Abstract

As key centers for adolescent development, schools present sites for intervention ensuring the wellbeing of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) students. Given mounting evidence on the association between LGBTQ+ identities, negative school climates, and disparities in mental health and suicidality, schools must maintain inclusive environments. This review focuses on strategies for schools to emerge as gateways to improved mental health and resilience among LGBTQ+ students. This study provides clear recommendations, including supporting anti-bullying policies, LGBTQ+-inclusive curricula, and safe spaces, for counselors, educators, school policy makers, and other stakeholders in school ecosystems to intervene professionally on behalf of LGBTQ+ students. The implications of this study help school counselors to be catalysts moving schools to better serve LGBTQ+ students.

1. Introduction

High school environments play a crucial role in influencing students’ well-being and overall health. Conversely, LGBTQ+ students suffer high rates of discrimination, stigma, and bullying while at school due to their perceived gender expression or sexual identity, which makes them feel insecure at school ^{1, 2}. This can lead to numerous negative educational and mental health outcomes such as high dropout rates, self-harm, abuse of alcohol and drugs, suicide, low self-esteem, isolation, and depression ^{3, 4, 5, 6}. The effects of bullying also end up shaping pivotal developmental processes among these students and significantly influence mental health disparities ^{7, 8, 9}. The prevalence of victimization in schools is worrying mainly because it is linked to short-term and long-term challenges such as increased suicidality, poor psychosocial adjustment, and poor academic and health outcomes ¹⁰. Considering these disparities between LGBTQ+ students and their cisgender-heterosexual peers, it is important to comprehend the factors that instigate these inequalities and address them through school-based prevention efforts, policies, and programs. LGBTQ+ students can fully realize their potential if they are accorded the support they need and valued as school community members. Accomplishing this requires schools to focus on fostering positive academic, emotional, and social development for all students while eliminating sexuality-based and gender-based biases.

School interventions that tackle discrimination against LGBTQ+ students can foster inclusivity and enhance the well-being of students. This study reviews the existing literature on risk factors and protective factors for LGBTQ+ youth in schools and explains common findings regarding interventions to prevent risks associated with homophobia and transphobia. By cataloging evidence-based practices for schools to support LGBTQ+ youth, this review provides clear recommendations for counselors and other stakeholders within school ecosystems.

2. School Risk Factors

LGBTQ+ students’ exposure to victimization and bullying at school has been associated with many negative academic and health outcomes such as poor individual and school-level academic performance, poor physical and psychosomatic health, psychological stress, mental health challenges, absenteeism due to fear, depression, and suicidal ideation ^{11, 12, 13}. According to the 2013 National School Climate Survey from the Gay, Lesbian, and Straight Education Network (GLSEN) involving 7,898 students from 6th to 12th grade across 2,770 school districts, 55% of LGBTQ+ students did not feel safe at school due to their sexual orientation and 38% felt unsafe due to their gender expression ¹⁴. Almost 33% of LGBTQ+ students missed one or more school days over the past month, over one-third avoided gender-segregated locker rooms and bathrooms, and over two-thirds tended to avoid participating in events at schools because they did not feel safe ^{14, 15}. In addition, almost three-fourths of LGBT students indicated that they had been verbally harassed and 49% revealed that they had experienced electronic harassment in the past year ¹⁴. At the same time, 16.5% of these students revealed that they had been physically assaulted in the past year and 36% had been physically harassed ¹⁴. Given these high rates of discrimination, it is important to foster the development of safe and supportive school environments for LGBTQ+ youth. Therefore, it is evident that schools must address all the risk factors contributing to the victimization, bullying, stress, and mental health issues that LGBTQ+ students face.

Victimization based on stigma severely jeopardizes the psychosocial development and overall health of LGBTQ+ students ^{15, 16, 17, 18}. It poses a serious threat to these students’ mental health, and its negative effects are witnessed in their academic performance and overall well-being ^{19, 20, 21}. High levels of victimization for LGBTQ+ students are linked to reduced self-esteem, few plans for postsecondary education, increased substance abuse, high suicide risks, and increased incidences of depression ²². According to a survey covering 10 states and 10 large urban school districts, LGBTQ+ students are more likely to be harassed, bullied, and injured by a weapon compared to their cisgender-heterosexual counterparts ²³. These findings were replicated by the 2016 Youth Risk Behavior Survey (YRBS) by Kann and colleagues, which similarly found that more than one-third of LGBTQ+ teens had been bullied in school, 23% were sexual violence victims, and 18% had faced physical violence ¹⁶. This verbal and physical harassment, compounded by family rejection and substance use, can increase the odds of contemplating suicide ^{16, 24}. In addition, most recent data from the YRBS suggest that LGBTQ+ students experience more physical bullying (33% vs. 17%) and cyberbullying (27% vs. 13%) than their non-LGBTQ+ peers ²⁵. Another study involving 11,447 high school students examined the correlation between victimization and truancy, future plans after high school, and grades for both LGBTQ+ and cisgender-heterosexual students and found that LGBTQ+ students reported lower grades, higher truancy, a greater probability of not completing high school, and reduced expectations for attending a four-year college than their counterparts ²⁶. These differences were partially mediated by the victimization experienced by LGBTQ+ students. These findings underscore the contribution of victimization and bullying to the academic disparities between LGBTQ+ and non-LGBTQ+ students.

