Results: Temporal Relationships

Both risk and protective factors were associated with changes in participants’ likelihood of experiencing recent symptoms of anxiety and depression, as well as past-year suicide ideation. Over the course of the first year of the study, suicide attempts were too rare of an event to produce models that reliably converged. All models took into account the nested nature of the data, in which multiple observations from the same participant were taken over time. Models also controlled for age, sexual orientation, gender identity, and race/ethnicity.

Also, not described earlier, we examined the effects of high social support as a protective factor for the outcomes we look at below. Friend and family support were operationalized using an abridged version of the Multidimensional Scale of Perceived Social Support (MSPSS). Participants were categorized as having high support if they scored above 5 (“mildly agree” or higher) on the 1–7 response scale. Descriptive percentages at baseline and follow-up are not shown here because analyses focused on this dichotomized “high support” measure, which was used consistently across all models.

Anxiety

Risk Factors

The following risk factors were independently associated with an increase in the likelihood of anxiety symptoms:

• Having been recently hospitalized due to a mental health condition (adjusted odds ratio [aOR]=1.54, 95% Confidence Interval [CI] = 1.05-2.23).
• Being unable to meet basic needs (aOR=2.51, 95% CI = 1.73 – 3.64).
• Having a history of houselessness (aOR=1.41, 95% CI = 1.10 – 1.81).
• Being discriminated against because of sexual orientation (aOR=1.48, 95% CI = 1.09 – 2.02).
• Being physically threatened because of gender identity (aOR=1.96, 95% CI = 1.42 – 2.72).

Protective Factors

The following protective factors were independently associated with a reduction in the likelihood of anxiety symptoms:

• Receiving mental health care that was found to be helpful (aOR=0.75, 95% CI = 0.58-0.97).
• For TGNB participants, having access to gender-accurate identification documents (aOR=0.60, 95% CI = 0.43-0.83).
• Receiving high support from friends (aOR=0.68, 95% CI = 0.55-0.84).
• Receiving high support from family (aOR=0.34, 95% CI = 0.28-0.41).
• Living in an LGBTQ+-affirming home (aOR=0.82, 95% CI = 0.68-0.98).
• Experiencing supportive actions from family (aOR=0.65, 95% CI = 0.55-0.76).

Depression

Risk Factors

The following risk factors were independently associated with an increase in the likelihood of depressive symptoms:

• Being unable to meet basic needs (aOR=2.17, 95% CI = 1.52 – 3.12).
• Having ever been threatened with or subjected to conversion therapy (aOR=1.28, 95% CI = 1.01 – 1.55).
• Being discriminated against because of sexual orientation (aOR=1.37, 95% CI = 1.07-1.75).
• Being physically threatened because of sexual orientation (aOR=1.47, 95% CI = 1.13-1.90).
• Being physically threatened because of gender identity (aOR=1.61, 95% CI = 1.17-2.20).

Protective Factors

The following protective factors were independently associated with a reduction in the likelihood of depressive symptoms:

• Receiving mental health care that was found to be helpful (aOR=0.64, 95% CI = 0.50-0.82).
• Receiving high support from friends (aOR=0.51, 95% CI = 0.41-0.62).
• Receiving high support from family (aOR=0.38, 95% CI = 0.31-0.46).
• Living in an LGBTQ+-affirming home (aOR=0.63, 95% CI = 0.52-0.74).
• Experiencing supportive actions from family (aOR=0.51, 95% CI = 0.44-0.60).
• For TGNB participants, having access to desired hormones (aOR=0.55, 95% CI = 0.38-0.80) and puberty blockers (aOR=0.55, 95% CI = 0.38-0.80).
• For TGNB participants, having access to gender-accurate identification documents (aOR=0.67, 95% CI = 0.50-0.90).

Suicidal Ideation

Risk Factors

The following risk factors were independently associated with an increase in the likelihood of suicidal ideation:

• Being unable to meet basic needs (aOR=1.72, 95% CI = 1.18 -2.49).
• Having a history of houselessness (aOR=3.01, 95% CI = 2.21-4.08).
• Having ever been threatened with or subjected to conversion therapy (aOR=2.17, 95% CI = 1.76-2.67).
• Being discriminated against because of sexual orientation (aOR=1.35, 95% CI = 1.03-1.76).
• Being discriminated against because of gender identity (aOR=1.48, 95% CI = 1.07-2.05).
• Being physically threatened because of sexual orientation (aOR=2.10, 95% CI = 1.58 – 2.78).
• Being physically threatened because of gender identity (aOR=2.85, 95% CI = 2.03-4.00).

Protective Factors

The following protective factors were independently associated with a reduction in the likelihood of suicidal ideation:

• Receiving mental health care that was found to be helpful (aOR=0.48, 95% CI = 0.37-0.62).
• Receiving high support from friends (aOR=0.74, 95% CI = 0.59-0.92).
• Receiving high support from family (aOR=0.38, 95% CI = 0.33-0.46).
• Living in an LGBTQ+-affirming home (aOR=0.63, 95% CI = 0.52-0.74).
• Experiencing supportive actions from family (aOR=0.47, 95% CI = 0.39-0.56).
• For TGNB participants, having access to desired hormones (aOR=0.65, 95% CI = 0.44 – 0.97).
• For TGNB participants, having access to gender-accurate identification documents (aOR=0.62, 95% CI = 0.45-0.84).