Rural LGBTQIA+ Youth: A Review of the Literature (2015–2025)

Abstract

This article presents a structured review of literature published between 2015 and 2025 on the experiences of rural LGBTQIA+ youth. Using targeted search terms—including “LGBT*,” “rural,” “country,” “young people,” “sexual and gender minority (SGM),” “small town,” “youth,” and “students”—a research team identified 26 peer-reviewed articles that met inclusion criteria. Through team-based thematic analysis, six core themes emerged: (1) gaps in intersectional analysis, (2) mental health outcomes, (3) culturally responsive services and resources, (4) community climate and context, (5) experiences of victimization, and (6) policy. Across these themes, the review highlights the resilience, agency, and strength of LGBTQIA+ youth navigating rural environments. The literature consistently demonstrates how experiences of victimization are closely linked to mental health outcomes, while access to social support—particularly from affirming adults in systems (such as schools)—can mitigate harm and foster well-being. Implications for social work research, practice, and policy are discussed, with an emphasis on supporting LGBTQIA+ youth in U.S. Southern rural settings.

1. Introduction

This literature review examines the experiences of LGBTQIA+ youth in rural communities, addressing a critical gap in existing research. As societal acceptance of LGBTQIA+ identities grows, more people feel comfortable openly identifying as such (J. M. Jones, 2024). A recent Gallup Poll underscores this trend, particularly among young people, with 1 in 5 Gen Z-ers (people born between 1997 and 2012) identifying as LGBTQIA+ (J. M. Jones, 2024). However, in many rural areas, acceptance of gender and sexual diversity has lagged behind broader societal shifts (Boso, 2019; Rickard & Yancey, 2018; Thompson, 2023). The primary research aim of this literature review is to explore the lived realities of LGBTQIA+ youth in rural communities. Youth is a critical stage of development, with effects that ripple outward to influence individuals, families, and communities (Ansell, 2016; Galstyan, 2022; Nilan & Feixa, 2006; Tyler, 2020). This research is grounded in the understanding that a young person’s sociopolitical—and, in this context, geographic—environment profoundly shapes their identity and life trajectory (Tyler, 2020). Research questions this team sought to investigate were: What challenges do LGBTQIA+ youth encounter in rural communities? Where do they demonstrate strength and resilience? How does the current political climate affect LGBTQIA+ youth in rural areas?

Our research on sexual and gender minorities (SGM) and rurality is academic, political, and personal. As researchers in a rural Southern social work program, we are committed to the health and well-being of rural communities, broadly. As LGBTQIA+ individuals, students, and rural people, we recognize the urgent need for greater research attention on LGBTQIA+ youth in rural school settings. This project began as an exploratory literature review conducted by a research team composed of four faculty members and two students at a university social work department. Our research team’s shared priority is health equity in rural, low-income, and Indigenous communities.

This research is deeply relevant to the current sociopolitical landscape. Increasing backlash against LGBTQIA+ inclusion has fueled transphobic and homophobic rhetoric in policy and public discourse. For example, the current administration recently reinstated its ban on transgender people serving in the armed forces (Hurley & Yurcaba, 2025). Young LGBTQIA+ people are frequently at the center of this backlash, as political attacks increasingly target public education, schools, and universities (Hansen & Hubbard, 2025). A recent SCOTUS decision upholds the legal ban on gender-affirming healthcare for transgender youth in Tennessee (Cole & Fritze, 2025). Conservative lawmakers have increasingly weaponized anti-diversity, equity, and inclusion (DEI) narratives, falsely framing LGBTQIA+ inclusion in schools as harmful or as part of a so-called “gender ideology” (Flannery, 2024; Jackson, 2025; Mulvihill, 2025). Rural residents are often caught up in the wave of anti-LGBTQIA+ political rhetoric fueling the current backlash (Boso, 2019; Thompson, 2023). Right-wing political elites have strategically tapped into the socioeconomic resentment of rural communities—many of whom are predominantly white, Christian, and heterosexual—to advance their agendas (Berlet & Sunshine, 2019). In response, we assert that our position is pro-LGBTQIA+, pro-youth, and pro-rural. Dominant narratives often erase rural LGBTQIA+ voices, reinforcing the misconception that queer and trans individuals primarily or solely exist in urban areas—or even more damaging, that rural queer and trans people do not exist at all (Henriquez & Ahmad, 2021).

Internationally, scholars have noted that the rural-urban political divide impacts LGBTQIA+ peoples’ ability to live and thrive in rural areas (Drumheller & McQuay, 2010). Sociologist Stone (2018) argued that LGBTQIA+ research must better account for ordinary places, small towns, and rural communities, as much of the existing scholarship has focused on larger metropolitan centers. The prevailing myth of metronormativity suggests that to live an authentic queer life, one must reside in a city. This urban-centric framing casts the city as the ideal destination for queerness, falsely positioning rurality and queerness as incompatible. LGBTQIA+ people not only exist within rural communities, but are vital community members, even in the face of stigma and adversity.

The context of stigma and discrimination should not be discounted in terms of its impact on mental health outcomes. More supportive environments are consistently associated with reduced negative outcomes for LGBTQIA+ youth. The Trevor Project (2021), an organization that supports young people in crisis, reported that rural LGBTQIA+ youth experience slightly higher rates of depression, suicidality, and suicide attempts compared to their urban and suburban peers. Indeed, the conditions of rural areas are often particularly challenging for LGBTQIA+ adults (Drumheller & McQuay, 2010). LGBTQIA+ people of all ages report higher rates of victimization, discrimination, and less comfort disclosing their identities in rural communities (Rickard & Yancey, 2018).

The rural school context plays a significant role in shaping outcomes for LGBTQIA+ youth. School climate survey research has shown that hostile school environments can have detrimental effects on mental health for LGBTQIA+ students (Blackburn & Thomas, 2019; Kosciw et al., 2009). A report from Equity by Design highlights the unique barriers faced by rural LGBTQIA+ youth in schools, including limited access to resources and support, school staff’s lack of preparation and awareness, inadequate policies, the invisibility of transgender students, and ongoing resistance to inclusion (Blackburn & Thomas, 2019).

A common narrative is the deficit-based portrayal of young LGBTQIA+ people in rural areas, particularly regarding their health outcomes. Historically, LGBTQIA+ people have been stigmatized as “ill,” “criminal,” and “immoral” (Gates & Kelly, 2017). Contemporarily, these stigmas persist: LGBTQIA+ young people are often seen as “high risk” for mental health conditions, substance use concerns, and sexually transmitted infections (e.g., HIV). While health disparities are well-documented and require providers’ attention, it is critical to avoid reductionist narratives that frame LGBTQIA+ identities primarily through the lens of risk or pathology (Gates & Kelly, 2017; Lofstrom, 2025). These young people also bring profound strengths, creativity, resilience, and insight—qualities that often emerge precisely because they have navigated systems not built for them. For service providers, it is essential to resist assumptions that a person’s gender or sexuality is inherently a source of distress or the central “problem” in their lives (Gates & Kelly, 2017; Lofstrom, 2025). Approaching LGBTQIA+ youth primarily through a deficit lens can obscure their actual priorities, reinforce stigma, and limit the effectiveness of care. The narratives of rural LGBTQIA+ youth are more complex; reductionist portrayals offer an incomplete picture of their lived experiences, especially for those in rural communities. This article utilizes a strength-based social work perspective to ground the analysis (Devaney et al., 2022; MacArthur et al., 2011; Weick et al., 1989)

Much of the existing research has emphasized deficits, such as a lack of resources, poor mental health outcomes, and limited organizational support for LGBTQIA+ youth (Colpitts & Gahagan, 2016; Peel et al., 2023; Wilson & Cariola, 2020). Extant literature focuses on “making the case” for increased support and funding, resulting in predominantly deficit-based narratives (Colpitts & Gahagan, 2016; Peel et al., 2023). While important, this focus can create a two-dimensional portrayal that overlooks the strengths, resilience, hopes, and aspirations of LGBTQIA+ youth. Such narratives risk erasing the full reality of their lives and may inadvertently contribute to further harm and marginalization. A key objective of this paper is to disrupt deficit-based narratives and highlight the strengths and resilience of rural LGBTQIA+ youth, who are not only surviving but actively shaping their communities.

1.1. Terminology

All three aspects of this population—rurality, LGBTQIA+ identity, and youth—are defined in various ways across different studies, particularly in international contexts. A significant part of our research discussions centered on reaching a consensus on how to define these terms. This section outlines the parameters of the literature review and provides definitions and conceptualizations of the population, which serve as the foundation for our analysis.

