Community Support for Sexual and Gender Diversity, Minority Stress, and Mental Health: A Mixed-Methods Study of Adolescents With Minoritized Sexual and Gender Identities

The 21st century has been a time of change in recognition of sexual and gender diversity (SGD) in the United States, but we know little about how community-level variability in support for SGD shapes the experience of youth who hold minoritized sexual or gender (MSG) identities. This study used mixed methods to examine regional variability in community climate for SGD and its relationship with minority stress and mental health for adolescents with MSG identities (e.g., asexual, bisexual, gay, lesbian, transgender, nonbinary). Findings revealed differences in objective indicators, self-reported perceptions, and informant narratives of community climate, but survey and narrative data revealed that adolescents experienced heightened levels of depressive symptoms and minority stress processes across communities. Adolescent informants constructed narratives that identified anxiety/depression and self-harm as primary mental health challenges across communities, linking these experiences to societal stigma and insufficient education about SGD. Sources of resilience included mental health services, in-person resources (e.g., school gender-sexuality alliances [GSAs]), online resources, and peer support. Findings reveal the endurance of cultural ideologies that reinforce stigma (e.g., heterosexism, cissexism), activate minority stress processes (e.g., internalized stigma), and contribute to negative mental health (e.g., depressive symptoms), even for adolescents in supportive community settings. Public Significance Statement Disparities in mental health exist for adolescents with minoritized sexual or gender identities, but we lack sufficient knowledge of how different types of communities might exacerbate or ameliorate minority stress processes. This mixed-methods study allowed for a deep interrogation of the experience of minority stress and mental health for adolescents, providing information on possible interventions (e.g. formal education about sexual and gender diversity) to promote health and well-being.