Impact of Bullying and State Policies on Psychotic Symptoms in Gender-Diverse Adolescents

Overview

Between 2017 and 2022, the proportion of US adolescents identifying as transgender and gender diverse (TGD) doubled. This study found that bullying mediates the association between gender diversity and psychotic-like experiences (PLEs), with the strongest effects in the most gender-diverse youths. Additionally, lack of supportive state policies correlates with increased PLEs among gender-diverse adolescents.

Background

The prevalence of mental health issues, including psychotic spectrum symptoms, is disproportionately high among TGD individuals. The minority stress model explains how distal stressors like discrimination and structural stigma contribute to these mental health disparities. Supportive policies have been shown to protect TGD youths, whereas unsupportive legislation is linked to worsened mental health outcomes, including increased suicide attempts. Understanding the interplay of interpersonal bullying and structural stigma is critical to addressing mental health risks in this population.

Data Highlights

Key Findings

• The percentage of adolescents identifying as TGD doubled from 0.73% in 2017 to 1.43% in 2022.
• TGD youths are overrepresented in samples at high risk for psychotic-like experiences (PLEs).
• Bullying mediates the relationship between gender diversity and PLEs, with stronger associations in the most gender-diverse youths.
• Absence of supportive state policies correlates with increased PLEs and worsened mental health outcomes in gender-diverse youths.
• Enactment of unsupportive laws is associated with a 7% to 72% increase in suicide attempts among TGD youths.
• The proliferation of anti-LGBTQ+ legislation in the US is rapidly increasing, with 588 bills introduced in 2025 alone.

Clinical Implications

Clinicians should be aware that gender-diverse adolescents face heightened risks for psychotic-like symptoms, partly due to bullying and structural stigma. Interventions aimed at reducing bullying and advocating for supportive policies may mitigate mental health risks. Screening for PLEs in TGD youths, especially those in unsupportive environments, is recommended to provide timely mental health support.

Conclusion

This study highlights the critical impact of interpersonal and structural stressors on psychotic-like experiences in gender-diverse adolescents. Addressing bullying and promoting supportive policies are essential steps to improve mental health outcomes in this vulnerable population.

References

1. Movement Advancement Project (MAP) -- LGBTQ+ Rights Data