1.1.1. Rurality

This review revealed wide variation in how rurality is defined across studies and geographic contexts. In response, we sought to clarify common terms and classification systems used to define rural communities. One frequently used framework is the Rural-Urban Continuum (RUC) codes developed by the U.S. Department of Agriculture, which categorizes areas based on population size and proximity to metropolitan regions (USDA Economic Research Service, 2023). In addition to official designations, some studies emphasized the role of self-identification, recognizing that people may consider themselves rural based on cultural or social connections rather than administrative criteria (Elliott et al., 2022; Y. Li et al., 2018). The term “small town” also appeared in the literature, typically referring to size rather than other rural characteristics. RUC and similar tools adopt a continuum model of rurality—an approach that mirrors spectrum-based conceptualizations of gender and sexuality, recognizing complexity and fluidity rather than fixed categories (Epstein et al., 2012). Studies included in this review frequently engaged with questions of how rurality is defined and experienced (Agueli et al., 2022; Ballard et al., 2017; Eisenberg et al., 2018; Elliott et al., 2022; T. Jones, 2015; Logie et al., 2019; Paceley et al., 2017b, 2017c, 2018, 2019, 2020a). Common indicators across these studies included population size, distance from urban centers, sociopolitical climate, the presence of agriculture, and self-identification with rural life.

The RUC framework has been widely adopted by U.S. agencies and researchers as a tool for understanding rural communities. For example, Ballard et al. (2017) used RUC classifications in a study of two Appalachian high schools—one in a more rural district (RUC 7), and another in a less rural one (RUC 5). Eisenberg et al. (2018) applied an urban-rural comparison in their study of mental health outcomes among trans and gender-diverse adolescents in Minnesota. Likewise, T. Jones (2015) explored school experiences among LGBTQIA+ youth in both rural and urban areas of Australia, and Paceley et al. (2017a, 2017b, 2020a, 2020b) examined psychosocial outcomes for sexual and gender minority (SGM) youth in nonmetropolitan parts of the U.S. Midwest. Internationally, rurality is defined in diverse ways. Nine of the twenty-six studies reviewed were conducted outside the U.S., each using different criteria. For instance, Agueli et al. (2022) assessed rurality in Italy by population density, contrasting metropolitan and less-populated areas. Logie et al. (2019), studying Canada’s remote Arctic regions, relied on geographic isolation rather than a formal definition. Two studies in Jiangxi Province, China, used self-reported rural residence, with around 80% of youth identifying as living in rural areas (Y. Li et al., 2018; X. Li et al., 2019). Together, these approaches demonstrate that rurality is not a fixed or universally defined category but one shaped by intersecting geographic, social, and cultural factors.

1.1.2. LGBTQIA+ Identity

The terminology used to describe LGBTQIA+ individuals, families, and communities has evolved significantly over the past five decades, particularly following the sexual and gay liberation movements of the 1960s and 1970s. Early research and advocacy focused primarily on gay and lesbian identities, later expanding to include bisexual, transgender, and queer individuals. Yet the historical documentation of LGBTQIA+ identities and relationships reaches far earlier—extending from ancient civilizations to the modern era—illustrating diverse expressions of sexuality and gender across cultures and time periods. According to the World History Encyclopedia (2021), early records reflect a wide spectrum of sexual behaviors and gender roles, including same-sex relationships and non-binary identities (Mark, 2021). However, such narratives are often fragmented or biased due to prevailing social and cultural pressures, contributing to the erasure or suppression of LGBTQIA+ histories. Prior to the late nineteenth century, the notion of fixed sexual identities was virtually nonexistent, though many lived lives consistent with modern understandings of LGBTQIA+ experience (Ferris, 2006; Foucault, 1978). The emergence of gay identity as both a personal and political category is largely a mid-twentieth-century and Western development. Across different cultural, racial, and ethnic communities, terminology for gender and sexual minorities has varied, often lacking the specificity seen in contemporary language.

The LGBTQIA+ acronym has developed alongside—and in response to—shifting sociopolitical movements, expanding from initial uses of gay and lesbian to include bisexual, transgender, queer, intersex, and asexual identities (K. Hall et al., 2019; Ferris, 2006). Terms such as queer—once a slur—have been reclaimed by some as expansive and inclusive (Baker & Harris, 2020). Despite this evolution, gender diversity and intersex identities were historically marginalized in both community discourse and academic research. Until recently, many studies overlooked or excluded transgender and intersex experiences entirely, and when studied, often did so through unethical or harmful methods (Surendran et al., 2025). More recently, community-engaged research has advanced the visibility and inclusion of diverse identities, leading to more nuanced and respectful terminology. Academic terms such as sexual and gender minorities (SGM) and sexual orientation and gender identity (SOGI) have emerged, especially in public health and clinical research (Mayer et al., 2008; Center for Studies in Demography and Ecology, 2025). While useful for research consistency, these terms do not always reflect how LGBTQIA+ people describe themselves. In alignment with a community-engaged framework, our team intentionally uses the term LGBTQIA+ throughout this manuscript, while also honoring the terminology used in the original studies included in our review.

1.1.3. Youth

Defining youth presents yet another complexity, as studies vary in their delineation of age ranges. Defining the population within youth-centered research is notoriously challenging. Some researchers equate youth and students (individuals enrolled in K-12 or higher education), while others use the terms young adults or emerging adults to describe those in their late teens or twenties (Ansell, 2016; Arnett, 2000; Galstyan, 2022; Nilan & Feixa, 2006). Across the literature, age-based definitions of youth range broadly from 10 to 35 years. Specifically, in the international context, each national definition of ages included in youth varied greatly around the world. For example, the Italian government defines youth up to age 35 (Agueli et al., 2022). In most North American contexts, youth ends between 18 and 25 years old (Ansell, 2016; Nilan & Feixa, 2006). Given this global variety of age ranges, our team noted how each study conceptualized youth and young people to ensure clarity in our analysis. The conceptual category of youth extends well beyond the simple metric of age in years—the notion relates to developmental stage, social roles, and generational cohort.

1.2. An Intersectional Lens on the U.S. South

While we included publications from around the world, we closely examined research on the U.S. South, particularly given our institutional context in the Southern state of North Carolina. The distinct sociopolitical landscape of the U.S. South significantly influences the experiences of LGBTQIA+ youth in this region, making it a key area of focus in our review. Intersectionality—a framework recognizing that an individual’s multiple minoritized identities may create complex and overlapping sociopolitical obstacles—is essential for understanding the U.S. South as a region with both historic and contemporary global significance (Crenshaw, 1989; Ream, 2024). The U.S. South bears the enduring legacies of colonialism, white supremacy, and patriarchy, all of which continue to shape daily life (Acharya et al., 2016; Maxwell & Shields, 2019; Reed, 2022). Intersectionality is a vital framework for understanding the experiences of rural LGBTQIA+ youth and the complex ways their lives are shaped by structural forces such as ableism, racism, sexism, classism, and colonialism. It offers a lens through which to examine how multiple systems of oppression and identity interact, rather than viewing identities or experiences in isolation. Intersectionality serves as an analytical strategy for understanding LGBTQIA+ youth experiences globally—and is especially applicable within the regional context of the U.S. South, where histories of racialized violence, poverty, and colonization continue to shape lived realities.

For example, LGBTQIA+ people of color in the South face the intersecting forces of structural racism, heterosexism, and cissexism, profoundly affecting their lives (Movement Advancement Project, 2020b). A 2022 national survey of transgender Americans found that nearly one-third of respondents reside in the U.S. South—a predominantly rural region (James et al., 2024; U.S. Census Bureau, 2022). Similarly, a report by the organization Movement Advancement Project (2020a) estimated that one in three LGBTQIA+ individuals live in the South. Another report from MAP uses an intersectional framework, highlighting that race, faith, and poverty are the primary structural forces which shape LGBTQIA+ Southerners’ experiences with oppression and resilience (Movement Advancement Project, 2020b). Hostile geographies carry real health consequences. For instance, Joudeh et al. (2021) employed an intersectional, community-based, qualitative approach to examine barriers to healthcare access among LGBTQIA+ adults living in the rural South. Their findings revealed that limited access to quality healthcare stemmed from “compounding effects of the sociopolitical climate of the geographical area, religious attitudes toward SGMs, and the experience of racism” (Joudeh et al., 2021, p. 467). This research underscores the ways in which LGBTQIA+ Southerners must navigate their rights and protections within deeply hostile environments.

