Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2019 Dec 1.
Published in final edited form as: Curr Sex Health Rep. 2018 Aug 30;10(4):246–254. doi: 10.1007/s11930-018-0169-y

Bullying Victimization among LGBTQ Youth: Current and Future Directions

Amy L Gower a, G Nic Rider b, Barbara J McMorris c, Marla E Eisenberg a
PMCID: PMC6497454  NIHMSID: NIHMS1025454  PMID: 31057341

Abstract

Purpose of review:

This paper examines recent research on bullying victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth to identify critical issues and advocate for future research priorities.

Recent findings:

Recent studies have begun to document the importance of bullying in general, and bias-based bullying (rooted in stigma) in particular, on the health and wellbeing of this vulnerable subgroup of adolescents, as well as drivers of disparities. Current research demonstrates the role of multiple identities for and important differences among LGBTQ youth and has begun to identify protective factors for youth who are the targets of bullying.

Summary:

Researchers, clinicians, and those working with and on behalf of LGBTQ youth must measure and acknowledge the multiple reasons for which LGBTQ youth are the targets of bullying. Intervention and prevention efforts should focus on improving the supportiveness of the climates within which LGBTQ youth live.

Keywords: bullying, bias-based bullying, LGBTQ youth, minority stress, intersectionality

Introduction

A growing body of research documents the longitudinal and deleterious effects of bullying victimization on health and wellbeing for youth of all ages [1–5]. For youth who identify as lesbian, gay, bisexual, queer, or questioning (LGBQ) or as transgender or gender diverse (TGD; i.e., those whose current gender identity/expression is different than societal expectations based on their birth-assigned sex), rates of bullying victimization are several times higher than those of their straight cisgender (e.g., birth-assigned sex matches gender identity) peers [6–12]. The latest U. S. national data from the CDC’s Youth Risk Behavior Survey (YRBS) indicate that compared to their straight peers, lesbian, gay, and bisexual students report more cyberbullying (27% vs. 13%) and physical bullying on school grounds (33% vs. 17%) [13]. In a national U.S. study that focused on bullying (i.e., aggressive behaviors that occur frequently and with a power differential between actor and target) and harassment (i.e., behaviors that would be considered bullying, but they are infrequent or do not have a clear power imbalance), 80% of LGBQ adolescents reported bullying victimization or peer harassment [14].

The consequences of these bullying victimization experiences shape critical developmental processes and can drive documented health disparities. Given large disparities between LGBTQ youth and their peers in areas such as mental health, substance use, high risk sexual behaviors, and academic performance [7,15–20], understanding drivers of these disparities is urgently needed in order to address them through policy, programs, and other prevention efforts. The current paper reviews recent research on bullying victimization among LGBTQ adolescents, focusing on the last five years and disaggregating LGBQ and TGD youth where possible, with the goal of identifying critical issues and future research priorities. We describe general and bias-based bullying victimization, discuss theoretical foundations that explain the role of victimization in health outcomes, and review emerging issues in the study of bullying victimization for LGBTQ youth.

Important Distinctions in Bullying: General vs. Bias-Based Victimization

Bullying behaviors are diverse; recently, a distinction has emerged in the literature between general bullying and bias-based bullying. Bullying refers to unwanted, aggressive behavior that is repeated or has the possibility to be repeated, and where there is a real or perceived power imbalance between the actor and target [21]. Bullying can take multiple forms, including physical (e.g., hitting, kicking, threats of violence), relational (e.g., social exclusion, spreading rumors), verbal (e.g., name calling), and cyber (e.g., via social media, texts) [22]. We use the term “general bullying” to refer to these behaviors when the motivation for bullying is not based on bias (or motivation is not assessed) and the term “bias-based bullying” when the bullying is rooted in bias related to personal characteristics such as race/ethnicity, gender identity/expression, sexual orientation, or ability status.

General bullying victimization.

Rates of general bullying victimization among youth have decreased in recent years [9,10], although one study documented increases in cyberbullying victimization among LGBQ youth, with no change for straight youth [9]. However, even with these decreases, studies using large, population-based samples have found that the magnitude of disparities in bullying victimization between LGBQ and straight youth has remained the same [9,10]. For example, Massachusetts YRBS data indicates that past-year bullying victimization for straight youth decreased from 20.5% to 14.6% among males and 23.4% to 17.4% among females from 1999–2013. In the same time frame, rates among bisexual males have significantly decreased from 45.5% to 28.8%, but rates among bisexual females have remained essentially the same (42.9% to 41.0%). In other words, while bullying victimization rates are improving in general, LGBQ youth still experience bullying at higher rates than their straight peers, and some groups have not benefited from decreases at all. Due to the lack of gender identity questions included on most large surveillance surveys, similar trend data are not yet available for TGD youth.

Bullying has received much public health attention for adolescents in general and LGBTQ youth in particular due to its strong association with significant health outcomes [15,23,24]. General bullying victimization among LGBTQ youth is consistently associated with internalizing problems such as depressive symptoms, suicidal ideation, and suicide attempts [14,25–31]. National estimates suggest that lesbian, gay, and queer (LGQ) youth who experience peer harassment or bullying have 5–6 times the odds of suicide attempts compared to LGQ youth who do not report victimization [14]. Additionally, general bullying victimization is associated with poor academic outcomes such as truancy, unexcused absences, academic disengagement, educational aspirations, and lower grades and test scores [32–36]. Predictably, LGBTQ youth who are the targets of general bullying report feeling less safe at school, and it is likely this perceived lack of safety that compromises young people’s ability to fully engage in their educational experiences. Further, bullying is related to high risk health behaviors, such as alcohol, tobacco, and other substance use for LGBTQ youth [37–41].

