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Mental health inequality in young LGBT+ people demands early universal interventions

Nature Mental Health volume 2, pages 257–258 (2024)Cite this article

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We highlight three main reasons why school-based universal interventions should be more widely developed, evaluated and implemented to reduce mental health inequalities among sexual and gender minorities. First, school-based universal interventions aim to decrease minority stressors, such as bullying and victimization, and increase inclusivity and acceptance towards young people from sexual and gender minorities. As a result, universal interventions can improve the overall school climate and reduce depression, anxiety and self-harm among young people from sexual and gender minorities6. Second, universal interventions are delivered to sexual and gender minority as well as heterosexual and cisgender students and staff. This avoids placing the burden for change only on the minoritized group affected by the mental health inequality. Instead, the responsibility for creating more equitable, safe and inclusive environments is shared with the entire school population. Third, as part of a previous project, young sexual and gender minorities with lived experience of mental health difficulties have mentioned that universal interventions avoid the risk of some students and staff not participating in interventions6. This ensures that no young person is singled out or feels judged or uncomfortable in front of peers and/or teachers.

Previous research suggests that preventative interventions are needed from early adolescence, if not late childhood. There is evidence that the mental health inequality is present from as early as 10 to 11 years of age1. Around this age, the brain undergoes structural and functional changes associated with the development of romantic feelings and sexual attraction7. This often happens before young people become fully aware of their sexual and gender identity. In one prospective cohort study, adolescents who identified as a sexual minority at 16 years of age were twice as likely to be bullied at ages 10, 12 and 168. Young sexual and gender minorities might be targeted due to being perceived as different from their peers — for example, due to non-conformity to gender norms and stereotypes — even if the young person has not yet ascribed this difference to their sexual or gender identity9. This suggests that exposure to minority stressors occurs earlier in adolescence than perhaps generally expected. Early implementation of universal interventions might prevent the development of discriminatory attitudes and behaviors by fostering acceptance and inclusivity of diverse sexual and gender presentation and identities from an early age.

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Acknowledgements

G. Lewis is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (grant number 223248/Z/21/Z). The authors thank the members of the Young People Advisory Group, who have provided important insights on the potential prevention of mental health inequalities among young sexual and gender minorities.

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Author notes

  1. These authors contributed equally: Elizabeth Ingram, Merle Schlief

Authors and Affiliations

  1. Department of Applied Health Research, University College London, London, UK

    Elizabeth Ingram

  2. Division of Psychiatry, University College London, London, UK

    Merle Schlief, Grace Levy, Theodora Stefanidou, Talen Wright & Gemma Lewis

  3. School of Public Health, Yale, New Haven, CT, USA

    John E. Pachankis

  4. Bipolar UK, London, UK

    Talen Wright

Authors
  1. Elizabeth Ingram
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  2. Merle Schlief
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  3. John E. Pachankis
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  4. Grace Levy
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  5. Theodora Stefanidou
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  6. Talen Wright
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  7. Gemma Lewis
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Contributions

E.I. and M.S. drafted and revised the manuscript. J.P., G. Levy, T.S., T.W. and G. Lewis reviewed and provided written feedback on the manuscript drafts.

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Correspondence to Merle Schlief.

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The authors declare no competing interests.

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Ingram, E., Schlief, M., Pachankis, J.E. et al. Mental health inequality in young LGBT+ people demands early universal interventions. Nat. Mental Health 2, 257–258 (2024). https://doi.org/10.1038/s44220-024-00201-9

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