2. Materials and Methods

The research team used a structured literature review process, employing a team research strategy, with the following elements:

• Review extant literature independently using shared search terms;
• Facilitate research team meetings for discussion and analysis;
• Compile a shared dataset document with literature summaries;
• Conduct thematic analysis of prominent themes in the literature;
• Achieve consensus on themes and subthemes across the literature;
• Identify relationships between articles and the overarching themes;
• Analyze findings across the literature from a strength-based perspective.

Initially, team members searched the literature from the past 20 years (since 2005). However, after reviewing the first round of studies, our team decided to narrow the publication date range to the past decade (since 2015). This adjustment allowed us to focus on the most recent scholarship that reflects the significant sociopolitical shifts in LGBTQIA+ inclusion and acceptance during this period. Team members searched for relevant studies using Google Scholar and our university library databases, applying a shared set of search terms (see

Table 1. Search terms used for literature review.

Search Terms
LGBT *	rural
country	young people
sexual and gender minority (SGM)	small town
youth	students

Note: An asterisk (*) functions as a Boolean truncation operator, enabling database searches to return results that include any term beginning with “LGBT” (e.g., “LGBTQ,” “LGBTQIA+,” “LGBTQIA2S+”), thereby capturing a broader range of related acronyms.

). The initial search returned over three hundred (347) articles from Google Scholar and two hundred (200) articles from our university library database. To be included in the review, articles had to meet the following criteria: a primary focus on (1) youth, (2) rural populations, and (3) LGBTQIA+ experiences. Duplicate articles were removed, and additional exclusions were made for studies focusing on adults, urban settings, or non-LGBTQIA+ populations. This process resulted in twenty-six (26) articles retained for this structured review.

The research team met regularly to collaboratively process findings across the existing literature. Each week, team members independently reviewed a subset of articles from the dataset, identifying elements such as research aims, methods, and key findings. During team meetings, team members provided information on the articles they had reviewed. Team members engaged in discussion about the thematic findings and examined patterns across the literature. Certain articles—those including particularly rich reference lists, meta-analyses or systematic reviews (e.g., Elliott et al., 2022)—often led to the identification of additional relevant studies, expanding the dataset and prompting further review. This iterative process allowed the team to develop an understanding of the extant literature. One extended meeting was dedicated entirely to a full-group review of the dataset and consensus-building around thematic patterns, while another meeting focused on our discussion of the most salient themes and implications. The team reached an agreement on the final list of themes presented in the Findings section. The team regularly met to discuss and clarify our understanding of the findings, reaching consensus on key definitions and ensuring consistency across our thematic analysis. We reviewed the studies, cross-checked that selected articles met our inclusion criteria and confirmed that we were following the same search methods throughout the review process. These meetings helped us stay aligned in our interpretation of themes in this literature.

Additionally, the first author utilized artificial intelligence software (Manus, 2025; OpenAI, 2025) to support thematic categorization, data analysis, and writing. AI tools were employed to classify articles by theme, design tables of themes, identify the presence of multiple themes within single articles, and interpret how each article represented the strengths of LGBTQIA+ youth. To ensure the validity of the software’s analysis, the research team reviewed its output and confirmed that the results aligned with the key themes we independently identified in the dataset (see

Table A1. Summary table of the structured review of the literature about rural LGBTQIA+ youth.

