Is the mental health of LGBT young adults getting better, or worse?
A mystery in the age of greater acceptance
What’s happened to the mental health of LGBT young people in the U.S. over the last decade?
Given that LGBT teens and young adults are more likely to suffer from mental health issues than their straight and cis peers, it’s crucial to have up-to-date information about this vulnerable and historically marginalized population. Documenting trends may also help us understand the causes of poor mental health among LGBT young adults.
The last decade has seen enormous cultural changes, most of which – in theory -- should improve the mental health of LGBT young people.
First, there have been historic milestones for LGBT rights. Same-sex marriage was legalized in the U.S. in 2015, and employment discrimination based on LGBT status was outlawed by the Supreme Court in 2020. Since 2021, transgender people have been able to serve openly in the U.S. military. It’s now been exactly 10 years since TIME magazine declared the “Transgender Tipping Point” with a cover featuring Laverne Cox, ushering in a time of greater visibility for transgender people in popular culture.
Backlash has also occurred, especially since 2022, particularly in Republican-leaning states. Still, LGBT people in the U.S. have more rights now than they did in 2014, and public-opinion surveys continue to show gains in acceptance of same-sex relationships. If LGBT young adults’ mental health partially depends on public attitudes and government policies, their rates of depression and poor mental health should decline 2014-2022 – or at least 2014-2021, before Florida’s “Don’t Say Gay” and other controversial bills passed.
Second, the way people use technology has changed tremendously. Young people now spend much more time online and on social media than they once did. The Pew Research Center found that the number of teens who say they are online “almost constantly” increased from 24% in 2014-15 to 46% in 2022, with similar proportions among young adults.
Many have argued that being online more often is important for the mental health of LGBT young people, helping them connect with others and understand their identities. As a New York Times article explained in 2023, social media is “a lifeline” for LGBT youth, with a “clear net benefit.” The article continues, “Though data shows that the mental health of L.G.B.T.Q. teens is worse than that of straight teens, it can be improved by being online, said Shelley L. Craig, a Canada Research Chair in sexual and gender minority youth at the University of Toronto. Her research has found that L.G.B.T.Q. youth find two things online that are known to reduce depression and suicidal thoughts: hope, and a sense of control over their actions and environment.”
If so, the mental health of LGBT young people should improve as they spent more time online between 2014 and 2022. At the very least, increases in depression should be mitigated among LGB (lesbian, gay, or bisexual) young people compared to straights. In a previous post, I found that was not true among LGB high school students in the U.S. – their rates of depression increased just as much as straight students’ did. However, that survey had data from only four timepoints and did not ask about transgender identity. It’s also likely some LGB high school students are not yet out, giving an incomplete view of the population.
We’ll look first at LGB young adults. Is their mental health better than it was a decade ago, or worse? And how do their trends compare to that of straight young adults?
Poor mental health increased more among LGB than straight young adults between 2014 and 2022 (see Figure 1). LGB young adults experienced nearly 5 more days of poor mental health per month in 2022 than they did in 2014, while straight young adults experienced just 2 additional days.
Figure 1: Days per month of poor mental health, U.S. 18- to 25-year-olds, by sexual orientation, 2014-2022. Source: Behavioral Risk Surveillance System survey, CDC. NOTE: Gathers a nationally representative sample of U.S. adults. Item on poor mental health days: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”
In another survey, clinical-level depression (see Figure 2) increased more among LGB young adults than straights between 2015 and 2022.
Figure 2: Percent of U.S. 18- to 25-year-olds with major depressive episode in the last year, by sexual orientation, 2014-2022. Source: National Survey of Drug Use and Health. NOTE: Gathers a nationally representative sample of U.S. teens and adults; only adults are asked their sexual orientation. Major depressive episode is assessed using DSM criteria.
So did suicidal ideation (see Figure 3).
Figure 3: Percent of U.S. 18- to 25-year-olds who made a suicide plan in the last year, by sexual orientation, 2014-2022. Source: National Survey of Drug Use and Health.
