Protecting the mental health of LGBTQIA+ youth – CHOC

Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Pride Month is celebrated each year in the month of June.  

“We all benefit from living in a world in which we can be our true selves, and we can thank our LGBTQIA+ trailblazers for helping to shape that world,” says Dr. Adrianne Alpern, pediatric psychologist at CHOC.  

For LGBTQIA+ youth, being a trailblazer for acceptance can also be hard for their mental health. They did not choose to be trailblazers. If they are not out to selected friends or family, they might experience worries about whether they will face rejection or loss of important relationships.

Whether they are out in certain settings or not, they might experience discrimination, rejection and minority stress. But support from their families, schools, and communities can make a huge impact on decreasing mental health risks and promoting resilience in this already-resilient group.

Here, Dr. Alpern offers guidance to parents and caregivers on how to best support the LGBTQIA+ youths in their lives.

Who are LGBTQIA+ youths?

LGBTQIA+ is an inclusive term that includes people of all genders and sexualities, such as lesbian, gay, bisexual, pansexual, transgender, queer, intersex and asexual.

Most human traits — like height, hair color, toe length and earwax consistency — exist along a spectrum, including gender and sexual orientation. Diversity in gender identity and sexual orientation — including being trans, nonbinary and gender fluid — is a normal part of the world’s overall diversity.

LGBTQIA+ youth come from all different ethnicities, races, religions, cultures, income levels, and abilities. As humans, we must acknowledge that in history and current practice, many minority groups within the LGBTQIA+ community have been left out or left behind. LGBTQIA+ youths can hold multiple identities at once, while also having incredibly different experiences within those identities — so we should not over-simplify or generalize their experiences.

Important terms about the LGBTQIA+ community

Education about the LGBTQIA+ community is such a major step for understanding and respect—but it can be overwhelming for some parents and caregivers.

The following terms and definitions are commonly used in the LGBTQIA+ community:

  • Sex — this is also referred to as “assigned sex at birth,” based on anatomy. It’s what is printed on a birth certificate.
  • Gender identity – the internal sense of one’s own gender. There is no medical test for this.
  • Gender expression – how someone advertises or wears their gender through their hairstyle, clothing, voice and mannerisms.
  • Sexual orientation – the sexual attraction and behaviors towards others (or no one) and how someone sexually identifies – like gay, lesbian, pansexual and asexual.
  • Transgender (trans) – when someone’s true inner gender experience doesn’t match the assigned sex at birth. People may identify as trans male or trans masculine and trans female or trans feminine. They may also not identify as either trans male or trans female and rather identify as gender fluid, nonbinary, genderqueer or gender expansive.
  • Cisgender – gender identity matched the sex assigned at birth.
  • Pronouns – she/her, he/him, they/them, ze/zir. These pronouns used to be referred to as “preferred” pronouns, but that has fallen out of favor. It is essential to be called by the pronouns that match your gender. 

Terminology can be confusing, and you may not always understand it right away. If you have an LGBTQIA+ person in your life that mentions a term you don’t know, have them explain it to you. For more helpful terms, visit PFLAG’s glossary.

Risk factors for LGBTQIA+ youths’ mental health  

LGBTQIA+ youth may experience certain risk and protective factors that affect their mental health. A risk factor is a trait or experience that increases someone’s risk for developing a mental health problem.

It’s important to know that not everyone with risk factors develops mental health problems, and not everyone with protective factors will end up free of mental health problems, says Dr. Alpern. Although LGBTQIA+ youth may be at risk for developing depression or anxiety due to being unaccepted or marginalized by their identity, they can also develop depression or anxiety for any other reason just like any other person.

The following risk factors may affect an LGBTQIA+ youth’s mental health:

Being rejected by family after coming out

There is an 8.4 to 12-fold increase in risk of attempting suicide for youths that feel rejected by their families compared to youths who feel accepted after coming out. There’s also a 5.9-fold increase in risk for developing depression and a 3.4-fold increase in risk for abusing substances for these youths. 1 in 3 LGBTQIA+ youths says their home is affirming of their identity.     

