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 Children who identify as gender-queer experienced the highest prevalence of emotional distress related to homophobic and transphobic, or bias-based, bullying.

“Research often treats LGBTQ+ youth as if they’re all the same, but of course, we know they are diverse in all sorts of ways—just like everyone,” Marla Eisenberg, ScD, MPH, notes. “Our study was designed to look at youth who are marginalized due to sexual orientation and gender identity as well as racial and ethnic identities. More importantly, we wanted to focus on stigmatizing experiences rather than just these identities, as we think this is where the problem really lies.”

Dr. Eisenberg and colleagues used an intersectional lens to assess disparities in emotional distress among youth (N=80,456), including multiple social positions and experiences with bias-based bullying. Social positions (race and ethnicity; sexual orientation; gender) and two types of bias-based bullying (racist or homophobic and transphobic) were entered into decision tree models for depression, anxiety, self-injury, suicidal ideation, and suicide attempts.

The findings, which were published in Pediatrics, showed that LGBQ identities (90%) and transgender, gender diverse, and questioning identities (54%) were common among groups with the highest prevalence of emotional distress, often concurrently, and racial and ethnic identities rarely emerged in this regard. Specifically, bias-based bullying characterized 82% of the highest-prevalence groups. Among comparable groups who did not experience bias-based bullying, emotional distress rates were 20% to 60% lower.

Physician’s Weekly (PW) spoke with Dr. Eisenberg to learn more about the implications of their results.

PW: How was your study conducted?

Dr. Eisenberg: We used existing data from a very large statewide survey to identify diverse groups of youth with the highest rates of emotional distress. Because most groups with high rates of emotional distress also said they had been bullied about their social identities, especially about sexual orientation and/or gender identity, we also looked at the rates of emotional distress among the same groups who had NOT been bullied in this way.

What findings are important to emphasize?

There is a lot of research showing that emotional distress is higher among LGBTQ+ youth than among straight, cisgender youth, and this is often seen as a problem with the young people themselves. This study shows, very clearly, that the problem is stigma—or, in the case of this study, bias-based bullying. If we can “remove” that experience, we can begin to address the disparities.

Can you elaborate on the results related to race and ethnicity?

The finding that racial and ethnic identities rarely emerged in the groups with the greatest emotional distress could be due to a couple of different things. It’s possible that we did not have large enough numbers in some intersecting groups (eg, Latina/x/o bisexual transgender or gender diverse youth versus Asian American bisexual transgender or gender diverse youth) to be able to find statistically significant differences between them. It’s also possible that, because we included race-based bullying in our models, this experience washed out any disparities across race groups that have been seen in other research.

What did the study show regarding suicide attempts?

Suicide attempts are a critical indicator of mental health and one that gets a lot of attention in the media and prevention activities. This also happens to be where our findings are most dramatic, with the greatest disparities between youth who have and have not experienced bias-based bullying. For example, more than half of pansexual/queer youth who were bullied about both race and sexual orientation/gender identity had attempted suicide, but only about 24% of pan/queer youth had NOT been bullied about these things. This is a huge difference.

What are the implications of these findings?

Preventing bias-based bullying is critical to reducing health disparities among youth. Clinicians should talk with their patients about these experiences and advocate on their behalf with school personnel, families, and community contacts.

What would you like to see future research focus on?

We are broadening our inquiry to look at other experiences of stigma faced by youth with intersecting marginalized identities, how these contribute to emotional distress, and effective support for diverse youth.