Gender modality, internalized stigma, and mental health of sexual and gender diverse youth

Sexual and gender diverse youth (SGDY) experience disproportionately high levels of depression and anxiety, which are particularly elevated among gender minority youth compared to their cisgender counterparts. Internalized stigma has been documented to predict elevated levels of depression and anxiety among SGDY. It remains unclear, however, whether internalized stigma is particularly influential for youth who are both sexual and gender minority, as compared to their cisgender sexual minority peers. The current study explores the interaction between internalized stigma and gender modality on mental health among sexual minority youth. Using cross-sectional survey data from N = 17,259 US American youth aged 13-18 (M_age = 15.79, SD_age = 1.48), we found that gender modality and internalized stigma were both significantly associated with mental health, but there was no significant moderation between the two, despite adequate power to detect one. As such, internalized stigma may be similarly harmful for gender minority and cisgender sexual minority youth. Sensitivity analyses among gender minority youth revealed a significant interaction between internalized stigma and binary gender identity, suggesting internalized stigma plays a unique role for nonbinary youth as compared to binary trans youth. Implications for prevention and intervention are explored.