In addition to negative academic outcomes, victimization in high school is also linked to adverse mental health outcomes among LGBTQ students ²⁷. According to a study involving 145 LGBT students, victimization at school mediates the relationship between depressive symptoms and high school belonging and the overall feelings of psychological distress in early adulthood ²⁷. These findings imply that school victimization may be the reason LGBTQ+ students experience higher levels of psychological distress and depression and lower levels of school belonging compared to their cisgender-heterosexual peers ²⁷. Russell et al. analyzed the data covering 245 LGBT youth aged between 21 and 25 and found that victimization at school was linked to high suicidal ideation, reduced self-esteem, and low levels of satisfaction with life ²⁸. In addition, a UK-based Youth Chances community survey involving 1,948 LGBTQ+ university students examined both general as well as LGBTQ+-specific factors linked to mental health problems, self-harm, suicide risks, and use of mental health services ²⁹. The findings revealed that negative experiences on account of one’s LGBTQ+ identity can be linked to self-harm, heightened suicide risks, and mental health problems ²⁹. A different study also performed a secondary data analysis of 145 LGBT adults aged between 18 and 20 from 59 LGBT college and university student groups. This study found that school environment is a key determinant of students’ mental health and a hostile climate at school is linked to heightened psychological distress ^{27, 30}.

According to 2016 national estimates by Kann and colleagues, suicide is alarmingly prevalent among sexual minority youth, with statistics indicating that almost 30% of lesbian, gay, and bisexual (LGB) high school students tried to commit suicide over the past year as opposed to 6.4% of their heterosexual counterparts ³¹. Similarly, the 2015 YRBSS reported that 60.4% of LGB students experienced hopelessness and sadness, about 43% contemplated committing suicide, 38.2% devised a plan to commit suicide, nearly 30% attempted to commit suicide at least once, and 9.4% were involved in a suicide attempt that lead to an injury, overdose, or poisoning ³². Notably, bullying and victimization of LGBTQ+ students is consistently linked to depressive symptoms, suicidal ideation, and suicide attempts ^{33, 34, 35}. This is corroborated by the findings of various studies, including a nationally representative US survey (YRBSS), which indicate that suicidality among LGBTQ+ students is linked to harassment, bullying, or violence based on sexual orientation in schools.

A 2004 Minnesota Student Survey involving 2,255 LGB 9th and 12th grade students found that more than 50% of LGB students had suicidal thoughts and 37.4% had attempted suicide ³⁶. Similarly, a 2006-2008 survey of 31,852 11th grade students in Oregon, which included 1,413 LGB students, found a 21.5% risk for attempting suicide in the LGB group as compared to a 4.2% risk within the heterosexual group over the past year ³⁶. A study of the data collected between 2007 and 2011 comprising 246 LGBT students aged between 16 and 20 found that suicide attempts were associated with impulsivity, a lack of social support, and victimization ³⁶. Robinson and Espelage conducted a large-scale study in Dane County, Wisconsin, involving 13,213 students from 30 middle schools and high schools to determine the discrepancies in mental health outcomes between cisgender-heterosexual and LGBT students ³⁷. Their findings revealed that compared to their non-LGBT counterparts, LGBT students were more likely to seriously contemplate committing suicide (7.7% vs. 23.1%). Even in instances where there were attempts to control the effects of victimization, lesbian and gay students were almost four times more likely to attempt suicide and bisexual students were six times more likely to attempt suicide compared to their heterosexual counterparts ^{38, 39}.

