The toll of adverse events on LGBTQ teens

Lesbian, gay, bisexual, transgender, questioning (LGBTQ), and gender-nonconforming adolescents often report higher rates of depression, self-harm, suicidal ideation, and other physical and mental health issues. A series of new studies in Pediatrics sought to assess the rates of adverse events in these groups compared with their peers, and what childhood factors may have contributed to these problems in hopes that better screening and intervention tools might be developed.

The goal of the first study was to find patterns of childhood adversity in transgender and gender-nonconforming teenagers when compared with their peers.¹ The study assessed more than 81,000 students in grades 9 to 11 across 348 Minnesota schools. The research team uncovered low levels of abuse in 85.3% of males and 80.1% of females.

The report broke down specific types of adversity in the study group, revealing that 24.42% of gay or lesbian students, 31.1% of bisexual students, and 26.93% of transgender students had a parent or guardian in prison compared with 15.67% of nontransgender and 14.94% of heterosexual students. Another 12.67% of gay or lesbian students, 14.65% of bisexual students, and 14.61% of transgender students witnessed parental abuse compared with 6.12% of nontransgender and 5.92% of heterosexual students.

Rates of abuse experienced by the students themselves also were significant. According to the report, 12.29% of gay or lesbian students, 16.19% of bisexual students, and 13.36% of transgender students reported experiencing sexual abuse from a nonfamily member compared with 3.55% of nontransgender and 2.85% of heterosexual students. Sexual abuse from family members also was reported at higher rates in LGBT students in comparison with their peers, with 8.73% of gay or lesbian students, 8.65% of bisexual students, and 9.23% of transgender students reporting this kind of abuse compared with 2.11% of nontransgender and 1.74% of heterosexual students.

Laura Baams, PhD, assistant professor in Pedagogy and Educational Sciences at the University of Groningen in the Netherlands and lead author of the first study, says she hopes the study will increase awareness of disparities for LGBTQ and gender-nonconforming youths.

“The knowledge that these youth are more likely to experience severe forms of abuse at young ages might encourage pediatricians to monitor or ask questions about youth's wellbeing and behavior,” she says.

Many adolescents experience bullying, Baams adds. She says bullying based on bias (for example, for someone's gender expression) has been found to have profound effects on adolescents' mental health, even in adulthood.

“Creating an accepting and affirming environment, both in school and at home, might reduce the occurrence and impact of bullying,” Baams says.

Although the study did not investigate therapies or interventions in response to adverse events, it does highlight the need for additional support in these groups, Baams points out.

“The findings of my study are important for understanding LGBTQ and gender-nonconforming youth's experiences, and how these vary across the population,” Baams says. “Many LGBTQ and gender-nonconforming youth do not experience adversity or abuse. However, a small group experiences severe forms of abuse, and for these youth clinicians may help to monitor, diagnose, and intervene when appropriate.”

In the second study, which assessed mental health trends in nearly 1500 children and teenagers who identified as transgender and gender-nonconforming individuals, depressive disorders were found to be common, with 49% of transfeminine and 62% of transmasculine individuals receiving these diagnoses.² Attention-deficit disorder diagnoses were also significant, at 15% in transfeminine participants and 16% in transmasculine participants. Rates of self-harm and suicidal ideation were also higher in these groups, according to the report.

In an accompanying commentary, Stanley Ray Vance Jr, MD, and Stephen M. Rosenthal, MD, both of Benioff Children’s Hospital, San Francisco, California, review both studies and discuss the growing evidence of stress associated with adverse childhood experiences and its link to health.³ They note that in the first study, polyvictimization, psychologic and/or physical abuse, and household dysfunction were most common in LGBTQ and gender-nonconforming adolescents.

“Understanding the types of trauma and adverse experiences for which LGBTQ and gender-nonconforming youth are at risk could be crucial for screening of risk factors and providing appropriate services,” Vance and Rosenthal note. “Additionally, although LGBTQ and gender-nonconforming youth had higher rates of adverse experiences, it must be noted that 85% of birth-assigned male youth and 80% of birth-assigned female youth were placed in the no- or low-adversity profile; therefore, clinicians should be careful not to assume that all sexual-minority and gender-diverse youth have had adverse childhood experiences.”

The commentators add that these studies reinforce the need for clinicians to assess for risk factors of psychosocial problems in LGBTQ and gender-nonconforming individuals.

“A first crucial step is creating clinical environments that promote these youth feeling comfortable with disclosing their sexuality and gender identity. In addition, from residency through continuing medical education, providers themselves need the tools, skills, and guidance to feel comfortable and confident in their ability to assess for risk factors for poor psychosocial outcomes that disproportionately affect these youth,” Vance and Rosenthal add. “Only by identifying LGBTQ and gender-nonconforming youth and appropriately screening them can they be provided with specific, potentially lifesaving supports that may be needed, including gender-affirming treatments for transgender youth, referral to a mental health provider, family engagement, and referrals to community programs for peer engagement.”