Article	Geography	Sample Demographics	Definition of Rurality	Findings	Theme Alignment
Agueli et al. (2022)	Italy	N = 30 young LGBQ people living in metropolitan and rural areas of southern Italy Sex and gender: 23 males and 7 females. Age: 18–35 y.o. (μ = 25.07) Sexual orientation, rural/nonrural, martial status, profession, and religion were also reported	Population density with one area being the third most populated and the others being much less populated areas.	The analysis of the textual material resulted in 130 unique codes, subsequently grouped into 12 categories and five macro-categories: (1) freedom of identity expression in the urban and rural context; (2) identity construction and acceptance process; (3) need for aggregation and identification with the LGB community; (4) role of the interpersonal relationship in the process of identity acceptance; (5) socio-cultural context and LGB psychological well-being.	□ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
Ballard et al. (2017) †	United States (North Carolina)	N = 1550 high school students Sex and gender: 51% female and 49% male; importantly, there were no options for students to identify as transgender) Sexual orientation: 90% heterosexual, 2% gay or lesbian, 4% bisexual, and 4% not sure. Due to low numbers in the minority sexual orientations, these groups were combined into one LGBQ category Grade-level: 28% 9th grade, 27% 10th, 26% 11th, and 19% 12th Race and ethnicity: 90% white sample, and the ethnicity distribution aligns with regional census data. To protect individual students’ identities in this rural area, all non-white student data was aggregated	Survey conducted by the local health department in two county district (CD) high schools located in rural Appalachia. CD1 had a Census-based rural-urban continuum code (RUC) of 7, indicating a nonmetro area with a population of 2500 to 19,999, not near a metropolitan area. CD2 had an RUC of 5, indicating a nonmetro area with a population over 20,000, also not near a metro area.	LGBQ students were significantly more likely to report suicidality and suicide risk, bullying, school violence, drug use, and risky sexual behavior, compared to their heterosexual peers. Additionally, they were more likely to report having insufficient social and communal support compared to their heterosexual peers.	☑ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
De Pedro et al. (2018)	United States (California)	N = 611 students Race and ethnicity: White (62%), multiracial (29.1%) and Latino (29.2%) LGBTQ students have slightly more Black or African American representation (7.7%) compared to Non-LGBTQ students (2.6%) Sex & gender: 50% female and 50% male. In the LGBTQ group 5.4% identified as transgender (5.4%), compared to 0% in the Non-LGBTQ group. Additionally, 8.1% of LGBTQ students reported “questioning” their gender	The school district itself qualified as rural—“students enrolled in a rural school district in Central California” (De Pedro et al., 2018, p. 269).	The results show that LGBTQ support, along with peer and teacher intervention, contributed to increased safety for LGBTQ youth. The presence of a GSA in schools was, surprisingly, linked to lower levels of safety among LGBTQ students.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Dwyer et al. (2015)	Australia	Data from multiple studies Study 1: N = 35 LGBTIQ young people from a community resource center Age: 16 to 25 years N = 7 LGBTIQ youth service provider staff Study 2: LGBTIQ individuals completed an online questionnaire about their experiences with police liaison officers in Queensland (QLD), New South Wales (NSW), and Western Australia (WA) Study 3: Third project interviewed lesbian and gay police officers who had previously served with the Queensland Police Service (2009–2010)	Authors offered no specific definition for rurality. Some aspects that indicate community’s level of rurality are the “hiddenness of LGBTQIA+ individuals,” police attitudes, racism, and the amount of ethnic minorities present.	Policing LGBTIQ people in rural contexts is markedly different than urban contexts. Due to homophobia experienced in rural areas, some young LGBTIQ people relocate to urban areas. Relocation of rural officers impacts the availability of police who know LGBTIQ issues. The effectiveness of policing LGBTIQ people in rural areas depends on outreach. LGBTIQ people in rural areas often fear homophobic police responses.	□ Gaps in Intersectional Analysis ☑ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Eisenberg et al. (2018)	United States (Minnesota)	Full MSS sample N = 81,885 students Grade-level: 5th, 8th, 9th, and 11th grades in participating districts were eligible to complete surveys (grades were selected to range across early and middle adolescent age groups) Sex and gender: Evenly distributed by birth-assigned sex (49.5% female) Race and ethnicity: 68.3% white, non-Hispanic students, similar to the demographic profile of adolescents in the state. The gender identity question was only included at the high school level (grades 9 and 11), so this analysis is restricted to these grades TGD subsample N = 2168 TGD youth Sex and gender: 68.1% were assigned female at birth. and 58.6% were in the 9th grade Race and ethnicity: White, non-Hispanic students comprised 58.7% of the TGD sample Socioeconomics: 38.8% received free/reduced-price lunch Geographic context: TGD students from all across the state were included; 16.6% went to school in city settings, 44.8% in suburbs, 23.2% in towns, and 15.4% in rural locations	Categories include city (i.e., a principal city inside an urbanized area), suburb (i.e., outside a principal city and inside an urbanized area), town (i.e., inside an urban cluster that is separate from an urbanized area), and rural location (i.e., census-defined rural territory that is separate from an urbanized area and/or urban cluster).	Bullying and emotional distress increases for LGBTQ students in rural communities; however, in some areas (like suburbs), those phenomena also increase. Findings regarding heightened emotional distress among TGD students in suburban settings were surprising, despite greater proximity to supports and resources in city settings. They showed higher rates of depressive symptoms and suicidal ideation than their peers in nonmetropolitan towns, and statistically equivalent rates of all four (4) indicators of emotional distress to those attending school in rural locations. Very similar rates of family connectedness and positive teacher relationships suggest that supportive, caring individuals exist to provide critical support to vulnerable students regardless of the geographic context, or existence of formal resources in the schools or communities.	□ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Elliott et al. (2022)	International	N = 30 articles and studies included in the structured review	Authors include a discussion of the categorization of rurality including factors like zip codes, population size, the presence of agriculture and farming, remoteness, and other factors (Food and Agriculture Organization of the United Nations, 2018) This paper discusses how measures of rurality varied greatly across included papers around the world, from self-reported data to population metrics (e.g., Census data).	Found risk and protective factors for rural youth mental health across four ecological levels: individual, interpersonal, institutional (school), and community. A major emphasis was placed on mental health and well-being outcomes, including depressive symptoms, emotional distress, suicidality, non-suicidal self-injury (NSSI), substance use, and other risky behaviors—highlighted as central concerns across the literature. A figure (p. 321) maps risk and protective factors across levels and offers a clear synthesis to guide multi-level intervention and research efforts in rural contexts.	☑ Gaps in Intersectional Analysis ☑ Mental Health Outcomes ☑ Culturally responsive services and resources □ Community Climate and Context □ Experiences with Victimization ☑ Policy
Goldbach et al. (2023)	United States	N = 2558 sexual minority youth completed an online survey Age: 14–17, μ = 15.90 yrs, SD = 0.98	Survey participants indicated whether they were in urban area (i.e., “urbanicity”).	Sexual minority adolescents living in rural areas reported higher levels of minority stress, depression, and PTSD symptoms compared to those in urban settings. Minority stress mediated the relationship between where they lived (urban vs. rural) and both depression and PTSD symptoms, and partly explained the connection between geography and anxiety.	□ Gaps in Intersectional analysis ☑ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization □ Policy
W. J. Hall et al. (2018) †	United States (North Carolina)	N = 20 adults who attended the photovoice exhibit about the experiences of rural LGBTQIA+ youth	Does not explicitly provide a definition of rurality in the article.	Participants responded to an online survey about their experiences with the intervention—and it’s effect on their willingness to take protective action to benefit or advocate for rural LGBTQIA+ youth. 85% reported that the intervention made them think about issues they had not previously considered, including the struggles LGBTQ youth face, gender issues, and living in a rural community. Common emotions experienced at the intervention included feeling excited, concern for the youth, and proud of the youth. 81% of the adults indicated that they would take action or behave differently as a result of the intervention, including supporting and affirming LGBTQ students, using gender-neutral and -inclusive language, and confronting bias in themselves and others.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
Hulko and Hovanes (2018)	Canada	N = 13 Participants identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ) living in a small Canadian city Age: μ = 19.8 years	The participants self-identified as living in a small city (i.e., a small town that qualified as “rural” by Canadian standards).	Several themes emerged from in-depth interviews, including the following: 1. Living in a small town; 2. Identifying and being identified by others as SGM; 3. Talking about intersectionality. Sexual identities and gender identities and expressions of LGBTQ youth change across time and context and are impacted by often overlooked factors including faith, Indigenous ancestry, disability and class.	☑ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
T. Jones (2015)	Australia	Data from multiple studies Study 1: N = 3134 (2010; Australian GLBTIQ students aged 14–21) Study 2: N = 273 (2012; Australian transgender female-to-male people aged 16–64) Study 3: N = 189 (2013; Australian transgender and intersex students aged 14–25)	Compares rural to urban students.	Where the youth went to school shaped their lives, and many discussed moving (metronormativity), finding safety, social acceptance, and thriving more in urban areas after leaving the rural context at home. Participants across studies discussed safety and well-being risks in rural school contexts. Trans students in both rural and urban environments stated their schools were not accepting of trans identity. There was also a call for increased access to SGM community in rural areas—clubs, services, cultural events, and school-based supports.	☑ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources □ Community Climate and Context ☑ Experiences with Victimization □ Policy
Y. Li et al. (2018)	China	N = 1742 high school students in Jiangxi province Sexual orientation: 4% self-identified as LGB, and 14% reported being unsure of their sexual identity Geography: 80% from rural communities; Age: 80% 16 and 17 years old	Survey was conducted in China’s Jiangxi province − 80% of the sample self-reported their family residence was in a rural community.	After controlling for confounding variables, LGB students had significantly higher risk for depressive symptoms [AOR = 6.16 (2.13–17.83; for males) and AOR = 2.29 (1.13–4.63; for females)] compared with heterosexual students.	□ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
