Family support linked to reduced depression and suicidal thoughts among LGBTQ+ youth in primary care

A new study from researchers at Children’s Hospital of Philadelphia (CHOP) found that LGBTQ+ youth are more likely to experience depression and suicidal thoughts and attempts than non-LGBTQ+ youth. However, these mental health symptoms were significantly reduced when LGBTQ+ youth reported receiving support from their parents.

These findings underscore the critical role families play in helping these young people lead healthier lives. The findings were recently published in JAMA Pediatrics.

Previous research has shown that the prevalence of depression and anxiety among LGBTQ+ adolescents is 58% and 73%, respectively, and that almost half of these youth had seriously considered suicide in 2022. Importantly, previous research has shown that higher rates of mental health problems among LGBTQ+ youth are not due to the identity itself, but rather are caused by the fear, shame, discrimination, and victimization that young people face from society because of their identity.

There is ample evidence that a supportive family plays an important role, but these previous findings were based on nonclinical samples. In this study, researchers wanted to accurately measure the impact of family support because these findings could help guide important discussions between teens, their families, and pediatricians during routine clinical visits.

“Brief health checks are incredibly valuable for clinicians because they allow patients to share what they are experiencing and help them have better conversations during appointments,” said Joey Whelihan, MD, study author and a fellow in adolescent medicine at CHOP and a member of the PolicyLab at CHOP.

“This is critical for LGBTQ+ youth because it provides a safe and comfortable environment for them to talk about mental health, and it gives pediatricians the opportunity to develop appropriate health interventions.”

In this study, researchers used The Adolescent Health Questionnaire, developed and piloted by the Possibilities Project (TPP), which includes pediatricians, researchers at Clinical Futures, and technology experts at CHOP. This pre-visit questionnaire, which uses evidence-based screening tools, helps foster discussion about specific topics targeted at adolescents, identifies which adolescents may benefit from further intervention, and expedites the visit to focus on important topics.

The study population consisted of 60,226 adolescents aged 13 to 19 who completed the survey between February 2022 and May 2023. Of these, 9,936 were LGBTQ+ (16.4%), 15,387 (25.5%) were Black, and 30,296 (50.0%) were assigned female at birth.

The study found that LGBTQ+ youth had higher average depression scores on the Patient Health Questionnaire–9 Modified for Teens (PHQ-9-M) than non-LGBTQ+ youth (5 vs. 1) and a significantly higher prevalence of suicidal ideation compared to their peers (15.8% vs. 3.4%) and were more likely to have attempted suicide.

While most youth reported receiving support from their parents and caregivers, fewer LGBTQ+ youth reported receiving support from their parents, including discussing strengths and listening to feelings. However, LGBTQ+ youth who reported parental support had lower rates of depression and suicidal ideation, and significantly lower rates of suicide attempts.

“This study builds on our understanding of the prevalence of depression and suicide among LGBTQ+ youth. As pediatric health systems, we need broader efforts to train pediatricians to provide affirming care and increase funding for nurse navigators and social workers to facilitate more frequent follow-up for youth with depression,” said senior study author Sarah M. Wood, MD, MSHP, a specialist in adolescent medicine and member of Clinical Futures at CHOP.

“However, this study clearly shows how important a supportive family can be in improving the mental health of these teens. Health care systems should strongly consider integrating family-based interventions as an important factor in achieving health equity for LGBTQ+ youth.”