Which Anti-LGBTQ+ Bills Hurt Most? a Computational Policy Analysis of Legislative Domains and Adolescent Suicidal Ideation

Background and Purpose: Proposed discriminatory legislation targeting LGBTQ+ individuals has proliferated since 2020. A growing body of research links discriminatory policies to elevated rates of suicidal ideation among young people. However, limited research has examined the extent to which (a) proposed (vs. enacted) legislation impacts youth mental health and (b) there is variation in these effects across bill substantive domains (e.g., education vs. healthcare restrictions). This study examines the relationship between different domains of proposed anti-LGBTQ+ bills and past-year suicidal ideation risk among high schoolers in the US, using causal inference to identify which bill domains exert more influence on youth mental health.

Methods: State-level anti-LGBTQ+ legislative data from the American Civil Liberties Union for 21 states from 2020 to 2023 were merged with 2021 and 2023 Youth Risk Behavior Survey (YRBS) past-year suicidal ideation data (N = 190,748). Using deductive content analysis, legislative bills were coded into seven substantive domains: education and school facilities; athletics; healthcare; religious exemptions; identification documentation; civil rights; and other anti-LGBTQ+ bills (e.g., bills preempting local nondiscrimination protections). Legislative data were aggregated at the state-year level and aligned with YRBS data with a time lag, where past-year suicidal ideation was predicted by prior-year bills. Bill counts were standardized within each domain to enable cross-domain comparisons. We conducted difference-in-differences modeling by bill domain to estimate the association between changes in proposed discriminatory bills and past-year suicidal ideation, controlling for sexual identity, race/ethnicity, sex, grade, and state fixed effects.

Results: Among bill domains, education and school facility bills showed the greatest increase in risk of suicidal ideation (β = 0.11; 95% CI: 0.10-0.11; p < .001), indicating that each standard deviation increase in the count of bills in the discriminatory education and school facility domain was associated with an 11 percentage point increase in probability of past-year suicidal ideation, followed by other anti-LGBTQ+ (β = 0.04; 95% CI: 0.02, 0.07; p = .001) and athletics/athletic participation (β = 0.02; 95% CI: 0.01, 0.04; p = .009) bills. Religious exemption and identification documentation domains were not significant, which may be related to a narrower scope of impact as they reach a small subset of adolescents in the overall population (e.g., transgender youth engaged in care). Limited gender identity data in the YRBS prevented assessing effects among transgender youth, who are most affected by the healthcare bill domain, likely contributing to statistical insignificance.

Conclusions and Implications: Results extend understandings of the impact of anti-LGBTQ policies to demonstrate how proposed anti-LGBTQ+ legislation harms not only sexual minority youth but also heterosexual youth's mental health. Findings demonstrate how, at the population level, proposed anti-LGBTQ+ bill domains most directly associated with youth’s everyday environments (e.g., school climate, sports participation, and sweeping anti-LGBTQ+ bills) are associated with the highest risk of suicidal ideation. Given the unwillingness of policymakers to cease the proposal and implementation of anti-LGBTQ+ legislation, these findings identify key environments and strategies for school staff, clinicians, and advocates to more effectively support student mental health.