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The risk of suicide among LGBTQ+ youth is almost 4 times higher than for youth who don’t identify as LGBTQ+. If that surprises you, the cause of the increase will be even more shocking.

Today we talk with Dr. Amy Green from The Trevor Project as she reveals the findings of the 2021 National Survey on LGBTQ+ Youth Mental Health and discusses what we, as a society, can do to reduce the risk of LGBTQ+ youth suicide.

Dr. Amy Green

Dr. Amy Green (she/her) is Vice President of Research at The Trevor Project. Her team supports the organization’s life-saving work by using internal and external data and research findings to advance its crisis services and peer support programs, as well as advocacy and education initiatives. Under Green’s leadership, the research team produces innovative research that brings new clinical implications to the field of suicidology and LGBTQ+ mental health, and which enables the organization to better understand the lives of LGBTQ+ youth and suicidality. In addition to leading The Trevor Project’s annual National Survey on LGBTQ Youth Mental Health, her team publishes multiple research reports per year, plus monthly research briefs that help inform the work of LGBTQ+ youth serving agencies and mental health organizations.

She has spent nearly 20 years conducting research related to youth mental health and well-being and has published over 50 peer-reviewed manuscripts. Her primary research interests include understanding and promoting resilience among LGBTQ+ youth, examining the social context of suicide risk, and utilizing implementation science to increase the positive impact of programs, policies, and practices, to reduce disparities for LGBTQ+ youth.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of Inside Mental Health: A Psych Central Podcast, I’m your host, Gabe Howard, and I want to thank our sponsor, Better Help. You can get a week free just by visiting BetterHelp.com/PsychCentral. Calling into the show today we have Dr. Amy Green. Dr. Green is the vice president of research at the Trevor Project. In addition to leading the Trevor Project’s annual National Survey on LGBTQ Youth Mental Health, her team publishes multiple research reports per year, plus monthly research briefs that help inform the work of the LGBTQ youth-serving agencies and mental health organizations. Dr. Green, welcome to the show.

Dr. Amy Green: Thanks so much for having me. Great to be here.

Gabe Howard: Since 1999, June has been set aside to celebrate and honor the experiences of the LGBTQ+ community. Since 2009, June has officially been called Pride Month, and I’m excited to welcome the Trevor Project to our show to help us understand the unique risk factors that members of the LGBTQ+ community face when it comes to suicidality. But before we dive into that, Dr. Green, can you tell our listeners what the Trevor Project does?

Dr. Amy Green: The Trevor Project is the world’s largest suicide prevention and crisis intervention organization for LGBTQ young people, and we provide support to youth who are in crisis, feeling that they need an accepting person in their life to help get them through a challenging time. And so we do this through a number of confidential crisis programs on our platforms, such as TrevorLifeline, TrevorChat and TrevorText. And so those are 24/7 available ways for LGBTQ youth to reach out to someone at any time that they are in need. And we do that again over online and, on the phone, since that’s where youth are often spending their time. We also have the world’s largest safe space social networking site for LGBTQ youth, and that is called TrevorSpace. And we have innovative public education advocacy and research programs. This all works together as a united force to really better support LGBTQ youth.

Gabe Howard: Now it sounds like you’re saying, and please correct me if I’m wrong, that the LGBTQ youth have a higher risk for suicide than the national average. Is that true?

Dr. Amy Green: Yes, unfortunately, that is true and it’s something that folks suspected for a decent amount of time just out of anecdotes, stories, things that they knew, stories about bullying and then more recently, so like in 2015, 2017, 2019 at the federal government level, a lot of data was collected and it actually showed that compared to straight and cis-gender youth, so those who aren’t LGBTQ, LGBTQ youth were at more than four times greater risk of attempting suicide in the past year. Let’s go to high school youth, for example, those who aren’t LGBTQ, about 5% of them attempt suicide in any given year. And that in itself is a really high number to think of one in 20 youth in high school. When we get the LGBTQ youth, that number gets up above 20%. Youth suicide is unacceptable and preventable in the first place. But now we have a population who, unfortunately, is at much higher risk.