There are almost no other risk factors in the mental health world that will increase someone’s risk of severe mental health challenges to that degree, says Dr. Alpern. Family support is often critical. Still — especially for those without family support — having one caring adult in their life can reduce suicide risk by 40%, reports The Trevor Project.

Lack of school protections for LGBTQIA+ youth

This risk is associated with two-fold elevated suicide risk. About half of LGBTQIA+ youth report that their school is affirming of LGBTQIA+ youth.

Experiencing peer victimization due to being LGBTQIA+

LGBT-based bullying is associated with higher rates of depression, suicide attempts, substance use and truancy.

Belonging to multiple marginalized groups

When you belong to more than one marginalized group, you may face discrimination from within a group you belong to and from the outside world. It can be harder for young people to find spaces where they feel that their whole authentic selves are welcome and celebrated. Unsurprisingly, that can take a toll on someone’s mental health.

But on the other hand, young people with intersectional identities may also experience pride about their race, culture and/or their LGBTQIA+ identity.

According to a report by Trevor Project, 40% of AAPI LGBTQIA+ youth considered suicide within the past year, and those who reported discrimination based on their race or immigration status had higher rates of suicide attempts. The rise in discrimination and hate crimes targeting AAPI communities since the beginning of the COVID-19 pandemic is most certainly a contributing factor. Additionally, some AAPI communities face barriers to seeking mental health services, and youth are appropriately worried about whether a therapist would be competent and accepting of all aspects of their identity.

Latinx LGBTQIA+ youths are reported to experience higher rates of suicidal thoughts and attempts compared to all other LGBTQIA+ youth. However, the report noted this increase is driven by worries about family members being detained and deported. Once those worries are accounted for, Latinx LGBTQIA+ youth seem to have equal rates of suicidal thoughts and attempts as other LGBTQIA+ youth.

Until recently, Black/African American LGBTQIA+ youth had similar rates of depression and suicidal thoughts to all other LGBTQIA+ youth, but they are less likely to access mental health services. A recent Trevor Project Survey found that 49% of Black LGBTQIA+ youth considered suicide in the past year, and this increase is likely due to experiences of discrimination and minority stress.  

When experiences of discrimination and marginalization affect young people’s mental health, it is clear that they are not broken; the system is broken. It is of critical importance to directly confront and address discrimination, help young people access culturally competent care, and create LGBTQIA+ affirming spaces that will embrace and celebrate their whole authentic selves (see below for resources).

The Trevor Project conducted a national survey of over 60,000 LGBTQIA+ youth about mental health challenges they experience.

Protective factors for LGBTQIA+ youth

Even though LGBTQIA+ kids may face risk factors for mental health challenges, some may have access to protective factors that help them stay optimistic, proud and resilient. A protective factor is a trait or experience that decreases the risk of developing a mental health problem.

The following experiences serve as protective factors for LGBTQIA+ youth:

Support from caregivers, friends and community

Community support leads to higher self-esteem, a lower incidence of depression and fewer suicide attempts. According to the surveys, about 50% of LGBTQIA+ youth report having an adult in their family they could turn to for help, versus 79% of non-LGBTQIA+ youth.

Presence of school protections for LGBTQIA+ youth

School inclusivity protections lower suicide risk. The HRC’s Welcoming Schools program offers a great checklist for an inclusive and welcoming school environment.

Respecting pronouns for trans/non-binary youth

Transgender and nonbinary youth who report having their pronouns respected by all or most of the people in their lives attempted suicide at half the rate of those who did not have their pronouns respected. Using the correct pronouns can be life saving.

Access to desired clothing, accessories and shapewear (binders) for trans and nonbinary youth

Some trans masculine and non-binary youth may want to wear binders, and it’s important that they are doing so safely. The LGBTQ Center Orange County offers free binders and the Fenway Health offers a comprehensive binding guide.

Access to gender-affirming medical care for trans/non-binary youth

When trans or non-binary youth have access to the gender-affirming care that they want or need, it reduces the risk of suicide by 70% even after controlling for parental support.

Gender-affirming care can mean many different things for different young people and offers them choices for what type of care they want. There is no one right way to transition. Everyone gets to explore their options, learn about risks and benefits, and discuss options with their medical team.