Bias-based bullying.

Historically, research on bullying has focused on specific behaviors (e.g., hitting, spreading rumors, etc.). New research in the last decade, however, has begun to explore motivations and stigma underlying these behaviors, shifting the focus to “bias-based bullying,” sometimes called prejudiced-based harassment, stigma-based bullying, or homophobic teasing when specific to sexual orientation [42–48]. Bias-based bullying victimization is receiving increased attention due to well-replicated studies of its detrimental effects on emotional distress, suicidality, and academic engagement [33,44] as well as economic costs for schools and states [49]. In fact, studies note effects of bias-based bullying that are as large or larger than the effects seen for general bullying victimization [44,49,50]. LGBTQ youth are more likely than their straight cisgender peers to be the targets of bias-based bullying [7,32,42,51,52], and importantly, this is not just bias related to their sexual orientation and gender identity. For example, LGBQ youth are more likely than their straight peers to be the targets of bullying based on race, weight/appearance and ability, even after controlling for race/ethnicity, weight and ability status [42].

Growing understanding of the harm caused by bias-based bullying indicates a clear need and direction for future research. Surveys should include measures of a variety of types of bias-based bullying victimization. It is critical that future research and measures also focus on bias-based bullying experiences that are specific not only to the characteristics of the sample of interest but also a broader range of characteristics. For example, studies of TGD youth should include measure of bullying experiences due to gender identity, expression, and sexual orientation as well as race/ethnicity, weight, and ability. Clinicians can also be aware of and explicitly address bullying victimization experiences related to bias.

Theoretical Foundations and Implications of Bullying Victimization for Health

The minority stress model can be used to understand the role of bullying victimization on long-term health for LGBTQ youth [53,54]. In addition to the typical stressors of adolescence, LGBTQ youth experience additional stress related to their stigmatized sexual orientation and/or gender identity, some of which comes in the form of victimization experiences including bullying, harassment, and discrimination. LGBTQ youth may internalize experiences of victimization, leading to expectations of rejection from others and hypervigilance about being targeted for future victimization incidents, which in turn influence mental and physical health. Adolescence is a critical time to examine these associations, as stress and psychological distress are particularly high during this developmental period [26].

Several key studies explicitly test and support the underlying tenets of the minority stress model for LGBTQ youth, both concurrently and longitudinally. For example, longitudinal studies document that sexual orientation-based victimization, including bias-based bullying, partially mediated the association between sexual orientation and both depressive symptoms and suicidality in samples of LGBTQ youth [25,26,55]. Cross-lagged analyses indicate that as sexual orientation-related victimization declines across adolescence and into early adulthood, emotional distress decreases [26]. Cross-sectional studies are consistent with these findings [19], indicating, for example, that bias-based victimization mediates associations between sexual orientation and academic achievement and truancy among LGBQ youth [33] and between sexual orientation and gender identity and substance use for TGD youth [56,39].

Bullying, whether general or bias-biased, cannot be considered in isolation. On their own, experiences of bullying do not completely explain health disparities for LGBTQ youth [27]. Rather, building on the minority stress model and social ecological frameworks, bullying victimization should be understood in the context of other experiences of victimization that may be present for this vulnerable subgroup, such as harassment within families or in the community [35,57]. Although beyond the scope of this review, a body of research documents the ways in which LGBTQ youth are at heightened risk of victimization in the family and the larger community [58–60], and it is likely that these multiple forms of victimization (i.e., polyvictimization) compound resulting emotional distress [59]. When coupled with victimization in multiple contexts (e.g., school, neighborhood, religious institution), the minority stress model suggests that related processes, such as hypervigilance and identity concealment, may be greater, increasing the impact on health. However, this area requires further empirical investigation, with particular attention to social ecological perspectives that suggest factors that can buffer victimization in multiple contexts.

Relatedly, researchers and clinicians must understand the broader climate in which their participants or patients live, as this has direct and important implications for bias-based bullying victimization. Because bias-based bullying is rooted in stigma, experiences of this kind of victimization are organically tied to the broader community climate and social norms of an area, such as whether the area is welcoming to LGBTQ people [61]. As the social climate of a community becomes more or less supportive of LGBTQ people, due to recent event in the community for example, bias-based bullying rates may fluctuate as well, which can influence the health of LGBTQ youth. For example, LGBTQ youth aged 13–18 in the U.S. report increases in the bias-based bullying they have witnessed, such as hearing someone make derogatory comments about another person, that can be directly attributed to the 2016 U.S. Presidential Election (e.g., because the person making the derogatory comment also repeated a campaign slogan). As a result, youth report modifying their behavior, including changing plans or clothing so they would be less recognizable as LGBTQ [62].

Emerging Research Areas

Informed by the minority stress model and social ecological frameworks, three areas of emerging research will be reviewed that can further our understanding of the role of bullying victimization in the health of LGBTQ youth: intersectionality, variation among LGBTQ youth, and the role of protective factors.

Intersectionality.