The same was true for transgender young adults, for whom days of poor mental health increased more between 2014 and 2022 than among cisgender young adults (see Figure 4). Transgender young adults experienced 10 more days of poor mental health per month in 2022 than they did in 2014, while cisgender young adults experienced 4 additional days.
Figure 4: Days per month of poor mental health, U.S. 18- to 25-year-olds, by gender identity, 2014-2022. Source: Behavioral Risk Surveillance System survey, CDC.
This graph is especially striking as the mental health of transgender and cisgender young adults was very similar in 2014. It then rapidly diverged as transgender young adults experienced a much steeper rise in poor mental health days.
Overall, LGBT young adults have always reported more mental health struggles than straight or cisgender young adults, but that gap has widened since 2014. The gap for LGB vs. straights was 3.5 days of poor mental health in 2014 and 6.5 days in 2022. Suicidal ideation once differed 6 percentage points between LGB and straight young adults, and now the gap is 9 percentage points. Depression used to differ 14 percentage points and now differs by a whopping 26.
For trans vs. cis the difference in poor mental health was just one day in 2014. By 2022, it was 8 days. Thus in the space of less than a decade transgender young adults were experiencing week more of poor mental health compared to cis young adults.
The question is: Why? Honestly, it’s a mystery. Let’s consider a few possibilities.
1. Increasing discrimination. Except, as we saw above, systemic discrimination against LGBT people has lessened since 2014. In 2014 gay people couldn’t get legally married in 15 U.S. states, and as late as 2019 employment discrimination against LGBT people was legal. These are rights that LGBT activists have been fighting for for decades, and they finally happened. Plus, with more young Americans identifying as LGBT (see Figures 6.5 and 6.9 in Generations), and more coming out at younger ages, LGBT young people should feel less isolated.
The “backlash” laws, like Florida’s “Don’t Say Gay” bill and Mississippi’s ban on gender transition procedures for minors, did not pass until 2022 or later. Thus, increases in poor mental health between 2021 and 2022 could plausibly be due to these new policies, but that does not explain the steeper rise in poor mental health among LGBT young adults up to 2021. If rights and policies are important for LGBT mental health, the more pronounced rise in poor mental health, depression, and suicidal ideation among LGBT vs. straight or cis young adults between 2014 and 2021 is very counterintuitive. With more rights and greater acceptance, LGBT mental health should improve.
2. Increasing use of technology. The Times and several researchers concluded that social media has a “clear net benefit” for LGBT young people, with one researcher specifically saying that being online should reduce depression and suicidal thoughts. However, LGBT young adults experienced an increasing number of poor mental health days, depression, and suicidal thoughts during years when people spent more time online, at an even faster pace than straight and cis individuals. That suggests living in the age of being constantly online may not be beneficial for LGBT young adults.
If LGBT young adults are spending more time on online than straight or cis young adults, and that time is harmful once it becomes excessive, that may explain why their mental health suffered more than straight or cis young adults’. Even if LGBT young adults aren’t spending more time on social media, perhaps they are having more negative experiences online (like cyberbullying), and this got worse between 2014 and 2022. Overall, these trends do not support the theory that social media is a “net benefit” for this group.
3. More distressing content online. In Generations (Figure 6.65), I found that depressive symptoms increased more 2012-2022 among liberal teens than conservative teens. That might be because liberal teens spend more time on social media and less time with friends in person than conservative teens. It might also be because liberals are exposed to more distressing content online about rampant injustice, police shootings, racism, and discrimination, or respond to that content differently. While discussions of these issues once took place in person where they were less likely to get out of hand, they increasingly took place in the anonymous negative frenzy of social media. If, like liberal teens, LGBT young people are also more exposed to that type of content and more likely to find it distressing, it might explain why their mental health suffered more between 2014 and 2022 than straight or cis young people’s did.
4. More depressed young adults are identifying as LGBT. As the number of young adults identifying as LGBT has increased, so have poor mental health and suicidal ideation in the group, with the mental health gap between LGBT and straight or cis people widening. In the absence of another compelling explanation, perhaps the young adults who identify as LGBT in 2022 who would not have in 2015 are more likely to be depressed and have suicidal thoughts. The mechanism for that isn’t entirely clear, however.
