Photo Credit: Chanakon Laorob

Improving strengths-based communication and family support for LGBTQ+ youth may be particularly effective in mitigating stress and enhancing resilience.

Among adolescents attending annual primary care visits, lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) status was significantly linked with more depressive symptoms and higher odds of suicidal ideation and past suicide attempt, according to study findings published in JAMA Pediatrics.

“Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support–focused interventions to mitigate mental health inequities for LGBTQ+ youth,” Joseph Whelihan, MD, and colleagues wrote.

The study included 60,626 youths aged 13 to 19 who completed the Patient Health Questionnaire–9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ) during well visits at 32 clinics in Pennsylvania and New Jersey. Among them, 16.4% were LGBTQ+, 25.5% were Black, and 50.0% were assigned female sex at birth.

Median scores on the PHQ-9-M, on which higher scores indicate higher levels of depressive symptoms, were 5 for LGBTQ+ adolescents compared with 1 for non-LGBTQ+ adolescents, according to the study. The prevalence of suicidal ideation was 15.8% for LGBTQ+ adolescents and 3.4% for non-LGBTQ+ adolescents.

LGBTQ+ status was associated with a mean 3.3-point higher PHQ-9-M score after adjustment for demographics and parental support, analysis showed. Adjusted odds ratios were 4.3 for suicidal ideation and 4.4 for prior suicide attempts for LGBTQ+ youth.

While all participants reported fairly high levels of family support, LGBTQ+ youth reported family support less frequently than non-LGBTQ+ youth. 85.9% of LGQTQ+ youth reported parental discussion of adolescent strengths compared with 92.7% of non-LGBTQ+ youth. 79.8% of LGBTQ+ youth reported having parents or guardians who listened to and took their feelings seriously compared with 93.1% of non-LGBTQ+ youth.

“Across mental health outcomes, parental discussion of strengths and having a parent who listened to feelings were significantly protective,” researchers wrote. “Having a parent who listened to feelings was associated with a 3.4-point reduction (95% CI, -3.5 to -3.3) in PHQ-9-M score.”

By identity, parental support was even more protective for LGBTQ+ than non-LGBTQ+ youth on PHQ-9-M score and suicidal ideation.

“This finding suggests that while interventions to enhance family support and strengths-based communication may be effective methods of mitigating stress and enhancing resilience for all youth,” researchers wrote, “they may be particularly effective among LGBTQ+ youth.”