Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
. 2024 Dec 29;35(1):e13052. doi: 10.1111/jora.13052

LGBTQ+ youth policy and mental health: Indirect effects through school experiences

Samantha A Moran 1,✉, Meg D Bishop 1, Ryan J Watson 2, Jessica N Fish 1,3
PMCID: PMC11682966  PMID: 39734104

Abstract

The link between state policies and LGBTQ+ youth mental health is well‐established, yet less well‐understood are the mechanisms that drive these associations. We used a sample from the LGBTQ+ National Teen Survey (n = 8368) collected in 2022 to examine whether and to what degree LGBTQ+ inclusive school strategies, student perceptions of school safety, and experiences with bias‐based bullying and peer victimization explain the association between state LGBTQ+ youth‐focused policies and LGBTQ+ youth mental health symptomology. We observed significant indirect effects between policy and LGBTQ+ youth mental health through all four constructs, suggesting that each of these more proximal school experiences was independently implicated in this association. Findings underscore how state policies shape LGBTQ+ youth mental health symptomology via more proximal contexts and emphasize the importance of policy implementation following enactment.

Keywords: bias‐based bullying, LGBTQ+ policy, LGBTQ+ youth, mental health, peer victimization, school climate, school safety

LGBTQ+ YOUTH POLICY AND MENTAL HEALTH: INDIRECT EFFECTS THROUGH SCHOOL EXPERIENCES

Conservative estimates suggest that approximately 9.5% of U.S. adolescents ages 13–17 identify as lesbian, gay, bisexual, or transgender (LGBT; Conron, 2020). Despite recent considerable social progress in LGBTQ+ visibility and rights (Russell & Fish, 2016), expanding legislative efforts seek to restrict and eliminate the rights of LGBTQ+ adolescents, particularly those who identify as transgender and gender diverse. In the 2024 legislative session, 530 proposed bills aimed to curtail the rights of LGBTQ+ youth, including access to healthcare, gendered facilities (e.g., bathrooms), and inclusive educational opportunities (i.e., curriculum, sports participation; ACLU, 2024). The association between state‐level policy and LGBTQ+ health is well‐established (Hatzenbuehler et al., 2024; Miller‐Jacobs et al., 2023; Watson et al., 2021); however, less is known about the specific means through which state policies influence LGBTQ+ youth well‐being (Hatzenbuehler, 2017). To reduce LGBTQ+ health inequity and strengthen the impact of policy on LGBTQ+ youth health, it is imperative to examine the mechanisms through which state policies influence youth mental and behavioral health. In the current study, we use a large national data source to determine whether the relationship between state‐level youth‐focused LGBTQ+ policy and LGBTQ+ youth mental health symptomology is explained by more proximal contextual factors, such as youth's reports of LGBTQ+ inclusive school strategies, school safety, school bias‐based bullying, and peer victimization.

LGBTQ+ youth mental health and state‐level policy

LGBTQ+ adolescents are disproportionately burdened by poor mental health (Russell & Fish, 2016), reporting higher rates of depression, suicide ideation, and suicide attempts relative to their cisgender, heterosexual peers (Green et al., 2022; Plöderl & Tremblay, 2015; Price‐Feeney et al., 2020). According to recent national data, LGBTQ+ youth report significantly greater odds of suicide risk than heterosexual cisgender youth, including persistent feelings of sadness or hopelessness and past‐year suicidal ideation, suicide attempt, and medical treatment as a result of suicidal behavior (Johns et al., 2020), with transgender youth showing four times greater odds of past‐year suicide attempt than their cisgender peers (Centers for Disease Control and Prevention [CDC], 2024; Johns, Lowry, et al., 2019).

Mental health disparities between LGBTQ+ and cisgender, heterosexual adolescents arise from social factors rooted in stigma, such as discrimination, harassment, and victimization related to their minoritized sexual and/or gender identity (Brooks, 1981; Goldbach et al., 2017; Meyer, 2003). Per minority stress theory, identity‐based environmental stressors contribute to felt stress for LGBTQ+ individuals (Hatzenbuehler & Pachankis, 2016; Hendricks & Testa, 2012; Meyer, 2003), increasing the risk for poor mental health and maladaptive coping strategies, such as substance use. LGBTQ+ experiences of minority stress can also arise from structural stigma, such as policies or social attitudes that limit rights or resources (Hatzenbuehler, 2016).

State policy is a uniquely malleable component of structural stigma. A growing body of research now demonstrates that state‐level policies are associated with state‐level variability in LGBTQ+ youth mental health. For example, one study found a 14% decline in the proportion of sexual minority youth who reported past year suicide attempts in states that instituted same‐sex marriage laws (Raifman et al., 2017). Other studies reported that transgender adolescents in states with explicit transgender guidance in their anti‐discrimination laws were less likely to report depressive symptoms compared to transgender youth in states without such guidance (Miller‐Jacobs et al., 2023) and that LGBTQ+ youth in states with LGBTQ+‐specific anti‐bullying policies reported less bullying (Hatzenbuehler et al., 2015). Despite increased scientific examination of the relationship between state‐level policies and LGBTQ+ youth mental health, there remains limited research exploring the mechanisms through which policies operate. Such understanding could improve policy implementation and enforcement to help maximize the positive benefits for LGBTQ+ youth's health and well‐being.

LGBTQ+ school climate, bias‐based bullying, and peer victimization

Studies that assess associations between state policies, particularly those specific to schools (e.g., enumerated anti‐bullying laws), and LGBTQ+ youth mental health are often predicated on the idea that these policies improve school experiences for LGBTQ+ youth. School settings are important contexts for adolescent mental health outcomes, given that youth spend significant time at school (Day et al., 2020; Johns, Poteat, et al., 2019). For LGBTQ+ youth, schools can provide important social support and affirmation by instituting inclusive policies, curricula, and programs, which may have a positive influence on youth development and mental health (Day et al., 2018, 2020; Kosciw et al., 2022; Poteat et al., 2020; Watson et al., 2019). However, school grounds are also prominent settings in which LGBTQ+ youth experience stigma and harassment, particularly from peers (CDC, 2024; Miller‐Jacobs et al., 2023).

School climate is a multifaced construct that broadly reflects a pattern of student experiences shaped by the quality and character of school life and reflects norms, goals, values, interpersonal relationships, teaching and learning practices, and organizational structures (National School Climate Council, 2007). It is also well‐understood that the school's sustained support for student social, emotional, and physical safety is necessary to enhance youth learning and development (National School Climate Council, 2007; Thapa et al., 2012). Several prominent and interrelated factors influence LGBTQ+ youth's perceptions of school climate, such as LGBTQ+ inclusion and strategies, school safety, and experiences with peer harassment. It is established in the literature that school‐level programs and strategies contribute to the safety and well‐being of LGBTQ+ students (Bishop et al., 2023; Ioverno & Russell, 2021; Russell et al., 2021). For example, the presence of LGBTQ+‐affirming student‐led clubs such as gender sexuality alliances (GSAs) is associated with lower rates of peer victimization and more perceived safety within schools, which reduce negative health outcomes for LGBTQ+ youth (Day et al., 2020; Ioverno et al., 2016; Poteat et al., 2020, 2021, 2024; Saewyc et al., 2014). Implementing LGBTQ+‐inclusive curricula is another factor associated with fewer reports of adverse mental health outcomes (e.g., sadness, depression), less bias‐based bullying, more positive perceptions of school safety (Ioverno, 2023; Proulx et al., 2019), and improved academic achievement and connection with peers (Snapp et al., 2015).

