— Our Research Must Be More Nuanced
Young people do not fall into neat categories of race, sexual orientation or gender identity. Research into LGBTQ mental health must take that into account
Our youth are in a mental health crisis. Young people describe steadily increasing sadness, hopelessness and suicidal thoughts. These mental health challenges are greater for youth who hold marginalized identities that include sexual orientation, gender identity or race or ethnicity. Near-constant exposure to traumatizing media and news stories, such as when Black youth watch videos of people who look like them being killed or when transgender youth hear multiple politicians endorse and pass laws that deny their very existence, compounds these disparities.
But young people do not fall into neat categories of race, ethnicity, sexual orientation or gender identity. They reject antiquated norms and societal expectations, especially around gender and sexuality. Yet most research on people in this group, especially on LGBTQ youth, does not fully account for how they identify themselves. Approaching research as though sex is binary and gender is exact leads to incomplete data. This mistake keeps us from creating the best possible mental health policies and programs.
We need to collect robust data on specific populations of LGBTQ young people to better understand the unique risks they face, such as immigration concerns that Latinx youth may have that others may not. We can also better understand factors that uphold well-being, such as how family support affects Black trans and nonbinary youth.
LGBTQ young people of color, including those who identify in more nuanced ways than either gay or lesbian, are more likely to struggle with their mental health than their white LGBTQ counterparts. As researchers, if we can equip ourselves with this information about their unique needs and experiences, we can create intervention strategies that support the mental health of every LGBTQ young person rather than attempting to apply a “broad strokes” approach that assumes what works for one group must work for all.
As director of research science at the Trevor Project, the premier suicide prevention organization for LGBTQ youth, I lead projects that examine LGBTQ young people and their mental health in an intersectional way, accounting for the many facets of their identities and how society and culture influence how they value themselves. I and my colleagues conduct studies with groups of people who are geographically diverse and gender- and race-diverse to understand what drives mental health distress in a way that allows us to address specific needs in different populations. For advocates trying to improve mental health outcomes, this means they must consider stigma, how it turns into victimization, discrimination, and rejection and how it disproportionately affects people who hold multiple marginalized identities.
Our 2023 U.S. National Survey on the Mental Health of LGBTQ Young People, for example, found that LGBTQ youth with multiple marginalized identities reported greater suicide risk, compared with their peers who did not have more than one marginalized identity. To learn this, we asked young people demographic questions about race/ethnicity, sexual orientation and gender identity amid a battery of assessments. Based on survey questions about mental health and suicide risk, we’ve found that nearly one in five transgender or nonbinary young people (18 percent) attempted suicide in the past year, compared with nearly one in 10 cisgender young people whose sexual orientation was lesbian, gay, bisexual, queer, pansexual, asexual or questioning (8 percent). Among almost all groups of LGBTQ young people of color, the rates of those who said they had attempted suicide—22 percent of Indigenous youth, 18 percent of Middle Eastern/Northern African youth, 16 percent of Black youth, 17 percent of multiracial youth and 15 percent of Latinx youth—were higher than that of white LGBTQ youth (11 percent). And youth who identified as pansexual attempted suicide at a significantly higher rate than lesbian, gay, bisexual, queer, asexual and questioning youth.
The majority of research exploring LGBTQ young people’s mental health does not have the sample size to do subgroup analyses in this way or, in rare cases, opts to unnecessarily aggregate findings (such as when bisexual young people are not analyzed separately despite representing the majority of the LGBTQ population). Our recruitment goals are set on finding enough people in harder-to-reach groups, such as Black transgender and nonbinary young people, and not to simply have a high overall sample size. In doing so, we are able to analyze findings specific to each group and also ensure these findings reach a wide audience. However, just as other researchers, when we are unable to collect enough data for subgroups to appropriately power our analyses, we do not publish those findings.
What we hope is that people working in small community settings can design targeted prevention programs. For example, an organization that aims to improve well-being among Latinx LGBTQ young people can also provide appropriate support for immigration laws and policies because immigration issues feed into mental health. Or an organization focused on family and community support among Asian Americans and Pacific Islanders can also focus on LGBTQ young people. The data we have gathered can informed services at organizations such as Desi Rainbow Parents & Allies, National Black Justice Coalition (NBJC) and the Ali Forney Center, among others.
Researchers must be intentional about which aspects of sexual orientation and gender identity are most relevant to the questions they are trying to answer when designing their studies. They must use survey items closely matched to those categories. Researchers must find a balance between nuance and analytic utility—allowing young people to describe their own identities in addition to using categorical descriptors. This can look like including open-ended questions or longer lists of identity options. Taking steps like these are critical for collecting and analyzing data that reflect the multitudes of this diverse group of young people. I urge researchers to apply an intersectional lens to their work and public health officials and youth-serving organizations to tailor services and programming to meet the unique needs of all young people. That’s because a “one-size-fits-all” approach has never and will never work when the goal is to save lives.
IF YOU NEED HELP
If you or someone you know is struggling or having thoughts of suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 or use the online Lifeline Chat. LGBTQ+ Americans can reach out to the Trevor Project by texting START to 678-678 or calling 1-866-488-7386.
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