There is sufficient evidence that school-based interventions to reduce bullying of LGBTQ+ students can improve social and health outcomes. Such interventions help improve LGBTQ+ students’ mental health, reducing the risk for suicidal ideations and attempts, and reduce discrimination and victimization.
The findings below synthesize the results of the studies on school-based interventions to reduce bullying of LGBTQ+ students. Interventions reviewed include, but are not limited to, gender-neutral restrooms, Gay Straight Alliances (GSAs), LGBTQ+ health services, and anti-bullying policies across three domains of measurement:
Bullying is a common occurrence in the United States (US) with one in five high school students reporting being bullied at school[1]. Bullying can take multiple forms both directly and indirectly including physical, verbal, and relational behaviors, actions used to form or maintain relationships, and actions used to harm the reputation and relationships of the targeted youth[2]. Youth who experience bullying are at greater risk of physical injury, emotional distress, dropping out of school, self-harm, depression, anxiety, and even death[3]. Youth who are both victims of and perpetrators of bullying experience worse short and long-term health outcomes across their lifespan[4],[5],[6],[7],[8],[9].
While there is no national or federal standardized method to record and report national youth bullying statistics, it is well documented that bullying is more prevalent among youth who identify as a member of the LGBTQ+ community[10],[11],[12],[13]. In 2021, the Trevor Project reported that 52% of LGBTQ+ youth enrolled in middle or high school reported being bullied either in person or electronically in the past year[14]. Within the LGBTQ population, higher rates of bullying are experienced among transgender and non-binary students with 61% of students reporting bullying compared to 45% of cisgender LGBQ students.
LGBTQ+ students who reported experiences of bullying in the past year had three times greater odds of attempting suicide[15]. Additionally, LGBTQ+ students experience more violence, poor mental health, and suicidal ideation than their cisgender, and heterosexual counterparts[16]. These elevated health risks are compounded and enhanced by the internal and external effects of the stigma LGBTQ+ youth may face in their daily lives due to their sexual and gender identities[17]. Health risk data collected in the 2015 Youth Risk Behavior Surveillance System[18], which was analyzed without taking into account the compounding impact bullying may have, found that LGBTQ+ youth, when compared to their heterosexual peers, reported an increased prevalence of obesity, cigarette use, alcohol and illegal drugs, feelings of hopelessness, and risky sexual behaviors.
Healthy People 2030 has multiple objectives related to reducing bullying of lesbian, gay, bisexual, or transgender high school students[19],[20],[21],[22].
Anti-bullying interventions, and specifically those aimed at protecting LGBTQ+ youth, can be promoted through programs and policies. In the US, 22 states and 2 territories have laws prohibiting bullying on the basis of sexual orientation and gender identity[23]. For example, California has multiple laws and policies specific to LGBTQ+ students, including nondiscrimination, anti-bullying, and state curricular standards that are required to be LGBTQ+-inclusive[24].
Examples of LGBTQ+ school-based anti-bullying programs include Gay-Straight Alliances (GSAs), identified safe spaces, and staffdevelopment to support LGBTQ+ students. Nationally collected School Health Profiles of secondary schools found that on average 43% had GSAs and 82% had an identified safe space, and 29% of staffreceived professional development to support LGBTQ+ students[25]. Anti-bullying media-based interventions can also be utilized to address bullying among LGBTQ+ populations. One example of this is the Out in Schools program in which screenings of LGBTQ+ films were facilitated along with group discussion[26]. Interventions can also support the inclusion of gender-neutral bathrooms and implementation of LGBTQ+ inclusive sex education[27],[28]. Funding can be acquired to support anti-bullying interventions via private grants and programs through the National Institute of Justice.
Students in grades 8–12 (Lesbian, gay, bisexual, and heterosexual students) from British Columbia, Canada.
Film-based intervention (Out in Schools) designed to reduce sexual orientation prejudice through LGBTQ film screenings and facilitated group dialogues.
Observational study with comparison group (n = 998).
Health: Lesbian, gay, and bisexual girls in schools with Out in School events had a significantly lower risk of seriously considering suicide after Out in Schools events (AOR 0.62, 95% CI .43- .90)
Social: Lesbian and bisexual girls in schools with Out in School events reported significantly lower odds of experiencing discrimination based on their sexual orientation (AOR 0.64, 95% CI, 0.44-0.95)
Gay and bisexual boys in schools with Out in School events had a lower chance of being teased or harassed in the past year (AOR 0.54, 95% CI .33-0.89).