Unfortunately, LGBTQ+ adolescents report high rates of peer victimization, school bullying, and less school safety related to their sexual orientation and gender identity (SOGI; CDC, 2024; Kann, 2018; Kosciw et al., 2022), particularly when compared to heterosexual (Birkett et al., 2009; Toomey & Russell, 2016) and cisgender peers (Day et al., 2018; Reisner et al., 2015). Experiences of peer bullying and victimization, particularly those related to identity (e.g., bias‐based bullying) have profound effects on LGBTQ+ students mental health, increasing risk for depressive symptoms and suicidal ideation and attempt (Gower et al., 2022; O'Malley et al., 2022; Ybarra et al., 2015). Gender diverse youth experience additional stress related to safety, reporting avoidance of bathrooms, and other sex‐segregated spaces to reduce peer victimization (Kosciw et al., 2022; Price‐Feeney et al., 2021; Wernick et al., 2017).

State and national policies that address LGBTQ+ inclusive school strategies play a crucial role in safeguarding the mental health of LGBTQ+ youth, and studies from around the world support the role of protective policies in enhancing school climate (Bryan, 2019; Ioverno, 2023; Prentis, 2023) and mitigating school bullying and peer victimization for LGBTQ+ adolescents (Domínguez‐Martínez and Robles, 2019; Hall, 2017; Ioverno, 2023). Although several school‐based strategies (e.g., GSA's, inclusive curriculum, anti‐bullying policies) offer important contributions to inclusive school climates (Day et al., 2020; Kosciw et al., 2022; Russell et al., 2021; Snapp et al., 2015) and LGBTQ+ youth mental health, the extent to which these factors help to explain associations between state‐level policy and LGBTQ+ youth mental health remains unclear.

The current study

Based on the current literature, we identify three major opportunities to advance understanding of the association between state policy and LGBTQ+ health. First, current studies that examine the association between policy and LGBTQ+ youth mental health often measure policy as a function of the broader structural stigma by using composite indicators of policy and other state‐level factors (Hatzenbuehler, 2017; Hatzenbuehler et al., 2014). Although critically important, these approaches limit opportunities to assess the unique function of policy independent of other social influences (e.g., attitudes, the density of same‐sex‐headed households). Second, several studies in this area examine LGBTQ+ youth mental health outcomes in association with adult‐focused policies or policy indices (e.g., marriage equality, adoption laws, employment discrimination; Fish et al., 2024; Hatzenbuehler et al., 2009, 2010; Ramos et al., 2023) and not policies more immediately relevant to youth and the school context (e.g., enumerated anti‐bullying policies; c.f., Hatzenbuehler, 2017; Hatzenbuehler et al., 2015; Watson et al., 2021). Third, studies rarely assess the specific mechanisms through which these policies improve youth mental health (Fish et al., 2024; Hatzenbuehler, 2017), the findings of which could help enhance evidence‐based recommendations for policy implementation and enforcement.

We address these limitations in the current study by testing the association between LGBTQ+ youth‐specific state policies and LGBTQ+ youth mental health symptomology and whether and to what degree this association is explained by youth reports of LGBTQ+ inclusive school strategies, perceptions of safety, and experiences of school bias‐based bullying and peer victimization. We hypothesize that there will be a significant direct association between LGBTQ+ youth‐specific state policies and LGBTQ+ youth mental health symptomology. Further, we anticipate that there will be a significant indirect effect between policy and LGBTQ+ youth mental health via student reports of LGBTQ+ inclusive school strategies, perceptions of safety, reports of school bias‐based bullying, and peer victimization. Specifically, the protective LGBTQ+ state policies will positively associate with youths' perceptions of LGBTQ+ inclusive school strategies and perceptions of safety and are inversely related to bias‐based bullying and peer victimization. In turn, we expect that perception of LGBTQ+ inclusive school strategies and perceptions of safety will be inversely related to LGBTQ+ youth's mental health symptomology and that school bias‐based bullying and peer victimization will be positively associated with LGBTQ+ youth mental health symptomology.

METHODS

Data sources

Data are from two independent sources: the LGBTQ National Teen Survey collected in 2022 and the Movement Advancement Project. The LGBTQ National Teen Survey (N = 17,578) is a national cross‐sectional survey aimed at understanding the experiences of contemporary LGBTQ+ youth in their family settings, schools, peer groups, and communities. The survey was conducted in 2022 and assessed a variety of mental, emotional, and physical health outcomes, social and familial support and experiences, and aspects of daily living for LGBTQ+ young people (Watson et al., 2023). Eligible respondents were youth 13–18 years old, residents of the United States at the time of the survey, and self‐identified as LGBTQ+. Participants were recruited through social media (e.g., Facebook, Instagram) advertisements, community partners, and in‐person and online advertisements at high school GSAs, LGBTQ+ centers, and youth pride events. A waiver of parental consent was granted, given the sensitive nature of questions related to youth SOGI (Watson et al., 2023). Cisgender heterosexual youth did not fit the survey criteria and were therefore excluded from participating through an eligibility screening process.

We merged data from the LGBTQ National Teen Survey with a second data source compiled by the Movement Advancement Project (MAP; “Movement Advancement Project,” n.d.‐b). MAP is an independent, nonprofit website that provides research and communication on advancements of LGBTQ+‐focused laws across states and territories in the United States. MAP has been used to provide valuable insights into the presence of state policies and policy changes over time, as well as to document the association between LGBTQ+ policy and health‐related outcomes for LGBTQ+ individuals (Chien et al., 2022; Watson et al., 2021).

Participants

The present study consists of an analytic sample of 8368 LGBTQ+ youth ages 13–18 (M = 15.9 years, SD = 1.45) from the LGBTQ National Teen Survey collected in 2022. Our sample was restricted to youth with valid state and mental health symptomology data. Demographic characteristics of the analytic sample can be found in Table 1 (Table S1 provides tests of demographic differences between the analytic sample and those excluded. Table S2 presents participant distribution by state).

TABLE 1.

Demographic characteristics of study sample (n = 8368).

Variable (n) (%)
Age M(SD) 15.93 (1.45)
Race
White 6114 73.29
Asian 365 4.38
Black/African American 451 5.41
Multiracial 827 9.91
Another race not listed 585 7.01
Hispanic/Latinx
No 6930 83.00
Yes 1419 17.00
Gender Modality
Cisgender 2592 31.06
Gender Minority 5752 68.94
Sexual Orientation
Gay or lesbian 2421 28.93
Bisexual 2332 27.87
Queer/Questioning 1170 13.98
Pansexual 1204 14.39
Something else 1241 14.83
Caregiver Education
High school/GED or less 1162 14.19
Vocational/technical/some college 1258 16.14
College graduate 2980 38.24
Graduate degree or higher 2393 30.71
LGBTQ+ Inclusive State Policies
0 806 9.63
1 2293 27.40
2 1259 15.05
3 4010 47.92
Open in a new tab

Note: LGBTQ+ state policy data were derived from data compiled by the Movement Advancement Project for 2020 (Movement Advancement Project, n.d.‐a, n.d.‐c).

