Lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual (LGBTQIA) youth are more likely than cisgender heterosexual youth to experience traumatic stress across all social systems, including within family, school, and health care settings. LGBTQIA youth may be particularly susceptible to traumatic stressors associated with medical illness or injury and health care, due to both to higher baseline levels of stress and adversity and unique identity-linked stressors pervasive across systems of care. Pediatric providers can greatly impact mental health in their LGBTQIA patients by providing trauma-informed care that is affirming of gender and sexual identities. This article presents foundational concepts pertaining to medical trauma and practice priorities for pediatric providers, who are uniquely positioned to mitigate medical traumatic stress experienced by LGBTQIA youth. [Pediatr Ann. 2021;50(9):e379-e383.].

Traumatic stress increases the risk for mental health conditions and adversely impacts health, academic performance, and coping. Transgender and gender diverse (TGD) youth experience higher rates of abuse and maltreatment and interpersonal and community-embedded discrimination than their cisgender peers. Neurobiologic stress responses and social stress theory provide useful frameworks for understanding the effects of discrimination, stigma, and rejection. Despite facing higher rates of interpersonal trauma, TGD youth are quite resilient when able to access supports and affirming trauma-informed services. Clinicians play an important role in identifying and addressing traumatic stress impacting TGD youth and bolstering resilience.

Background

Adolescents today have unprecedented and uninterrupted access to news and current events through broadcast and social media. Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) adolescents may be especially cognizant of media and public discourse pertaining to law and policy changes affecting the legal rights of their communities. The minority stress framework explains how sociopolitical discourse impacts mental health among sexual and gender minority youths.

Objectives

This paper identifies and describes contemporary sociopolitical and legal issues that may impact LGBTQ adolescents' mental health.

Methods

Authors describe the minority stress framework as applied to gender and sexual identity and explore key sociopolitical and legal topics relevant to LGBTQ adolescents, including employment; medical care bans; health insurance coverage; conversion therapy; religious exemptions in health care; housing rights; and rights in schools and school districts, including participation in sports.

Results

LGBTQ youth experience rejection, prejudice, and discrimination directly through adverse legislative or administrative action and more pervasively through the dominant cultural beliefs and sociopolitical messaging that such developments manifest.

Conclusion

Mental health clinicians who are aware of legal issues and sociopolitical debate pertinent to LGBTQ rights are better prepared to address their significant impact on LGBTQ adolescents' mental health.

While growing awareness of the unmet mental health needs of LGBTQ youth populations has prompted calls for greater emphasis on health equity, efforts have largely overlooked glaring inequities affecting LGBTQ youth who become involved with the justice system. The disproportionality of juvenile justice system involvement for LGTBQ youth is a public health concern that merits focused attention and advocacy from child and adolescent mental health professionals. The proportion of incarcerated youth in the juvenile justice system who are LGBTQ is twice that of LGBTQ youth in the general adolescent population.¹ Disparities are even more pronounced for girls-40% of incarcerated girls identify as LGB and/or report same-sex attraction.² Furthermore, gender and sexuality dimensions intersect with racial and ethnic identities for many youth involved in the justice system. In fact, 85%-90% of incarcerated LGBTQ youth are from ethnic or racial minority backgrounds.^2,3 Thus, we call for attentiveness to the intersectional inequities facing LGBTQ youth involved in the justice system and offer solutions for improving their mental health outcomes. Child and adolescent mental health professionals can change trajectories of LGBTQ youth through clinical work that addresses modifiable risk factors facing LGBTQ youth, targeted research efforts on the experiences of LGBTQ youth in justice settings as well as intervention studies, and legislative advocacy that provides protective and appropriate services to LGBTQ youth across various justice system touchpoints.

The workforce of mental health providers serving lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth lags far behind the demand for LGBTQ-focused mental health care. Unsatisfactory training and a lack of standardized training metrics for accredited programs perpetuate the lack of preparedness among providers. The presence of LGBTQ+ faculty and mentors in medical education increases the amount of LGBTQ+ content taught to trainees and improves professional development for LGBTQ+ trainees. Inclusive workplace practices and affirming care policies may also improve retention and recruitment of LGBTQ-serving mental health providers.

The U.S. Navy Atlantic Fleet Weapons Training Area (AFWTA) located in Vieques, Puerto Rico, includes land areas, waters and islets impacted by 63 years of military training operations. High-density universal SSU rRNA gene microarray analysis for Archaea and Bacteria were used to describe the microbial community structure of soil and marine sediment samples from Vieques and two reference locations. Total community DNA was extracted, PCR amplified and hybridized to an array encompassing 16S rRNA for over 8,900 distinguishable taxonomic units. Hierarchical clustering of the 100 most variable sub-families detected by the array demonstrated that variable sequences fell into six (6) primary response groups. Samples from sediments and soils are very similar between each of their kind. Furthermore, samples from closer geographical locations were more similar than distant sites. Higher numbers of OTU's were observed in soil samples with 193 to 318 sub-families identified in each sample. Bacteroidetes, actinobacterias and acidobacteria were the more common phyla detected in Vieques than reference samples. The presence of diverse groups of bacteria may indicate a great potential for natural or enhanced biological restoration. Understanding the function and community structure of highly disturbed ecosystems could assist environmental restoration strategies.

The U.S. Navy Atlantic Fleet Weapons Training Area (AFWTA) located in Vieques, Puerto Rico, includes land areas, waters and islets impacted by 63 years of military training operations. High-density universal SSU rRNA gene microarray analysis for Archaea and Bacteria were used to describe the microbial community structure of soil and marine sediment samples from Vieques and two reference locations. Total community DNA was extracted, PCR amplified and hybridized to an array encompassing 16S rRNA for over 8,900 distinguishable taxonomic units. Hierarchical clustering of the 100 most variable sub-families detected by the array demonstrated that variable sequences fell into six (6) primary response groups. Samples from sediments and soils are very similar between each of their kind. Furthermore, samples from closer geographical locations were more similar than distant sites. Higher numbers of OTU's were observed in soil samples with 193 to 318 sub-families identified in each sample. Bacteroidetes, actinobacterias and acidobacteria were the more common phyla detected in Vieques than reference samples. The presence of diverse groups of bacteria may indicate a great potential for natural or enhanced biological restoration. Understanding the function and community structure of highly disturbed ecosystems could assist environmental restoration strategies.

There is growing concern about the mental health and social impact of COVID-19 on underresourced children, youth, and families given widespread social disruption, school closures, economic impact, and loss of lives. In this commentary we describe how an existing public-public partnership between a large county mental health department and a state university responded to COVID-19. This partnership, originally designed to address workforce needs, rapidly pivoted to support providers through a trauma- and resilience-informed approach to mitigating adverse mental health effects among youth and families in Los Angeles County. (PsycInfo Database Record (c) 2020 APA, all rights reserved).