The intersectionality framework provides a useful heuristic to understand how a person’s multiple identities (e.g., race/ethnicity, sexual orientation, gender identity) come together, with a specific eye toward the ways social structures and systems impinge on individuals because of those identities [63,64]. Youth with more than one stigmatized identity, such as youth who identify as LGBQ and TGD, may experience increased levels of stigma and minority stress and report more bullying victimization than members of just one group (e.g., either LGBQ or TGD) [65]. Because LGBTQ youth are more likely than straight cisgender youth to be youth of color [7,66], stress related to experiencing and coping with multiple forms of victimization around the intersections of sexual orientation, gender identity, and race/ethnicity may be particularly challenging to wellbeing [63,67,68].

Many LGBTQ youth navigate multiple identities, for which they may also experience bias-based bullying [69]. For example, birth-assigned male and black and multiracial LGBTQ youth, along with TGD youth report higher levels of bullying based on sexual orientation than their peers with a single stigmatized identity [26,70]. Studies examining the full scope of bullying experiences for youth that take into account their multiple identities are needed. Supporting young people by addressing societal barriers that prevent positive integration of their multiple personal identities in adolescence and early adulthood is a key opportunity for prevention and intervention.

Variation among LGBTQ youth.

A second emerging area of research examines heterogeneity among LGBTQ youth. Researchers and research-focused best practices are clear that disaggregating sexual orientation and gender identity groups is critical to a more accurate understanding of LGBTQ youth. Variation within these groups, however, must also be considered. For example several studies have noted differences in general bullying and bias-based bullying rates between lesbian, gay, bisexual, questioning, and straight youth who report same sex sexual activity [14,42], all of whom are typically grouped together as LGBQ. Research evidence is building that youth who identify as bisexual report elevated rates of health-risk and health-compromising experiences, and bullying is among them [10,35,71]. Disaggregating groups for analysis will allow for a more nuanced understanding of which groups experience health disparities and which may not.

Among TGD youth, evidence is emerging that not adhering to a binary gender is associated with additional risk, which may be due to transgressing societal stereotypes about gender. Nonbinary youth (i.e., those who do not identify as strictly male or female, but rather as both, neither, or somewhere between masculine/man and feminine/woman) are an understudied group in part because survey questions rarely allow for this response option with larger samples [72]. In a recent study in Canada, 41% of TGD youth identified as nonbinary, and compared to binary transgender youth (i.e. those who were assigned female at birth and identify as male or assigned male at birth and identify as female), the nonbinary group reported poorer mental and physical health and healthcare utilization [73]. In a national U.S. convenience sample, 86.7% of nonbinary (“genderqueer” identified in this study) youth assigned male at birth reported bullying victimization, a rate significantly higher than the rate for assigned males identifying as transgender (78.2%) or LGBQ cisgender (66.9%) [59]. Nonbinary youth were also more likely to report polyvictimization (including bullying) than transgender and LGBQ cisgender youth. These preliminary investigations are intriguing and identify a range of critical needs for support and prevention that can be addressed by clinicians, school personnel, community members and organizations, and families. Further, they highlight variation within the TGD community that typically goes unmeasured or unidentified, due to a lack of survey questions with appropriate response options and a lack of power to examine differences. Researchers and clinicians must ensure that they are using up-to-date terminology for both sexual orientation and gender identity and providing response options that allow youth to identify themselves accurately [72,74,75].

Variation also exists within LGBTQ populations around gender presentation, or how one expresses their gender (through dress, style, mannerisms, etc.) as well as others’ perceptions of one’s presentation, typically assessed on a continuum from masculine to feminine. For example, TGD youth who are perceived by their peers as more incongruent with their birth-assigned sex (e.g., assigned male, perceived by others as somewhat or mostly feminine) are more likely to be the targets of general bullying and bullying based on gender and gender expression than those perceived as congruent with their birth-assigned sex [52]. Among LGBQ youth, similar associations exist. In a key test of this hypothesis, Toomey and colleagues examined associations between retrospective reports of gender expression and LGBT-specific victimization in adolescence (13–19 years) and depression and life satisfaction in young adulthood (21–25 years) [76]. They found that LGBT-specific victimization fully mediated associations between gender non-conformity in adolescence and young adult depression and life satisfaction for both the full LGBTQ sample and the subsample of LGBQ youth. These studies lead the field toward a more complex understanding of the experiences and health drivers of LGBTQ youth; additional research in this vein will allow for more nuanced approaches to promoting health equity.

Protective factors.

With health disparities well-documented among LGBTQ youth relative to their straight cisgender peers, research has begun examining protective factors in this population, grounded in Bronfenbrenner’s [77] social ecological model, which specifies risk and protective processes at multiple levels of human ecology. Protective factors are characteristics of the individual (e.g., optimism), relationships (e.g., with family members), organizational contexts (e.g., school) and the broader community (e.g., social climate, resources, public policy) that are associated with better than expected outcomes among youth who have experienced some type of risk or vulnerable identity [77,78]. Consistent with findings from general youth samples [78–80], two key areas of protection consistently emerge as conferring critical protection for both LGBQ [71,81–83] and TGD [19,70,84–89] youth on a range of health-related outcomes: 1) having supportive, caring relationships with parents and important adults and 2) attending schools in which youth feel safe, supported, and connected to teachers and the school community. Importantly, multiple cross-sectional studies document these associations, but the few existing longitudinal examinations are equivocal [26]. This is not surprising, as the persistent levels of victimization experienced by LGBTQ youth likely require ongoing support to navigate.