X. Li et al. (2019)	China	N = 1810 students Sex and gender: 805 female and 1005 male students Age: 96 were less than15 years old, 553 were 16 y.o., 867 were 17 y.o. and 294 students were 18 y.o. or older	Used Chinese national economic development metrics to define rurality.	The authors found that the rates of NSSI among high school students was higher for students with high academic pressure at 7.92%, but students who were victims of bullying and fights at school had a rate of 18.90%. Authors also examined Adverse Childhood Experiences (ACE’s), finding that LGBQ students with ACEs have a three times higher probability of NSSI.	□ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources □ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Logie et al. (2019)	Canada	N = 51 Young LGBT participants (n = 37) Key informants who worked with LGBT people (n = 14) Age: 15–24 y.o. (n = 16), 25 y.o. and older (n = 21) Race and ethnicity: The sample size was not racially or ethnically diverse—with only 2 Indigenous participants out of 16	The authors did not explicitly define “rural, but uses their geographical location, Artic Canada—a notably rural and remote territory.	The authors found that geographical, social, and healthcare factors converged to shape overall healthcare access. Confidentiality concerns, heterosexism, and cisnormativity were also voiced as being large concerns by the respondents.	☑ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization □ Policy
O’Bryan et al. (2020)	United States	N = 141 participants identified as transgender Age: Under 18 up to age 21 y.o.	The authors did not explicitly define rurality in this article.	Transgender youth showed significantly poorer mental health measures compared to the general population.	☑ Gaps in Intersectional Analysis ☑ Mental Health Outcomes ☑ Culturally responsive services and resources □ Community Climate and Context □ Experiences with Victimization □ Policy
Paceley et al. (2020a)	United States (Midwest)	N = 201 young LGBTQIA+ people Age: μ = 16.28 (SD = 1.24) Sex and gender: assigned female at birth (81.41%), cisgender (72.14%), Race and ethnicity: non-Latinx, White (76.50%) Sexual orientation: 25.63% gay/lesbian identity, 24.62% bisexual, 18.09% questioning, and 3.66% pansexual or queer Socioeconomic status: Receiving free and reduced lunch at schools (47.40%) Community size: 38.30% lived in a medium or large metropolitan area, 33.83% in a small metropolitan area, 26.87% in a nonmetropolitan area Community climate: 63% perceived their community climate as tolerant, 22.50% as supportive, 14.50% as hostile	This study examined community climate and community size as the measure of rurality—they do not explicitly define rural, but they compare different community sizes and climates.	Community climate was associated with anxiety and depression but not physical health; community size was unrelated to health outcomes. Victimization was a mediating factor between community size/climate and adverse health outcomes.	□ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Paceley et al. (2017a)	United States	296 SGM-identified youth Age: 14–18 y.o.	Authors cite the National Center for Health Statistics (2014) urban–rural classification scheme for examining rural/urban differences. They also mention research which challenges the notion that rural communities are inherently hostile towards LGBTQIA+ people.	Nonphysical victimization was the only predictor of clinically significant depression, anxiety and stress scores (DASS-21). Those with higher nonphysical victimization scores were over twice as likely to score within the clinically significant range on depression, anxiety and stress. Those who lived in a small metropolitan area were 2.66 times more likely to score in the clinically significant range for stress. Nonphysical victimization scores were highest for those in a nonmetropolitan community size. There was a difference between physical victimization and perceived community climate, which indicates that the lowest level of physical victimization was reported by those in a community climate perceived as supportive. There was a difference between non-physical victimization and perceived community climate, which indicates that the highest level of non-physical victimization scores was among those in a community climate perceived as hostile. There was no difference in physical victimization among various levels of community size.	□ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization □ Policy
Paceley et al. (2020b)	United States	N = 34; SGM youth from nonmetropolitan communities; mostly high school students Age: 14–18 years (μ = 16) Geography: 25% participants lived in nonmetropolitan communities; 75% lived in small metropolitan communities (i.e., small towns) Race and ethnicity: White (65%), Multiracial (17%), African American (12%); Asian or Latinx (6%) Sex and gender: 53% female, 26% male, 12% transgender, 9% gender questioning Sexual orientation: Bisexual (32%), pansexual (32%), gay (21%), lesbian (12%), and queer (3%)	“Non-metropolitan communities” encompass all towns with fewer than 250,000 people (including traditional rural communities, and smaller towns/cities that are not adjacent to a metro area)—in the sample, actual population sizes ranged from 3000 to 120,000.	The study found that youth use online platforms to establish a sense of community, express themselves, and access culturally responsive resources and information.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
Paceley et al. (2017b)	United States (Midwest)	‡	‡	“Social support, friendships, and a sense of community can help SGM youths cope with hostility and stigma” (p. 401). From both SGM and non-SGM friends, youth received general emotional support, relationship advice, and protection. From SGM friends, participants received greater closeness, emotional intimacy, and assistance with SGM identity development. Acceptance was important from their non-SGM friends. Participants noted that there were limits to the support non-SGM friends could offer.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Paceley et al. (2018)	United States (Midwest)	‡	‡	Factors that make a community supportive for LGBTQIA+ youth can be grouped in four categories: 1. Supportive people; 2. Resources and education; 3. Visibility; 4. Policies. As the title suggests, youth expressed the power of symbolic visibility (i.e., “rainbows everywhere”) in community spaces.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
Paceley et al. (2019)	United States (Midwest)	N = 193 participants in a survey and 34 participated in interviews Survey participants demographics Age: μ = 16.4 Race and ethnicity: 78.2% White, 5.1% Black, 4.1% Hispanic/Latino, 1.0% Asian, and 11.9% multiracial; Sex and gender: 58% female, 21.2% male, 17.1% transgender, 3.6% gender questioning Sexual orientation: 29.5% bisexual, 21.2% pansexual, 13.5% gay, 11.4% lesbian, 5.2% queer, 11.9% questioning, and 5.7% other Interview participants demographics Age: μ = 16 Race and ethnicity: 56% White, 9% Black, 3% Hispanic, 3% Asian, and 26.5% multiracial Sex and gender: 53% female, 26% male, 15% transgender, and 6% gender questioning Sexual orientation: 29% bisexual, 29% pansexual, 15% gay, 9% lesbian, 9% queer, 9% questioning, and 5.7% other	‡	Four salient categories of factors were discovered related to barriers for accessing LGBTQIA+ community organizations: 1. Accessibility (including distance, lack of information, and conflict with parents); 2. Utility (congruence (existing organizations were not the space they needed); 3. Interpersonal conflict (‘drama’ at the organizations); 4. Wider societal stigma.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
Paceley et al. (2017c)	United States (Midwest)	N = 23 transgender youth from small towns Age: 14–22 years	The study defined “small towns” as communities with smaller populations and fewer resources compared to urban areas. However, the exact population size or criteria for rural/urban classification were not defined explicitly. Participants self-identified as residing in a “small town.”	The findings revealed that transgender youth in small towns often face the following: 1. Limited resources and support systems compared to urban areas; 2. Negative community climates, including discrimination, stigma, and lack of understanding; 3. Resilience and coping strategies, such as seeking online support or forming close-knit peer networks.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Price-Feeney et al. (2019)	United States	N = 5100 Age: 13–18 y.o.	The authors do not define rural but discuss characteristics of rural communities.	Rural status was not associated with additional challenges beyond those posed by LGB+ status. Most noted differences in indicators of psychosocial challenge were between LGB+ and heterosexual youth, regardless of rural vs. nonrural community living status. For example, sexual minority youth, both male and female, were more likely to report having used substances, having depressive symptomatology, having low self-esteem, and being bullied in the past year compared with both rural and nonrural heterosexual youth.	☑ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources □ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Rand and Paceley (2022)	United States	N = 7 LGBTQ+ high school students Age: 14–18 years old Sexual orientation: 1 asexual male, 2 transgender males, 2 bisexual females, and 2 lesbians	Participants were recruited from a town 50 miles away from an urban area with a population of 4700 residents.	Students felt they faced hostility concerning their LGBTQ+ identities, which led to them not being able to express themselves fully. Pronouns and preferred names were not always respected by school faculty and peers. They mentioned a “double standard” of discipline in their schools, meaning they would get in trouble for something that a straight cisgender person would not. When participants were asked about their community’s tolerance, many respondents stated they felt like they were misunderstood and stigmatized due to community politics and religious beliefs.	□ Gaps in Intersectional Analysis □ Mental Health Outcomes ☑ Culturally responsive services and resources ☑ Community Climate and Context □ Experiences with Victimization ☑ Policy
Roberts et al. (2018)	Australia	N = 531 adolescents Age: 13–18 y.o. Sex and gender: 55% female, 43% male Sexual orientation: 31 of whom identified as “same-sex attracted”	Used the Australian governmental definition of rural areas.	Same-sex attracted adolescents reported significantly more depression symptoms compared to heterosexual adolescents.	☑ Gaps in Intersectional Analysis ☑ Mental Health Outcomes ☑ Culturally responsive services and resources □ Community Climate and Context □ Experiences with Victimization □ Policy
Stevenson et al. (2024) †	United States (Mid-South)	N = 94 LGBTQIA+ college students at a public four-year university Geography: 63 rural and 31 urban participants Age: 18 to 25 Student status: enrolled in courses at the university either full or part-time	Rural-urban comparison groups—students self-identified their geographic status.	More adolescents who were LGBTQIA+ screened positive for depression there was a significant difference in responses to the item assessing suicidality between LGBTQIA+ and other adolescents. LGBTQIA+ adolescents reported more experiences of stressors relating to relationships, bullying and physical assault than heterosexual adolescents but, contrary to expectations, did not report perceiving more barriers to seeking mental health services.	☑ Gaps in Intersectional Analysis ☑ Mental Health Outcomes ☑ Culturally responsive services and resources □ Community Climate and Context ☑ Experiences with Victimization ☑ Policy
Wike et al. (2021) †	United States (Southeast)	N = 11 young LGBTQIA+ people Age: 12–21 years old	Participants were recruited from an LGBTQIA+ community center serving a rural five-county region in the Southeastern US.	Themes related to navigating victimization across contexts: (1) Conflicting family messages, (2) navigating personal safety at school, (3) connecting through technology, (4) confronting negative religious sentiment, and (5) demonstrating individual and collective resilience.	☑ Gaps in Intersectional Analysis ☑ Mental Health Outcomes □ Culturally responsive services and resources ☑ Community Climate and Context ☑ Experiences with Victimization ☑ Policy