Measures

State LGBTQ+ policies

The measure of state LGBTQ+ policies was derived from the MAP policy index (“Movement Advancement Project,” n.d.‐a; “Movement Advancement Project,” n.d.‐c). MAP data from 2020 were utilized to account for the time needed for policies to be enforced, visible, and (potentially) influential on school strategies and school experiences when survey data were collected in 2022. The three items included in our youth‐focused state LGBTQ+ policy index were “anti‐bullying laws,” which prohibit discrimination and bullying in schools on basis of perceived or actual SOGI; “nondiscrimination laws,” which protect LGBTQ+ students from discrimination in school, such as being unfairly denied access to facilities (e.g., bathrooms, locker rooms), sports teams, or clubs based on SOGI; and “anti‐LGBTQ laws,” which include policies that prohibit classroom discussion of LGBTQ+ topics and/or policies that prevent schools from adding protections for LGBTQ+ students. Items were coded as the presence (1) or absence (0) of the policy, with anti‐LGBTQ+ laws reverse scored, where the absence was coded as (1) and presence as (0). When summed, scores ranged between 0 and 3, with a higher score indicating greater state legal protections for LGBTQ+ youth in schools.

Mental health symptomology

Mental health symptomology was assessed with the PHQ‐4, a brief validated scale of depression and anxiety symptomology (Kroenke et al., 2009). Youth were asked to report their experience being bothered by the following problems in the previous 2 weeks: “Feeling nervous, anxious, or on edge,” “Not being able to stop or control worrying,” “Feeling down, depressed, or hopeless,” “Little interest or pleasure in doing things.” These items were assessed on a scale from “not at all” (0) to “nearly every day” (3). Items were summed to an aggregate score of depression and anxiety symptomology (Cronbach's α = .84).

LGBTQ+ inclusive school strategies

Participants indicated the presence of three key individual school strategies: (1) LGBTQ+ school clubs (i.e., a GSA), (2) LGBTQ+ inclusive sex education, and (3) LGBTQ+ inclusive history. For GSAs, youth were asked, “Does your school have a Gay/Straight Alliance, Gender/Sexuality Alliance Group, or similar club?” with three response options “yes” (1), “no” (0), and “I don't know.” “I don't know” was recoded to “no” (0) under the assumption that students unsure of these organizations' existence in their school reflect a lack of visible presence or impact on their mental health. Youth reported whether their school offered sexuality education and if it was “LGBTQ+ inclusive” (1), “not LGBTQ+ inclusive” (0), or “no,” as in did not offer any sex education, which was recoded to reflect an absence of inclusive sex education (0). Participants also indicated if their history classes ever had a lesson, unit, or chapter on LGBTQ+ history, with response options “yes” (1), “no” (0), or “I don't know,” (recoded to 0).

School safety

School safety was assessed with nine items related to youth's perceptions of safety within various school contexts. Youth were asked, “While at school, how often do you feel safe,” in the following school areas: classroom, bathroom, locker room, hallways and stairwells, library, cafeteria, outside on school grounds, getting to and from school, and on the school bus. Response options included “never” (1) to “always” (5), and “not applicable” was set to missing. The mean score of the nine safety items was used to assess the perception of school safety, where higher scores reflect greater safety (Cronbach's α = .90).

School bias‐based bullying

Youth were asked “in the past 12 months, how often have you been teased, bullied, or treated badly by other students at your school because of your: (a) gender and (b) sexual identity.” Response options included “never” (1) to “very often” (5). A mean scale score was computed, where higher scores indicate more bias‐based bullying (Cronbach's α = .74).

Peer victimization

The University of Illinois Victimization Scale (Espelage & Holt, 2001) was used to measure peer victimization, and included 4 items measuring past 30 days experiences of in‐person peer victimization such as “other students called me names,” “other students made fun of me,” “other students picked on me,” and “I got hit and pushed by other students.” Response options ranged from “never” (1) to “7 or more times” (5). Items were averaged to create a mean scale score of peer victimization, where higher scores indicated more frequent peer victimization (Cronbach's α = .88).

Covariates

Covariates were selected based on prior research that documents associations between specific sociodemographic factors and endogenous variables of mental health, school climate, bias‐based bullying, and victimization (Berkowitz et al., 2017; Ioverno & Russell, 2022; Johns, Poteat, et al., 2019; Watson et al., 2023). Models were adjusted for race (White [ref], Asian), Black/African American, Multiracial, and “another race not listed” (i.e., Native Hawaiian/Pacific Islander, American Indian/Alaska Native, or another race not listed) and ethnicity (non‐Latinx [ref], Latinx). Parental education was assessed with the question, “Across all of your caregivers, please indicate the highest level of education that any of your caregivers completed” (diploma/GED/or less than high school [ref], some college/vocational/technical school (2 years), college graduate, postgraduate degree or higher). Models were also adjusted for sexual orientation (gay/lesbian [ref], bisexual, queer/questioning, pansexual, and something else [i.e., straight/heterosexual, asexual, or something not listed]) and gender modality (cisgender [ref] and gender minority).

Analytic strategy

We used Stata 17.0 SE (StataCorp, 2021) for data management and descriptive (Table 1) and bivariate analyses (e.g., Pearson's correlation; see Table 2). Preliminary data analysis showed that the intraclass correlation coefficient (ICC = .005) did not warrant multi‐level modeling. We then ran a series of regression‐based path analyses using Mplus 8 (Muthén & Muthén, 2017) to estimate and test direct and indirect associations between youth‐focused state‐level LGBTQ+ policies and mental health symptomology. First, we assessed the association between state policy and mental health symptomology of LGBTQ+ youth without adjusting for covariates. Second, we tested these relations adjusted for covariates. Third, we added LGBTQ+ inclusive school strategies, school safety, school bias‐based bullying, and peer victimization to the model, testing for direct and indirect effects using bootstrapping with 1000 draws (see Table 3; Figure 1). We also tested whether and to what degree these associations and pathways differed for youth based on race, ethnicity, gender modality (i.e., cisgender and gender minority), and gender identity (i.e., cisgender, transgender girl, transgender boy, gender fluid, and questioning). We accounted for missing data using full information maximum likelihood estimation techniques.

TABLE 2.

Correlations, means, range, and standard deviations for main study variables.

Variable 1 2 3 4 5 6
1. Mental Health Symptomology –
2. LGBTQ+ Inclusive State Policies −.01 –
3. LGBTQ+ Inclusive School Strategies −.12*** .28*** –
4. School Safety −.36*** .07*** .20*** –
5. School Bias‐Based Bullying .28*** −.08*** −.16*** −.48*** –
6. Peer Victimization .24*** −.06*** −.15*** −.41*** .60*** –
Range 0–3 0–3 0–3 1–5 1–5 1–5
M 1.62 2.01 1.08 3.72 2.02 1.63
SD 0.85 1.07 0.79 0.80 1.08 0.88
N 8368 8368 7075 7496 8326 8309
Open in a new tab

Abbreviations: M, mean; N, total sample; SD, standard deviation.

*p < .05.

**p < .01.

***p < .001.

TABLE 3.

Test of indirect effects from LGBTQ+ state policies and mental health symptomology.

β SE p‐value
LGBTQ+ Inclusive State Policies → LGBTQ+ Inclusive School Strategies → Mental Health Symptomology −.01 .00 <.001
LGBTQ+ Inclusive State Policies → School Safety → Mental Health Symptomology −.01 .00 <.001
LGBTQ+ Inclusive State Policies → School Bias‐Based Bullying → Mental Health Symptomology −.01 .00 <.001
LGBTQ+ Inclusive State Policies → Peer Victimization → Mental Health Symptomology <−.01 .00 <.001
Total indirect effects −.03 .01 <.001
Total effects −.01 .01 .638
Open in a new tab

Note: Estimates and 95% confidence intervals are bootstrapped with 1000 draws. Coefficients are standardized beta coefficients.

