Mental health · Aug 6, 2026
I have an LGBTQIA+ teenager, how can I help them?
Many parents arrive at the office frightened by what they have read about the mental health of LGBTQIA+ teenagers, and afraid they are doing something wrong. Science points, with rare clarity, to where a family’s care makes the greatest difference.
A mother I had followed for a while rescheduled the appointment three times before she could say what had brought her. When she sat down, she told me quietly that her fifteen-year-old daughter had come out, the week before, as a lesbian, and that she, the mother, had answered with a silence she regretted the instant it left her. Do not ask me whether I did the right thing, she said, ask me what I do from here. She carried in her face the fear of having pushed her daughter away, and a sincere wish to get it right. I told her that science has, on this, a message rare in its clarity, and that it begins by undoing a common mistake.
The risk is real, and it does not come from where many think
I started by undoing the mistake, because it changes everything that follows. In 2011, Michael Marshal and colleagues, at the University of Pittsburgh in the United States, gathered the studies comparing sexual minority adolescents with their heterosexual peers and found, among the former, close to a 3 times higher risk of suicidal behavior and more symptoms of depression. It is a figure that frightens, and it is worth reading for the right reason. That extra suffering does not spring from being gay, lesbian, bisexual, or trans. It comes, the authors themselves show, from what these young people face on the outside, discrimination, hostility, the weight of hiding. Researchers call it minority stress, and the distinction is not academic. I make a point of it in the office, because it lifts from the young person a guilt that was never theirs and hands the family a role it genuinely has. If the risk came from who they are, there would be nothing to do. Because it comes from the environment, there is a great deal to do, and the family stands at the center of it.
Rejection at home weighs heavily
A teenager’s first environment is home itself, and that is where the effect shows up most strongly. In 2009, Caitlin Ryan and her team, at San Francisco State University in the United States, interviewed 224 lesbian, gay, and bisexual young adults about how their families had reacted during adolescence. Those who reported a high degree of rejection at home were 8.4 times more likely to have attempted suicide and 5.9 times more likely to report high levels of depression than those who came from families with little or no rejection. I tend to pause on that figure with parents, not to frighten them, but because it names precisely the size of what is at stake. A family’s reaction is not an emotional detail, it is a health factor.
The weight of a family’s reaction
In 2009, a team at San Francisco State University interviewed 224 lesbian, gay, and bisexual young adults. Those who lived through high family rejection in adolescence were 8.4 times more likely to have attempted suicide.
A family’s reaction is not a detail. It enters the young person’s health for years.
Acceptance protects, and it has been measured
The good news came from the same researcher, looking at the other side of the coin. In 2010, Caitlin Ryan and colleagues measured, in 245 young people, the effect of a family’s accepting attitudes during adolescence. Acceptance predicted greater self-esteem, more social support, and better general health, and it protected against depression, substance use, and suicidal thoughts and behaviors. Put another way, the same place that can be the greatest source of risk is also the greatest protective factor this young person has. You do not need to understand everything, nor have the right words on the tip of your tongue. What the research measures is simpler and more within reach, it is a family signaling, in concrete ways, that love is not in question. In practice, accepting is rarely a solemn speech. It is still inviting their friends to Sunday lunch, asking how the day went with the same ease as always, firmly correcting the relative who cracks a cruel joke. They are small gestures, and it is the sum of them that the young person reads as belonging.
Acceptance as a protective factor
In 2010, a team at San Francisco State University measured, in 245 young people, the effect of family acceptance. It protected against depression, substance use, and suicidal behavior, and raised self-esteem and support.
The same place that can be the greatest risk is the greatest protective factor. It is where the family can act.
Small gestures already move the number
Acceptance can sound too large for someone just starting out, so it helps to show how it appears in the small things. In 2018, Stephen Russell and colleagues, at the University of Texas at Austin in the United States, followed 129 transgender young people and saw something almost moving in how concrete it was. Being able to use their chosen name in more areas of life, at home, at school, among friends, at work, was linked to fewer symptoms of depression and fewer suicidal thoughts, and the lowest risk was in those who could use the name in all of those places. A name is a small thing to say and an enormous thing to hear. It carries, without any speech, the message that the person is recognized where they live.
What I do in the office grows out of these findings put together. First, I take off the table the idea that there is something in the young person to fix, because there is not, and that is the ground of everything. Second, I help the family turn the affection it already feels into visible signs, the right name, the right pronoun, standing up to a hostile relative, the question asked with curiosity rather than alarm. Third, I care for the young person without reducing them to a statistic, attentive to sleep, school, and friendships, and ready for an evaluation when the suffering calls for it. None of this fits on one person, which is why I treat the home as a unit of care, not the teenager in isolation.
The gesture I suggest to anyone with an LGBTQIA+ teenager fits in a single sentence, and you can say it today. Call them by the name they asked for, use the pronoun they asked for, and say out loud that their place at home does not depend on any of this. The research does not measure grand speeches, it measures exactly these small, repeated signs that love is not up for negotiation. It is a small thread, and one of the ones that hold most. Pulled with steadiness, it shows the young person that the door of the house stays open, and it is from that door that safety grows. None of this replaces the individual evaluation of whoever follows your family, and it is right beside that care that this conversation goes furthest.
Frequently asked questions
My child told me they are LGBTQIA+, what do I do first?
The first step is the simplest and the most decisive, making clear that the bond stays the same. A sentence of belonging said early, something like thank you for trusting me and I am with you, protects more than any perfect conversation you try to assemble later. Research shows that a family’s reaction in the first moments carries real weight in the young person’s health over the years. You do not need to have all the answers, you need to make clear that they are not alone.
Is being LGBTQIA+ a phase or a health problem?
It is neither an illness nor a disorder, and no serious medical body treats sexual orientation or gender identity as something to be corrected. When more suffering appears among LGBTQIA+ young people, it does not come from who they are, but from what they face, rejection, discrimination, and fear. That is why a family’s stance changes the course so much, it acts precisely on the part that makes the difference.
How do I know if my teenager needs professional help?
It is worth seeking an evaluation when changes appear that persist and get in the way of life, such as disrupted sleep, falling school performance, pulling away from friends, sadness that will not lift, or any sign that they are thinking of hurting themselves. A professional who welcomes the young person’s identity, rather than questioning it, is part of the care. When in doubt, a conversation with whoever follows your family is worth more than waiting for the picture to grow.
Does using the name my child asked for really make a difference?
It does, and it has been measured. Among transgender young people, being able to use their chosen name in more areas of life was linked to fewer symptoms of depression and fewer suicidal thoughts, with the lowest risk when the name could be used everywhere. It is a small gesture day to day and a large one in effect, because it tells the person, without any speech, that they are recognized where it matters.
References
- MARSHAL, M. P. et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. Journal of Adolescent Health, v. 49, n. 2, p. 115-123, 2011. PMID: 21783042.
- RYAN, C. et al. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, v. 123, n. 1, p. 346-352, 2009. PMID: 19117902.
- RYAN, C. et al. Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, v. 23, n. 4, p. 205-213, 2010. PMID: 21073595.
- RUSSELL, S. T. et al. Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, v. 63, n. 4, p. 503-505, 2018. PMID: 29609917.
Dr. Marcelo Gobbo Jr.
Family and Community Physician (CRM-MG 74.511 · RQE 69038), with a master’s degree in Psychology from the Federal University of Uberlândia and a Laboratory Associate appointment in the Department of Psychiatry at Yale School of Medicine, based at the Program for Recovery and Community Health. He cares for neurodiverse families and people living with severe mental illness, in person and remotely.