Gabe Howard: Why are LGBTQ+ youth at a higher risk for suicide?

Dr. Amy Green: Well, there’s been a number of studies done over the years, and what it’s really boiled down to is that there’s not something inherent about being LGBTQ that increases risk for mental health challenges or considering or attempting suicide. Unfortunately, it’s the way LGBTQ youth and LGBTQ people in general are treated by those who are close to them, like rejection from friends and family and other important people in their lives, by schools and bullying experiences that may be hostile to them all the way up to, on a societal level, experiences of discrimination, victimization, having policies that prevent them from having equal rights, that this is pretty cumulative and it adds up. And when we think about adolescents in general, it’s a time where folks are seeking acceptance so much, just looking for people to accept them and to love them as and for LGBTQ youth, unfortunately, a lot of those youth face rejection and that can be really painful.

Gabe Howard: What are some of the key risk factors for LGBTQ+ youth suicide? Are there specific warning signs that differ from the general population?

Dr. Amy Green: In terms of warning signs, I haven’t seen too much research that talks about different warning signs for suicide. And they may be things like talking very specifically about not wanting to be there or making comments about people being better off if they were gone, things like giving away some of their possessions, really withdrawing from life, not caring as much anymore. I haven’t seen too much that shows that that might differ. But the parts that get them to that point are often a bit different for LGBTQ youth. One of the most powerful negative risk factors is rejection, particularly as it comes from people who are close to them. So their friends and family. That’s something that fortunately most youth don’t have to experience in terms of existing, being who they are. And your friends and family are usually the people who stand up for you and love you the most. And having those be the folks who are saying you’re wrong, I don’t accept this, you can’t be this way, is really painful.

Dr. Amy Green: Also, bullying is a problem for youth in general, but the bullying takes on specific risk when it’s related to aspects of a youth’s identity. So related to their sexual orientation and gender identity, as well as experiences of discrimination and for transgender and non-binary youth, those experiences happen in all sorts of places and can include things like not being able to use the bathroom that aligns with their gender. And it’s really a lot of cumulative risk related to how they’re treated based on their sexual orientation and gender identity. And then also we see a lot about that there are unfortunately right now a lot of discriminatory policies continue to pop up across the country. And we think about youth sometimes as being maybe disengaged from the political process. But they’re not. They’re paying attention and they’re seeing hate and they’re seeing harmful rhetoric about who they are and their identities. Those are all risk factors and those are risk factors that are pretty specific to LGBTQ youth. So, while the things to look out for in terms of if a youth might be at risk for attempting suicide look pretty similar, the things that get them there are actually different and pretty centered around their identity.

Gabe Howard: Dr. Green, I know that you lead the research team for the Trevor Project and the 2021 National Survey on LGBTQ+ Youth Mental Health just came out. I know we can’t read the entire thing on this podcast, but what are some of the key findings of that survey?

Dr. Amy Green: Yeah, thanks for asking, Gabe, this past year has been incredibly difficult for so many with everything that happened, but we also know that LGBTQ youth face some unique challenges and our 2021 survey was able to capture the experiences of nearly 35,000 of those between the ages of 13 and 24. This is our third year doing it. And so one of the things that we’re seeing is that we’re not seeing large overall changes in terms of the percentage of LGBTQ youth who said they seriously considered suicide or attempted suicide in the past year. It was about 42% this year for those who seriously considered in the past 12 months and our past years, it’s been around 40. So pretty close. In terms of suicide attempts, our overall rates in the past couple of years have always been somewhere around 14 to 15 percent. So seeing some stability there. Not seeing high increases necessarily related to what’s happened in the past year with the COVID-19 pandemic. But one of the things that we did new this year is that when our overall report came out, we segmented not just by sexual orientation, gender identity and age, but we really looked at that data on how it interplays between LGBTQ identities and youth race, ethnicity, and that’s where some of the findings really start to look more stark. So when I said that 14% overall attempted suicide in the past year, well, it was 12% of white youth. That’s around or a little lower than we’ve seen in the past years, but for our LGBTQ youth of color.