FIGURE 1.

FIGURE 1

Open in a new tab

Path analysis model from LGBTQ+ state policies to mental health symptomology. Note: Model estimates adjusted for covariates on all endogenous variables. Coefficients are standardized beta coefficients. Outcomes are shown on the arrows. * p < .05, ** p < .01, *** p < .001.

RESULTS

Table 2 reports univariate and bivariate descriptive statistics of our study sample. The average state policy score for the sample was moderately high (M = 2.01, SD = 1.07). On average, participants reported low presence of LGBTQ+ inclusive school strategies (M = 1.08, SD = .78). Youth in the study reported moderately high experiences of school safety (M = 3.72, SD = .80), moderate levels of school bias‐based bullying (M = 2.02, SD = 1.07), and peer victimization (M = 1.63, SD = .87). Mental health symptomology in the sample was relatively low (M = 1.62, SD = 0.85). All correlations were observed in the predicted directions. Although there was no significant correlation between LGBTQ+ youth mental health symptomology and LGBTQ+ state policy, there were statistically significant inverse correlations between mental health symptomology and LGBTQ+ inclusive school strategies (r = −.12, p < .001), as well as school safety (r = −.36, p < .001), indicating that greater mental health symptomology was associated with fewer reports of LGBTQ+ inclusive school strategies and less perceived school safety. We also observed that mental health symptomology was positively correlated with school bias‐based bullying (r = .28, p < .001) and peer victimization (r = .24, p < .001).

Associations between state LGBTQ+ policy and mental health symptomology

Results from unadjusted path analyses show a nonsignificant direct association between LGBTQ+ youth state policies and mental health symptomology (see Table S3). Figure 1 shows path estimates in our adjusted model, from LGBTQ+ state policy to youth mental health symptomology via LGBTQ+ inclusive school strategies, school safety, school bias‐based bullying, and peer victimization. Consistent with our hypotheses, we observed that LGBTQ+ state policies were significantly and positively associated with youth's report of LGBTQ+ inclusive school strategies and perception school safety (β = .27, p < .001; β = .05, p < .001, respectively), and inversely related to youth's reports of school bias‐based bullying and peer victimization (β = −.06, p < .001; β = −.04, p < .001, respectively). We also observed that LGBTQ+ school strategies and school safety were significantly inversely associated with youth mental health symptomology (β = −.05, p < .001; β = −.26, p < .001, respectively), whereas higher reports of bias‐based bullying and peer victimization were significantly associated with greater mental health symptomology (β = .09, p < .001; β = .08, p < .001, respectively).

As anticipated, we observed significant indirect effects between LGBTQ+ state policy and youth mental health symptomology via LGBTQ+ inclusive school strategies, school safety, school bias‐based bullying, and peer victimization (see Table 3). We also observed that the direct effect of LGBTQ+ state policy on youth mental health symptomology was significant (β = .03, p = .005) in the presence of the indirect effect pathways.

Finally, we conducted a series of robustness checks and post hoc analyses. First, we reran our models using MAP policy data from 2022 (instead of 2020) to assess if issues of temporality might influence our results; results were fully equivalent (results available on request). Second, we ran models where mediating variables were correlated and uncorrelated and found that the results were substantively unchanged. Lastly, we ran multigroup models to examine potential differences in these associations by race (W = 38.13, df(32), p = .210), ethnicity (W = 11.86, df(9), p = .221), gender modality (W = 16.08, df(9), p = .065), and gender identity (W = 42.91, df(32), p = .094). There were no significant differences across models.

DISCUSSION

The present study expands understandings of how LGBTQ+ youth‐focused state policies are related to school programs and practices, and mental health symptomology of LGBTQ+ youth. Findings indicate that LGBTQ+ youth who live in states with more protective LGBTQ+ policies (e.g., nondiscrimination, anti‐bullying) reported more LGBTQ+ inclusive school strategies, greater school safety, and fewer instances of school bias‐based bullying and peer victimization. In turn, these perceptions of the school environment were related to LGBTQ+ youth's mental health symptomology, suggesting that these state policies operate through youth's everyday contexts to influence mental health. Our findings are consistent with previous research highlighting how structural factors, such as policies, are associated with LGBTQ+ youth mental health symptomology (Hatzenbuehler, 2017; Miller‐Jacobs et al., 2023) and add additional nuance by demonstrating how these distal, contextual factors play out in youths' more proximal environment.

In particular, our study addressed three underdeveloped areas in the state policy and LGBTQ+ youth health literature. First, we demonstrated the importance of focusing on policy, independent of other structural stigma and state‐climate factors. A focus on state policy is particularly salient at the current sociopolitical moment, given the rise in anti‐LGBTQ+ state policies (ACLU, 2024; Haas & Lannutti, 2023). Consistent with prior studies, our findings support the need for LGBTQ+ protective state policies to ensure protective school‐based strategies and supports (e.g., GSA's, inclusive curriculum, anti‐bullying policies). In turn, states that implement anti‐LGBTQ+ policies stifle opportunities to provide and maintain the exact protective school‐based mechanisms that support positive mental health outcomes for LGBTQ+ adolescents. In the absence of school‐based support, there is a critical need for more community‐based services for LGBTQ+ youth, particularly in states that have either abolished LGBTQ+ policy protections or enacted anti‐LGBTQ+ legislation. This includes access to LGBTQ+ affirmative mental health services and LGBTQ+ youth drop‐in centers to provide alternative avenues for LGBTQ+ youth to connect with peers and mentors, feel affirmed, and support positive development and mental health (Fish et al., 2019).

Second, many studies that assess the association between state policy and LGBTQ+ youth health use measures comprised of adult‐focused policy, which often enhance rights and protections in institutions and contexts more relevant to adults (e.g., marriage, housing, work; Fish et al., 2024). In contrast, in the current study, we examined policies specific to LGBTQ+ youth and the school context (e.g., inclusive curriculum, nondiscrimination, and anti‐LGBTQ+ policies). By focusing on the relationship between policy and LGBTQ+ mental health symptomology in youth‐specific contexts, we can better understand how these policies designed to protect youth may be relevant to and provide benefits for LGBTQ+ youth mental health. There may be other state policies that have direct and indirect effects on LGBTQ+ adolescent health, including employment protections for LGBTQ+ educators or state training mandates for educators, which may increase opportunities for LGBTQ+ students to feel safe and affirmed in the school context (GLSEN, 2020; Wright & Smith, 2015). Less well‐understood, and an area for future research, is the degree to which a specific constellation of LGBTQ‐related policies may be most effective in shaping LGBTQ+ youth's mental health and through what mechanisms.

Third, and perhaps our most novel contribution, was our interest in examining the more proximal factors that facilitate the association between LGBTQ+ youth state policies and LGBTQ+ mental health. Our results supported our hypothesis that state policies were related to mental health symptomology through perceptions of LGBTQ+ inclusive school strategies, school safety, school bias‐based bullying, and peer victimization, suggesting that state‐level policy likely influences school culture, social norms, policies, and programs that more readily show up in the everyday lives of LGBTQ+ adolescents. This emphasizes the importance of implementing policies that lead to tangible changes in youth's everyday environment—that enacting state policies is not a means to an end but must be accompanied by strategic implementation and enforcement so that these policies create change in school strategies and climate. For example, Ioverno et al. (2022) found that in a state with protective LGBTQ+ policies, students in schools that implemented sexual orientation and gender identity‐based training for educators reported more positive school climates and less peer victimization a decade later, particularly for LGBTQ+ students. It is crucial to consider how policy implementation plans consider these more downstream influences and equip educators and other school personnel with the appropriate training to enforce inclusive policies and deliver inclusive curricula. Integrating robust training programs for school personnel in tandem with implementing inclusive policies and programs could ensure that supportive policies operate as intended and strengthen the impact of policy on LGBTQ+ youth's mental health. The implementation of LGBTQ+ youth‐focused policy and the mechanisms through which policies operate is an area ripe for future investigation and has the potential to strengthen the positive consequences of state policies for LGBTQ+ youth development and health.

