Sexual and Dating Violence and Mental Health Among LGB Youth: Findings from the 2023 Youth Risk Behavior Surveillance System

Background and Purpose

Lesbian, gay and bisexual (LGB) youth are at increased risk of experiencing sexual and dating violence, which are associated with poor mental health outcomes. Despite growing attention to youth mental health, there is limited research using nationally representative data that examines multiple forms of dating violence and their relationship to mental health across sexual identity groups. This study aims to examine differences in experiences of sexual and dating violence by sexual identity, assess the associations between these experiences and mental health, and test whether these associations differ for LGB and heterosexual youth.

Methods
We used data from the 2023 National Youth Risk Behavior Surveillance System (YRBSS), a nationally representative, cross-sectional, and school-based survey of U.S. high school students. Participants who identified as transgender were excluded to focus this analysis specifically on differences by sexual identity, yielding a final analytic sample of 19,491 students.

Participants were recoded into heterosexual (81.1%) and LGB (18.9%) based on self-reported sexual identity. Sexual violence experiences included forced sexual intercourse and sexual or physical dating violence in the past year. Mental health was assessed by self-reported mental health status over the past 30 days. All variables were dichotomized.

A design-based analytic approach was used, accounting for the survey design (including clusters and strata) and sample weights in all models. Descriptive analyses were conducted to estimate weighted proportions of demographics and outcomes for the overall sample and by sexual identity. Chi-square tests examined group differences. Multivariate logistic regression models examined associations between sexually violent experiences and mental health, controlling for race/ethnicity and age.

Results

Most participants were between ages 15-17 (75.7%). The study sample was 47.6% White, 13.6% Black, 7.8% Hispanic, and 25.9% multiracial. LGB youth reported significantly higher rates of all forms of sexual violence compared to heterosexual youth, including forced sexual intercourse (18.2% vs. 5.8%, p < .001), sexual violence (19.7% vs. 8.6%, p < .001), sexual dating violence (10.9% vs. 4.3%, p < .001), and physical dating violence (16.9% vs. 7.7%, p < .001). Poor mental health was reported by 52.1% of LGB youth compared to 21.4% of heterosexual youth (p < .001). Multivariate logistic regression showed that LGB youth had higher odds of reporting poor mental health (OR = 1.97, 95% CI [1.72, 2.25]). All forms of sexual and dating violence were significantly associated with increased odds of poor mental health (ORs 1.58-1.85, p < .001). The association between forced sexual intercourse and poor mental health differed by sexual identity, with a smaller effect observed among LGB youth (OR = 0.87, 95% CI [0.78, 0.98]).

Conclusions and implications

LGB youth are at greater risk for sexual and dating violence and poor mental health. While sexual violence strongly predicts poor mental health for all youth, the effect appears less significant among LGB youth, potentially due to elevated baseline psychological distress or other intersecting factors. These findings underscore the need for inclusive dating and sexual violence prevention efforts and targeted mental health support.