Note: A dagger (^†) indicates the study examines a geography within the U.S. South. A double dagger (^‡) indicates that the information is the same as in the table cell above.

in Appendix A). This cross-sectional analysis was conducted in Spring 2025, and the included articles reflect what was available and relevant at that time.

3. Results

Twenty-six (26) articles fully met the criteria to be included in the dataset (see Table A1 in Appendix A). Six core themes emerged from the team-based thematic analysis, including the following:

• Gaps in intersectional analysis;
• Mental health outcomes;
• Culturally responsive services and resources;
• Community climate and context;
• Experiences of victimization;
• Policy.

Several articles included information relevant to multiple themes. The resiliency and strengths of LGBTQIA+ youth in rural communities are also highlighted throughout the literature.

3.1. Gaps in Intersectional Analysis

One salient theme across the literature on rural LGBTQIA+ youth is the limited use of intersectionality as a theoretical framework (Ballard et al., 2017; Elliott et al., 2022; Hulko & Hovanes, 2018; T. Jones, 2015; Logie et al., 2019; O’Bryan et al., 2020; Price-Feeney et al., 2019; Roberts et al., 2018; Stevenson et al., 2024; Wike et al., 2021). Studies were grouped under this theme if demographic data about other identity categories such as race, ethnicity, gender identity, ability, and socioeconomic status was minimal or absent, or if the sample was predominantly white. Studies were also included in this thematic category if they mentioned the intersectional framework as their theoretical foundation. Many studies either omit racial and ethnic demographic data entirely or report predominantly White samples. For example, Ballard et al. (2017) report a sample that is approximately 90% White. Among the studies reviewed, De Pedro et al. (2018) presented the most racially diverse sample—62% White, 29% Latino, 29% multiracial, and 8% Black or African American—yet Indigenous participants were significantly underrepresented across North American studies overall. Despite the presence of multiple identity factors in some samples, few studies conducted a true intersectional analysis. One study in this review, Hulko and Hovanes (2018), explicitly applied intersectionality as a guiding framework, examining how sexuality, gender, rurality, faith, Indigenous ancestry, disability, and class interconnect in the lives of rural LGBTQIA+ youth. Elliott et al. (2022) systematic review identified the lack of intersectional analysis as a major limitation within the field. Notably, demographic data about other minoritized and marginalized experiences—disability, migration, religion, and socioeconomics remain underreported. These missed opportunities to examine intersecting identities represent a critical shortcoming in current research.

3.2. Mental Health Outcomes

Across the literature, LGBTQIA+ youth—particularly those in rural settings—face significantly elevated risks to their mental health and well-being compared to their heterosexual peers (Agueli et al., 2022; Ballard et al., 2017; Dwyer et al., 2015; Eisenberg et al., 2018; Elliott et al., 2022; Goldbach et al., 2023; Y. Li et al., 2018; X. Li et al., 2019; O’Bryan et al., 2020; Paceley et al., 2017a, 2020a; Price-Feeney et al., 2019; Roberts et al., 2018; Stevenson et al., 2024; Wike et al., 2021). Studies consistently identify higher rates of depression, suicidality, substance use, and non-suicidal self-injury among LGBTQIA+ youth (Ballard et al., 2017; Goldbach et al., 2023; Y. Li et al., 2018; X. Li et al., 2019; O’Bryan et al., 2020; Roberts et al., 2018; Stevenson et al., 2024). These disparities are closely linked to experiences of bullying, victimization, and limited access to affirming social supports (Eisenberg et al., 2018; Paceley et al., 2017a, 2020a; Wike et al., 2021).

While rurality does not universally intensify these challenges (Price-Feeney et al., 2019), several studies highlight unique stressors for rural LGBTQIA+ youth. These include homophobic policing (Dwyer et al., 2015), hostile community climates (Paceley et al., 2017a), and limited visibility and support, often driving relocation to urban areas (Agueli et al., 2022; Dwyer et al., 2015). Importantly, studies also document protective factors across ecological levels—such as supportive relationships, affirming school environments, and technology-enabled connections—that can mitigate risk and foster resilience (Eisenberg et al., 2018; Elliott et al., 2022; Wike et al., 2021).

Taken together, these studies reflect a troubling trend: rural LGBTQIA+ youth are disproportionately impacted by poor mental health outcomes, often compounded by isolation, limited access to affirming services, and structural stigma embedded within their communities. Conditions mentioned across the literature included depression, anxiety, stress, suicidality, self-harm, and problematic substance use among LGBTQIA+ rural youth. Overall, the findings call for multi-level, contextually tailored interventions that both reduce harm and amplify protective community support for LGBTQIA+ youth in diverse geographic contexts.

3.3. Culturally Responsive Services and Resources

Culturally responsive healthcare for LGBTQIA+ individuals emphasizes the importance of inclusive language and practices to provide effective care (Moore et al., 2019). Supportive and culturally responsive resources and services were limited in rural areas and LGBTQIA+ youth experienced travel burdens to urban centers for supportive, affirming, culturally responsive services and resources. Culturally responsive and affirming services are identified as essential components in improving access and outcomes (Dwyer et al., 2015; Elliott et al., 2022; Goldbach et al., 2023; W. J. Hall et al., 2018; Hulko & Hovanes, 2018; T. Jones, 2015; Logie et al., 2019; O’Bryan et al., 2020; Paceley et al., 2017c, 2018, 2019, 2020b; Rand & Paceley, 2022; Roberts et al., 2018; Stevenson et al., 2024). Across studies, rural LGBTQIA+ youth mentioned their use of online resources to support them when culturally responsive services were not available within reasonable geographic proximity (e.g., telehealth therapy, social media communities; Paceley et al., 2020b). A central theme across the literature highlights the critical role of accessible, affirming, and culturally responsive services and resources for LGBTQIA+ youth in nonmetropolitan contexts. Youth in rural and small-town communities often encounter limited formal supports, with substantial disparities in mental health resources and culturally affirming care (O’Bryan et al., 2020; Paceley et al., 2017c; Roberts et al., 2018). Even when services are geographically available, they may not be perceived as safe or inclusive for LGBTQIA+ youth (T. Jones, 2015).

Paceley et al. (2018) documented that youth themselves identify four key factors that signal a supportive community: the presence of affirming people, access to relevant resources and education, visibility of LGBTQIA+ life, and inclusive policies (Paceley et al., 2018). Informal support systems—such as teachers, mentors, and family members—can be protective even when formal resources are sparse (Eisenberg et al., 2018). Technology and social media also emerge as vital tools, enabling youth to connect, build community, and access affirming information in the absence of local support (Paceley et al., 2020b). While disparities in mental health persist (Stevenson et al., 2024), some youth report fewer perceived barriers to seeking services than expected, suggesting complex and context-dependent dynamics in how LGBTQIA+ youth navigate their care environments. Findings emphasize that culturally responsive services must go beyond mere availability—they must be visibly affirming, actively inclusive, and embedded in broader community efforts to support LGBTQIA+ youth well-being in rural and small-town settings.

3.4. Community Climate and Context

Research underscores the critical impact of community climate and context on the well-being of rural LGBTQIA+ youth. Across varied studies, themes of visibility, support, social isolation, and safety emerge as core components of rural LGBTQIA+ youth experiences (Agueli et al., 2022; Ballard et al., 2017; De Pedro et al., 2018; Dwyer et al., 2015; Eisenberg et al., 2018; Goldbach et al., 2023; W. J. Hall et al., 2018; Hulko & Hovanes, 2018; Y. Li et al., 2018; Logie et al., 2019; Paceley et al., 2017a, 2017b, 2017c, 2018, 2019, 2020a, 2020b; Rand & Paceley, 2022; Wike et al., 2021). Rural settings are often characterized by limited resources, heightened stigma, and isolation, which shape identity development and access to support. Agueli et al. (2022) highlight that rural youth in Italy experience more restricted opportunities for identity expression, face unique challenges in disclosure (i.e., coming out) processes, and often lack communal spaces for affiliation with LGBTQIA+ peers. These findings align with T. Jones (2015), who underscores that rural “GLBTIQ students” report seeking access to community and services, often finding acceptance only upon migration to urban areas. The concept of metronormativity—that LGBTQIA+ life and visibility is tied to urban settings—recurs as a structural force influencing youth decisions about belonging and movement.

School environments are particularly consequential for LGBTQIA+ youth. De Pedro et al. (2018) emphasize the role of teachers and peers in mitigating or exacerbating victimization, highlighting how LGBTQIA+ youth in rural schools benefit from active intervention. However, the presence of a gay-straight alliance (GSA) alone was not always protective, suggesting that token inclusion efforts without systemic support may fall short. In some cases, there were unintended consequences of GSAs, where leadership places people in a small town ‘spotlight’ that may compromise their safety. Adult allies are crucial for supportive environments. W. J. Hall et al. (2018), through a participatory photovoice intervention, demonstrated the potential of adult allyship in schools, showing how structured engagement with community adults shifted understanding and empathy.

Community climate—including norms, visibility, and support structures—has also been directly linked to mental health outcomes. Paceley et al. (2017a, 2020a) found that hostile community climates were associated with increased victimization and mental health issues, regardless of community size. In both studies, perceived hostility—not simply rurality—was a stronger predictor of negative mental health outcomes. Conversely, supportive climates foster resilience. Paceley et al. (2018) categorized protective community features into four domains: visible LGBTQIA+ presence, supportive people, affirming policies, and available resources. These findings were echoed by Elliott et al. (2022), who organized their literature review by psychosocial risk and protective factors across ecological levels, including interpersonal and institutional (school-based) dimensions. Policing and justice systems are also implicated. Dwyer et al. (2015) critique rural policing practices, identifying emerging tensions and distrust among LGBTQIA+ individuals in these spaces. Youth experiences of criminalization and surveillance compound broader challenges related to visibility and belonging in small towns.