Notably, tests of indirect effects provide compelling evidence for the multifaceted influence of these policies. We observed that LGBTQ+ inclusive school strategies, perceptions of school safety, school bias‐based bullying, and peer victimization were each independent significant indirect pathways between LGBTQ+ state‐level policy and LGBTQ+ mental health symptomology. This suggests the importance of considering how state policy can mitigate harmful experiences (i.e., peer victimization, bias‐based bullying; see also Hatzenbuehler et al., 2015) and enhance affirmative school climate (e.g., GSA's and LGBTQ+ inclusive curricula; Harper et al., 2022; Ioverno, 2023)—all of which were implicated in LGBTQ+ mental health. We acknowledge that our indirect effects were generally weak, but this can occur when the signs of the direct and indirect effects are opposite (Fairchild & McDaniel, 2017). We also observed that school safety had the strongest effect on youth mental health, suggesting the importance of enhancing school climate and inclusion in ways that ensure LGBTQ+ youth feel safe. These findings underscore the importance of policy implementation for increasing the positive impact of state policies for LGBTQ+ mental health.

We also want to briefly draw attention to the direct effect between LGBTQ+ state policy and youth mental health. Although not significant in our unconditional model, including our indirect effects led to a significant and unexpectedly positive association between state policy and greater mental health symptomology. Given the absence of this relation in the unadjusted direct effects model, we may be observing a suppression effect (Pandey & Elliott, 2010), where there are other mechanisms not accounted for in the model that may explain why protective state policies are associated with mental health symptomology in LGBTQ+ youth. One example may be that LGBTQ+ youth are more visible in states with more protective policies and, therefore, may be exposed to more instances of stigma, including outside the school context (e.g., family, faith communities), resulting in greater mental health symptomology. This pattern is established in the literature (see Russell et al., 2014). There is an amalgam of experiences influencing LGBTQ+ youth mental health across contexts, and there are likely other critical mediating factors that help to explain the links between protective state policy and youth mental health symptomology that are worth exploring. More research is needed, particularly with longitudinal data, to understand these associations fully.

Limitations and future directions

In addition to our contributions, the current study includes several limitations that inform our recommendations for future research. First, although we found no statistical differences in our models by race and ethnicity, this could be an artifact of power. Investigations into the association between LGBTQ+ state policy and LGBTQ+ youth health must consider the degree to which these protections may be more salient for socially advantaged youth based on sex/gender, race, ethnicity, class, and disability, among others. This is a meaningful direction given that schools can be particularly difficult environments for LGBTQ+ youth of color and/or gender minoritized youth who experience peer victimization and discrimination based on SOGI and race/ethnicity (Russell et al., 2014; Truong et al., 2020; Zongrone et al., 2022). Intersectional perspectives and methods would help strengthen understanding of how youth mental health may be differentially shaped by state policies and related school experiences. Prioritizing who and under what conditions youth are more likely to benefit from LGBTQ+ state policy protections is an important area of future research. Second, although we operationalized our policy variable to include policies two years prior to data collection, the use of cross‐sectional data limits our ability to establish causality and track differences in perceptions of school climate and school safety over time. Longitudinal data and natural experimental designs will help advance understanding of how changes in LGBTQ+ state policy influence school experiences and youth mental health symptomology over time.

Third, in our assessments of school‐based factors implicated in the associations between policy and youth mental health, we could not assess variation in state policy implementation influences on school culture and programs and the timing of these factors. We were also limited in our ability to examine within‐state variation in the implementation of the policy, as county‐ and district‐level adherence to these policies likely influences school culture, climate, programs, and safety. Future work focused on these more local factors will yield important insights into within‐in state factors that alter the implementation and enforcement of state‐level policy. Lastly, our measures of state policies, LGBTQ+ inclusive school strategies, and mental health symptomology are more centered on youth's experiences in upper middle school and high school; however, disparities in peer victimization and mental health are present by age 10 (Fish et al., 2023). There would be benefits to understanding how state‐level policies are related to school experiences and mental health for younger age groups and inform strategically timed efforts to prevent the onset of poor mental health for LGBTQ+ youth.

IMPLICATIONS AND CONCLUSION

This study documents associations between state‐level LGBTQ+ youth‐focused policies, various social‐ecological experiences of school contexts, and mental health symptomology among LGBTQ+ adolescents. Findings emphasize the need for LGBTQ+ protective policies and the strategic implementation of these policies to mitigate bias‐based bullying and peer victimization and increase school climate and safety for LGBTQ+ youth. Unfortunately, many states are moving in a different direction, enacting policies that restrict the rights and visibility of LGBTQ+ youth in schools. The volatility of the current state policy context demands federal action, particularly when armed with the knowledge that these policies effectively reduce school bullying (Hatzenbuehler et al., 2015; see our findings) and are related to better mental health for LGBTQ+ (and all) youth (Miller‐Jacobs et al., 2023). Establishing and enforcing federal protections that explicitly prohibit discrimination based on sexual orientation and gender identity in all public educational settings will contribute to more equitable learning and social conditions for LGBTQ+ young people.

In the absence of federal action, our findings inform several practical recommendations for schools. For example, we recommend mandatory and on‐going professional development and training for all school staff on LGBTQ+ issues to enhance the effectiveness of policy and programmatic changes that contribute to more supportive and equitable school climates. Moreover, it is critical that schools offer robust support services that are specific to the needs of LGBTQ+ students, including properly trained school counselors, comprehensive mental health services, and appropriate referrals to LGBTQ+ affirmative health services and community resources. Lastly, schools, families, and communities must collaborate to reform the educational climate for LGBTQ+ students. We recommend that school's partner with local LGBTQ+ organizations and develop school‐run initiatives that engage families and community members around issues of LGBTQ+ equity through local LGBTQ+ community events and informational workshops.

The current study and its implications are timely in light of the current political landscape directed at removing LGBTQ+ inclusive education and other school supports for primary and secondary students (ACLU, 2024). Our findings emphasize the importance of protective LGBTQ+ state policies to help combat sexual orientation and gender identity disparities in poor mental health for LGBTQ+ youth and the potential for these policies to increase opportunities for thriving for these youth in one of their most important contexts. These opportunities for safety and support in early adolescence are critical in our effort to help improve LGBTQ+ youth's chances for positive development, health, and well‐being across the life course.

FUNDING INFORMATION

This research was supported by F32AA030194, awarded to Bishop by the National Institute on Alcohol Abuse and Alcoholism. Fish received support from the University of Maryland Prevention Research Center cooperative agreement U48DP006382 from the Centers for Disease Control and Prevention (CDC). Fish, Moran, and Bishop acknowledge support from P2CHD041041, awarded to the Maryland Population Research Center by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Watson acknowledges support from the National Institute of Drug Abuse, grant K01DA047918, and National Institute of Minority Health Disparities grant R01MD015722‐S1.

