Structural stigma and LGBTQ+ youth mental health in the United States

Structural stigma, or systemic barriers to equity for minoritized populations, has been shown to have negative consequences on LGBTQ+ youth’s mental health. Most research has focused on stigma at the national or state level, limiting understanding of how local institutions and environments influence mental health. In the current study, we sought to examine the association of multiple layers of structural stigma (e.g. at the county and state levels) on depression and anxiety severity, substance use, and mental healthcare access, for LGBTQ+ youth in the United States. We recruited 690 LGBTQ+ youth (Mage = 15.6, SDage = 1.17; 71.9% White) to complete survey measures. Further, we extracted 2023 data from Project Implicit and the Human Rights Campaign to create measures of structural stigma at the county and state levels. These factors were linked to survey responses by county and state entered as predictors in mixed-effects models predicting mental health outcomes. Our results demonstrated that structural stigma, when examined at the county level (as opposed to the state level), may impact mental health outcomes such as depression, anxiety, and substance use severity. These findings underscore the importance of county-level interventions and policies, alongside broader state-level legislation, in addressing mental health disparities among LGBTQ+ youth.