Dr. Amy Green: Thirty one percent for native indigenous youth. Twenty one percent for black youth. Twenty one percent for youth who had more than one race ethnicity, 18 percent for Latinx youth. And then Asian Pacific Islander were right around what white youth were at 12%. But it’s really important for us to think intersectionally. And that’s one of the things we’ve really focused on in our work, because if we look overall, the message could be, oh, yeah, well, maybe everybody’s kind of doing OK in this COVID-19 pandemic. It looks like not too much different from the previous year, but when we really start breaking that out, we see that there are youth who are struggling more and that really in our work ends up being LGBTQ youth of color and LGBTQ youth who are transgender and non-binary, who also had much higher risk. One, it’s an unacceptable level in terms of considering and attempting suicide, but also that there are segments of the LGBTQ population who are struggling more and that ends up paralleling the data that we see on risk factors. So we have data on discrimination experiences, on food insecurity in the past year, on whether or not they’ve experienced conversion therapy or someone trying to change their sexual orientation or gender identity. And these are experienced by those who are transgender and non-binary and LGBTQ youth of color at higher rates. And so we’re sort of directly seeing this interplay of some of these risk factors and having greater levels relating to suicide risk. I think in the pandemic, one thing that’s been really interesting is the conversation has shifted towards mental health a lot.

Dr. Amy Green: And it’s been really interesting and great to see in terms of when we think about de-stigmatizing mental health and all the interesting things that have happened with digital therapeutics and telehealth. But in our data, we’re still seeing big gaps in terms of LGBTQ youth who want mental health care and are able to receive it. Most of our sample who wanted mental health care weren’t able to get it. And that’s even greater disparities for LGBTQ youth of color in terms of most of those who wanted it, weren’t able to get it.

Gabe Howard: It seems like all of the risk factors that you keep mentioning are societal. There doesn’t seem to be any risk factors that are physical attributes or anything like that. It’s just the way that our society and culture treat people who are in the LGBTQ community. Is that an oversimplification or is that exactly right?

Dr. Amy Green: I love that framing. When we talk about LGBTQ youth, we need to get away from thinking at this individual level or risk that’s inherent to a person. And think about this, what’s called the social context, everything that’s happening around them. And you’re spot on that with LGBTQ youth at risk factors that we’re seeing or that social context, it’s the environment that they’re living in. When LGBTQ youth are provided with support, they have an affirming space, they’re not having discrimination, they’re doing pretty well. It’s one of those things where there really need to be some changes in the way that we treat people in order for the mental health and the mental well-being of this group of youth to start improving.

Gabe Howard: Back to the 2021 national survey, you noted disparities across gender and race. Is that still just caused by our society and nothing more?

Dr. Amy Green: You know, 2021 was, it was a rough year for a lot of folks, but one of the data points from our survey was that 67% of black LGBTQ youth and 60% of Asian Pacific Islander LGBTQ youth reported that they were discriminated based on their race ethnicity. With some data that we looked at where we broke down ways that youth could have been discriminated against based on their sexual orientation, based on their gender identity, and then based on their race ethnicity. And I would encourage folks to take a look at the survey when they’re able to on our website. But you’ll see it’s probably one of the most drastic bar charts that we have on our graph, because you can see the numbers go from when these youth have no instances of discrimination, it’s quite low. And then it goes all the way up to 36% if they have three different instances of discrimination. So going from I think 7% when they say no, I’ve had none of these types of discrimination. And remember I said that that national average was around like 5%, all the way up to 36%. And so yeah absolutely. It’s compounded. Those youth have multiple aspects of their identity that they are experiencing rejection, discrimination, stigma, and it unfortunately adds up.