A significant number of studies examining protective factors with respect to bullying victimization focus on aspects of the school environment. Gay-straight alliances or gender/sexuality alliances (GSAs) have received the most attention, with studies indicating that LGBTQ youth who attend a school with a GSA report less bullying than those attending schools without GSAs [34,90–92]. A recent meta-analysis has extended these findings to bias-based bullying, documenting that GSAs are related to lower levels of personally experiencing as well as witnessing sexual orientation-based bullying and feeling unsafe at school [90]. Effect sizes for this first and second-hand victimization were considered small, whereas the effect of a GSA on feeling safe at school was of a medium size. Further, the presence of a GSA can buffer LGBTQ youth who experience sexual orientation-based bullying from harm, including feelings of hopelessness and suicide attempts [91].

A range of other school practices, including supportive school personnel, curriculum that includes LGBTQ figures or events, safe spaces, and teacher professional development related to sexual orientation and gender identity, protect LGBTQ youth from both general and bias-based bullying victimization [34,81,87,93]. These practices are thought to exert their effects in part through school climate, or the “quality and character” of the school [94,95], which in turn supports adults and students in the school to be supportive of LGBTQ youth and less likely to tolerate bullying, particularly related to bias [90,96]. Emerging research indicates that the effects of these school practices on bullying may extend to straight youth as well, demonstrating beneficial effects of supporting LGBTQ youth for the whole student body [93,97].

Three key limitations of the protective factors work must be noted. First, much of the research in this area is based on non-random sampling strategies that may underestimate the experiences of youth who are less involved in the LGBTQ community, especially those who are not out. Secondly, no studies involve experimental design, which is particularly relevant for school findings. It is possible that schools that choose to have GSAs, for example, are inclusive in other ways that are unmeasured. Third, research on protective factors has focused largely on interpersonal and school factors. As noted above, the broader community climate may likewise exert influence over bullying of LGBTQ youth, but the few studies that have examined the community have focused on risk factors rather than protective factors. For example, LGBQ youth living in areas with high levels of LGBTQ hate crimes are more likely to be the targets of relational and cyber bullying [98]. Protective community effects must also be identified; this is a critical area for future research. Finally, it is important to note that LGBTQ youth in general, and TGD youth in particular, report lower levels of many protective factors, including feeling safe at school, parental connectedness, school connectedness, and friend caring [7,11]. These findings point to clear implications for intervention with families, schools, and communities. They also highlight critical recommendations for future research, in particular the use of random or representative sampling techniques and experimental designs.

Conclusions

Disparities in rates of general and bias-based bullying victimization among LGBTQ youth are clear. Emerging research is beginning to elucidate heterogeneity within members of the LGBTQ community, particularly around key questions of intersectionality and the identification of protective factors. Such studies have the potential to drive our understanding of the etiology of health disparities for this vulnerable population and inform new approaches to prevention and intervention.

Clinicians from a range of disciplines have an important role when working with LGBTQ youth and would benefit from training grounded in an understanding of the unique needs of this community and how these needs may be related to the reason the young person is seeking care. Specifically, clinicians need to create a welcoming and inclusive space to help LGBTQ young people feel more comfortable discussing gender, sexual orientation, and sexual health and behaviors - topics that may have been the target of bullying, judgment, and other insensitive experiences by their peers, family members, community members, and possibly previous healthcare providers.

Those working with LGBTQ youth in clinical settings should consider history taking as part of a broader risk assessment that includes asking above bullying victimization. For instance, the use of comprehensive assessment tools, such as the HEADSSS Assessment [99], would allow clinicians to obtain a psychosocial review of a variety of both risk and protective factors from their patients. When working with LGBTQ youth, an understanding of victimization experiences is important, as these experiences may affect identity exploration and self-actualization, foster shame and internalization of negative messages, and increase the likelihood of deleterious health outcomes such as high risk sexual behaviors, emotional distress, and substance use. Patient-provider discussions around these issues are also key for treatment planning and/or for clinicians to identify and facilitate appropriate referrals as necessary. Additionally, a broader understanding of the victimization experiences of LGBTQ people across identities (e.g., sexual orientation, gender identity, race/ethnicity) and contexts (e.g., family, school, community) will inform clinical-, school-, and public health-based approaches to the promotion of health equity in this population.

With regard to next steps for research, the inclusion of items on national or state-level surveillance surveys that assess sexual orientation, gender identity, bias-based bullying, and protective factors has the ability to move the field forward. These samples are large enough to examine variation within LGBTQ youth, including intersections of sexual orientation, gender identity, and race/ethnicity and have the benefit of random or representative sampling techniques to improve generalizability of findings. At the same time, research using smaller and more in-depth samples and methods, particularly longitudinal data collection, will add essential depth to the current knowledge base. For example, qualitative and quantitative studies that examine the coming out process, the role of gender presentation, how community organizations and structures can support LGBTQ youth, and creative approaches to the measurement of LGBTQ-related school and community climate are needed to better understand how factors at all levels of the social ecological model are related to bullying victimization and health among LGBTQ youth. Understanding intrapersonal factors related to bullying victimization is crucial, as is bolstering support for LGBTQ youth in the communities where they live and learn to improve health and wellbeing.

