Paths to resilience: Exploring risk and protective factors among gender and sexually diverse youth

Youth with diverse sexual orientations, gender identities and/or expressions, and sex characteristics (SOGIESC), including those who are lesbian, gay, bisexual, transgender, intersex, queer/questioning, nonbinary, or asexual/aromantic (LGBTIQNA+) face elevated mental health risks linked to stigma and discrimination. In Thailand, quantitative evidence on these disparities is growing, yet qualitative research, particularly on protective factors and resilience mechanisms, remains limited. This descriptive qualitative study explored risk and protective factors shaping mental health and well-being among SOGIESC-diverse youth nationwide. Using purposive maximum-variation sampling guided by an identity-region grid, we conducted semi-structured online in-depth interviews, informed by minority stress theory and socio-ecological perspectives, with 38 LGBTIQNA+ youth aged 15-24 across six Thai regions. Data were analyzed using thematic analysis. Five recurrent risk contexts were identified: 1) family rejection and violence, 2) interpersonal and structural school-based victimization, 3) pressure to conceal identity and restrict gender expression, 4) internalized sexual and gender stigma, and 5) religion-based rejection. Protective processes operated across six levels, including 1) affirming family relationships, 2) supportive peers and teachers, 3) empowerment through self-expression and advocacy, 4) access to role models and community (including online networks), 5) youth-friendly and affirming mental health care, and 6) inclusive school or university policies. Findings highlight a patterned linkage between distal and proximal stressors, counterbalanced by multi-level protective processes. Improving LGBTIQNA+ youth mental health in Thailand requires coordinated action across families, schools, communities, services, and policy, centering youth voices to strengthen context-specific pathways to durable resilience.