5. Something else. I suspect there are other factors at work here. Any ideas? I’d love to know what you think.
For kids dealing with Gender Dysphoria, the prevailing evidence -- most notably in the Cass report -- points to several comorbidities, that are not being dealt with. Vulnerable kids and young adults end up believing one answer -- medical interventions to give them the illusion that they are the opposite sex -- will alleviate their suffering. Essentially they are fighting their own bodies, their own humanity. They can try that for a while, maybe a long while, but in the end, biology and reality catches up to them.
Surgeon General Vivek Murthy acknowledged (buried in a 2022 report) that “76% of LGBTQ+ high school students reported persistent feelings of sadness or hopelessness and 74% reported emotional abuse by a parent, compared with 37% and 50% of heterosexual students, respectively.”
That’s not “acceptance;” it’s an incredible level of abuse and official dereliction in confronting it, associated with terrible outcomes. Of the LGBQ youth (transgender youth weren’t separated) who told the CDC survey they were often violently and/or emotionally abused by parents and household adults, 90% reported persistent sadness, 70% considered suicide, 42% attempted suicide, and 15% were medically treated for self harm.
Now, here’s the astounding puzzle the 7,000-subject CDC survey (the only one that asked such comprehensive questions) revealed. Both the 300+ teens who report rarely or never using screens and the 3,300+ who are online 5+ hours a day report fascinating, seemingly contradictory results, consistent for both sexes, all ages, and gay/bi or straight.
For LGBQ teens, compared to those who never/rarely go online, those who spend the most time in front of screens (5+ hours per day) are:
• MORE likely to report poor mental health (57% vs 45%), persistent sadness (76% vs 61%), and considering suicide (48% to 42%).
• LESS likely to report actually attempting suicide (22% vs 39%) or self-harming (5% vs 9%).
• LESS likely to report being victimized at school (8% vs 27%), raped (17% vs 44%), getting in fights (18% vs 30%), missing school due to fear (15% vs 33%), being physically inactive (33% vs 64%), getting less than 6 hours of sleep per night (41% vs 56%), and other major risks.
In short, Jean Twenge, Jonathan Haidt, Vivek Murthy, and others wrongly assume that because teens who are online a lot also report being more depressed and sad, therefore, online teens must also be more suicidal, self-harming, sleepless, and otherwise endangered.
That might seem like a logical assumption – but it is dramatically contradicted by CDC survey and direct vital statistics data as well as mounting longer-term research.
In fact, the safest LGBQ and straight teens are those who are online (3-4 hours a day on average seems the ideal), even though they report more sadness and depression. In contrast, the teens most at risk of actual harm are those who are not online, even though they report less depression.
This huge paradox parallels others. For example, liberal teens self-report the most depression, but teens in conservative areas suffer much higher actual suicide rates that rise along with conservative political dominance.
Another complication could help explain these paradoxes: LGBQ teens who use screens the most are also much more likely to be abused by parents (39% vs 18%), a pattern also found for straight teens. Or, stated in reverse (correlations can be both backward and forward), teens who are abused by grownups are the most likely to be online a lot.
We don’t know whether grownups abuse teens more today (one would hope the very high levels of abuse teens, especially girls and LGBQs, reported in 2021 were not the norm), but we do know that 25-64-age grownups’ deadly and injurious abuse of alcohol and illicit drugs has skyrocketed to many millions of annual cases during exactly the period teens reported becoming more depressed.
It's years past time for those who blame social media for teen problems to stop ignoring and denying-by-nitpicking these glaring contradictions. We don’t understand the diverse array of things that teens mean by “poor mental health,” “depression,” “sadness,” or “unhappiness.” We are asking the wrong questions, poorly specifying variables, then drawing simplistic conclusions reinforced by some low-association “experiments” and “studies” that fixate on social media as if it were the only factor affecting teens’ behaviors rather than a relatively minor one.