Acknowledgements:

Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Numbers R21HD088757 and R01HD078470. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

1 Variation in terms/acronyms reflects variations in samples in the literature cited. We use LGBTQ as an umbrella term where findings apply to both LGBQ and TGD youth or data from LGBQ and TGD youth were analyzed together without distinctions between groups

References

  • 1.Copeland WE, Wolke D, Lereya ST, Shanahan L, Worthman C, Costello EJ. Childhood bullying involvement predicts low-grade systemic inflammation into adulthood. Proc Natl Acad Sci. 2014;111:7570–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Gini G, Pozzoli T. Association between bullying and psychosomatic problems: a meta-analysis. Pediatrics. 2009;123:1059–65. [DOI] [PubMed] [Google Scholar]
  • 3.Reijntjes A, Kamphuis JH, Prinzie P, Telch MJ. Peer victimization and internalizing problems in children: a meta-analysis of longitudinal studies. Child Abuse Negl. 2010;34:244–52. [DOI] [PubMed] [Google Scholar]
  • 4.Zarate-Garza PP, Biggs BK, Croarkin P, Morath B, Leffler J, Cuellar-Barboza A, et al. How well do we understand the long-term implications of childhood bullying. Harv Rev Psychiatry. 2017;25:89–95. [DOI] [PubMed] [Google Scholar]
  • 5.Reijntjes A, Kamphuis JH, Prinzie P, Boelen PA, van der Schoot M, Telch MJ. Prospective linkages between peer victimization and externalizing problems in children: a meta-analysis. Aggress Behav. 2011;37:215–22. [DOI] [PubMed] [Google Scholar]
  • 6.Toomey RB, Russell ST. The role of sexual orientation in school-based victimization: a meta-analysis. Youth Soc. 2016;48:176–201. [DOI] [PMC free article] [PubMed] [Google Scholar]; *This meta-analysis contextualizes the size of the disparity in bullying victimization for LGBQ compared to straight youth.
  • 7.Eisenberg ME, Gower AL, McMorris BJ, Rider GN, Shea G, Coleman E. Risk and protective factors in the lives of transgender/gender nonconforming adolescents. J Adolesc Heal. 2017;61:521–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Berlan ED, Corliss HL, Field AE, Goodman E, Austin SB. Sexual orientation and bullying among adolescents in the Growing Up Today Study. J Adolesc Health. 2010;46:366–71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Kessel Schneider S, O’Donnell L, Smith E. Trends in cyberbullying and school bullying victimization in a regional census of high school students, 2006–2012. J Sch Health. 2015;85:611–20. [DOI] [PubMed] [Google Scholar]
  • 10.Goodenow C, Homma Y, Watson RJ, Adjei J, Saewyc E. Sexual orientation trends and disparities in school bullying and violence-related experiences, 1999–2013. Psychol Sex Orientat Gend Divers. 2016;3:386–96. [DOI] [PMC free article] [PubMed] [Google Scholar]; *This trend analysis examines bullying over time for LGBQ youth.
  • 11.Clark TC, Lucassen MFG, Bullen P, Denny SJ, Fleming TM, Robinson EM, et al. The health and well-being of transgender high school students: results from the New Zealand Adolescent Health Survey (Youth ‘12). J Adolesc Heal. 2014;55:93–9. [DOI] [PubMed] [Google Scholar]
  • 12.Schuster MA, Bogart LM, Elliott MN, et al. A longitudinal study of bullying of sexual-minority youth. N Engl J Med. 2015;372:1873–4. [DOI] [PubMed] [Google Scholar]
  • 13.Kann L, et al. Youth Risk Behavior Surveillance - United States, 2017. MMWR Surveill Summ. 2018;67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Ybarra ML, Mitchell KJ, Kosciw JG, Korchmaros JD. Understanding linkages between bullying and suicidal ideation in a national sample of LGB and heterosexual youth in the United States. Prev Sci. 2015;16:451–62. [DOI] [PubMed] [Google Scholar]; *This paper examines variations within LGBQ youth.
  • 15.Institute of Medicine . The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, D.C; 2011. [PubMed] [Google Scholar]
  • 16.Corliss HL, Rosario M, Wypij D, Fisher LB, Austin SB. Sexual orientation disparities in longitudinal alcohol use patterns among adolescents. Arch Pediatr Adolesc Med. 2008;162:1071–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Calzo JP, Roberts AL, Corliss HL, Blood EA, Kroshus E, Austin SB. Physical activity disparities in heterosexual and sexual minority youth ages 12–22 years old: roles of childhood gender nonconformity and athletic self-esteem. Ann Behav Med. 2014;47:17–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Heal. 2011;49:115–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Veale JF, Peter T, Travers R, Saewyc EM. Enacted stigma, mental health, and protective factors among transgender youth in Canada . Transgender Heal. 2017;2:207–16. [DOI] [PMC free article] [PubMed] [Google Scholar]; *This paper examines protective factors for TGD youth.
  • 20.Watson RJ, Adjei J, Saewyc E, Homma Y, Goodenow C. Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. Int J Eat Disord. 2017;50:22–31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.U.S. Department of Health and Human Services. What is bullying [Internet]. Available from: https://www.stopbullying.gov/what-is-bullying/index.html
  • 22.Espelage DL, Swearer SM. Research on school bullying and victimization: what have we learned and where do we go from here? Sch Psychol Reveiw. 2003;32:365–83. [Google Scholar]
  • 23.United States Department of Health and Human Services. Healthy People 2020 [Internet]. 2011. Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=24
  • 24.National Academies of Sciences, Engineering and Medicine . Preventing bullying through science, policy, and practice [Internet]. Washington, D.C.; 2016. Available from: http://www.nap.edu/catalog/23482 [PubMed] [Google Scholar]
