Mental Health
Mental Health Disparities Among Rural LGBTQ+ Youth in Kentucky Meredith Cahill* Meredith Cahill Robert Illback Lisa Crabtree Ben Birkby
In 2023, Kentucky mandated that schools prohibit transgender students from utilizing facilities in alignment with their gender identity. The mandate also banned school staff from using student-requested pronouns and instruction on gender identity and sexual orientation. This raised concerns about subjecting already vulnerable LGBTQ+ youth to further discrimination, and subsequent increased risk for poor mental health outcomes, especially in rural communities. The current study examined mental health disparities experienced by rural LGBTQ+ youth in Kentucky through a secondary analysis of 2021 data from a statewide behavioral health survey of middle and high school students. Self-reported data on sexual orientation and gender identity, 30-day serious psychological distress, past year suicidal ideation, and past year suicide attempts were analyzed using multivariate logistic regression, controlling for student grade level and race/ethnicity to compute odds ratios (ORs) and 95% confidence intervals. Analyses were stratified by rurality using federal designations. The prevalence of 30-day serious psychological distress, suicidal ideation, and suicide attempts was 22%, 14%, and 8%, respectively. Prevalence rates for these indicators varied by gender and sexual orientation, with students outside of the gender binary reporting the highest rates. For LGBTQ+ students, significantly higher odds of 30-day serious psychological distress (OR:8.6;95%CI:7.9-9.3), past year suicidal ideation (OR:8.0;95%CI:7.5-8.7), and past year suicide attempt (OR:5.4;95%CI:5.0-5.9) were seen. These disparities were heightened for LGBTQ+ youth in rural counties for suicidal ideation (OR:9.1; 95%CI:8.2-10.1) and attempted suicides (OR:6.2;95%CI:5.6-7.0). Kentucky LGBTQ+ students, especially in rural areas, had increased odds of poor mental health compared to their peers. These findings highlight the urgent need for policies supporting safe and affirming school environments throughout the state.