3. School Protective Factors

Although both victimization and bullying are strongly correlated to health inequities, research has demonstrated that supportive school-level initiatives can be crucial protective factors against these disparities ^{10, 40}. A number of strategies in schools can potentially minimize educational and health inequities for LGBTQ+ students and encourage the establishment of supportive climates to protect these students from victimization and bullying ⁴¹. Some of the strategies linked to positive school climates for LGBTQ+ students include implementing policies against bullying and discrimination, developing curricula that include LGBTQ+ activities and events, having supportive teachers and staff, creating safe spaces such as GSAs, and fostering professional development covering sexual orientation and gender identity ^{25, 42, 43}. Feeling safe and connected to the school environment are crucial protective mechanisms that can lower the probability of suicide attempts, suicidal ideation, and depression among sexual minority students ^{44, 45}.

4. Gateway to Mental Health

Since LGBTQ+ students are present in nearly every school in the country, schools can take the lead in providing access to mental health systems across all geographies, classes, ethnicities, and races ¹⁸. Considering that schools regularly interact with the student population and often provide them with mental health services, it would be beneficial if they take part in providing mental health support for LGBTQ+ students ¹⁸. According to statistics, students who need mental health services are 40% more likely to utilize these services when they are located within school campuses ⁴⁶. Mental health services offered at schools are reported to lower ethnic and racial disparities ⁴⁷. If schools can offer these services, they can lower the stigma associated with seeking mental health services, which is prevalent in society at large ¹⁸.

5. Better School Environment

Previous research has shown that protective school environments provide LGBTQ+ students with significant benefits ⁴⁸. Connectedness at school is associated with caring interpersonal relationships, engaged participation in activities, better academic outcomes, and lower suicidal ideation among this group of students ^{12, 49, 50}. Policies that curtail victimization in schools have also proven to have positive outcomes such as fewer incidences of suicide attempts and bullying ^{51, 52}. In addition, LGBTQ+ students can have more positive development and decreased danger of victimization through open support from schools, the implementation of inclusive curricula, and the establishment of safe spaces such as GSAs ^{15, 53}. Available evidence also shows that schools can play a role in lowering students’ aggressions by improving relationships between students and teachers ⁵⁴.

Counselors, school staff, and teachers can enhance LGBTQ+ students’ well-being and experience at school ⁵⁵. If students perceive school staff as being supportive, then they can easily identify one adult with whom they can confidently share their worries, and this can help mitigate the negative health, social, and psychological challenges that they face and enable them to attain better academic outcomes ^{15, 53, 56}. Moreover, counselors, school staff, and teachers’ interventions to curb the bullying and harassment against LGBTQ+ students are linked to fewer incidences of truancy, assault, and harassment among this group of students ⁵⁷. A Canada-based study of LGB students recently observed that the presence of a supportive teacher attenuates the relationship between victimization and substance use ^{17, 58}. In addition, three studies across a nationally representative sample of high school students also found that when parents and teachers show empathy toward LGBTQ+ students, the suicidality rate among these students drops ⁵⁹. Students feel a stronger sense of belonging at school when counselors and teachers take keen interest in their social and academic lives, and this may lead to fewer cases of bullying ⁶⁰. In related findings, students who have at least one adult on campus that they trust to be supportive have better outcomes ⁶¹.

All staff at school are responsible for the well-being of LGBTQ+ students, but school counselors may be best positioned to support the mental well-being of these students ^{62, 63}. Various studies show that out of all school administrators, LGBTQ+ students consistently feel most comfortable talking to school counselors about their gender identity and/or sexual orientation ⁶⁴. This was evidenced in a 2016 study from Kosciw and colleagues, where 51.7% of LGBTQ students felt comfortable conversing with school counselors, which was substantially higher when compared to security officers (24.2%), assistant principals (24.3%), and principals (25.1%) ⁶².

Sparse or inconsistent staff intervention when it comes to LGBTQ+ students’ needs typically increases incidences of assault and harassment ^{15, 56}. Among students who report such incidents, 62% said that school staff neither responded appropriately nor took tangible measures ¹⁴. This can be attributed to school counselors lacking appropriate resources and training to address LGBTQ+ students’ concerns ⁶⁵. When school personnel become more confident in intervening in incidents that involve gender and sexuality stigma, students attain improved outcomes ^{66, 67}. Professional development regarding LGBTQ+ students has also been reported to increase empathy and intervention when LGBTQ+ students are victimized ⁶⁸. Table 1 illustrates the recommendations for school counselors to prepare the school to support LGBTQ+ students and Table 2 illustrates the recommendations for school counselors to effectively support LGBTQ+ students ^{15, 22, 62, 69, 70}.