Heterosexual girls in schools with Out in School events had significantly lower odds of being excluded in the past year (AOR 0.88, 95% CI 0.79 - 0.97).
Heterosexual boys in schools with Out in School events showed no significant difference in discrimination or bullying.
LGBTQ youth (ages 15-21 years) from three urban cities in the Northeast, Southwest, and West Coasts (47% were gay/lesbian, 42% bisexual, 10% questioning; 87% cisgender, 12% transgender; 24% were Black, 21% White, and 22% multiracial).
Presence of GSAs and LGBTQ-focused school policies such as antibullying and harassment policies that establish protections based on sexual orientation and gender identity, and training for staff on how to create supportive environments for LGBTQ youth.
Observational study with comparison group (n = 1,061). Multivariate regression used to analyze the relationship between GSAs, LGBTQ-focused policies, and bullying/perceived support.
Social: The presence of GSAs was associated with higher reported classmate support (p ≤ .05). The presence of LGBTQ-focused policies was associated with higher teacher support (p ≤ .05). The combination of both GSAs and LGBTQ-focused policies was associated with reduced bullying (p ≤ .001) and higher perceived support from both classmates (p ≤ .001) and teachers (p ≤ .05).
Adolescents from 30 Massachusetts public high schools (n = 20,790, mean age 16 years; 70% non-Hispanic White). Participants included gay, bisexual, questioning, and heterosexual boys and girls.
School and community-based LGBTQ+ supportive resources. School resources included GSAs, safe spaces, LGBTQ+ events, LGBTQ+ school staff, LGBTQ+ inclusive academic subjects and library books, LGBTQ+ staff training, and gender-neutral restrooms. Community resources included youth organizations, bars, churches, pride activities, and LGBTQ+ service providers.
Observational study with a comparison group. Multivariable regression models were used.
Health: The study found that among gay, bisexual, and questioning boys, the availability of gender-neutral restrooms was associated with a lower risk of a past-year suicide attempt (p<0.01). Staff training was associated with lower suicide risk among boys who are questioning (p<0.05). Additionally, for questioning and heterosexual boys, living in communities with more LGBTQ+ resources was associated with fewer suicide attempts (p<0.01). For questioning and heterosexual girls, living in communities with more supportive resources was associated with significantly fewer suicide attempts (p<0.05).
Adolescents aged 11 to 16 years from 22 schools in Spain (n = 2,057; 987 in experimental group, 1,070 in control group).
The Spanish Tutoría Entre Iguales (TEI) program, a peer tutoring intervention designed to reduce bullying, cyberbullying, and improve the school climate. Intervention takes place in different stages including 1) Dissemination and Awareness about the Intervention along the School Community 2) Teacher Training 3) Student Tutors Training 4) Pairing Students and 5) Intervention Development which consists of cohesion activities, tutorial activities, and specific training activities.
Randomized control trial at the school level. Quasi-experimental design with experimental and control groups.
Social: Over time, the experimental group showed significant decreases in the Bully Behavior, Peer Victimization, and Fighting subscales, with statistically significant differences between the experimental and control groups (p = 0.001). Similarly, cyberbullying scores in the EG decreased significantly over time, with notable differences between the EG and control group (p = 0.001). Additionally, the experimental group demonstrated significant improvements in school climate variables, with statistically significant differences between the EG and control groups (p = 0.001).
31,183 ninth and eleventh grade students (ages 14-18) from 103 schools in Minnesota, USA.
Reported school practices aimed at creating a supportive LGBT climate. These included having a point person for LGBT student issues, displaying sexual orientation-specific content, establishing a gay-straight alliance, discussing bullying based on sexual orientation, and providing professional development on LGBT inclusion and LGBT student issues.
Observational study with a comparison group.
Social: Students (regardless of identity) attending schools with more supportive LGBTQ+ climates reported lower odds of relational bullying victimization, physical bullying perpetration, and sexual orientation-based harassment. These findings indicate that a supportive LGBT climate has a positive effect on reducing bullying behaviors. The social outcomes highlighted that these LGBT-supportive practices benefitted all students, regardless of sexual orientation.
327 lesbian, gay, bisexual, and questioning (LGBQ) students across three U.S. cities.
Presence of and participation in GSAs at school.
Observational, longitudinal study with a comparison group. This study followed students over two school years to observe and compare the impact of GSA.
Health: No differences were found in depression between students with GSAs and those without.
Social: LGBQ students who had GSAs in their schools or were members of GSAs in the prior year reported stronger perceptions of school safety (p = 0.023) and less bullying (p < 0.001) in the following school year. No differences were found in self-esteem between students with GSAs and those without.
17,112 sexual and gender minority adolescents (mean age = 15.57 years; 27.7% male, 61.9% White, 16.8% other, 11.4% Latino, 5.8% Black, 4.1% Asian; 67.1% cisgender, 32.9% transgender; 37.4% gay or lesbian, 34.9% bisexual, 1.6% straight, 13.2% pansexual).
Presence of GSAs in schools.
Observational study with a comparison group. This study compared students in schools with GSAs and those without, analyzing the effects of GSA presence and bias-based bullying on various health outcomes using structural equation modeling.
Health: The reduction in bias-based bullying was associated with lower levels of stress, sleep problems, unhealthy weight control behaviors, and improvements in depression.
Social: Students in schools with GSAs reported lower levels of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, sexual orientation) compared to those in schools without GSAs.
16 sexual minority-oriented youth (ages 15-20) from a predominantly rural area in a Midwestern state who self-identified as having been bullied based on their perceived minority sexual orientation status.
Access to supportive school personnel in coping and survival among bullied sexual minority-oriented youth.
Descriptive study. This study conducted in-depth interviews, either in-person or online, with youth to explore their experiences of bullying and coping mechanisms.
Social: Supportive school personnel played a meaningful role in the coping and survival of bullied sexual minority-oriented youth. Participants described school personnel as providing emotional support and helping them navigate their bullying experiences.
US sexual minority youth, including lesbian, gay, bisexual, transgender, and questioning individuals
LGBTQ inclusive sex education in schools, with a focus on the proportion of schools in a state teaching LGBTQ inclusive sex education.
Observational study with a comparison group. The analysis used data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles. Multilevel logistic models were used to compare outcomes based on varying levels of LGBTQ inclusive sex education in schools.
Health: LGBTQ inclusive sex education had protective effects for suicidal thoughts (adjusted odds ratio [AOR]: 0.91, 95% CI: 0.89–0.93) and making a suicide plan (AOR: 0.79, 95% CI: 0.77–0.80) across all youth. Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR: 0.92, 95% CI: 0.87–0.98).
Social: Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools teaching LGBTQ inclusive sex education increased (AOR: 0.83, 95% CI: 0.71–0.97).
Secondary school students across British Columbia (BC), Canada.
The implementation of school-based GSAs and explicit anti-bullying policies in secondary schools.
Observational study with a comparison group. Analysis used data from the 2008 province-wide random cluster-stratified BC Adolescent Health Survey (n = 21,708). Multinomial logistic regression was used to compare experiences of discrimination, suicidal ideation, and suicide attempts in schools with and without GSAs or anti-discrimination policies, as well as between those with different durations of implementation.
Health: LGB students had lower odds of suicidal ideation and suicide attempts when GSAs and policies were in place for three or more years (p < .05). Additionally, heterosexual boys (but not girls) had lower odds of suicidal ideation and attempts in schools with longer-established anti-discrimnation policies (p < .05).
Social: LGB students experienced lower odds of past-year discrimination in schools with GSAs and anti bullying policies that had been in place for three or more years (p < .05).
2,678 self-identified LGB and mostly heterosexual adolescents (69% girls) from 274 schools in British Columbia, Canada.
LGBTQ-supportive community resources and positive political climates in the communities surrounding the schools.
Observational study with a comparison group. Adjusted multilevel models were employed.
Health: For sexual minority adolescent girls, higher community LGBTQ-supportiveness was associated with marginally significant lower suicidal ideation (p < 0.001) and suicidal attempts (p < 0.001) and significantly lower self-harm behaviors (p < 0.001). Progressive political climates also predicted marginally significant lower suicidal ideation (p < 0.001) and significantly lower self-harm behaviors (p < 0.01).
For sexual minority adolescent boys, no community-level variables were found to be associated with suicidal behavior in adjusted models.
