Associations Between State-Level Structural Stigma and Sexual and Gender Minority Youth Mental Health

Introduction: Sexual and gender minority youth (SGMY) face high levels of discrimination, which in turn is related to mental health inequalities. Structural stigma perpetuated by macro-level forces (social norms, laws, and policies) constrains opportunities and resources for SGMY, thereby contributing to downstream mental health outcomes. While a large body of work has explored SGMY’s increased risk for adverse mental health outcomes, little research has directly examined the roles of structural factors on SGMY mental health. Methods: In the current study, we employed structural equation modeling to examine the association of laws and policies explicitly aimed at SGMY with depression and self-esteem outcomes in a diverse national sample of youth (N = 17,112) surveyed between April and December 2017. Results: The presence of protective laws and the absence of antagonistic laws in the state SGMY lived in were associated with decreased depression and increased self-esteem. Sensitivity analyses revealed that this association held only for cisgender sexual minority youth. Trans and nonbinary (TNB) youth reported uniformly higher levels of depression and lower levels of self-esteem, neither of which were associated with SGMY equity-focused laws, possibly reflecting higher baseline levels of interpersonal and societal stigma directed at TNB youth. Conclusions: These findings suggest the importance of implementing laws and policies specifically aimed at protecting SGMY and removing laws targeting SGMY, while revealing the need for greater support for TNB youth specifically. Policy Implications: The presence of laws explicitly aimed at protecting SGMY and the absence of laws targeting SGMY are linked to lower depression and higher self-esteem among sexual minority youth. There is a need for trans youth-specific protective laws as well.