School principals can make a significant contribution by creating awareness about LGBTQ+ students’ needs and rights among students, teachers, counselors, and school personnel ^{69, 71}. They can revise their school policies and handbooks to explicitly protect LGBTQ+ students through discussing the language and names used at school and devising appropriate discipline codes to ensure that these policies are implemented. Principals should also create a school culture that encourages everybody to accept and respect diversity. All of these can be achieved by establishing a planning committee to set up an in-service training dealing with such concerns of tolerance. Students can also be part of these inclusion efforts by taking part in planning student assemblies that cover these topics and to be active participants in LGBTQ+ community events. In addition, school principals can also consider forming a curriculum committee that finds resources that can be used to create a curriculum that celebrates diversity. These steps can move the school closer to its goal of respecting all community members without incubating gender identity or sexual orientation biases. Table 3 lists recommendations for principals to effectively support LGBTQ+ students.

Among LGBTQ+ students in particular, a supportive school environment has been linked to decreased rates of truancy, substance use, suicidal ideation, and depression ⁵⁷. The implementation of safe spaces in school, such as a student-led GSA, is one of the measures that contribute to a positive school climate and has been recognized as a supportive resource for LGBTQ+ students ^{72, 73}. The main function of this group is to provide a space for advocacy to lower harassment and prejudice within the school environment while fostering increased self-empowerment and self-esteem for LGBTQ+ students ^{74, 75, 76, 77}. LGBTQ+ students attending schools equipped with a GSA are known to be more likely to feel safe about their sexual orientation and experience fewer cases of victimization and bullying than those who attend schools without GSAs ^{25, 78, 79}. A meta-analysis quantitatively synthesized 15 primary research studies involving 62,923 respondents to examine the linkage between the presence of GSA and students’ accounts of victimization at school, with various study-level factors acting as controls ¹⁰. According to the findings of this meta-analysis, the presence of GSAs is linked to substantially lower homophobic victimization, homophobic remarks, and safety-related fears reported by students ¹⁰.

The visibility of GSAs additionally allows LGBTQ+ students to easily identify supportive school staff ⁵⁷. Regardless of whether or not they individually engage in the GSAs, LGBTQ+ students in schools with GSAs record positive perceptions about their school experiences and better mental health in the long term ^{80, 81, 82}. One study surveyed 240 sexual and gender minority high school students nationwide, where 53% of the respondents had GSAs in their schools, asking questions about their school environments ⁸³. The results from the survey revealed that supportive staff and overall school environment are crucial for positively impacting sexual and gender minority students’ mental health ⁸³. LGB students were less suicidal and had a lower likelihood of discrimination in schools where GSAs and relevant policies had been in place for at least three years, and the effect of duration was particularly strong for GSAs ⁴⁵. Therefore, GSAs play a variety of supportive roles, including: (a) providing individual support and counseling; (b) establishing safe spaces for students to discuss matters on gender identity and sexuality; (c) enhancing LGBTQ+ visibility across school; and (d) ensuring that schools are safe for LGBTQ+ students ¹⁰. However, beyond GSAs, there are a number of other strategies that can help create a positive school climate such as teaching inclusive curricula in classrooms.

Teaching curricula that reflect the histories and experiences of LGBTQ+ individuals also contributes to the creation of a supportive environment for LGBTQ+ students ^{73, 84}. When LGBTQ+ inclusive curricula are taught in classrooms, both LGBTQ+ and cisgender-heterosexual students report greater safety, fewer instances of victimization and use of homophobic slurs, and more acceptance of LGBTQ+ students by their peers ^{31, 85, 86}. Inclusive curricula may also potentially lower health risks for LGBTQ+ students ^{87, 88, 89}. However, currently, LGBTQ+ topics are not prioritized in school curricula ^{61, 90}. GLSEN’s National School Climate Survey conducted in 2009 showed that only 17.9% of 7,000 LGBTQ+ students indicated that their school curricula included information on LGBTQ+ topics ^{22, 91}. LGBTQ+ inclusive curricula are crucial as they encompass information about this community, including historical events and people, and are known to make students feel accepted and safe, thereby lowering their victimization in school ^{22, 48}.

According to a 2015 YRBS and 2014 School Health Profiles, students in states that have a higher proportion of schools with LGBTQ+ inclusive curricula have a lower likelihood of negative mental health outcomes and victimization at school ⁹². Additional research suggests that the inclusion of LGBTQ+ topics within elementary schools positively impacts the learning environment for students ⁹³. LGBTQ+ inclusive curricula have also been linked to higher peer support. For instance, two-thirds of LGBTQ+ students indicated that their classmates supported the LGBTQ+ community when inclusive curricula were emphasized in schools ^{22, 84}. In another finding supporting the importance of inclusive curricula, more than 75% of LGBTQ+ students in schools that had adopted inclusive curricula reported that their classmates accepted LGBTQ+ individuals compared to 39.6% of those who did not have such curricula ²². A 2008 Preventing School Harassment survey involving 1,232 LGBTQ+ and cisgender-heterosexual students in middle schools and high schools also found that there is a direct correlation between inclusive curricula and higher individual and school safety, as well as fewer cases of bullying ^{73, 84}.

