Gender-diverse adolescents who experience bullying and live in states with persistently unsupportive gender identity laws are significantly more likely to suffer escalating psychological distress compared to their peers, according to new research by UCLA Health.
The findings, published in JAMA Network, draw on one of the largest, most comprehensive adolescent brain development studies in the U.S. The study results suggest that the mental health burden carried by gender-diverse youth is not an inherent consequence of gender diversity but rather is shaped by the social and political environments in which these young people live.
What we're seeing is that stigma has measurable neuropsychiatric consequences. Bullying and unsupportive legislation are not abstract policy concerns; they translate into real and serious symptoms in adolescents' day-to-day lives."
Carrie Bearden, study's senior author, professor of psychiatry at the UCLA Semel Institute of Neuroscience and Human Behavior and the UCLA Brain Research Institute
Specifically, researchers found that gender-diverse teens reported higher rates of subtle but clinically meaningful warning signs of psychological stress. These experiences, known clinically as psychotic-like experiences (PLEs), are subtle, distressing internal experiences such as feeling unusually suspicious of others, thinking others are talking or laughing at them, feeling threatened or hearing sounds others do not. PLEs are not clinical psychosis. However, if untreated, these experiences can lead to increased risk of developing mental disorders such as depression, anxiety, self-harming behavior and psychotic disorder.
About the study
UCLA researchers analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, a large, population-based longitudinal study that has tracked adolescents across 21 sites in 17 U.S. states since they were 9 years old. Researchers used the data to perform both a point-in-time analysis of 8,463 participants with an average age of 13, and a longitudinal analysis followed 4,200 participants across five data collection waves between 2017 and 2022.
Participants were assessed for gender diversity, bullying victimization and PLEs. Gender diversity was measured dimensionally by capturing how congruent or incongruent each adolescent's sense of gender was with their birth-assigned sex, rather than relying solely on whether a participant self-identified as transgender or gender nonconforming. Bullying victimization was captured through self-reported frequency of bullying experiences. Psychotic-like experiences (PLEs) were measured using the Prodromal Questionnaire-Brief Child Version, a validated screening tool that asks adolescents about the presence and associated distress of subtle psychological symptoms.
Researchers also used state-level policy data from the Movement Advance Project (MAP) nonprofit group to determine whether the participant's state maintained supportive or unsupportive legislation related to gender identity in a given year.
What the research found
Gender-diverse youth reported significantly higher rates of both bullying victimization and PLEs than their peers. Bullying acted as a mediator between gender-diversity and PLEs and accounted for 18% of that difference.
State policy told a more gradual story. No differences emerged at any single point in time, but adolescents in states that consistently lacked supportive gender identity legislation showed significantly greater increases in PLEs over four years. In all other groups, regardless of gender diversity, PLEs declined or held steady.
The proportion of U.S. adolescents ages 13 to 17 identifying as transgender or gender diverse doubled from 0.73% to 1.43% between 2017 and 2022, according to a UCLA study in 2022. Separate research cited by the authors found that the passage of unsupportive laws between 2018 and 2020 was associated with a 7% to 72% increase in suicide attempt rates among transgender and gender-diverse youth. In 2025, more than 600 anti-LGBTQ+ bills were introduced throughout the U.S., which was double that of 2022, according to ACLU data cited in the study.
Researchers hypothesize that chronic exposure to bullying and an unsupportive political climate may foster hypervigilance in gender-diverse teens, which is a core feature of psychotic-spectrum symptoms.
"Without clinicians asking the right questions about a patient's social environment, we may miss out on robust treatment targets," said the study's first author Dylan Hughes, a clinical psychology graduate student at UCLA. "At the same time, policy makers – and voters – also play an important role. Voting on a policy with the intention of helping our youth should include consideration of the policy's downstream effects on these kids' mental health."
Funding for the study was provided by the National Institute of Neurological Disorders and Stroke and the National Institute of Mental Health, NIH.
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