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interest to disclose.

PATIENT CONSENT STATEMENT

A waiver of parental consent was granted by the study IRB due to the sensitive nature of questions related to youth sexual orientation and gender identity.

Supporting information

Tables S1–S3.

JORA-35-0-s001.docx (46.5KB, docx)

ACKNOWLEDGMENTS

The authors thank the youth participants in the 2022 LGBTQ+ National Teen Survey.

Moran, S. A. , Bishop, M. D. , Watson, R. J. , & Fish, J. N. (2025). LGBTQ+ youth policy and mental health: Indirect effects through school experiences. Journal of Research on Adolescence, 35, e13052. 10.1111/jora.13052

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

REFERENCES

  1. ACLU . (2024). Mapping attacks on LGBTQ rights in U.S. State legislatures [webpage]. ACLU. Retrieved on October 1, 2024, from: https://www.aclu.org/legislative‐attacks‐on‐lgbtq‐rights‐2024 [Google Scholar]
  2. Berkowitz, R. , Moore, H. , Astor, R. A. , & Benbenishty, R. (2017). A research synthesis of the associations between socioeconomic background, inequality, school climate, and academic achievement. Review of Educational Research, 87(2), 425–469. 10.3102/0034654316669821 [DOI] [Google Scholar]
  3. Birkett, M. , Espelage, D. L. , & Koenig, B. (2009). LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence, 38(7), 989–1000. 10.1007/s10964-008-9389-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bishop, M. D. , Gonzales, R. A. , & Russell, S. T. (2023). Putting research on LGBTQ+ youth in schools to use: The stories and numbers project. Sociological Forum, 38(2), 978–998. 10.1111/socf.12903 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brooks, V. R. (1981). Minority stress and lesbian women. Lexington Books. https://cir.nii.ac.jp/crid/1130282271372632320 [Google Scholar]
  6. Bryan, A. (2019). A sociological critique of youth strategies and educational policies that address LGBTQ youth issues. International Journal of Bullying Prevention, 1(4), 255–268. 10.1007/s42380-019-00047-1 [DOI] [Google Scholar]
  7. Centers for Disease Control and Prevention . (2024). Youth Risk Behavior Survey data summary & trends report: 2013–2023. U. S. Department of Health and Human Services. Retrieved on October 1, 2024, from https://www.cdc.gov/yrbs/dstr/index.html
  8. Chien, Y.‐S. , Schwartz, G. , Huang, L. , & Kawachi, I. (2022). State LGBTQ policies and binge drinking among sexual minority youth in the US: A multilevel analysis. Social Psychiatry and Psychiatric Epidemiology, 57(1), 183–194. 10.1007/s00127-021-02119-4 [DOI] [PubMed] [Google Scholar]
  9. Conron, K. J. (2020). LGBT youth population in the United States. The Williams Institute, UCLA. https://williamsinstitute.law.ucla.edu/wp‐content/uploads/LGBT‐Youth‐US‐Pop‐Sep‐2020.pdf [Google Scholar]
  10. Day, J. K. , Fish, J. N. , Grossman, A. H. , & Russell, S. T. (2020). Gay‐straight alliances, inclusive policy, and school climate: LGBTQ youths' experiences of social support and bullying. Journal of Research on Adolescence: The Official Journal of the Society for Research on Adolescence, 30 Suppl 2, 418–430. 10.1111/jora.12487 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Day, J. K. , Perez‐Brumer, A. , & Russell, S. T. (2018). Safe schools? Transgender youth's school experiences and perceptions of school climate. Journal of Youth and Adolescence, 47(8), 1731–1742. 10.1007/s10964-018-0866-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Domínguez‐Martínez, T. , & Robles, R. (2019). Preventing transphobic bullying and promoting inclusive educational environments: Literature review and implementing recommendations. Archives of Medical Research, 50(8), 543–555. [DOI] [PubMed] [Google Scholar]
  13. Espelage, D. L. , & Holt, M. K. (2001). Bullying and victimization during early adolescence: Peer influences and psychosocial correlates. Journal of Emotional Abuse, 2(2–3), 123–142. 10.1300/J135v02n02_08 [DOI] [Google Scholar]
  14. Fairchild, A. J. , & McDaniel, H. L. (2017). Best (but oft‐forgotten) practices: Mediation analysis. The American Journal of Clinical Nutrition, 105(6), 1259–1271. 10.3945/ajcn.117.152546 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Fish, J. N. , Bishop, M. D. , & Russell, S. T. (2023). Age trends in bias‐based bullying and mental health by sexual orientation and gender identity. Prevention Science, 24(6), 1142–1151. 10.1007/s11121-023-01530-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Fish, J. N. , Dunkwu, L. , Tchangalova, N. , & McFarlane, S. (2024). Associations between policy and health for sexual and gender minority youth in the United States: A scoping review. [Manuscript submitted for publication].
  17. Fish, J. N. , Moody, R. L. , Grossman, A. H. , & Russell, S. T. (2019). LGBTQ youth‐serving community‐based organizations: Who participates and what difference does it make? Journal of Youth and Adolescence, 48(12), 2418–2431. 10.1007/s10964-019-01129-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. GLSEN . (2020). Supporting LGBTQ students by protecting LGBTQ teachers. (research brief). GLSEN. [Google Scholar]
  19. Goldbach, J. T. , Schrager, S. M. , & Mamey, M. R. (2017). Criterion and divergent validity of the sexual minority adolescent stress inventory. Frontiers in Psychology, 8, 2057. 10.3389/fpsyg.2017.02057 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Gower, A. L. , Rider, G. , Brown, C. , & Eisenberg, M. E. (2022). Diverse sexual and gender identity, bullying, and depression among adolescents. Pediatrics, 149(4), e2021053000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Green, A. E. , Price, M. N. , & Dorison, S. H. (2022). Cumulative minority stress and suicide risk among LGBTQ youth. American Journal of Community Psychology, 69(1–2), 157–168. 10.1002/ajcp.12553 [DOI] [PubMed] [Google Scholar]
  22. Haas, S. M. , & Lannutti, P. J. (2023). “They are giving folks permission to discriminate and hate”: A 4‐year longitudinal analysis of perceived impact of the trump administration on LGBTQ+ individuals and relationships, 2017–2020. Sexuality Research & Social Policy, 21, 62–75. 10.1007/s13178-023-00843-x [DOI] [Google Scholar]
  23. Hall, W. (2017). The effectiveness of policy interventions for school bullying: A systematic review. Journal of the Society for Social Work and Research, 8(1), 45–69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Harper, C. R. , Johns, M. M. , Orenstein, D. , Pampati, S. , Jones, T. M. , Leonard, S. , Taylor, K. R. , & Robin, L. (2022). Association between LGBTQ student nondiscrimination laws in selected states and school district support for gay‐straight alliances. Journal of Adolescent Health, 70(4), 584–587. 10.1080/00131725.2015.1069514 [DOI] [PubMed] [Google Scholar]
