Rural Health: Breaking down the data. What does the 2025 U.S. National Survey say about LGBTQ+ young people living in rural areas?

The Trevor Project’s 2025 U.S. National Survey on the Mental Health of LGBTQ+ Young People analyzed the experiences of more than 16,000 LGBTQ+ young people ages 13 to 24 across the United States. The survey covers an array of risk factors, protective factors, and day-to-day experiences that impact LGBTQ+ young people’s mental health and well-being. This blog post offers a deeper dive into the data – and offers a breakdown of what the 2025 U.S. National Survey reveals about the experiences of LGBTQ+ young people living in rural areas.

What is a rural area and why does it matter for health?

Though there are many ways to define what makes an area “rural,” the definition most commonly used by the U.S. Census Bureau describes rural communities as areas located outside densely populated urban centers or cities, with comparatively fewer people and housing spread across a geographic area.

On average, those living in rural areas have increased morbidity and mortality compared to their urban counterparts, and research suggests this gap is actually growing over time.¹ One major driver of these inequities is unequal access to health care. A lack of health care facilities, and difficulty in recruiting and retaining health care professionals to live in rural areas, have created a situation in which rural Americans are on average sicker than non-rural Americans, but less able to get the health care they need.²

Notably, people living in the rural U.S. consistently point to mental health as a primary unmet health need. Rural health care workers, government officials, academics, and others responsible for promoting the health of rural Americans all pointed to mental health as the most common rural health priority.³

What is happening in the lives of LGBTQ+ young people living in rural areas?

While much is known about health inequities in rural communities, far less research has explored the experiences of LGBTQ+ young people living in these areas. What we do know, however, underscores the importance of prioritizing the unique needs of this group. In addition to the broader challenges already facing rural communities, LGBTQ+ young people often navigate added barriers such as:^4,5

• Lack of health care providers trained to provide LGBTQ+-affirming care
• Stigma and a reluctance to disclose LGBTQ+ identity to providers
• Social and geographic isolation from other LGBTQ+ people
• Prevalence of anti-LGBTQ+ policies being proposed and enacted in local communities and schools
• Higher rates of mental health and suicide risk but reduced access to mental health care

What do we know about the mental health of LGBTQ+ young people living in rural areas?

The combination of previously mentioned factors have encouraged researchers to document health inequities of LGBTQ+ people living in the rural U.S., although most of this work only includes cisgender adults.⁴ However, new research from The Trevor Project’s 2025 U.S. National Survey on the Mental Health of LGBTQ+ Young People now treats rurality as one of the key demographic factors by which to explore the mental health experiences of LGBTQ+ young people.

We found that rural LGBTQ+ young people are doing worse than their peers living in other areas of the country in terms of mental health and suicide risk:

• 64% of LGBTQ+ young people in rural areas reported recent symptoms of anxiety, and 51% reported recent symptoms of depression.
• 43% of LGBTQ+ young people living in rural areas considered suicide in the last year. This rate was significantly higher than those who lived in a large city (33%), just outside a large city (35%), or in a small city or town (37%).
• 13% of LGBTQ+ young people living in rural areas attempted suicide in the past year, compared to those who lived in other parts of the country (10%).

Though we have a lot left to learn, we have identified some factors that may explain these findings:

• Only 50% of LGBTQ+ young people living in rural areas said they could access the mental health care they wanted, compared to 59% of those who lived in a large city, 56% of those just outside a large city, or 55% of those in a small city or town.
• Nearly 1 in 3 (29%) TGNB young people had been physically threatened or harmed in the past year due to their gender identity. 
• 38% of LGBTQ+ young people in rural areas reported experiencing discrimination on the basis of their sexual orientation; 26% of those in large cities reported the same.
• Over half (53%) of TGNB young people in rural areas reported discrimination on the basis of their gender identity in the past year; 46% of those in large cities reported the same.
• Nearly 1 in 5 (19%) LGBTQ+ young people in rural areas reported having been threatened or subjected to conversion therapy; 15% of those in large cities reported the same.

How can you support LGBTQ+ young people living in rural areas?

Despite the numerous challenges LGBTQ+ young people in rural areas face, these findings also point to possible solutions. For example, increasing and promoting access to specially trained providers who can provide LGBTQ+-affirming care remotely can help address a lack of providers within a physical geographic location.

For more information about supporting LGBTQ+ young people in rural areas, check out our Resource Center, as well as guides like “How to Signal You are an Ally in a Hostile Environment” and “Navigating Personal Safety while Taking Action as an LGBTQ+ Young Person.”

References

1. Abrams, L. R., Myrskylä, M., & Mehta, N. K. (2021). The growing rural–urban divide in US life expectancy: contribution of cardiovascular disease and other major causes of death. International Journal of Epidemiology, 50(6), 1970-1978. https://doi.org/10.1093/ije/dyab158 

2. Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to health care access in the rural USA. Public Health, 129(6), 611-620. https://doi.org/10.1016/j.puhe.2015.04.001 

3. Callaghan, T., Kassabian, M., Johnson, N., Shrestha, A., Helduser, J., Horel, S., Bolin, J. N., & Ferdinand, A. O. (2023). Rural healthy people 2030: New decade, new challenges. Preventive Medicine Reports, 33, 102176. https://doi.org/10.1016/j.pmedr.2023.102176 

4. Rosenkrantz, D. E., Black, W. W., Abreu, R. L., Aleshire, M. E., & Fallin-Bennett, K. (2017). Health and Health Care of Rural Sexual and Gender Minorities: A Systematic Review. Stigma and Health, 2(3), 229-243. https://doi.org/10.1037/sah0000055 

5. Whitten, C., (2025) Queerness in Rural Schools: A Literature Review Exploring the Intersection of Rurality and Queerness in K–12 Schools. Journal of Research in Rural Education, 41(2), 1–16. https://doi.org/10.26209/JRRE4102