  • 25.Russell ST, Ryan C, Toomey RB, Diaz RM, Sanchez J. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J Sch Health. 2011;81:223–30. [DOI] [PubMed] [Google Scholar]
  • 26.Birkett M, Newcomb ME, Mustanski B. Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth. J Adolesc Heal. 2015;56:280–5., [DOI] [PMC free article] [PubMed] [Google Scholar]; **This multi-wave longitudinal study sheds light on the interplay of victimization and emotional distress across time.
  • 27.Robinson JP, Espelage DL, Rivers I. Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth. Pediatrics. 2013;131:423–30. [DOI] [PubMed] [Google Scholar]
  • 28.Liu RT, Mustanski B. Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. Am J Prev Med. 2012;42:221–8. [DOI] [PubMed] [Google Scholar]
  • 29.Mustanski B, Andrews R, Puckett JA. The effects of cumulative victimization on mental health among lesbian, gay, bisexual, and transgender adolescents and young adults. Am J Public Health. 2016;106:527–33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Espelage DL, Merrin GJ, Hatchel T. Peer victimization and dating violence among LGBTQ youth: the impact of school violence and crime on mental health outcomes. Youth Violence Juv Justice. 2018;16:156–73. [Google Scholar]
  • 31.Hall WJ. Psychosocial risk and protective factors for depression among lesbian, gay, bisexual, and queer youth: a systematic review. J Homosex. 2018;65:263–316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolesc. 2009;38:989–1000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Birkett M, Russell ST, Corliss HL. Sexual-orientation disparities in school: the mediational role of indicators of victimization in achievement and truancy because of feeling unsafe. Am J Public Health. 2014;104:1124–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Kosciw JG, Palmer NA, Kull RM, Greytak EA. The effect of negative school climate on academic outcomes for LGBT youth and the role of in-school supports. J Sch Violence. 2013;12:45–63. [Google Scholar]
  • 35.Robinson JP, Espelage DL. Bullying explains only part of LGBTQ-heterosexual risk disparities: implications for policy and practice. Educ Res. 2012;41:309–19. [Google Scholar]
  • 36.Aragon SR, Poteat VP, Espelage DL, Koenig BW. The influence of peer victimization on educational outcomes for LGBTQ and non-LGBTQ high school students. J LGBT Youth. 2014;11:1–19. [Google Scholar]
  • 37.Newcomb ME, Heinz AJ, Mustanski B. Examining risk and protective factors for alcohol use in lesbian, gay, bisexual, and transgender youth: a longitudinal multilevel analysis. J Stud Alcohol Drugs. 2012;73:783–93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Newcomb ME, Heinz AJ, Birkett MD, et al. A longitudinal examination of risk and protective factors for cigarette smoking among lesbian, gay, bisexual, and transgender youth. J Adolesc Heal. 2014;54:558–64. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Coulter RWS, Bersamin M, Russell ST, Mair C. The effects of gender- and sexuality-based harassment on lesbian, gay, bisexual, and transgender substance use disparities. J Adolesc Heal. 2018;62:688–700. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Seil KS, Desai MM, Smith MV. Sexual orientation, adult connectedness, substance use, and mental health outcomes among adolescents: findings from the 2009 New York city Youth Risk Behavior Survey. Am J Public Health. 2014;104:1950–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Day JK, Fish JN, Perez-Brumer A, Hatzenbuehler ML, Russell ST. Transgender youth substance use disparities: results from a population-based sample. J Adolesc Heal. 2017;61:729–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Bucchianeri MM, Gower AL, McMorris BJ, Eisenberg ME. Youth experiences with multiple types of prejudice-based harassment. J Adolesc. 2016;51:68–75. [DOI] [PubMed] [Google Scholar]
  • 43.Bucchianeri MM, Eisenberg ME, Wall MM, Piran N, Neumark-Sztainer D. Multiple types of harassment: associations with emotional well-being and unhealthy behaviors in adolescents. J Adolesc Heal. 2014;54:724–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Russell ST, Sinclair KO, Poteat VP, Koenig BW. Adolescent health and harassment based on discriminatory bias. Am J Public Health. 2012;102:493–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Espelage D, Aragon S, Birkett M, Koenig B. Homophobic teasing, psychological outcomes, and sexual orientation among high school students: what influence do parents and schools have? School Psych Rev. 2008;37:202–16. [Google Scholar]
  • 46.Salmon S, Turner S, Taillieu T, Fortier J, Afifi TO. Bullying victimization experiences among middle and high school adolescents: traditional bullying, discriminatory harassment, and cybervictimization. J Adolesc. 2018;63:29–40. [DOI] [PubMed] [Google Scholar]
  • 47.Walton LM. The effects of “bias based bullying” (BBB) on health, education, and cognitive-social-emotional outcomes in children with minority backgrounds: proposed comprehensive public health intervention solutions. J Immigr Minor Heal. 2017;1–5. [DOI] [PubMed] [Google Scholar]
  • 48.Earnshaw VA, Reisner SL, Menino DD, Poteat VP, Bogart LM, Barnes TN, et al. Stigma-based bullying interventions: a systematic review. Dev Rev. 2018;48:178–200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Baams L, Talmage CA, Russell ST. Economic costs of bias-based bullying. Sch Psychol Q. 2017;32:422–33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Jones LM, Mitchell KJ, Turner HA, Ybarra ML. Characteristics of bias-based harassment incidents reported by a national sample of U.S. adolescents. J Adolesc. 2018;65:50–60. [DOI] [PubMed] [Google Scholar]