Providing LGBTQ+-specific resources and implementing anti-bullying policies on campuses have also been associated with improved academic performance and better mental health outcomes among LGBTQ+ students ^{31, 94, 95, 96}. This may be attributed to the implementation of anti-harassment guidelines that influence these students to have positive perceptions about their environment and a lower likelihood of being harassed ⁹⁷. Schools that have policies against bullying on the basis of gender identity and sexual orientation report significantly lower abuse and bullying of LGBTQ+ students ^{14, 87, 94, 98}. Anti-bullying policies rooted in evidence are known to have an impact similar to inclusive curricula on improving the mental health and academic achievements of LGBTQ+ students, creating safer school environments, and lowering cases of bullying ⁷⁸. It is also worth noting that beyond having these policies in place, full implementation and strict enforcement are necessary to guarantee maximum protection for LGBTQ+ students ^{99, 100}. In a meta-analysis of 30,934 youth aged between 7 and 16 across 14 anti-bullying interventions, researchers found that school-based anti-bullying programs effectively prevent bullying, school violence, and victimization ¹⁰¹. However, a 2005 study by GLSEN and the National Association of Secondary School Principals observed that although most schools have policies against bullying on the basis of gender identity or sexual orientation, fewer than half of them actually enforce those policies ⁶⁹. To address the issue of LGBTQ+ victimization, experts recommend enforcing comprehensive anti-harassment and bullying policies that explicitly include sexual orientation and gender identity protections, as well as well-defined systems to report violations of these guidelines ⁹⁵.

6. Strategies to Prevent Bullying and Suicide

In a 2010 study by Blumenfeld and Cooper, LGBTQ+ respondents suggested that schools should establish internet-based methods for students to report cyberbullying anonymously to create more opportunities for intervention and take swift action when bullying is reported ⁵⁵. Such policies play an important role in curbing the harassment of LGBTQ+ students and prove that schools are serious about ending the menace of cyberbullying. School employees should be trained about their respective states’ guidelines on cyberbullying, including laws protecting gender expansive and sexual minority students. It is also necessary to create and enforce non-discrimination policies that can be applied to all students in schools ¹⁰². At the same time, it is important to include LGBTQ+ students in devising policy statements to legitimize schools’ mission to support the education and well-being of all students. School policies must reflect this mission and ensure that all students are treated fairly and get equal access to mental health and educational services. Both students and school personnel must also be aware of these anti-bullying policies, and the consequences of violating them need to be consistently implemented whenever intimidation, victimization, and harassment occur ¹⁰². A random survey of 8th, 9th, and 11th grade students from 325 schools found that schools that made use of supportive practices had significantly lower prevalence of physical and relational bullying, as well as victimization based on sexual orientation ⁷⁸. Therefore, it can be surmised that a safe and supportive environment is a crucial element of a comprehensive public health strategy for preventing suicide among students ^{97, 103}. Table 4 illustrates the specific policies that schools can implement to prevent bullying and suicide among LGBTQ+ students ^{16, 30, 78, 97}.

7. Implications

The findings of this review have significant implications for how school counselors, educators, and school policymakers can intervene on behalf of LGBTQ+ students in their practice. Counselors have the potential to drive significant changes in the school’s climate through their position of trust with students and their expertise about mental health. As such, they can be effective advocates on behalf of students through educating colleagues by delivering professional development, intervening in bullying and supporting preventative policies, supporting GSAs, and designing inclusive curricula with teachers. These evidence-based strategies allow counselors to be catalysts moving schools to better serve LGBTQ+ students in collaboration with teachers, school administrators, and other personnel.

8. Conclusion

High schools are a key center for adolescent development, and they present significant opportunities for interventions aimed at ensuring the well-being of LGBTQ+ students. Setting up safe and supportive school environments can protect LGBTQ+ students from victimization and discrimination while fostering resilience and increasing achievement. Establishing such an environment involves training counselors and teachers on how to intervene effectively against bullying. LGBTQ+ students feel safer in schools that have anti-discrimination policies that include sexual orientation and gender identity, GSAs and other support groups, LGBTQ+-inclusive curricula, and teachers who engage in professional development with regard to supporting LGBTQ+ students. A safe, enabling, and supportive school environment is a key element of a public health strategy that can prevent suicidality among LGBTQ+ students.

Author Contributions

Both authors contributed equally. Both authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

References