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• W4200609997 abstract "Although the negative impacts of COVID-19 on youth and young adult global mental health are recognised,1Racine N McArthur BA Cooke JE Eirich R Zhu J Madigan S Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis.JAMA Pediatr. 2021; 175: 1142-1150Crossref PubMed Scopus (194) Google Scholar less attention has been paid to LGBTQ youth—a historically neglected population in health care, policies, and research, despite evidence of high unmet mental health needs.2Sachdeva I Aithal S Yu W Toor P Tan JCH The disparities faced by the LGBTQ+ community in times of COVID-19.Psychiatry Res. 2021; 297113725Crossref PubMed Scopus (5) Google Scholar, 3Fish JN McInroy LB Paceley MS et al.“I'm kinda stuck at home with unsupportive parents right now”: LGBTQ youths' experiences with COVID-19 and the importance of online support.J Adolesc Health. 2020; 67: 450-452Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar, 4Salerno JP Williams ND Gattamorta KA LGBTQ populations: psychologically vulnerable communities in the COVID-19 pandemic.Psychol Trauma. 2020; 12: S239-S242Crossref PubMed Scopus (116) Google Scholar Unfortunately, the pandemic is likely to have far-reaching negative effects on LGBTQ health and wellbeing. Before COVID-19, LGBTQ youth bore a disproportionate burden of mental health problems, with their sexual and gender identity being risk factors for victimisation, trauma, discrimination, and abuse.5Wainberg ML Scorza P Shultz JM et al.Challenges and opportunities in global mental health: a research-to-practice perspective.Curr Psychiatry Rep. 2017; 19: 28Crossref PubMed Scopus (166) Google Scholar Also, LGBTQ youth, especially non-binary and transgender youth, are at a higher risk for depression, suicide, substance use, and anxiety.2Sachdeva I Aithal S Yu W Toor P Tan JCH The disparities faced by the LGBTQ+ community in times of COVID-19.Psychiatry Res. 2021; 297113725Crossref PubMed Scopus (5) Google Scholar, 3Fish JN McInroy LB Paceley MS et al.“I'm kinda stuck at home with unsupportive parents right now”: LGBTQ youths' experiences with COVID-19 and the importance of online support.J Adolesc Health. 2020; 67: 450-452Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar, 6Green A Price-Feeney M Dorison S Implications of COVID-19 for LGBTQ youth mental health and suicide prevention: The Trevor Project.https://www.thetrevorproject.org/blog/implications-of-covid-19-for-lgbtq-youth-mental-health-and-suicide-prevention/Date: 2020Date accessed: December 16, 2021Google Scholar, 7Salerno JP Doan L Sayer LC Drotning KJ Rinderknecht RG Fish JN Changes in mental health and well-being are associated with living arrangements with parents during COVID-19 among sexual minority young persons in the U.S.Psychol Sex Orientat Gend Divers. 2021; (published online Sept 13.)https://doi.org/10.1037/sgd0000520Crossref Google Scholar COVID-19 control measures, such as lockdowns, working from home, school shutdowns, and remote learning, are likely to have exacerbated these mental health disparities. Although knowledge on the long-term impacts of COVID-19 on the mental health of LGBTQ youth is still evolving, preliminary research suggests that LGBTQ youth are disproportionately affected by the pandemic.3Fish JN McInroy LB Paceley MS et al.“I'm kinda stuck at home with unsupportive parents right now”: LGBTQ youths' experiences with COVID-19 and the importance of online support.J Adolesc Health. 2020; 67: 450-452Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar, 8Hawke LD Hayes E Darnay K Henderson J Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic.Psychol Sex Orientat Gend Divers. 2021; 8: 180-187Crossref Google Scholar Moreover, LGBTQ youth who live in unsupportive homes are vulnerable to abuse, do not feel safe to express themselves, or are cut off from supportive peers.3Fish JN McInroy LB Paceley MS et al.“I'm kinda stuck at home with unsupportive parents right now”: LGBTQ youths' experiences with COVID-19 and the importance of online support.J Adolesc Health. 2020; 67: 450-452Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar Since the start of the COVID-19 pandemic, more than 50% of sexual and gender minority youth in the USA have reported increased anxiety or depressive symptoms.7Salerno JP Doan L Sayer LC Drotning KJ Rinderknecht RG Fish JN Changes in mental health and well-being are associated with living arrangements with parents during COVID-19 among sexual minority young persons in the U.S.Psychol Sex Orientat Gend Divers. 2021; (published online Sept 13.)https://doi.org/10.1037/sgd0000520Crossref Google Scholar, 8Hawke LD Hayes E Darnay K Henderson J Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic.Psychol Sex Orientat Gend Divers. 2021; 8: 180-187Crossref Google Scholar, 9The Trevor Project2021 national survey on LGBTQ youth mental health.https://www.thetrevorproject.org/survey-2021/Date: 2021Date accessed: December 16, 2021Google Scholar Factors likely to be implicated in such findings are isolation from support systems, absence of family support (only 33% of LGBTQ youth report living in an LGBTQ-affirming home during the pandemic), and disruptions to health services.7Salerno JP Doan L Sayer LC Drotning KJ Rinderknecht RG Fish JN Changes in mental health and well-being are associated with living arrangements with parents during COVID-19 among sexual minority young persons in the U.S.Psychol Sex Orientat Gend Divers. 