Today, Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ+) youth are coming of age in the setting of increased LGBTQ+ rights and visibility, yet they remain vulnerable to higher rates of negative mental health outcomes, including depression, anxiety, eating disorders, self-harm, and suicide.

Scope in Pediatrics

  • Youth identifying as LGBTQ+ has been steadily on the rise.  The 2019 Youth Risk Behavioral Survey found that 11.2% of high school students surveyed identify as LGB.  Studies have estimated about 0.7-2.0% of youth 13-17 years old identify as transgender.  However, methodological variations exist across epidemiological studies.  
  • LGB youth are more than twice as likely as their heterosexual peers to experience persistent sadness or hopelessness and transgender and gender diverse (TGD) youth are more than twice as likely as their non-TGD peers to experience depressive symptoms, serious suicidal ideation, or suicide attempts.  

Teaching Points

  • According to Minority Stress Theory, disparities in mental health outcomes are believed to stem from stigma and a number of unique factors that contribute to internal psycholocial stress, including discrimination, rejection, trauma, hostile school environments, and housing instability. 
  • Pediatricians need to ask patients about relationships, romantic attractions, and gender identity in a developmentally appropriate manner. 
  • LGBTQ+ patients should be routinely screen for relevant risk and resiliency factors for adverse mental health outcomes. 
  • Individualized treatment plans should be developed to bolster resiliency factors and interrupt the minority stress pathway.  

Resources

For Physicians

Related AAP Policy

Policy Statement: Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth
Technical report: Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth
Policy Statement: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents 

Related AAP Resources

A Pediatrician’s Guide to an LGBTQ+ Friendly Practice 
Adolescent Health Care Resources 

Other Resources

A Practitioner's Resource Guide: Helping Families to Support Their LGBT Children  
National Alliance on Mental Health 
National LGBTQIA+ Health Education Center 
Guidelines for the Care of LGBT Patients (GLMA) 
World Professional Association for Transgender Health: Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People  
Reproductive Health Access Project: Birth Control Across the Gender Spectrum  
Transgender Law Center: 10 Tips for Improving Services for Transgender People 

References/Additional Reading

2015 U.S. Transgender Survey. Retrieved from Washington, DC: http://www.ustranssurvey.org/report

Fish JN. (2020). Future Directions in Understanding and Addressing Mental Health among LGBTQ Youth. J Clin Child Adolesc Psychol, 49(6), 943–956.

Hendricks ML, Testa RJ. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation for the minority stress model. Prof Psychol Res, 5, 460.

Herman JL, et al. Age of individuals who identify as transgender in the United States. Los Angeles, CA: The Williams Institute, 2017.

Johnson B, et al. Risk versus resiliency addressing depression in lesbian, gay, bisexual, and transgender youth. Child Adolesc Psychiatric Clin N Am, (2019) 28 ,509–521.

Meyer IH. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull, 129, 674.

Olson KR, et al. (2015). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics, 137(3), e0153223.

Price-Feeney M, et al. (2020). Understanding the Mental Health of Transgender and Nonbinary Youth. J Adolesc Med, 66(6), 684-690.

Underwood JM, Brener N, Thornton J, et al. (2020). Overview and methods for the Youth Risk Behavior Surveillance System—United States, 2019. In: Youth Risk Behavior Surveillance—United States, 2019. MMWR Suppl, 69 (No. Suppl 1).

For Families

AAP Resources for Families on HealthyChildren.org

Gender Diverse & Transgender Children 
Parenting a Gender Diverse Child: Hard Questions Answered 

Other Resources

PFLAG (”Parents and Families of Lesbians and Gays”) 
Family Acceptance Project 
Gender Spectrum (resources, trainings for gender sensitivity)  
The Gender Book (book explaining complexities of gender, resources) 
The Parents Project 
Trans Student Educational Resources
Unofficial Book List: http://www.bidstrup.com/parbiblio.htm   

Hotlines  

GLBT National Youth Talkline (peer counseling, local resources) 800-246-PRIDE 
The Trevor Project (suicide prevention, resources) 866-488-7386 
Crisis Text Line: Text START to 741-741 

Contacts

For COVID related questions, please email covid-19@aap.org.
For Mental Health related questions, please email mentalhealth@aap.org.
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Special Acknowledgment

The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI.