The Associations between Internalized Stigma, Victimization, and Mental Health Service Utilization Among a National Sample of Sexual and Gender Diverse Youth

Background and Purpose

Sexual and gender diverse youth experience intersecting challenges related to their sexual and gender identities, including internalized stigma and peer victimization, which can significantly impact their mental health. Internalized stigma, the internalization of societal prejudice, is linked to negative self-perceptions, psychological distress, and barriers to help-seeking. While previous studies have explored internalized stigma as both consequences of victimization and a mediator between victimization and adverse mental health outcomes, few have examined how internalized stigma contributes to recent victimization and mental health service utilization. The current analysis examined the associations between internalized stigma, peer victimization, and mental health service utilization among a national sample of sexual and gender diverse youth in the US.

Methods

We conducted a secondary data analysis using a national sample of sexual and gender minority youth aged 13-18 years. Internalized stigma was assessed using four items measuring negative self-perceptions related to LGBTQ+ identity (e.g., “I wish I were not LGBTQ+”). Peer victimization was measured using the 4-item University of Illinois Victimization Scale, capturing verbal and physical victimization in school settings over the past 30 days (e.g., being called names or physically harmed). Depressive and anxiety symptoms were measured using the PHQ-4. We used multivariable logistic regression models to assess the relationship between internalized stigma and victimization, adjusting for age, gender identity, race/ethnicity, tobacco and marijuana use.

Results

The average age of 12,641 sexual and gender diverse youth was 15.81 years old (SD=1.48). Most youth were female at birth (64.42%), identified as gay or lesbian (29.17%) and bisexual (27.49%). Among all youth, 57.54% reported experiencing peer victimization, and 45.87% and 52.94% were screened positive for depressive symptoms and anxiety based on PHQ-4. Experiencing victimization was associated with younger age, smoking cigarette, any unprescribed drug use (p<0.001 for all). In multivariable model, higher levels of internalized stigma was associated with higher odds of experiencing peer victimization (adjusted odds ratio = 1.07, 95% CI: 1.05-1.09). Among those who screened positive for depressive symptoms or anxiety, only 50.68% received therapy or counseling services in the past 12 months, and SGD youth who experienced peer victimization were more likely to had received therapy or counseling services compared to those who did not report victimization (p<0.001).

Conclusions and Implications

Findings highlight that internalized stigma is significantly associated with increased odds of peer victimization among sexual and gender diverse youth, compounding their risk for poorer mental health outcomes. Despite elevated rates of depressive symptoms and anxiety, mental health service utilization remains low. Sexual and gender diverse youth who experienced peer victimization were more likely to access counseling or therapy, suggesting that traumatic experiences may prompt help-seeking, while internalized stigma and minority stressors continue to hinder broader service engagement. These results underscore the need for inclusive, trauma-informed interventions that affirm sexual and gender diverse identities, reduce internalized stigma, and proactively connect youth to mental health care—before victimization occurs. Schools, providers, and policymakers must prioritize safe environments and stigma-reducing strategies to ensure timely, equitable mental health support for sexual and gender diverse youth