LGBTQ adolescents in schools, based on data from six studies conducted between 2005 and 2019, with participants ranging from 11 to 19 years old.
Positive school climate, as assessed through various environmental factors within schools.
Systematic review.
Health: LGBTQ students in schools with more positive climates were at lower risk of suicidality and reported fewer depressive symptoms compared to those in less positive school climates.
LGBTQ students.
School bullying policies, including those with protections based on sexual orientation and gender identity.
Systematic review of 21 studies.
Social: Mixed findings on the effectiveness of anti-bullying policies in reducing bullying overall. However, schools with anti-bullying policies that include protections for sexual orientation and gender identity were associated with better protection for LGBTQ students, including less harassment and more frequent and effective intervention by school personnel.
LGBTQ+ students.
School-related interventions including school policies (at the district and state level), school programs (such as GSAs), and universal bullying prevention programs aimed at creating a safer, more accepting environment for LGBTQ+ students.
Systematic review of 46 studies.
Health: Positive school climates, which prioritize safety, acceptance, and the reduction of stress related to students’ minority status, were associated with a lower risk of suicidal thoughts and behaviors.
62,923 students (mean age = 16 years; 66% White, 41% male).
Presence of GSAs or other school-based gender and sexuality diversity clubs.
Meta-analysis of 15 quantitative studies. The association between GSA presence and student-reported school-based victimization was evaluated. Seven studies drew from national samples and eight from local samples. Eleven used non-random sampling, and four used random sampling.
Social Outcomes: Schools with GSAs were associated with significantly lower levels of students’ self-reports of victimization, fear for safety, and hearing homophobic remarks compared to schools without GSAs. These findings remained robust after controlling for study-level factors such as sampling method and socioeconomic variations in samples across studies.
Youth in the US and Canada, including both LGBTQand heterosexual students.
School-based interventions, including GSAs, LGBTQ-inclusive policies, and LGBTQ-inclusive curriculum.
Literature review of 12 studies. Six were based on representative school samples, while the remaining studies relied on convenience samples, such as participants recruited through online surveys or community organizations.
Health: GSAs were linked to better mental health and lower rates of substance use, with evidence suggesting reductions in suicidal thoughts and suicide attempts. Specifically, GSAs could result in as many as seven fewer students with suicide attempts and 21 fewer students with problem substance use in a typical BC school. These outcomes were consistent across both LGB and heterosexual youth.
Social: The review found that GSAs and LGBTQ-inclusive policies were associated with reduced bullying and anti-gay discrimination, as well as reduced binge drinking and problem substance use.
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[4] The Centers for Disease Control and Prevention (CDC), 2021. Fast fact: preventing bullying. Available at: https://stacks.cdc.gov/view/cdc/158968 . Accessed January 6, 2023
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[7] Marx RA, Kettrey HH. Gay-straight alliances are associated with lower levels of school-based victimization of LGBTQ+ youth: a systematic review and meta-analysis. J Youth Adolesc. 2016;45(7):1269-1282.
[8] The National Academies of Sciences, Engineering, and Medicine. 2016. Preventing bullying through science, policy, and practice. Washington, DC: The National Academies Press. Available at: https://nap.nationalacademies.org/catalog/23482/preventing-bullying-through-science-policy-and-practice. Accessed January 6, 2023.
[9] The Trevor Project. The Trevor project research brief: bullying and suicide risk among LGBTQ youth. October 2021. Available at: https://www.thetrevorproject.org/research-briefs/bullying-and-suicide-risk-among-lgbtq-youth/. Accessed January 6, 2023.
[10] The Centers for Disease Control and Prevention (CDC) A, 2021. Fast fact: preventing bullying. Available at: https://stacks.cdc.gov/view/cdc/158968. Accessed January 6, 2023.
[11] Marx RA, Kettrey HH. Gay-straight alliances are associated with lower levels of school-based victimization of LGBTQ+ youth: a systematic review and meta-analysis. J Youth Adolesc. 2016;45(7):1269-1282.
[12] The National Academies of Sciences, Engineering, and Medicine. 2016. Preventing bullying through science, policy, and practice. Washington, DC: The National Academies Press. Available at: https://nap.nationalacademies.org/catalog/23482/preventing-bullying-through-science-policy-and-practice. Accessed January 6, 2023.
[13] The Trevor Project. The Trevor project research brief: bullying and suicide risk among LGBTQ youth. October 2021. Available at: https://www.thetrevorproject.org/research-briefs/bullying-and-suicide-risk-among-lgbtq-youth/. Accessed January 6, 2023.
[14] The Trevor Project. The Trevor project research brief: bullying and suicide risk among LGBTQ youth. October 2021. Available at: https://www.thetrevorproject.org/research-briefs/bullying-and-suicide-risk-among-lgbtq-youth/. Accessed January 6, 2023.
[15] The Trevor Project. The Trevor project research brief: bullying and suicide risk among LGBTQ youth. October 2021. Available at: https://www.thetrevorproject.org/research-briefs/bullying-and-suicide-risk-among-lgbtq-youth/. Accessed January 6, 2023.
[16] Centers for Disease Control and Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023. U.S. Department of Health and Human Services; 2024.
[17] The Institute of Medicine (IOM). The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. 2011. Washington, DC: The National Academies Press. Available at: https://nap.nationalacademies.org/catalog/13128/the-health-of-lesbian-gay-bisexual-and-transgender-people-building. Accessed January 6, 2023.
[18] Kann L, Olsen EOM, McManus Tim, et al. Sexual identity, sex of sexual contacts, and health-related behaviors Among students in grades 9–12 — United States and selected sites, 2015. MMWR Surveill Summ 2016;65(No. SS-9).
[19] The U.S. Department of Health and Human Services (HHS) B, HealthyPeople 2030. Reduce bullying of lesbian, gay, or bisexual high school students – LGBT 05. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt/reduce-bullying-lesbian-gay-or-bisexual-high-school-students-lgbt-05. Accessed January 6, 2023.
[20] The U.S. Department of Health and Human Services (HHS) C, HealthyPeople 2030. Reduce suicidal thoughts in lesbian, gay, or bisexual high school students – LGBT 06. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt/reduce-suicidal-thoughts-lesbian-gay-or-bisexual-high-school-students-lgbt-06. Accessed January 6, 2023.
[21] The U.S. Department of Health and Human Services (HHS) D, HealthyPeople 2030. Reduce bullying of transgender high school students – LGBT-D01. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt/reduce-bullying-transgender-students-lgbt-d01. Accessed January 6, 2023.
[22] The U.S. Department of Health and Human Services (HHS) E, HealthyPeople 2030. Reduce suicidal thoughts in transgender high school students – LGBT-D02. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt/reduce-suicidal-thoughts-transgender-students-lgbt-d02. Accessed January 6, 2023.
[23] Movement Advancement Project. "Equality Maps: Safe Schools Laws." https://www.lgbtmap.org/equality-maps/safe_school_laws. Accessed 07/12/2024.
[24] Movement Advancement Project. "Equality Maps: Safe Schools Laws." https://www.lgbtmap.org/equality-maps/safe_school_laws. Accessed 07/12/2024.
[25] The Centers for Disease Control and Prevention (CDC) C, 2020. Profiles 2020 – school health profiles, characteristics of health programs among secondary schools. Available at: https://www.cdc.gov/healthyyouth/data/profiles/pdf/2020/CDC-Profiles-2020.pdf. Accessed January 6, 2023.
[26] Burk, J., Park, M., & Saewyc, E. M. (2018). A Media-Based School Intervention to Reduce Sexual Orientation Prejudice and Its Relationship to Discrimination, Bullying, and the Mental Health of Lesbian, Gay, and Bisexual Adolescents in Western Canada: A Population-Based Evaluation. International journal of environmental research and public health, 15(11), 2447. https://doi.org/10.3390/ijerph15112447
[27] Eisenberg, M. E., Wood, B. A., Erickson, D. J., Gower, A. L., Kessel Schneider, S., & Corliss, H. L. (2021). Associations between LGBTQ+-supportive school and community resources and suicide attempts among adolescents in Massachusetts. The American journal of orthopsychiatry, 91(6), 800–811. https://doi.org/10.1037/ort0000574
[28] Proulx, C. N., Coulter, R. W. S., Egan, J. E., Matthews, D. D., & Mair, C. (2019). Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning-Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 64(5), 608–614. https://doi.org/10.1016/j.jadohealth.2018.11.012
