Family support linked to decreased depression and suicidal thoughts for LGBTQ+ youth in primary care

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

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

Prior studies have shown that the prevalence of depression and anxiety in LGBTQ+ adolescents is 58% and 73%, respectively, and nearly half of these youth seriously considered suicide in 2022. Importantly, prior studies have shown that higher rates of mental health problems in LGBTQ+ youth are not due to identity itself, but rather caused by the fear, shame, discrimination, and victimization youth face from society because of their identity.

Ample evidence suggests the important role played by a supportive family, yet these prior findings were based on nonclinical samples. In this study, researchers wanted to accurately measure the impact of family support, as these findings could help guide important discussions among teens, their families and pediatricians in routine clinical visits.

"Brief health screeners are incredibly valuable for clinicians because they empower patients to report on what they are experiencing and help facilitate better discussions during appointments," said study author Joey Whelihan, MD, an adolescent medicine fellow at CHOP and a member of PolicyLab at CHOP.

"This is critical for LGBTQ+ youth as it provides them with a safe and comfortable environment to discuss mental health and provides pediatricians an opportunity to develop appropriate health interventions."

In this study, researchers utilized The Adolescent Health Questionnaire, developed and piloted by the Possibilities Project (TPP), which consists of pediatricians, researchers at Clinical Futures, and technology experts at CHOP. Utilizing evidence-based screening tools, this pre-visit questionnaire helps promote discussion about certain adolescent-focused topics, identifies which adolescents may benefit from further intervention, and expedites the visit to focus on key topics.

The study population included 60,226 adolescents between the ages of 13 and 19 who completed the questionnaire between February 2022 and May 2023. Of those, 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 much higher prevalence of suicidal thoughts compared with their peers (15.8% vs. 3.4%) and were more likely to have attempted suicide.

While most youth reported parent and caregiver support, fewer LGBTQ+ youth reported parental support, including discussion of strengths and listening to feelings. However, LGBTQ+ youth who reported parental support saw lower rates of depression and suicidal thoughts and significantly reduced rates of attempted suicide.

"This study builds upon 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, an Adolescent Medicine specialist and member of Clinical Futures at CHOP.

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