Gabe Howard: I think that the average person can understand that when things go wrong in your life, you’re more prone to a mental health issue, for example, a breakup, divorce, losing your job, financial issues. The thing that helps alleviate all those things is support, time, and understanding. Grief may be misunderstood, but when somebody dies, we have rituals surrounding it. People bring you food. There’s an understanding from your coworkers. Is it fair to say that it’s sort of like that for the LGBTQ community, minus all of the understanding and the support? They’re just, I hate to use the word. It’s just an onslaught of negativity that they can’t escape from and that nobody seems to be looking to resolve.

Dr. Amy Green: For some. So, and I think it’s important when we talk about resilience and you talked about resilience in adults, there are a lot of youth that we hear from in our surveys. One of my favorite parts of the survey, especially when I’m looking at some of the harder to swallow data, is that we have this really rich quality of data where we ask youth questions like what’s helped them thrive in their life? Or what’s helped them find joy in their life? And the responses are just overwhelmingly positive for some youth and for other youth that they struggle with figuring out that answer. We’ve made a lot of progress in the past couple of decades for LGBTQ rights. And so there are a lot of youth where they’re in supportive environments and so there’s some youth for whom this is not a day to day struggle for them. It’s a celebration. We talk about pride. They are proud of their identity. They have a rich community of LGBTQ friends, of friends who are not members of the LGBTQ community who support them. Those youth are really doing well. But we also have some youth who, as you described, where it’s hard when we talk about suicide risk, we often talk about hopelessness and inability to look towards a brighter future. So for those youth, yeah, it can feel sometimes like there’s an onslaught of negative news, particularly if they’re then in a home or school environment where they’re not supportive and that hopelessness is another risk factor for depression and suicide, unfortunately.

Gabe Howard: We’ll be right back after a word from our sponsors.

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Gabe Howard: And we’re back discussing the Trevor Project’s 2021 National Survey on LGBTQ+ Youth Mental Health with Dr. Amy Green. Now, I know that the reason that the Trevor Project does the national survey on LGBTQ+ Youth Mental Health is not just to give us a whole bunch of negative information, it’s to help find solutions.

Dr. Amy Green: Yes, it’s actually one of my favorite parts to talk about in our survey, which is that a lot of times when we talk about LGBTQ youth and suicide, because it’s such a strong public health problem that we have to solve, we think of LGBTQ youth as all being at risk for suicide. And, well, maybe as a society, there’s always that sort of inherent risk in anyone. The majority of LGBTQ youth are not attempting suicide each year. And despite the world not being as fair and as equal as it should be for LGBTQ youth, particularly those who are LGBTQ youth of color and the non-binary youth, there’s still a lot of good things happening. And so we have a section on our national survey where we actually pull out some of the words that they have. And a lot of it is visibility. So things like seeing rainbow flags and stickers in public, when there are celebrities who are out with pride. So LGBTQ celebrities who are proud of who they are. Being connected to other people. Having schools that support them.

Dr. Amy Green: One of the more interesting ones, I thought that you said it, how they thrive and find joy is something that, you know, we started this podcast with, which is learning more about LGBTQ history and learning more about the LGBTQ community. For youth, that can often be a source of strength. And so there’s a lot really that can be done out there in terms of when we talk about that, the society and the negative pressures of society on LGBTQ youth. There are also a lot of, a lot of folks in society who are doing really great things, sometimes just by being who they are and being visible that are helping LGBTQ youth to feel better about themselves. If the social context is one of the biggest sources of risk for LGBTQ youth, then the social context is something that we can change. And by having more positivity around, that’s something that can help them actually feel better.

Gabe Howard: And as we’ve mentioned, the Trevor Project does the national survey on LGBTQ+ Youth Mental Health so that they can increase access and, well, find ways to increase access. What are some of those ways?

