Interpretations and Implications

This longitudinal study that followed 1,689 LGBTQ+ young people ages 13 to 24 in the U.S. from September 2023 to March 2025, captured three waves of data at six-month intervals. Findings highlight both alarming increases in mental health concerns and suicide risk, as well as critical insights into protective factors and systemic barriers faced by LGBTQ+ youth amid a shifting sociopolitical landscape.

Worsening Mental Health and Suicide Risk

Over the one-year period, symptoms of anxiety, depression, and suicidal ideation significantly increased among participants. Anxiety symptoms rose from 57% to 68%, depressive symptoms increased from 48% to 54%, and suicidal ideation rose from 41% to 47%. While suicide attempts declined slightly over the study period (11% to 7%), the overall prevalence remains concerningly high. These increases in mental health distress may reflect escalating social and political pressures facing LGBTQ+ young people, particularly during a period marked by increased legislative targeting of LGBTQ+ rights across the U.S. (Movement Advancement Project, 2025).

These trends may also be linked to broader economic uncertainty (Center on Budget and Policy Priorities, 2024) and a reduction in access to affirming spaces due to sociopolitical shifts following the 2024 presidential election. Prior research has shown that anti-LGBTQ+ policy rhetoric can contribute to significant psychological distress among LGBTQ+ youth (Hatzenbuehler et al., 2010; Russell & Fish, 2016).

Disparities Across Subgroups

Across mental health outcomes, TGNB youth and younger participants (ages 13-17) consistently reported higher levels of distress than their cisgender and older peers. For example, at baseline, TGNB youth were nearly twice as likely to report anxiety (70% vs. 42%) and suicidal ideation (53% vs. 28%) compared to cisgender peers, a pattern that persisted a year later. In addition, youth ages 13 to 17 were more likely than those ages 18 to 24 to report suicide attempts, depression, and anxiety at baseline – and continued to report higher rates of suicide attempts and anxiety one year later. Sexual orientation also played a role: gay and lesbian participants generally reported lower levels of mental health distress, while bisexual, pansexual, and queer youth experienced significantly higher rates.

These findings align with a substantial body of research showing that both TGNB young people and bisexual youth are at significantly greater risk for depression, anxiety, and suicidal thoughts and attempts compared to cisgender and gay/lesbian peers (Feinstein & Dyar, 2017; Liles et al., 2024; Veale et al., 2017). For TGNB youth, elevated risk is attributed to experiences of gender-based discrimination, victimization, and barriers to transgender health care (Nath et al., 2024), while bisexual youth face unique stressors such as erasure and invalidation from both heterosexual and gay/lesbian communities (Price et al., 2021). Younger LGBTQ+ adolescents are also particularly vulnerable, with studies indicating that mental health disparities emerge early and may be exacerbated by limited access to supportive environments and affirming resources (McDermott et al., 2021; Russell & Fish, 2016).

Notably, while race/ethnicity was not associated with depression or suicidal ideation at baseline, by Wave 3, White youth reported higher rates of both compared to youth of color.

Persistent Minority Stress

LGBTQ+ youth in this study experienced persistently high levels of violence and discrimination. Roughly one-third of participants reported harassment or threats because of their sexual orientation both at baseline (31%) and again one year later (32%), while about two-fifths reported gender-identity-based victimization at both time points (43% and 42%). Discrimination was even more pervasive: about 55% of participants experienced sexual-orientation discrimination at both baseline and one year later, while roughly two-thirds of TGNB respondents faced gender-identity discrimination at each time point (62% and 67%). These burdens were especially severe for TGNB youth and youth of color. Experiences of victimization and discrimination are well-established drivers of minority stress and mental health disparities in LGBTQ+ youth (Poteat et al. 2020, Russell & Fish, 2016). These findings mirror national survey data and reinforce the urgent need for systemic anti-bullying and anti-discrimination policies (Kosciw et al., 2020, 2022; Nath et al., 2024; The Trevor Project, 2023a).

Conversion therapy exposure in this cohort is deeply troubling. By Wave 3, almost one-quarter of participants (22%) had been threatened with conversion therapy and 15% had actually experienced it – 11 and 6 percentage-point increases, respectively, since baseline. LGBTQ+ young people of color reported the highest levels of both threats and exposure. Given that every major medical and psychological association condemns conversion therapy (The Trevor Project, 2023b) and links it to severe mental health harm (Green et al., 2020), these rates demand urgent attention. The uptick may stem from the recent weakening or uneven enforcement of state and local bans, along with a resurgence of anti-LGBTQ+ rhetoric that may have emboldened some providers and faith-based groups to resume or expand these practices. Because the study relies on a non-probability sample, the exact percentages may not represent all LGBTQ+ youth; nonetheless, the pattern signals a serious and growing risk within this population.