  25. Hatzenbuehler, M. L. (2016). Structural stigma: Research evidence and implications for psychological science. American Psychologist, 71(8), 742–751. 10.1037/amp0000068 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Hatzenbuehler, M. L. (2017). Advancing research on structural stigma and sexual orientation disparities in mental health among youth. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division, 46(3), 463–475. 10.1080/15374416.2016.1247360 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Hatzenbuehler, M. L. , Birkett, M. , van Wagenen, A. , & Meyer, I. H. (2014). Protective school climates and reduced risk for suicide ideation in sexual minority youths. American Journal of Public Health, 104(2), 279–286. 10.2105/AJPH.2013.301508 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Hatzenbuehler, M. L. , Keyes, K. M. , & Hasin, D. S. (2009). State‐level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99(12), 2275–2281. 10.2105/AJPH.2008.153510 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Hatzenbuehler, M. L. , Lattanner, M. R. , McKetta, S. , & Pachankis, J. E. (2024). Structural stigma and LGBTQ+ health: A narrative review of quantitative studies. The Lancet Public Health, 9(2), e109–e127. 10.1016/S2468-2667(23)00312-2 [DOI] [PubMed] [Google Scholar]
  30. Hatzenbuehler, M. L. , McLaughlin, K. A. , Keyes, K. M. , & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health, 100(3), 452–459. 10.2105/AJPH.2009.168815 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Hatzenbuehler, M. L. , & Pachankis, J. E. (2016). Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics of North America, 63(6), 985–997. 10.1016/j.pcl.2016.07.003 [DOI] [PubMed] [Google Scholar]
  32. Hatzenbuehler, M. L. , Schwab‐Reese, L. , Ranapurwala, S. I. , Hertz, M. F. , & Ramirez, M. R. (2015). Associations between antibullying policies and bullying in 25 states. JAMA Pediatrics, 169(10), e152411. 10.1001/jamapediatrics.2015.2411 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Hendricks, M. L. , & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460–467. [Google Scholar]
  34. Ioverno, S. (2023). Inclusive national educational policies as protective factors for LGBTI youth adjustment: An European cross‐national study. Journal of Adolescent Health, 72(6), 845–851. 10.1016/j.jadohealth.2023.01.013 [DOI] [PubMed] [Google Scholar]
  35. Ioverno, S. , Belser, A. B. , Baiocco, R. , Grossman, A. H. , & Russell, S. T. (2016). The protective role of gay–straight alliances for lesbian, gay, bisexual, and questioning students: A prospective analysis. Psychology of Sexual Orientation and Gender Diversity, 3, 397–406. 10.1037/sgd0000193 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Ioverno, S. , Bishop, M. D. , & Russell, S. T. (2022). Does a decade of school administrator support for educator training on students' sexual and gender identity make a difference for students' victimization and perceptions of school climate? Prevention Science: The Official Journal of the Society for Prevention Research, 23(1), 108–118. 10.1007/s11121-021-01276-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Ioverno, S. , & Russell, S. T. (2021). Homophobic bullying in positive and negative school climates: The moderating role of gender sexuality alliances. Journal of Youth and Adolescence, 50(2), 353–366. 10.1007/s10964-020-01297-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Ioverno, S. , & Russell, S. T. (2022). School climate perceptions at the intersection of sex, grade, sexual, and gender identity. Journal of Research on Adolescence, 32(1), 325–336. 10.1111/jora.12607 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Johns, M. M. , Lowry, R. , Andrzejewski, J. , Barrios, L. C. , Demissie, Z. , McManus, T. , Rasberry, C. N. , Robin, L. , & Underwood, J. M. (2019). Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. MMWR. Morbidity and Mortality Weekly Report, 68(3), 67–71. 10.15585/mmwr.mm6803a3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Johns, M. M. , Lowry, R. , Haderxhanaj, L. T. , Rasberry, C. N. , Robin, L. , Scales, L. , Stone, D. , & Suarez, N. A. (2020). Trends in violence victimization and suicide risk by sexual identity among high school students—Youth risk behavior survey, United States, 2015‐2019. MMWR Supplements, 69(1), 19–27. 10.15585/mmwr.su6901a3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Johns, M. M. , Poteat, V. P. , Horn, S. S. , & Kosciw, J. (2019). Strengthening our schools to promote resilience and health among LGBTQ youth: Emerging evidence and research priorities from the state of LGBTQ youth health and wellbeing symposium. LGBT Health, 6(4), 146–155. 10.1089/lgbt.2018.0109 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Kann, L. (2018). Youth risk behavior surveillance‐United States, 2017. MMWR Surveillance Summaries, 67, 1–114. 10.15585/mmwr.ss6708a1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Kosciw, J. G. , Clark, C. M. , & Menard, L. (2022). The 2021 national school climate survey: The experiences of LGBTQ+ youth in our nation's schools. GLSEN. [Google Scholar]
  44. Kroenke, K. , Spitzer, R. L. , Williams, J. B. , & Löwe, B. (2009). An ultra‐brief screening scale for anxiety and depression: The PHQ‐4. Psychosomatics, 50(6), 613–621. 10.1176/appi.psy.50.6.613 [DOI] [PubMed] [Google Scholar]
  45. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. 10.1037/0033-2909.129.5.674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Miller‐Jacobs, C. , Operario, D. , & Hughto, J. M. W. (2023). State‐level policies and health outcomes in U.S. transgender adolescents: Findings from the 2019 youth risk behavior survey. LGBT Health, 10(6), 447–455. 10.1089/lgbt.2022.0247 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Movement Advancement Project . (n.d.‐a). LGBTQ Curricular Laws [Webpage]. Movement Advancement Project. Retrieved January 15, 2024, from https://www.lgbtmap.org/equality‐maps/curricular_laws
  48. Movement Advancement Project . (n.d.‐b). Our Work and Mission [Webpage]. Movement Advancement Project. Retrieved January 10, 2024, from https://www.lgbtmap.org/our‐work‐and‐mission
  49. Movement Advancement Project . (n.d.‐c). Safe Schools Laws [Webpage]. Movement Advancement Project. Retrieved January 15, 2024, from https://www.lgbtmap.org/equality‐maps/safe_school_laws
  50. Muthén, L. K. , & Muthén, B. O. (2017). Mplus: Statistical analysis with latent variables: User's guide (version 8). Muthén & Muthén. [Google Scholar]
  51. National School Climate Council . (2007). The School Climate Challenge: Narrowing the gap between school climate research and school climate policy, practice guidelines and teacher education policy. Retrieved from October 1, 2024, from http://www.schoolclimate.org/climate/documents/policy/, school‐climate‐challenge‐web.pdf
  52. O'Malley, M. D. , Cerna, R. , Romero, L. , Zhang, G. , & Furlong, M. J. (2022). Reducing the impact of bias‐based bullying on suicidal thoughts among sexual and gender minority youth: Are psychological strengths enough? School Mental Health, 14(3), 655–671. [Google Scholar]
  53. Pandey, S. , & Elliott, W. (2010). Suppressor variables in social work research: Ways to identify in multiple regression models. Journal of the Society for Social Work and Research, 1(1), 28–40. 10.5243/jsswr.2010.2 [DOI] [Google Scholar]
  54. Plöderl, M. , & Tremblay, P. (2015). Mental health of sexual minorities. A systematic review. International Review of Psychiatry (Abingdon, England), 27, 1–19. 10.3109/09540261.2015.1083949 [DOI] [PubMed] [Google Scholar]
  55. Poteat, V. P. , Calzo, J. P. , Richburg, A. , Marx, R. A. , & Yoshikawa, H. (2024). How gender‐sexuality alliances cultivate a sense of school belonging from week to week for LGBTQ+ youth. Journal of School Psychology, 105, 101329. 10.1016/j.jsp.2024.101329 [DOI] [PubMed] [Google Scholar]