Dr. Amy Green: That’s a great question. Unfortunately for LGBTQ youth, there’s a large number of barriers when we talk about mental health care to receiving care. When I think about youth, I’m a licensed clinical psychologist as well and have been seeing youth and working with youth for a couple of decades now. And I remember in the beginning that the biggest problem with youth and mental health was awareness and stigma and getting folks to even acknowledge or know to have awareness that they might be struggling. Anyone who’s ever tried to access mental health care in the US has probably experienced that challenge of it is not, is not a straightforward, easy system to negotiate in terms of finding the right provider who accepts the right insurance, is accepting clients at that time who you’re able to get to. And so for youth, this is the barriers that we all know exist in the system. But they also have concerns about LGBTQ competence of providers. There’s a lot of fear that if I find someone, they might try to convert me and tell me that I shouldn’t be queer, I shouldn’t be LGBTQ, that they’d have to tell their parents and that their parents are part of the reason why they’re struggling, the rejection from their parents in the first place.

Dr. Amy Green: Part of it is getting the data out so that folks know what the barriers are. But also, Trevor has a public education team and a big part of that is providing training for folks in how to understand LGBTQ identities, how to support LGBTQ youth. And I think that’s really important because I believe that there are a lot of well-intentioned mental health care providers out there who would love to be able to support these youth, who may not have that knowledge and who may accidentally say something that is hurtful and harmful or who may unknowingly think that they’re helping but really provide further discrimination to those youth. And so that’s a big part of it in terms of increasing their access, is making sure that we increase the pool of folks who are able to serve them. And that includes both the knowledge, but also providers finding ways to let youth know that that they are accepting and supportive of those who are LGBTQ and that can include, you know, safe spaces, rainbow stickers, ensuring that their materials and their website feature folks who are part of the LGBTQ community, that talk about that as types of individuals who they’re looking to serve.

Dr. Amy Green: And then when I think about youth and access to mental health care, the immediate thing that comes to my mind are our schools. And so while there may not be a way to provide mental health care for every single youth through the school, I think our schools are going to need to find some ways to identify youth and have referral networks there. Some schools that have what are called school-based health centers where they actually have medical providers and mental health providers on staff. But particularly we think about if we go back to where this all started, we talk about suicide risk. The key to preventing suicide is to recognize and to refer. And so being able to have places like schools that have suicide prevention policies that are specific content on LGBTQ youth and how to assess and refer and to help those youth get care is a big step, I think, for our schools.

Gabe Howard: What are some of the protective factors or key ways to prevent LGBTQ plus youth suicide?

Dr. Amy Green: That’s a really important question for us to ask when we think about how to help and framing it from a positive standpoint. And my first answer to the question is always so easy, because there’s so much research supporting it and that is support and affirmation from others. When we look at differences in suicide risk among LGBTQ youth who have lots of access to affirming spaces, schools, their home, events in their community, and lots of people who affirm and support them relatives, friends, straight friends, LGBTQ friends, doctors, hospitals. When we look at that, the data is striking. One of our data findings found LGBTQ youth who have at least one accepting adult are 40% less likely to report a suicide attempt. When I say risk factors, rejection is one of the biggest ones on the other side for protective factors, it’s acceptance, its affirmation, its support. It’s so crucial during the adolescence and young adult period. Other protective factors are having a positive identity and ability to authentically express their identity. We know that positive role models, including folks who are in their day to day life, and that could be teachers, people who are in their churches, who are in their community events, as well as folks like celebrities and influencers who they follow on social media, when they have folks in their lives who are LGBTQ and visible and proud of their identity, it helps LGBTQ youth in turn feel proud of their own identity and feel comfortable as their authentic self. And that is also a protective factor in suicide. So finding ways to help youth feel accepted and feel that they are able to be authentically them.