The following are aspects of gender-affirming care that a trans/non-binary youth may want to pursue:

  • Social transition – an individual may want to use their hair, clothing, accessories, name and pronouns to express their gender identity. Some youths may only want to access social transition. It can be a low-cost way that decreases youth distress by allowing them to be themselves.
  • Puberty blocking medication – this is a medical treatment only done around puberty and is not allowed for young kids. It allows young trans and non-binary people to prevent the potentially negative outcomes of going through puberty that does not match their gender identity. This also prevents the development of characteristics that are irreversible (e.g., tall height) or that need to be corrected surgically in adulthood (e.g., an Adam’s apple).
  • Hormonal transition – medications such as testosterone for masculine transition and estrogen for feminine transition may be used to help youths feel more at home in their bodies. 
  • Gender-affirming surgery – surgical procedures that can help people adjust their bodies to match their innate gender identity more closely. This may include top surgery, bottom surgery or both. These surgeries are generally only available for adults 18 years and older, though there may be some exceptions.

Trans and non-binary youth who are supported in their gender identity experience a decreased risk of developing mental health concerns. They experience levels of depression that are comparable to non-trans (cisgender) peers. They also have a significantly lower suicide risk than unsupported trans people—their suicide risk lowers to be comparable to other peers. Trans/non-binary youths may experience slightly elevated anxiety levels. Even with support from friends and family, they may run into discrimination and hear negative messages from the rest of the world.

Learn 9 strategies for further supporting LGBTQIA+ youth

The do’s and don’ts of promoting resilience in LGBTQIA+ youths  

77% of LGBTQIA+ youth say they know things will get better. Although this group can feel stress, they also have optimism. Support from caregivers and other caring adults is such an important protective factor for LGBTQIA+ youth.

Families may not be able to control the way that the world responds to their LGBTQIA+ child, but they can offer them the support they need at home. Then, that support can help their child weather the storms of any discrimination they would face. Caregivers can’t protect their children from discrimination but can protect their children from the negative effects of discrimination.  

Don’ts for promoting resilience for LGBTQIA+ youth

Even parents and caregivers that wouldn’t engage in these unsupportive behaviors themselves may be in the position to intervene if they see others treating an LGBTQIA+ youth badly.

Dr. Alpern offers the following don’ts for caregivers and parents:

  • Don’t assume that you can tell who is closeted or questioning; anyone can be closeted or questioning.
  • Don’t force someone to come out if they are not ready.
  • Don’t expect young people to answer questions that you wouldn’t be able to answer (or would never be asked) about yourself like, “How do you really know your gender?”
  • Don’t tell an LGBTQIA+ youth that they are confused or might change their mind later.
  • Don’t try to hide their identity or persuade them to change it.
  • Don’t try to use bribes or rewards to pressure the child into changing their identity

The following are do’s for promoting resilience:

  • Do speak positively about the LGBTQIA+ community.
  • Do welcome your child’s LGBTQIA+ friends or partners.
  • Do defend them against others’ prejudice and advocate for their rights. Caregivers think by staying quiet that they are supporting their youth, but their silence is unnerving for their youth, who might think they’ll be rejected at any time.
  • Do try to help your youth’s school or place of worship be more accepting and inviting
  • Do help them access LGBTQIA+-affirming spaces either in-person through support groups or in online chat rooms and virtual groups.  
  • Do immerse yourself and your child in positive representation of LGBTQIA+ individuals online, on social media and/or in the media (follow GLADD and the It Gets Better Project).
  • Do understand that as caregivers, you can be accepting while also experiencing your own journey of loss or grief. You are important!

Addressing myths about LGBTQIA+ youths

As a supportive LGBTQIA+ parent or caregiver, you have the power to dispel myths about LGBTQIA+ youths in your community. The following myths provide opportunities to correct others’ misconceptions:

“LGBTQIA+ people are confused.”

It’s much more accurate to say the world is confused about them, says Dr. Alpern.

“A child couldn’t possibly know their gender or sexual orientation … their brains are still developing.”