Economic insecurity emerged as a growing concern over the study period. At baseline, 14% of participants reported lacking basic necessities, and 21% experienced such hardship during the subsequent year. Houselessness followed a similar pattern: 21% at baseline reported being unhoused currently or at some point in the past, and 10% reported an episode of houselessness during the follow-up year. Youth ages 18 to 24, TGNB participants, and youth of color reported higher rates than youth ages 13 to 17, cisgender participants, and White youth. Economic instability has been repeatedly shown to heighten suicide risk among LGBTQ+ youth (The Trevor Project, 2025). The uptick in economic insecurity likely reflects the combined impact of 2024–25 cost-of-living spikes (The Hope Center for Student Basic Needs, 2025) and anti-LGBTQ+ discrimination in housing and employment (Human Rights Watch, 2025). These pressures disproportionately affect TGNB youth and youth of color, while young adults ages 18 to 24 experience greater economic strain than 13 to 17 year-olds because they are often aging out of family homes and must secure other housing on their own.

Barriers and Progress in Access to Care

Access to mental health care remained a major challenge. While 81% of youth expressed a desire for mental health care at baseline, and 80% reported accessing it at some point, only 60% who wanted care received it during the subsequent year. Persistent demographic disparities were evident throughout the study period. Younger participants (ages 13–17), cisgender youth, and youth of color consistently reported lower rates of accessing desired mental health care. These disparities remained after a year, highlighting ongoing systemic inequities such as affordability issues, provider bias, and prior negative experiences as enduring barriers (Alencar Albuquerque et al., 2016; Dawes et al., 2023; Snow et al., 2019). At follow-up, affordability remained the leading barrier and fear-based concerns were still common; additional obstacles (e.g., needing parent/caregiver permission and insurance denials) also featured prominently. Because follow-up measured recent experiences rather than lifetime exposure at baseline, these patterns indicate persistent — and in some cases intensifying — access problems.

Conversion therapy exposure in this cohort is deeply troubling. By Wave 3, almost one-quarter of participants (22%) had been threatened with conversion therapy and 15% had actually experienced it – 11 and 6 percentage-point increases, respectively, since baseline. LGBTQ+ young people of color reported the highest levels of both threats and exposure. Given that every major medical and psychological association condemns conversion therapy (The Trevor Project, 2023b) and links it to severe mental health harm (Green et al., 2020), these rates demand urgent attention. The uptick may stem from the recent weakening or uneven enforcement of state and local bans, along with a resurgence of anti-LGBTQ+ rhetoric that may have emboldened some providers and faith-based groups to resume or expand these practices. Because the study relies on a non-probability sample, the exact percentages may not represent all LGBTQ+ youth; nonetheless, the pattern signals a serious and growing risk within this population.

Encouragingly, although a smaller share of LGBTQ+ youth obtained the mental health care they wanted within the past year than had ever accessed such care at baseline, the proportion who found that care helpful was higher. The proportion of youth who found mental health care helpful increased from 61% to 75% over the year. Helpful care is strongly associated with reduced depression, increased hope, and better coping (Craig et al., 2021). However, younger participants rated their care as less helpful than older peers, highlighting ongoing gaps in youth-centered, developmentally appropriate services.

Mental health-related hospitalizations also revealed disparities. Although only 4% of youth were hospitalized due to a mental health condition during the follow-up, those with prior mental health-related hospitalizations were much more likely to be hospitalized again, particularly TGNB youth. This points to gaps in post-hospitalization support, as well as the need for outpatient and preventative supports for youth with acute mental health needs.

For TGNB youth, access to medical, legal, and social supports for gender transition improved modestly over the year. Among those who initially lacked access, 59% obtained tools related to their gender expression or transition and 36% accessed hormones within one year. However, access varied widely by age, gender identity, and sexual orientation, with younger TGNB youth (ages 13-17) being much less likely to access hormones than older peers. These disparities reflect structural barriers (such as state laws and clinical policies), developmental factors (Durwood et al., 2021; Turban et al., 2020), and younger TGNB youth’s greater reliance on parental support when accessing transgender health care.

Environmental and Identity-Based Supports as Protective Factors in LGBTQ+ Youth Outcomes

Only about half of the participants had access to LGBTQ+-affirming environments – both in school and at home. While school affirmation rose modestly from 53% at baseline to 58% a year later, home affirmation did not change. Family support emerged as a critical but uneven resource: youth reported an average of only 1.9 supportive family actions (on a scale of 4-point scale) – closer to “some” than “most” – and this level barely changed over the study year. Support was lowest for younger adolescents and TGNB youth, both of whom remain at highest risk for poor mental health outcomes. The relative rarity of this support does not diminish its importance however, as each one-point of support on the family-support actions scale was associated with 53% lower odds of suicidal ideation over time. Even small increases in specific affirming behaviors (e.g., using chosen names, respectful conversation about identity) are linked to sharp drops in suicide risk (Ryan et al., 2010).

