Substance Use, Suicidal Behavior, and Other Mental Health Outcomes Among Youth With Intersectional Sexual and Gender Diverse Identities.

Objective: Sexual diverse (SD) and gender diverse (GD) youth are at increased risk for adverse mental health outcomes compared to heterosexual/cisgender youth (HC). In this study, we aimed to examine youth risk profiles. We hypothesized that there would be a synergistic effect of SD+GD on mental health outcomes. Method: In 2022, a total of 23,915 adolescents in grades 6 to 12 from 60 schools completed the voluntary, confidential Substance Use and Risk Factor (SURF) survey. Questions included screeners for substance use and mental health distress. Regression models examined associations between mental health outcomes and HC, GD, SD, and SD+GD. Results: Mean age was 14.7 years; 25% identified as SD, 5.3% as GD, and 5.2% as SD+GD. Compared to HC, SD+GD youth had higher odds of depression (95% CI = 4.8-6.3), anxiety (95% CI = 4.9-6.5), suicidal thoughts (95% CI = 7.7-10.1), plans (95% CI = 6.7-8.8), attempts (95% CI = 7.0-10.7), nonsuicidal behavior (95% CI = 7.19-9.55), psychotic-like experiences (PEs) (95% CI = 4.1-5.4), emotional reactivity (ER) (95% CI = 22.1-24.5), alcohol use (95% CI = 1.2-2.4), cannabis use (95% CI = 2.3-4.0), smoking (95% CI = 9.4-26.6), and vaped nicotine (95% CI = 1.5-2.6) (all p < .04). Compared to SD only, SD+GD had higher odds of depression (95% CI = 1.5-2.0), anxiety (95% CI = 1.5-2.0), suicidal thoughts (95% CI = 1.7-2.3), plans (95% CI = 1.5-2.1), attempts (95% CI = 1.4-2.2), nonsuicidal behavior (95% CI = 1.67-2.27), PEs (95% CI = 1.6-2.2), ER (95% CI = 8.0-18.3), and smoking (95% CI = 2.3-7.8) (all p < .001). Compared to GD only, SD+GD had higher odds of depression (95% CI = 1.3-4.5), anxiety (95% CI = 1.8-6.4), suicidal thoughts (95% CI = 1.4-4.7), plans (95% CI = 1.1-4.1), nonsuicidal behavior (95% CI = 1.4-6.3), PEs (95% CI = 1.1-3.7), and ER (95% CI = 6.9-9.6) (all p < .03). Conclusion: Although the GD only group is small, these findings on intersectional SD+GD identities have significant implications for adolescent mental health.