2021; (published online Sept 13.)https://doi.org/10.1037/sgd0000520Crossref Google Scholar, 8Hawke LD Hayes E Darnay K Henderson J Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic.Psychol Sex Orientat Gend Divers. 2021; 8: 180-187Crossref Google Scholar, 9The Trevor Project2021 national survey on LGBTQ youth mental health.https://www.thetrevorproject.org/survey-2021/Date: 2021Date accessed: December 16, 2021Google Scholar, 10Katz-Wise SL Rosario M Tsappis M Lesbian, gay, bisexual, and transgender youth and family acceptance.Pediatr Clin North Am. 2016; 63: 1011-1025Summary Full Text Full Text PDF PubMed Scopus (97) Google Scholar The lack of family support is especially alarming given LGBTQ youth who experience parental rejection are at increased risk of suicide and depression.2Sachdeva I Aithal S Yu W Toor P Tan JCH The disparities faced by the LGBTQ+ community in times of COVID-19.Psychiatry Res. 2021; 297113725Crossref PubMed Scopus (5) Google Scholar, 4Salerno JP Williams ND Gattamorta KA LGBTQ populations: psychologically vulnerable communities in the COVID-19 pandemic.Psychol Trauma. 2020; 12: S239-S242Crossref PubMed Scopus (116) Google Scholar Although less is known about transgender youth, research before COVID-19 suggests transgender youth experience higher rates of parental rejection than cisgender youth.10Katz-Wise SL Rosario M Tsappis M Lesbian, gay, bisexual, and transgender youth and family acceptance.Pediatr Clin North Am. 2016; 63: 1011-1025Summary Full Text Full Text PDF PubMed Scopus (97) Google Scholar Additionally, youth with intersectional identities, such as Black, Indigenous, and people of colour (BIPOC), people with low socioeconomic status, and homeless LGBTQ youth, are especially vulnerable during the pandemic.6Green A Price-Feeney M Dorison S Implications of COVID-19 for LGBTQ youth mental health and suicide prevention: The Trevor Project.https://www.thetrevorproject.org/blog/implications-of-covid-19-for-lgbtq-youth-mental-health-and-suicide-prevention/Date: 2020Date accessed: December 16, 2021Google Scholar BIPOC and low socioeconomic status LGBTQ youth may also have diminished access to services due to barriers resulting from the combination of their sexual and gender identity, ethnicity, and socioeconomic status.4Salerno JP Williams ND Gattamorta KA LGBTQ populations: psychologically vulnerable communities in the COVID-19 pandemic.Psychol Trauma. 2020; 12: S239-S242Crossref PubMed Scopus (116) Google Scholar Furthermore, Asian and Pacific Islander LGBTQ youth in the USA may experience an increase in abuse and discrimination given the uptick in anti-Asian rhetoric and hate crimes in the past year.11Gover AR Harper SB Langton L Anti-Asian hate crime during the COVID-19 pandemic: exploring the reproduction of inequality.Am J Crim Justice. 2020; 45: 647-667Crossref PubMed Scopus (173) Google Scholar Addressing the disproportionate toll of COVID-19 on LGBTQ youth is therefore of urgent concern. Crucially, the pandemic has disrupted mental health services at a time when the need for such services has increased, with young people and school-based services being especially affected.12Byrne A Barber R Lim CH Impact of the COVID-19 pandemic—a mental health service perspective.Progr Neurol Psychiatry. 2021; 25: 27-33bCrossref Scopus (14) Google Scholar LGBTQ youth have been affected by these disruptions.8Hawke LD Hayes E Darnay K Henderson J Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic.Psychol Sex Orientat Gend Divers. 2021; 8: 180-187Crossref Google Scholar For example, transgender and gender diverse youth report substantially more unmet needs and disruptions in mental health and substance use services than cisgender youth.8Hawke LD Hayes E Darnay K Henderson J Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic.Psychol Sex Orientat Gend Divers. 2021; 8: 180-187Crossref Google Scholar Additionally, LGBTQ youth and young adults will have reduced access to essential counselling, identity-based resources, and physical and mental health support programmes due to the closures of schools and universities, which often provide such services.4Salerno JP Williams ND Gattamorta KA LGBTQ populations: psychologically vulnerable communities in the COVID-19 pandemic.Psychol Trauma. 2020; 12: S239-S242Crossref PubMed Scopus (116) Google Scholar Moreover, school-based mental health services in high-income countries are predominantly used by BIPOC, homeless, and low socioeconomic status LGBTQ youth, making school closures especially harmful for intersectional LGBTQ youth.4Salerno JP Williams ND Gattamorta KA LGBTQ populations: psychologically vulnerable communities in the COVID-19 pandemic.Psychol Trauma. 2020; 12: S239-S242Crossref PubMed Scopus (116) Google Scholar Although the reopening of schools can mean returning to supportive communities and spending less time in isolation or in an abusive or unsupportive home, in-person schooling can also mean returning to school-based trauma for some individuals.3Fish JN McInroy LB Paceley MS et al.