The risk for depression, suicidality, substance use, and tobacco use is much higher among LGBTQ adolescents compared to their heterosexual or cisgender peers, according to a recent study presented at the PAS 2025 Meeting.

This finding emphasizes “the importance of incorporating routine, standardized assessments of gender identity/sexual orientation, as well as for depression and substance use, in primary care settings so that clinicians can better understand and address the unique needs of LGBTQ adolescents,” said Gabrielle DiFiore, researcher and analyst from the Children’s Hospital of Philadelphia, Pennsylvania, US.

“This screening strategy can help clinicians efficiently provide more tailored, personalized, and comprehensive care to LGBTQ youth,” she added.

DiFiore and her team performed a cross-sectional analysis of electronic health record data for adolescents aged 13?19 years seen for annual preventive visits in their institution across 31 sites between January 2022 and December 2024.

A total of 128,982 adolescents completed a questionnaire that assessed tobacco, substance use (eg, alcohol, marijuana, and others), sexual orientation and gender identity, as well as the validated Patient Health Questionnaire (PHQ-9) assessing depression and suicidality.

The associations between LGBTQ identity (including stratified by gender identity and sexual orientation minority) and three factors (ie, depression suicidality, substance use, and tobacco use) were explored. Finally, chi-square tests were used to assess the statistical significance of such associations.

Of the adolescents who completed the questionnaires, 15 percent reported LGBTQ identity, 10 percent had depression/suicidality, and 12 percent had a history of substance use, with alcohol being the most common (9 percent). [DiFiore, et al, PAS 2025]

Gender minority

LGBTQ identity showed a significant association with each risk factor. More LGBTQ teens reported depression/suicidality compared with their heterosexual/cisgender peers (27 percent vs 7 percent; p<0.001). In addition, substance use was also higher in this population (16 percent vs 9 percent; p<0.001), as was tobacco use (7 percent vs 3 percent; p<0.001).

Similar associations were observed among teens identifying as a gender identity minority (depression/suicidality: 31 percent vs 7 percent; substance use: 17 percent vs 9 percent; tobacco use: 7 percent vs 6 percent) or as a sexual orientation minority (depression/suicidality: 32 percent vs 9 percent; substance use: 13 percent vs 10 percent; tobacco use: 5 percent vs 4 percent).

“Capturing gender identity and sexual orientation is essential for a comprehensive understanding of adolescents' experiences and needs, ultimately informing tailored interventions that address both their identities and associated risks,” DiFiore said.

“Further studies should explore effective interventions within primary care that specifically address the mental health and substance use challenges faced by LGBTQ adolescents,” she added.

“The American Academy of Pediatrics emphasizes creating a safe, affirming environment for adolescents, including for those who identify as LGBTQ,” DiFiore said. “Affirmative care is linked to better mental health outcomes, including lower levels of depression and suicidality.”