Associations Between School Experiences and Mental Health Outcomes by Gender Identity in Sexual and Gender Minority Youth in Texas and California, 2022 - 2024

Background: Depression and anxiety affect populations differently, with diagnoses disproportionately higher among sexual and gender minority groups, including LGBTQ+ youth. School experiences shape mental health; negative environments, bullying, and lack of support worsen outcomes, while affirming policies, peer support, and inclusive curricula are protective. Methods: This secondary analysis of the Family, Housing, and Me (FHAM) Project followed 83 LGBTQ+ youth from South Texas and California's Inland Empire (2022-2024). Data on sociodemographic characteristics, school experiences, and mental health outcomes were collected at baseline and at Waves I and II over 25 months. Analyses included descriptive statistics, monthly comparisons, and bivariate and stratified analyses by cisgender identity to assess associations between school experiences and mental health. Results: Participants (N=83) were ages 16-19, and most identified as Hispanic/Latinx (61.4%) and as gender minorities (70.7%). Average anxiety scores indicated moderate-high levels (58.1%), and 90.7% met the cutoff for possible depression. Enjoyment of school (p=0.033) and homework completion (p=0.032) were associated with depression, while getting along with other students (p=0.017) was associated with anxiety. Those with a history of being bullied had significantly higher anxiety (M: 32.1 vs. 22.0, p=0.004) and depression (M: 16.8 vs. 14.1, p=0.019) scores. Changing schools, absenteeism, and transportation difficulties were not associated with anxiety and depression (ps>0.05). Stratified analyses by cisgender identity showed that the results for cisgender participants were similar to the overall associations but not for gender minority youth, for whom experiences with bullying were associated with anxiety. Although not statistically significant, mean anxiety scores increased with the number of school days missed. Public Health Implications: Positive school experiences were linked to lower anxiety and depression scores. Findings underscore the need for safe, affirming, inclusive schools, anti-bullying policies, accessible mental health services, and reduced transportation barriers, specifically to support the well-being of LGBTQ+ youth.