  • 51.Eisenberg ME, Gower AL, McMorris BJ, Rider GN, Coleman E. Emotional distress, bullying experiences, and protective factors among transgender and gender diverse youth in city, suburban, town and rural locations. J Rural Heal Available online June 25th, 2018. doi: 10.1111/jrh.12311 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Gower AL, Rider GN, Coleman E, Brown C, McMorris BJ, Eisenberg ME. Perceived gender presentation among transgender and gender nonconforming youth: approaches to analysis and associations with bullying and mental health. LGBT Heal. 2018;5:312–19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pract. 2012;43:460–7. [Google Scholar]
  • 55.Burton CM, Marshal MP, Chisolm DJ, Sucato GS, Friedman MS. Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: a longitudinal analysis. J Youth Adolesc. 2013;42:394–402. , [DOI] [PMC free article] [PubMed] [Google Scholar]; *This longitudinal mediation study examines the role of bias-based bullying in emotional distress for LGBQ youth.
  • 56.Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. J Sex Res. 2015;52:243–56. , [DOI] [PMC free article] [PubMed] [Google Scholar]; *This paper examines the mediating role of bias-based bullying on substance use for TGD youth.
  • 57.Pilkington NW, D’Augelli AR. Victimization of lesbian, gay, and bisexual youth in community settings. J Community Psychol. 1995;23:33–55. [Google Scholar]
  • 58.Roberts AL, Rosario M, Corliss HL, Koenen KC, Austin SB. Childhood gender nonconformity: a risk indicator for childhood abuse and posttraumatic stress in youth. Pediatrics. 2012;129:410–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59.Sterzing PR, Ratliff GA, Gartner RE, McGeough BL, Johnson KC. Social ecological correlates of polyvictimization among a national sample of transgender, genderqueer, and cisgender sexual minority adolescents. Child Abus Negl. 2017;67:1–12. [DOI] [PubMed] [Google Scholar]
  • 60.Sterzing PR, Hong JS, Gartner RE, Auslander WF. Child maltreatment and bullying victimization among a community-based sample of sexual minority youth: the meditating role of psychological distress. J Child Adolesc Trauma. Journal of Child & Adolescent Trauma; 2016;9:283–93. [Google Scholar]
  • 61.Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: research evidence and clinical implications. Pediatr Clin North Am. 2016;63:985–97. [DOI] [PubMed] [Google Scholar]
  • 62.Human Rights Campaign. Post-Election Survey of Youth [Internet] Washington, D.C.; 2017. Available from: https://assets2.hrc.org/files/assets/resources/HRC_PostElectionSurveyofYouth.pdf [Google Scholar]
  • 63.Bowleg L The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. Am J Public Health. 2012;102:1267–73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.Crenshaw K Mapping the margins: intersectionality, identity politics, and violence against women of color In: Albertson Fineman M, Mykitiuk R, editors. The Public Nature of Private Violence New York: Routledge; 1994. p. 93–118. [Google Scholar]
  • 65.Eisenberg ME, Gower AL, Rider GN, McMorris BJ, Coleman E. At the intersection of sexual orientation and gender identity: variations in emotional distress and bullying experience in a large population-based sample of U.S. adolescents Under review. [DOI] [PMC free article] [PubMed]
  • 66.Mustanski B, Birkett M, Greene GJ, Rosario M, Bostwick W, Everett BG. The association between sexual orientation identity and behavior across race/ethnicity, sex, and age in a probability sample of high school students. Am J Public Health. 2014;104:237–44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.López N, Gadsden VL. Health inequities, social determinants, and intersectionality. Natl Acad Med. 2016;1–15. [Google Scholar]
  • 68.Poteat VP, Mereish EH, DiGiovanni CD, Koenig BW. The effects of general and homophobic victimization on adolescents’ psychosocial and educational concerns: the importance of intersecting identities and parent support. J Couns Psychol. 2011;58:597–609. [DOI] [PubMed] [Google Scholar]
  • 69.Haines-Saah RJ, Hilario CT, Jenkins EK, Ng CKY, Johnson JL. Understanding adolescent narratives about “bullying” through an intersectional lens: implications for youth mental health interventions. Youth Soc. 2016;50:636–658. [Google Scholar]
  • 70.Hatchel T, Marx RA. Understanding intersectionality and resiliency among transgender adolescents: exploring pathways among peer victimization, school belonging, and drug use. In press. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 71.Taliaferro LA, Gloppen KM, Muehlenkamp JJ, Eisenberg ME. Depression and suicidality among bisexual youth: a nationally representative sample. J LGBT Youth. 2018;15:16–31. [Google Scholar]
  • 72.Bosse JD, Chiodo L. It is complicated: gender and sexual orientation identity in LGBTQ youth. J Clin Nurs. 2016;25:3665–75. [DOI] [PubMed] [Google Scholar]
  • 73.Clark BA, Veale JF, Townsend M, Frohard-Dourlent H, Saewyc E. Non-binary youth: access to gender-affirming primary health care. Int J Transgenderism. 2018;2739:1–12. [Google Scholar]
  • 74.The Williams Institute. Gender-related measures overview [Internet]. 2013. Available at: https://williamsinstitute.law.ucla.edu/wp-content/uploads/GenIUSS-Gender-related-Question-Overview.pdf
  • 75.Frohard-Dourlent H, Dobson S, Clark BA, Doull M, Saewyc EM. “I would have preferred more options:” accounting for non-binary youth in health research. Nurs Inq. 2017;24:1–9. [DOI] [PubMed] [Google Scholar]
