factors literature makes an important point of turning the conversation away from focusing solely on risk factors, pushing instead to focus on sources of support and building positive traits and resiliency. Protective factors are discussed in a variety of interdisciplinary contexts and ways, including classroom environments and educational outcomes, child welfare and wellbeing, the prevention of abuse and neglect, and positive life-course adjustment and coping [
16,
17,
18,
19]. With regard to adolescent mental health and wellbeing in particular, research notes that self-esteem, strong family and peer relationships, social support, and even finding meaning in life help mitigate particular risk factors and have a significantly positive influence on adolescent mental health [
20,
21]. Overall, there is noticeable overlap in protective factors and the risk that they help to improve and mitigate, but that does not negate their importance.
A meta-analysis on bullying and cyberbullying found that different types of individual, peer, familial, school, and community factors all acted as significant protective factors against bullying. Factors such as self-oriented personal competencies (i.e., self-esteem, cognition, emotional management, life satisfaction, openness, and consciousness), peer status (i.e., influence and support), a positive school climate, and positive parenting and supervision all contributed to lower levels of bullying and victimization [
22]. Additional research found that even aspects like family context were negatively associated with bullying behaviors and victimization [
23].
One of the biggest components of the LGBTQ protective factors literature deals with promoting resilience, or the capability that people have to overcome adversity. According to The Trevor Project, protective factors like social support, role models, and inclusive policies all help mitigate the stigma and isolation, bullying, and overt discrimination that can make LGBTQ youth vulnerable to a range of poor mental health outcomes [
24]. A meta-analysis on LGBTI+ wellbeing found that things such as interpersonal relationships with parents, peers, and providers, as well as community relations (online, faith, and cultural) and GSA’s, all served as protective factors for queer youth [
24].
To date, few studies have investigated protective factors using the YRBSS data. The purpose of this study is to explore whether different individual, school, and community protective factors moderate depression and suicidality as a result of bullying, particularly among LGBTQ youth. More specifically, this study utilizes the 2019 YRBSS survey data in order to answer the following research questions. First, do these protective factors moderate depression and suicidality among youth in general? Second, do these protective factors moderate depression and suicidality among LGBTQ youth in particular? Third, do these protective factors moderate depression and suicidality among youth who are bullied at school? Finally, do these protective factors moderate depression and suicidality among bullied, LGBTQ youth?
4. Discussion
This study found that individual, school, and community-level factors moderate depression and suicidality among youth. Overall, about 22% of youth in this sample identified as LGBTQ, which is higher than the national reported averages [
1] and affirms the need for the recognition that queer youth are an ever-growing population whose needs must be accounted for [
5,
6]. Poor mental health is a serious issue among youth, with 38% of the sample reporting depression and 28% of the sample reporting suicidality; these are numbers that are well above the national averages according to the National Institute of Mental Health [
27]. One of the most notable findings is that, despite higher-than-average percentages of youth reporting depression and suicidality,
Table 1 shows that only 26% of youth in the sample sought help when they felt depressed. Studies show that youth may not seek help even when they are struggling with poor mental health, because of negative attitudes towards mental illness and the stigma surrounding help-seeking behaviors [
28]. Reducing shame and stigma surrounding help-seeking behaviors must be a point of concern when fostering positive mental health and wellbeing among young people. Schools must take the lead on promoting mental health awareness and campaign to normalize help-seeking behaviors individually and institutionally.
There are consistencies in protective factors for both depression and suicidality, which warrant recognition. When students feel safe at school, feel that they matter to their community, and seek help when they feel depressed and from an adult, it significantly reduces the odds of reporting depression or suicidality as a result of bullying and LGBTQ identity. This coincides with the literature and affirms findings from other major surveys [
20,
21]. More importantly, however, is the fact that this illuminates the significance of a multilevel approach to supporting youth; this is an approach that considers personal, familial, school, and community-level factors. In addition to promoting positive attitudes about mental health, school systems must also work to improve their climates. The 2021 National School Climate Survey recommends that in order to improve the school climate of LGBTQ youth, schools must include LGBTQ history and curriculum, supportive clubs (such as GSAs), provide professional development for school staff and administration, support gender-affirming school policies and practices, and provide comprehensive bullying and harassment policies that protect LGBTQ students [
8]. All of these factors would affirm safer school environments, and families, schools, and communities must move towards implementing these aspects in order to create safer environments for students, especially LGBTQ youth.
Borrowing from the
Whole School, Whole Child, Whole Community (WSCC) model created by the CDC [
29]—an ecological approach to learning and health that links a child’s needs to both school and the community—these findings highlight the importance of ensuring that youth feel safe and supported in their communities, as well as the school system. The spectrum of community support can range from simply hanging a pride flag or a ‘Black Lives Matter’ sign outside one’s house in order to signal visibility and a safe community for young people, to local political action. Creating community support systems, safe spaces, and activism are a huge building block for helping youth feel not only accepted, but also truly wanted and supported in their communities. In creating these spaces, schools and communities could naturally ensure that youth, especially LGBTQ youth, have adequate mentorship and guidance to be able to talk about the issues they may face. All of these things would, in turn, help improve the lives of young people.
Limitations
While this study contributes to the broader literature, it does not exist without certain limitations. First, the YRBSS secondary data are limited in the scope of questions that are asked across districts and states. For example, the protective factor questions examined in this study are considered “optional” questions and are thus, not required to be included in surveys. Future YRBSS questionnaires should require that these questions be included. Second, the YRBSS survey does not collect school-level identifiers, and future research could benefit greatly from nested models that examine these issues within geographically identified regions with regard to the questions at hand. Third, the results showed that gender, race, and ethnicity matter with regard to depression and suicidality among youth; thus, future studies should push to be more intersectional in their understanding of the issue at hand. Despite these limitations, this study confirms the importance of acknowledging and cultivating protective factors that can benefit youth.
5. Conclusions
Lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ) youth are a growing population in the United States, and society must acknowledge the issues that they face, rather than work to perpetuate them. In this study, whether or not students were bullied or identified as LGBTQ, the odds ratios for depression and suicidality reduced when students felt safe at school, felt that they mattered to their community, sought help when they felt depressed, and could seek help from an adult other than their parents. Thus, schools and communities must move towards implementing strategies of support in the face of current state-level legislation that attempts to nullify their importance and visibility. While the purpose of this study was not to measure policy, it can highlight the need to halt the trajectory of the record number of state-level anti-LGBTQ legislations that are currently being put forth. The institutionalization of denying youth the ability to exist wholly as themselves desecrates feelings of protection and belonging, and as a result, increases the possibility of risk and harm to LGBTQ youth. Our goal as a society should be to continue building protection, connection, and belonging for youth, especially those most vulnerable.