Dr. Amy Green: So when we have inclusive policies, they also serve a protection function. The signifying of what those equality policies meant to them was enough that it in turn reduced their risk for suicide. When we can have policies that are supportive, that promote equality, how those can actually reduce risk.

Gabe Howard: What are some things that our listeners can do to support our LGBTQ+ youth?

Dr. Amy Green: So let’s start with the basics. First, letting LGBTQ youth they know know that they are loved and valued just as they are. That’s how you show acceptance and support. And we’re always encouraging everyone to work to be one of those accepting adults in a young person’s life. Going back to that statement that LGBTQ youth with at least one accepting adult had a 40% lower risk of suicide. We encourage folks to find ways to be that person to be that accepting and supporting adult. This also can include visible signs of support, rainbow, safe space stickers using LGBTQ inclusive language. So thinking about the way we talk, minimizing using gendered language and language that implies a world that is based purely on heterosexual cis gender folks, making sure that our language is inclusive. One way that folks can do this is to open the space when they’re working with LGBTQ youths by including their pronouns. So my name’s Amy Green. My pronouns I use are she/her and I’m the vice president of research at the Trevor Project. That’s how I open most of the meetings that I have with folks. It allows the space for someone to say their pronouns without having to be mis gendered in the beginning. And I think that it shows folks who are LGBTQ that this is a comfortable space. This is someone who is allowing me the space to be my authentic self. Paralleling when I talked about protective factors. Right. So we’ve got the visibility, the acceptance. I mean, let’s go to the other part, which is the ongoing fight for equality in the LGBTQ community, particularly for transgender and non-binary youth. For those who are able to who are in a position to speak out against some of these harmful initiatives, trying to ban trans and binary youth from participating in sports, from using bathrooms that are appropriate for their gender identity, that all of those we’re able to be in a place where we can support politicians who are not selling those types of policies, but also to vocalize support for these youth, to say these policies are wrong, this is harmful.

Dr. Amy Green: This is going to harm youth, particularly us, who are in the mental health field. There’s a number of places in which policies come up that we know are in direct opposition to the evidence base on what is good and what is bad for mental health. And so speaking out, finding a place where we are able to say this is harmful, you’re going to harm youth both to hopefully have an impact on those policies, but also because they’re listening. Youth are listening all of the time, even for things like politics and political decisions. But I think sometimes folks think like, oh, well, they have other things that they’re following. They’re listening. One of our stats that we use from our survey year over year is the percentage of youth who say that recent politics negatively impacted their mental health. We had our highest number this year, unfortunately. Ninety four percent of LGBTQ youth who said that recent politics had negatively impacted their mental health or sense of self and well-being. That’s a really high number. And so for each of us to do what we can to counter that message, whether it’s in person or it’s on your social media accounts, LGBTQ youth are listening and they’re looking for messages of support and care.

Gabe Howard: Dr. Green, thank you so much for being here. Where can folks find the 2021 National Survey on LGBTQ Youth Mental Health? And of course, where can they find the Trevor Project?

Dr. Amy Green: Thankfully, they can find them at the same place on our website, TheTrevorProject.org. There will be on the landing page a link to our national survey. We have a pretty cool micro site where they can go on and explore findings as well as a PDF. And that is also the starting point for all the other information, including our resources, as well as a place for LGBTQ youth to reach out for help and for folks to learn more about how they can help LGBTQ youth.

Gabe Howard: And listeners, please keep in mind, that’s TheTrevorProject.org. Thank you to all of our listeners for being here. My name is Gabe Howard and I’m the author of “Mental Illness Is an Asshole and Other Observations,” as well as a nationally recognized public speaker who would love to be at your next event. You can grab a signed copy of my book with free swag or learn more about me just by heading over to gabehoward.com. Wherever you download his podcast, please follow or subscribe to the show. It’s absolutely free and if you have a minute, review the show. Tell other people why they should be listening. I will see everybody next Thursday on Inside Mental Health.

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