Gender euphoria also increased over the year. This suggests that, despite external stressors, some youth are experiencing greater self-acceptance and affirmation, possibly due to increased internal resilience or support from peers and online communities. Peer connections – especially friends – are a cornerstone of support. When experiencing suicidal thoughts, participants turned to friends more than any other source, and this reliance grew markedly over time, outpacing increases for parents. These findings underscore the value of moderated peer platforms such as TrevorSpace – safe, scalable communities in which youth support each other and generate their own content – which complement clinical care and can especially reach younger adolescents who are least likely to access professional services.

Over the study’s first year, more LGBTQ+ youth reached out for support during suicidal crises, speaking of the rising need for support. Over the course of a year, contacts with mental health professionals doubled, and appeals to friends, partners, and family all jumped sharply. This pattern mirrors data from The Trevor Project’s crisis lines where a 700% spike in crisis contacts was logged in the days after the 2024 election (Alfonseca, 2024). The finding signals that young people’s desire for help is growing just as many LGBTQ+-affirming programs face cuts or bans, underscoring the urgency of protecting and expanding accessible, confidential services – especially for younger teens, who remain least likely to secure professional care.

Temporal Relationships and Causal Insights

Longitudinal analyses confirmed that risk factors – including discrimination, economic insecurity, violence, and conversion therapy – directly contributed to worsening mental health. Youth facing unmet basic needs, physical threats, or discrimination were significantly more likely to experience anxiety, depression, and suicidal ideation over time. Prior mental health-related hospitalization predicted higher levels of anxiety – likely reflecting ongoing psychological distress, limited access to outpatient care, or fear of future hospitalization (Daughtrey et al., 2024).

Conversely, protective factors played a clear role in reducing mental health symptoms over time. Youth who received helpful mental health care were significantly less likely to experience anxiety, depression, or suicidal ideation. Access to medical, legal, and social supports for gender transition – including hormones, puberty blockers, and accurate identification documents – contributed to improved mental health among transgender and nonbinary youth, highlighting the potential harm created by legislation reducing access to transgender health care and accurate identification documents. Supportive family environments, accepting friends, and greater cumulative family support actions all reduced the likelihood of anxiety, depression, and suicidal ideation, echoing decades of research on the protective power of family acceptance (Nath et al., 2025; Ryan et al., 2010; Snapp et al., 2015).

Broader Context and Policy Implications

The worsening mental health trends documented here must be understood within the context of growing sociopolitical hostility toward LGBTQ+ youth, particularly transgender and nonbinary individuals. State-level legislative attacks, public policy debates, and media coverage have compounded internal experiences of marginalization, especially for youth at the intersection of multiple identities (Dhanani & Totton, 2023; Moran et al., 2025; Roche et al., 2024). Research has shown that inclusive state policies and school climates are protective, while exclusionary or hostile environments increase risk (Kosciw et al., 2022; Lee et al., 2024; Moran et al., 2025).

At the same time, the data offer hope: access to mental health care and transgender health care, supportive relationships, and affirming environments not only mitigate distress but promote resilience. These findings echo the minority stress model (Meyer, 2003), which emphasizes the dual impact of stressors and resilience-promoting factors on LGBTQ+ well-being.

Limitations

Despite its strengths, this study has some important limitations. First, these findings represent an interim analysis and reflect only the first three waves of this longitudinal study; additional data from upcoming waves may alter observed trends and associations. Second, all measures rely on self-report, which can introduce recall bias or social-desirability effects, particularly around sensitive topics such as suicide or conversion therapy. Although validated screeners and standardized items help maximize reliability, objective linkage to administrative or clinical data would be needed to confirm hospitalization and treatment histories.

Attrition over time is another key limitation. Generalized linear mixed models (McCulloch & Searle, 2004) allow participants to contribute data even if they did not complete one or more follow-up surveys. These estimates are valid if the missing data can be explained by variables we observed – that is, the data are “missing at random” given measured factors such as age or baseline symptoms. However, if people who stopped participating differ from those who remained in ways we did not measure, the results could be biased. Also, the sample, though large and diverse, is not nationally representative; recruitment was primarily online, which may exclude youth without reliable internet access, limiting generalizability. For this reason, the point prevalences should not be generalized to LGBTQ+ young people broadly, but rather what is learned in terms of which factors are associated with mental health and suicide and how they change over time.

Finally, while the longitudinal design allows for examination of associations over time, causal inferences remain limited due to possible unmeasured confounding and the observational nature of the study. The broader sociopolitical context – including significant anti-LGBTQ+ legislation and rhetoric during the study period – likely influenced participants’ experiences and mental health, but the study was not designed to isolate the effects of specific external events or policies. These limitations highlight the need for cautious interpretation and underscore the importance of continued data collection and analysis in future waves.