Social connectedness, particularly through friendships and peer support, emerges as a vital buffer. Paceley et al. (2017b) found that both SGM and non-SGM friendships serve as meaningful sources of support, though connections with other SGM youth were especially protective. However, engagement with formal LGBTQIA+ organizations remains limited among the most rural youth (Paceley et al., 2019), who report barriers such as distance, fear of outing, and community stigma. Digital spaces may offer partial reprieve. Paceley et al. (2020b) document how rural LGBTQIA+ youth use social media to form relationships, build community, and express their identities. Yet, digital access and online safety concerns persist as areas for future intervention. Ultimately, the literature points to a nuanced ecology of place: while rurality introduces distinct challenges—including higher risks of victimization, fewer institutional supports, and cultural conservatism—positive interpersonal relationships and visible affirmation within communities can dramatically improve outcomes for rural LGBTQIA+ youth.

3.5. Experiences with Victimization

Victimization, including bullying, discrimination, and violence, is a prominent theme throughout the literature about rural LGBTQIA+ youth (Ballard et al., 2017; De Pedro et al., 2018; Dwyer et al., 2015; Eisenberg et al., 2018; Goldbach et al., 2023; T. Jones, 2015; X. Li et al., 2019; Paceley et al., 2017a, 2017b, 2017c, 2020a; Price-Feeney et al., 2019; Stevenson et al., 2024; Wike et al., 2021). This victimization is often embedded within broader community climates marked by hostility, stigma, or silence surrounding gender and sexual diversity. Ballard et al. (2017) found that LGBQ adolescents in rural Appalachia were significantly more likely than their heterosexual peers to experience bullying and violence—particularly within school environments. This aligns with findings from Eisenberg et al. (2018), who examined the experiences of transgender and gender-diverse youth across geographic regions and found that emotional distress and bullying victimization were often more acute in rural settings. Transgender young people were particularly attuned to issues of victimization and safety. Among transgender youth in small towns, perceptions of negative community climate—marked by discrimination, stigma, and misunderstanding—shaped their feelings of safety and inclusion (Paceley et al., 2017c).

Multiple studies demonstrate that victimization is not only more frequent in rural communities, but also strongly predictive of adverse mental health outcomes. For example, Paceley et al. (2020a) reported that victimization mediates the relationship between negative community climate and mental health outcomes such as anxiety and depression among SGM youth. This echoes an earlier study also by Paceley et al. (2017a), which found that nonphysical victimization was the only statistically significant predictor of symptoms of depression, anxiety, and stress. Importantly, the highest levels of nonphysical victimization were observed in youth residing in communities perceived as hostile. Stevenson et al. (2024) further found that same-sex attracted adolescents experienced more relational stressors, bullying, and physical assault than their heterosexual peers, though they did not necessarily perceive more barriers to seeking mental healthcare.

Relating victimization to other themes, community climate, rather than simply community size or rurality, appears to be a key factor. While physical victimization did not differ significantly by community size, supportive climates were associated with the lowest levels of physical victimization, underscoring the importance of perceived acceptance and safety (Paceley et al., 2017a). Similarly, X. Li et al. (2019) found that students in rural areas of China who reported experiences of bullying and school fights also reported increased rates of non-suicidal self-injury (NSSI), linking victimization to self-harming behaviors. Goldbach et al. (2023) found that the relationship between geography and negative mental health outcomes (i.e., higher rates of PTSD, anxiety, and depression) was mediated by minority stress, which is more likely in a hostile community climate. Qualitative insights further illustrate how LGBTQIA+ youth navigate hostile social environments. Wike et al. (2021) identified several strategies youth employed in response to victimization, including managing personal safety at school, confronting negative religious sentiment, and connecting with others through technology. These findings highlight the emotional and social labor involved in simply navigating everyday life as an LGBTQIA+ youth in rural spaces. Overall, these findings point to the deep entanglement of community climate, victimization, and mental health for LGBTQIA+ youth in rural contexts. Victimization emerges not just as a discrete event but as a pervasive force shaped by institutional, interpersonal, and cultural factors that normalize exclusion and violence.

3.6. Policy

Across the literature, researchers and LGBTQIA+ youth alike emphasized the importance of protective policies at school, local, state, and federal levels (Agueli et al., 2022; Ballard et al., 2017; De Pedro et al., 2018; Dwyer et al., 2015; Eisenberg et al., 2018; Elliott et al., 2022; W. J. Hall et al., 2018; Hulko & Hovanes, 2018; Y. Li et al., 2018; X. Li et al., 2019; Paceley et al., 2017b, 2017c, 2018, 2019, 2020a, 2020b; Price-Feeney et al., 2019; Rand & Paceley, 2022; Stevenson et al., 2024; Wike et al., 2021). Many youth—especially in rural areas—had not personally experienced affirming or protective policies but still expressed clear visions and hope for what such policies could offer in terms of safety, affirmation, and justice. Findings about policy effectiveness were mixed. For example, some studies found that anti-bullying or non-discrimination policies had little effect without active implementation or cultural change (Eisenberg et al., 2018; Paceley et al., 2017a). Others found that when combined with supportive educators or climates, policies could buffer the effects of victimization and improve health outcomes (Paceley et al., 2020a).

Youth participants frequently pointed to the gap between policy presence and practice—stating that policies alone were not enough without visible action and follow-through (Wike et al., 2021). At the same time, several studies raised concerns about anti-LGBTQIA+ and anti-DEI policies gaining traction in conservative political climates. These policies often targeted schools and youth-serving organizations, threatening punishment for staff who offered support or affirmed LGBTQIA+ identities (Paceley et al., 2017c; Stevenson et al., 2024). This policy context created additional barriers for rural LGBTQIA+ youth already navigating hostile climates or indifferent systems.

4. Discussion

This review synthesizes research on rural LGBTQIA+ youth, highlighting how rurality shapes identity, mental health, and access to support. Rather than a uniform experience, rural life spans a wide continuum—youth in some regions find belonging in micro-communities, while others face deep isolation due to stigma, geographic distance, or conservative norms (Agueli et al., 2022; Hulko & Hovanes, 2018; Paceley et al., 2017c). Isolation can increase risks related to visibility and access to care, especially where services are scarce or lack cultural responsiveness (Elliott et al., 2022; Logie et al., 2019).

A salient theme in the literature was negative mental health outcomes of LGBTQIA+ youth in rural communities. Mental health concerns are consistently higher among rural LGBTQIA+ youth, with elevated rates of depression, anxiety, suicidality, and self-injury (Eisenberg et al., 2018; X. Li et al., 2019; Roberts et al., 2018). Minority stress and unsupportive school climates are common drivers (Ballard et al., 2017; Stevenson et al., 2024). Although affirming formal resources like gender clinics or community centers can reduce distress (O’Bryan et al., 2020), youth frequently rely on informal or online networks due to fear of being outed or encountering discrimination (Paceley et al., 2020b). Social support in communities, schools, and families promotes positive mental health outcomes for LGBTQIA+ youth and may be especially beneficial for those living in more rural areas (Wilson & Cariola, 2020).

Community climate plays a pivotal role—visible support from peers, educators, or faith leaders can buffer harm, while hostile or silent environments compound risk (Paceley et al., 2018; Rand & Paceley, 2022). Experiences of bullying and systemic marginalization remain widespread, often with limited recourse due to institutional mistrust or lack of policy protections (De Pedro et al., 2018; Dwyer et al., 2015; T. Jones, 2015). These risks are further intensified at the intersections of race, class, and Indigeneity (Logie et al., 2019; Rand & Paceley, 2022), underscoring the need for affirming services and structural change. Particularly relevant are the policies and supportive services in rural school environments (Ballard et al., 2017; Blackburn & Thomas, 2019; Kosciw et al., 2009; Stevenson et al., 2024; Wilson & Cariola, 2020).

4.1. The Strengths of Rural LGTBQIA+ Youth

Research on rural LGBTQIA+ youth globally reveals consistent challenges with mental health, social stigma, and access to supportive resources. Studies from Australia (Roberts et al., 2018), Italy (Agueli et al., 2022), China (Y. Li et al., 2018; X. Li et al., 2019), Canada (Logie et al., 2019), and the United States (Eisenberg et al., 2018; Paceley et al., 2017a, 2017b, 2017c, 2020a, 2020b) show that internationally, rural LGBTQIA+ youth experience elevated mental health concerns, social isolation and victimization. The literature also shows that many rural LGBTQIA+ youth demonstrate notable resilience through community support networks and personal strength.