  • 76.Toomey RB, Ryan C, Diaz RM, Card NA, Russell ST. Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment. Dev Psychol. 2010;46:1580–9. [DOI] [PubMed] [Google Scholar]
  • 77.Bronfenbrenner U The ecology of human development: experiments by nature and design . Cambridge, MA: Harvard University Press; 1979. [Google Scholar]
  • 78.Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, et al. Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health. J Am Med Assoc. 1997;278:823–32. [DOI] [PubMed] [Google Scholar]
  • 79.Sieving RE, McRee AL, McMorris BJ, Shlafer RJ, Gower AL, Kapa HM, et al. Youth–adult connectedness: a key protective factor for adolescent health. Am J Prev Med. 2017;52:S275–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 80.Hong JS, Espelage DL. A review of research on bullying and peer victimization in school: an ecological system analysis. Aggress Violent Behav. 2012;17:311–22. [Google Scholar]
  • 81.Marshall A, Yarber WL, Sherwood-Laughlin CM, Gray ML, Estell DB. Coping and survival skills: the role school personnel play regarding support for bullied sexual minority-oriented youth. J Sch Health. 2015;85:334–40. [DOI] [PubMed] [Google Scholar]
  • 82.Greytak EA, Kosciw JG, Villenas C, Giga NM. From teasing to torment: school climate revisited, a survey of U.S. secondary school students and teachers [Internet]. 2016. Available from: https://www.glsen.org/sites/default/files/TeasingtoTorment%202015%20FINAL%20PDF%5B1%5D_0.pdf
  • 83.Kosciw JG, Greytak EA, Giga NM, Villenas C, Danischewski DJ. The 2015 National School Climate Survey: the experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. New York; 2015. Available from: https://www.glsen.org/sites/default/files/2015%20National%20GLSEN%202015%20National%20School%20Climate%20Survey%20%28NSCS%29%20-%20Full%20Report_0.pdf, [Google Scholar]; *This report includes LGBTQ youth’s experiences in school on a wide range of topics including general and bias-based bullying.
  • 84.Johns MM, Beltran O, Armstrong HL, Jayne PE, Barrios LC. Protective factors among transgender and gender variant youth: a systematic review by socioecological level. J Prim Prev. 2018;39:263–301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85.Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental health of transgender children who are supported in their identities. Pediatrics. 2016;137:e20153223–e20153223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 86.Katz-Wise SL, Ehrensaft D, Vetters R, Forcier M, Austin SB. Family functioning and mental health of transgender and gender-nonconforming youth in the Trans Teen and Family Narratives Project. J Sex Res. 2018;1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 87.Greytak EA, Kosciw JG, Boesen MJ. Putting the “ T “ in “Resource:” the benefits of LGBT-related school resources for transgender youth. 2013;45–63. [Google Scholar]
  • 88.Katz-Wise SL, Rosario M, Tsappis M. Lesbian, gay, bisexual, and transgender youth and family acceptance. Pediatr Clin North Am. 2016;63:1011–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 89.Gower AL, Rider GN, Brown C, McMorris BJ, Coleman E, Taliaferro LA, et al. Supporting transgender and gender diverse youth: protection against emotional distress and substance use Am J Prev Med. In press. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 90.Marx RA, Kettrey HH. Gay-straight alliances are associated with lower levels of school-based victimization of LGBTQ+ youth: a systematic review and meta-analysis. J Youth Adolesc. 2016;45:1269–82. [DOI] [PubMed] [Google Scholar]; *This meta-analysis summarizes research on GSAs.
  • 91.Davis B, Royne Stafford MB, Pullig C. How gay-straight alliance groups mitigate the relationship between gay-bias victimization and adolescent suicide attempts. J Am Acad Child Adolesc Psychiatry. 2014;53:1271–1278. [DOI] [PubMed] [Google Scholar]
  • 92.Heck NC, Flentje A, Cochran BN. Offsetting risks: high school gay-straight alliances and lesbian, gay, bisexual, and transgender (LGBT) youth. Sch Psychol Q. 2011;26:161–74. [Google Scholar]
  • 93.Gower AL, Forster M, Gloppen K, Johnson AZ, Eisenberg ME, Connett JE, et al. School practices to foster LGBT-supportive climate: associations with adolescent bullying involvement. Prev Sci. Prevention Science; 2017;1–9. [DOI] [PubMed] [Google Scholar]
  • 94.National School Climate Council. The school climate challenge: narrowing the gap between school climate research and school climate policy, practice guidelines, and teacher education policy [Internet]. 2007. Available from: http://www.schoolclimate.org/climate/documents/%0Aschool-climate-challenge.pdf
  • 95.Thapa A, Cohen J, Guffey S, Higgins-D’Alessandro A. A review of school climate research. Rev Educ Res. 2013;83:357–85. [Google Scholar]
  • 96.Porta CM, Singer E, Mehus CJ, Gower AL, Saewyc E, Fredkove W, et al. LGBTQ youth’s views on Gay-Straight Alliances: building community, providing gateways, and representing safety and support. J Sch Health. 2017;87:489–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 97.Konishi C, Saewyc E, Homma Y, Poon C. Population-level evaluation of school-based interventions to prevent problem substance use among gay, lesbian and bisexual adolescents in Canada . Prev Med. 2013;57:929–33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 98.Duncan DT, Hatzenbuehler ML, Johnson RM. Neighborhood-level LGBT hate crimes and current illicit drug use among sexual minority youth. Drug Alcohol Depend. 2014;135:65–70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 99.Simmons M, Shalwitz J, Pollock S, Young A. Adolescent health care 101: The basics [Internet]. 2003. Available from: http://www.ahwg.net/resources/toolkit.htm

RESOURCES