If we can let cisgender young children tell us their gender, then LGBTQIA+ children can too. The world expects LGBTQIA+ kids to justify and defend their identities in ways that other people don’t have to. Some kids can verbalize their gender identity by age 3. Some trans youth don’t have the words or concepts until they are older, and their gender is still real and valid.  

“A child or teen couldn’t possibly make decisions about who they are.”

In many situations, they are not deciding who they are. They are deciding what to do about it.

“Teens are claiming to be trans because it’s trendy and they are trying to fit in.”

It may seem sudden to outsiders, but to them, it was probably not sudden. They may have tried hard to make their assigned gender work for them and may have experienced stress that was not visible to others until it reached a critical point. They may finally be discovering terminology online that explains what they are feeling. Increased social acceptance and tolerance allows youth to be able to say who they are. They have the community and the language to speak up.

Although LGBTQIA+ may face mental health concerns from discrimination, bullying and minority stress, they are resilient. They are building a world where everyone can be their true selves and be accepted. We can learn a lot from our LGBTQIA+ youths, and it is important to make the effort to keep learning. Adult, family and community support can make a huge impact in the lives of LGBTQIA+ youths.

LGBTQIA+ resources

Dr. Alpern suggests the following helpful resources for youth, parents, schools and more:

For schools:

The Safe Zone Project

It Gets Better Project | Free-to-download EduGuides

Welcoming Schools | A Checklist for a Welcoming and Inclusive School Environment

Welcoming Schools | Gender Support Checklist for Transgender & Non-Binary Students

Welcoming Schools | Diverse Books to Create LGBTQ+ Inclusive Classrooms & Schools

CA Dept of Education | Educator Excellence: Supporting LGBTQ+ Students

For everyone:

Community Counseling & Supportive Services CCSS | Orange County, California Health Care Agency

LGBTQ Center Orange County | Offers social events, groups, mental health services, and parent support (including a support group for Spanish-speaking caregivers). Also has a free binder clinic, name/gender change legal clinic, immigration resources, and more.

The Trevor Project | A Guide to Being an Ally to Transgender and Nonbinary Youth

For parents and caregivers:

Family Acceptance Project ® | Educational material that highlights the importance of family support of LGBTQ youth | Gender-Diverse & Transgender Children | American Academy of Pediatrics

PFLAG | | Support and information for parents and families of LGBTQ+ people

Gender Spectrum | Information, virtual groups and discussion forums for parents

For youth: 

Q Chat Space | Online groups and resources for LGBTQ+ youth

Gender Spectrum | Online discussions for adults and youth

TrevorSpace | An affirming international community for LGBTQ young people ages 13 & older

The Trevor Project | The Coming Out Handbook

The Trevor Project | Resource Center

For supporting LGBTQ+ youth of color and their families: 

GLSEN | Supporting LGBTQ+ Students of Color

NQAPIA | Supporting LGBTQ Asian American, South Asian, Southeast Asian, and Pacific Islanders

PFLAG | Resources for API Families (available in English, Vietnamese, Mandarin, Cantonese, Korean, Japanese, Indonesian, Thai, Khmer, Hmong, Lao, Arabic, Hindi, Bengali and more)

Latino Equality Alliance

Somos Familia | Information, groups, and videos in English and Spanish

National Queer and Trans Therapists of Color Network

NBJC | National Black Justice Coalition


PFLAG National Faith Resources | LGBTQ-affirming resources related to Islam, Christianity, Judaism, and interfaith communities

Transgender Care Listings | Buddhist Trans Community Resources

National LGBTQ Task Force | Find a welcoming Christian congregation (International)

GALVA-108 | International organization for LGBTI Hindus and Vaishnavas

Sarbat Sikhs | Volunteer-led group addressing LGBT+ issues from a Sikh perspective


National Center for Transgender Equality

Transgender Law Center

Lambda Legal

Watch a webinar on this topic, presented by Dr. Alpern, as part of CHOC’s Mental Health Education Program (MHEP). MHEP offers free webinars to parents on a variety of timely topics. To view upcoming webinars, view the MHEP events calendar. You can also watch all recently aired MHEP webinars in the archive here.

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