Throughout the research on rural LGBTQIA+ youth, researchers discuss relationships among community climate, victimization, and mental health outcomes (Elliott et al., 2022; Goldbach et al., 2023; Paceley et al., 2017a, 2017b, 2018, 2019, 2020a, 2020b). A national LGBTQIA+ youth organization, The Trevor Project (2021) reports higher rates of suicidality and depression among rural LGBTQIA+ youth compared to their urban peers, reflecting the real consequences of these political and social stressors. Despite these challenges, rural LGBTQIA+ youth display extraordinary strengths and resilience. Across studies, youth show a capacity to build supportive networks, foster affirming identities, and navigate hostile environments (Agueli et al., 2022; Eisenberg et al., 2018; Hulko & Hovanes, 2018; Paceley et al., 2017b, 2017c, 2018, 2020b; Wike et al., 2021). These strengths must be foregrounded in social work and policy efforts, moving toward protective, affirming, and culturally responsive approaches.

A strengths-based approach to social work has been advocated since at least the 1980s (Devaney et al., 2022; MacArthur et al., 2011; Weick et al., 1989), and this framework can be applied when working with LGBTQIA+ youth in rural communities. These young people demonstrate the power of unity and collective resilience. Many find affirming connections and peer networks through digital communities and social media, which can be protective and empowering (Paceley et al., 2017b, 2017c, 2020b; Wike et al., 2021). Scholars have increasingly documented the strengths of rural LGBTQIA+ youth (Agueli et al., 2022; Eisenberg et al., 2018; Hulko & Hovanes, 2018; Paceley et al., 2017b, 2017c, 2018, 2020b; Wike et al., 2021), emphasizing their resilience in the face of social oppression and systemic barriers. Social media interactions can also lack some of the genuine social connections that youth need—when LGBTQIA+ youth form in-person friendships or communities in rural areas, they tend to be quite tight-knit and protective (Paceley et al., 2017c, 2020b).

We also want to highlight that when rural communities are accepting and affirming—especially in schools and other youth-centered spaces—they are not weakened but strengthened. This shifts the narrative that rural, particularly Southern, areas must be inherently hostile or closed-minded. In reality, affirming and culturally responsive environments can exist in rural areas, and they enhance community well-being. LGBTQIA+ youth are vital members of their communities, and the adults who support them embody courage and resilience amid ongoing cultural and political backlash (Cole & Fritze, 2025; Hurley & Yurcaba, 2025; Movement Advancement Project, 2020b).

4.2. LGBTQIA+ Youth in the Rural U.S. South

In the U.S. South, particularly in our context in North Carolina, a hostile political environment can exacerbate these experiences of victimization and mental health challenges. Even though one-third of all LGBTQIA+ people in the U.S. reside in the South, the regional sociopolitical environment is often characterized as culturally and politically hostile to LGBTQIA+ people, particularly transgender people (James et al., 2024; Movement Advancement Project, 2020b). Conservative lawmakers increasingly frame LGBTQIA+ inclusion in schools as harmful “gender ideology” (Flannery, 2024; Jackson, 2025; Mulvihill, 2025), pushing the boundaries of policies like the North Carolina Parents’ Bill of Rights (NCGA, 2023) to restrict affirming supports in education. These measures occur alongside national rollbacks, such as bans on transgender military service and transgender youths’ access to gender-affirming healthcare, creating a climate of social and political marginalization (Cole & Fritze, 2025; Hurley & Yurcaba, 2025).

From this analysis, there emerges a resounding call for intersectionality to be centered in studies concerning rural LGBTQIA+ youth. A substantial portion of existing literature is based on samples composed of 70–90% White participants, shaping a dominant image of LGBTQIA+ youth as White by default. This not only obscures the realities of youth of color but also misrepresents the diversity of rural communities—particularly in the U.S. South. Future research must intentionally include and analyze racial and ethnic demographics, socioeconomic status, disability, migration history, and other intersecting factors to produce more representative and nuanced findings. For example, North Carolina’s racial and ethnic demographics—69.8% White, 22.1% Black or African American, 1.6% American Indian and Alaska Native, 3.7% Asian, 0.2% Native Hawaiian and Pacific Islander, 2.7% two or more races, and 11.4% Hispanic or Latino (of any race)—underscore the need for more inclusive and contextually grounded research samples (U.S. Census Bureau, n.d.). The overreliance on predominantly White samples ultimately limits the field’s ability to capture the full range of rural LGBTQIA+ experiences. Locating peer-reviewed studies on Southern rural LGBTQIA+ young people proved challenging. This literature review includes twenty-six (26) articles, of which only four (4; 15.4%) name their focus on the Southern rural context for LGBTQIA+ youth. Given our institution’s location and our geographic context in North Carolina, our team believes it is essential to center the experiences of rural LGBTQIA+ youth in the U.S. South within the broader landscape of social work research. We aim to challenge the ongoing erasure of queer and trans lives in these regions. For most members of our team, the rural South is not a theoretical site—it is home.

4.3. Limitations

This study was an exploratory structured review rather than a scoping or systematic review, which may have resulted in the exclusion of relevant studies due to search strategy limitations and database access. Additionally, the review team’s location in the U.S. South, while providing valuable insight into this context, could introduce bias, particularly in interpreting rural contexts outside this region, such as those in the Arctic, China, or other global areas. The limited number of studies focusing specifically on rural LGBTQIA+ youth in the Southern United States underscores a research gap, limiting generalizability. More comprehensive, systematic reviews and regionally comparative research are needed to fully understand the varied rural experiences of LGBTQIA+ youth worldwide.

4.4. Implications for Social Work Practice and Research

The findings highlight an urgent need to develop and expand supportive, affirming services accessible to rural LGBTQIA+ youth. Social workers and other service providers must be trained in culturally responsive care tailored to the unique challenges faced by rural LGBTQIA+ youth. Efforts should focus not only on direct services for LGBTQIA+ youth but also on supporting educators, families, and community members who advocate for these youth in the face of increasing political backlash. Given the weaponization of anti-LGBTQIA+ rhetoric in state and federal policies, social workers must engage in advocacy and policy efforts to resist these harmful measures and protect vulnerable youth. Social work practice behaviors that support Southern rural LGBTQIA+ youth can take many forms—ranging from macro-level advocacy to micro-level interventions. These efforts might include engaging with legislators and community leaders, supporting families as they navigate the emotions surrounding a child’s coming out, or taking small, protective actions in schools, churches, or community centers to foster safer, more affirming environments. Research about youth development emphasizes that the presence of even one supportive, affirming adult can make a profound difference in a young person’s life (Murphey et al., 2013). While broader community and policy contexts matter deeply, individual practitioners carry a responsibility to exercise their personal power in support of LGBTQIA+ youth—especially in hostile or restrictive environments. Regardless of the surrounding climate, social workers can and must act to create relationships of safety, affirmation, and care.

This includes fostering environments where LGBTQIA+ people (of all ages) are affirmed and empowered. Research implications include the critical need for more studies centered on rural LGBTQIA+ youth in the U.S. South, a region marked by particularly hostile political and cultural climates. Expanding the evidence base with regionally specific Southern data will support the creation of effective, culturally responsive interventions. Future research should also explore rural LGBTQIA+ experiences in diverse global rural contexts to inform nuanced, place-based social work practices.

5. Conclusions

Despite the hostile sociopolitical climate, rural LGBTQIA+ youth continue to show remarkable strength, creativity, and care for one another. Living in the crosshairs of small-town scrutiny, legislative attack, and social exclusion, they persist—not only in surviving but in building tangible systems of support. This generation, shaped by climate catastrophe, COVID-19, and repeated political betrayals, holds a deep awareness that change may not come from the top down. In the face of anti-LGBTQIA+ laws and rising state surveillance, these youth are turning toward each other: creating supportive networks, joining social change movements, and imagining new futures in the margins of institutions that often fail them.

Multiple studies reviewed here affirm that the presence of even one affirming adult—an educator, a mentor, a social worker—can be transformative. In a time when legislation is increasingly hostile toward LGBTQIA+ people, we must remember that while policies matter, people matter more. Rural LGBTQIA+ youth deserve more than survival—they deserve connection, joy, justice, and access to culturally responsive, affirming support. The youth are building communities of support where possible—especially in digital spaces. As researchers, educators, and social work practitioners—especially those of us based in the U.S. South—it is our task to follow their lead, to resist harmful policies, and to show up with real, consistent support. The youth are already imagining a better world. The question is: will we meet them there?