“I'm kinda stuck at home with unsupportive parents right now”: LGBTQ youths' experiences with COVID-19 and the importance of online support.J Adolesc Health. 2020; 67: 450-452Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar Parents, school administrators, teachers, and clinicians must be aware of the heterogeneity in experiences of LGBTQ youth and the impact the return to in-person schooling could have on LGBTQ youth. Health practitioners, researchers, teachers, policy makers, and community members all have a role in supporting the mental health of LGBTQ youth. First, health practitioners need training on LGBTQ-affirming care and the unique issues LGBTQ youth may be facing due to the impacts of the COVID-19 pandemic. Training should be intersectional and include topics such as identity development, non-stigmatising language, and the specific concerns and needs of LGBTQ youth.2Sachdeva I Aithal S Yu W Toor P Tan JCH The disparities faced by the LGBTQ+ community in times of COVID-19.Psychiatry Res. 2021; 297113725Crossref PubMed Scopus (5) Google Scholar, 7Salerno JP Doan L Sayer LC Drotning KJ Rinderknecht RG Fish JN Changes in mental health and well-being are associated with living arrangements with parents during COVID-19 among sexual minority young persons in the U.S.Psychol Sex Orientat Gend Divers. 2021; (published online Sept 13.)https://doi.org/10.1037/sgd0000520Crossref Google Scholar Health providers should continue providing confidential telehealth services for youth who do not have access to in-person services while recognising the potential privacy issues for youth living in unsafe or uncomfortable environments.13DeMulder J Kraus-Perrotta C Zaidi H Sexual and gender minority adolescents must be prioritised during the global COVID-19 public health response.Sex Reprod Health Matters. 2020; 281804717PubMed Google Scholar Second, school leaders and administrators must provide and promote safe, inclusive spaces for LGBTQ youth as they return to school, including the provision of in-person and online mental health services, LGBTQ-affirming education and resources that LGBTQ youth can access (eg virtual communities, text-based mental health support platforms, and local identity-based organisations), and help educate parents and families. Schools with affirming, safe environments empower LGBTQ youth and strengthen resilience.14Russell ST Beyond risk: resilience in the lives of sexual minority youth.J Gay Lesbian Issues Educ. 2005; 2: 5-18Crossref Scopus (118) Google Scholar Third, evidence-based policy and interventions should include LGBTQ-specific language and issues and increase access to affordable and affirming services. Addressing structural barriers, including prejudiced and discriminatory institutions and policies,4Salerno JP Williams ND Gattamorta KA LGBTQ populations: psychologically vulnerable communities in the COVID-19 pandemic.Psychol Trauma. 2020; 12: S239-S242Crossref PubMed Scopus (116) Google Scholar, 5Wainberg ML Scorza P Shultz JM et al.Challenges and opportunities in global mental health: a research-to-practice perspective.Curr Psychiatry Rep. 2017; 19: 28Crossref PubMed Scopus (166) Google Scholar is also essential. Finally, a knowledge gap on LGBTQ youth issues continues to persist in health research. Studies should be better designed to accurately and comprehensively capture the health and wellbeing of LGBTQ youth.13DeMulder J Kraus-Perrotta C Zaidi H Sexual and gender minority adolescents must be prioritised during the global COVID-19 public health response.Sex Reprod Health Matters. 2020; 281804717PubMed Google Scholar LGBTQ youth mental health is a global issue and research should reflect and investigate the experiences of LGBTQ youth in low-income and middle-income countries.5Wainberg ML Scorza P Shultz JM et al.Challenges and opportunities in global mental health: a research-to-practice perspective.Curr Psychiatry Rep. 2017; 19: 28Crossref PubMed Scopus (166) Google Scholar Researchers should collaborate with LGBTQ populations and LGBTQ health experts and provide options to disclose sexual and gender orientation when collecting sociodemographic data. Studies should aim to comprehensively understand the diverse and evolving needs of LGBTQ youth as they navigate the pandemic; better research better informs policies to improve the health and wellbeing of LGBTQ youth. We must create spaces that foster resilience and agency for LGBTQ youth in our communities and institutions. Ultimately, we must engage with LGBTQ youth to design effective, participatory solutions that protect youth from COVID-19-related mental health outcomes and build a better, healthier future for all. CKO and FW are supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, US National Institutes of Health (NIH). The content of this Comment is solely the responsibility of the authors and does not necessarily reflect the views of the NIH. We declare no competing interests." @default.
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