  56. Poteat, V. P. , Calzo, J. P. , Yoshikawa, H. , Lipkin, A. , Ceccolini, C. J. , Rosenbach, S. B. , O'Brien, M. D. , Marx, R. A. , Murchison, G. R. , & Burson, E. (2020). Greater engagement in gender‐sexuality alliances (GSAs) and GSA characteristics predict youth empowerment and reduced mental health concerns. Child Development, 91(5), 1509–1528. 10.1111/cdev.13345 [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Poteat, V. P. , Fish, J. N. , & Watson, R. J. (2021). Gender‐sexuality alliances as a moderator of the association between victimization, depressive symptoms, and drinking behavior among LGBTQ+ youth. Drug and Alcohol Dependence, 229, 109140. 10.1016/j.drugalcdep.2021.109140 [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Prentis, J. (2023). Policy brief: Polish LGBTQIA+ students at risk: How can schools protect them? Australian and New Zealand Journal of European Studies, 15(3), 77–84. [Google Scholar]
  59. Price‐Feeney, M. , Green, A. E. , & Dorison, S. (2020). Understanding the mental health of transgender and nonbinary youth. Journal of Adolescent Health, 66(6), 684–690. 10.1016/j.jadohealth.2019.11.314 [DOI] [PubMed] [Google Scholar]
  60. Price‐Feeney, M. , Green, A. E. , & Dorison, S. H. (2021). Impact of bathroom discrimination on mental health among transgender and nonbinary youth. Journal of Adolescent Health, 68(6), 1142–1147. 10.1016/j.jadohealth.2020.11.001 [DOI] [PubMed] [Google Scholar]
  61. Proulx, C. N. , Coulter, R. W. S. , Egan, J. E. , Matthews, D. D. , & Mair, C. (2019). Associations of lesbian, gay, bisexual, transgender, and questioning–inclusive sex education with mental health outcomes and school‐based victimization in U.S. high school students. Journal of Adolescent Health, 64(5), 608–614. 10.1016/j.jadohealth.2018.11.012 [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Raifman, J. , Moscoe, E. , Austin, S. B. , & McConnell, M. (2017). Difference‐in‐differences analysis of the association between state same‐sex marriage policies and adolescent suicide attempts. JAMA Pediatrics, 171(4), 350–356. 10.1001/jamapediatrics.2016.4529 [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Ramos, N. , Burgess, A. , & Ollen, E. (2023). The current status of sociopolitical and legal issues faced by lesbian, gay, bisexual, transgender, queer, and questioning youth. Adolescent Psychiatry (Hilversum, Netherlands), 12(3), 180–195. 10.2174/2210676611666211105120645 [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Reisner, S. L. , Greytak, E. A. , Parsons, J. T. , & Ybarra, M. L. (2015). Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity. The Journal of Sex Research, 52(3), 243–256. 10.1080/00224499.2014.886321 [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Russell, S. T. , Bishop, M. D. , Saba, V. C. , James, I. , & Ioverno, S. (2021). Promoting school safety for LGBTQ and all students. Policy Insights From the Behavioral and Brain Sciences, 8(2), 160–166. 10.1177/23727322211031938 [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Russell, S. T. , & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology, 12, 465–487. 10.1146/annurev-clinpsy-021815-093153 [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Russell, S. T. , Toomey, R. B. , Ryan, C. , & Diaz, R. M. (2014). Being out at school: The implications for school victimization and young adult adjustment. American Journal of Orthopsychiatry, 84(6), 635–643. 10.1037/ort0000037 [DOI] [PubMed] [Google Scholar]
  68. Saewyc, E. M. , Konishi, C. , Rose, H. A. , & Homma, Y. (2014). School‐based strategies to reduce suicidal ideation, suicide attempts, and discrimination among sexual minority and heterosexual adolescents in western Canada. International Journal of Child, Youth & Family Studies: IJCYFS, 5(1), 89–112. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Snapp, S. D. , Burdge, H. , Licona, A. C. , Moody, R. L. , & Russell, S. T. (2015). Students' perspectives on LGBTQ‐inclusive curriculum. Equity & Excellence in Education, 48(2), 249–265. 10.1080/10665684.2015.1025614 [DOI] [Google Scholar]
  70. StataCorp . (2021). Stata statistical software: Release 17. StataCorp LLC. [Google Scholar]
  71. Thapa, A. , Cohen, J. , Higgins‐D'Alessandro, A. , & Guffey, S. (2012). School Climate Research Summary: August 2012. School climate brief, number 3. National School Climate Center. [Google Scholar]
  72. Toomey, R. B. , & Russell, S. T. (2016). The role of sexual orientation in school‐based victimization: A meta‐analysis. Youth & Society, 48(2), 176–201. 10.1177/0044118X13483778 [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Truong, N. L. , Zongrone, A. D. , & Kosciw, J. G. (2020). Erasure and resilience: The experiences of LGBTQ students of color. Black LGBTQ youth in U.S. schools. Gay, lesbian and straight education network (GLSEN). https://eric.ed.gov/?id=ED603847 [Google Scholar]
  74. Watson, R. J. , Caba, A. E. , Lawrence, S. E. , Renley, B. M. , McCauley, P. S. , Wheldon, C. W. , Eaton, L. A. , Russell, S. T. , & Eisenberg, M. E. (2023). Examining mental health and bullying concerns at the intersection of sexuality, gender, race, and ethnicity among a national sample of sexual and gender diverse youth. LGBT Health, 11, 20–27. 10.1089/lgbt.2023.0072 [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Watson, R. J. , Fish, J. N. , Denary, W. , Caba, A. , Cunningham, C. , & Eaton, L. A. (2021). LGBTQ state policies: A lever for reducing SGM youth substance use and bullying. Drug and Alcohol Dependence, 221, 108659. 10.1016/j.drugalcdep.2021.108659 [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Watson, R. J. , Fish, J. N. , Poteat, V. P. , & Rathus, T. (2019). Sexual and gender minority youth alcohol use: Within‐group differences in associations with internalized stigma and victimization. Journal of Youth and Adolescence, 48(12), 2403–2417. 10.1007/s10964-019-01130-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Wernick, L. J. , Kulick, A. , & Chin, M. (2017). Gender identity disparities in bathroom safety and wellbeing among high school students. Journal of Youth and Adolescence, 46(5), 917–930. 10.1007/s10964-017-0652-1 [DOI] [PubMed] [Google Scholar]
  78. Wright, T. E. , & Smith, N. J. (2015). A safer place? LGBT educators, school climate, and implications for administrators. The Educational Forum, 79(4), 394–407. 10.1080/00131725.2015.1068901 [DOI] [Google Scholar]
  79. Ybarra, M. L. , Mitchell, K. J. , Kosciw, J. G. , & Korchmaros, J. D. (2015). Understanding linkages between bullying and suicidal ideation in a national sample of LGB and heterosexual youth in the United States. Prevention Science: The Official Journal of the Society for Prevention Research, 16(3), 451–462. 10.1007/s11121-014-0510-2 [DOI] [PubMed] [Google Scholar]
  80. Zongrone, A. D. , Truong, N. L. , & Clark, C. M. (2022). Transgender and nonbinary youths' experiences with gender‐based and race‐based school harassment. Teachers College Record, 124(8), 121–144. 10.1177/01614681221121531 [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Tables S1–S3.

JORA-35-0-s001.docx (46.5KB, docx)

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Articles from Journal of Research on Adolescence are provided here courtesy of Wiley

RESOURCES