{"doi":"10.64898/2025.12.19.25342709","title":"Association between bullying, state-level policy and mental health symptoms in gender diverse youth","abstract":"ABSTRACT Importance As the percentage of young people in the United States identifying as transgender and gender diverse increases, more youth face identity-linked social and structural stigma and discrimination. Little is known about the impact of stigma on psychotic-like experiences in gender diverse youth. Objective To assess the impact of bullying victimization and state-level policies on psychotic-like experiences among gender diverse youth. Design In this prospective cohort study, cross-sectional and longitudinal analyses were conducted using data collected between 2017-2022 across 17 states. Setting The Adolescent Brain Cognitive Development (ABCD) Study is a U.S. population-based longitudinal study that follows and deeply phenotypes adolescents from the age of 9 to 18. Participants Cross-sectional analyses included data from 9,112 participants (mean age=13 ± 0.6) collected between 2019 and 2022. Longitudinal analyses comprised 4,529 participants with data collected across 5 waves between 2017 and 2022. Exposures Self-reported frequency of bullying victimization and data on annual state-level policies related to gender identity. Main Outcomes Self-reported psychotic-like experiences and associated distress, measured by the Prodromal Questionnaire - Brief Child Version. Results Based on a dimensional measure of gender, 689 adolescents were identified as most gender diverse (i.e., least congruent with birth-assigned sex) and 8,240 as least gender diverse (i.e., most congruent with birth-assigned sex). Rates of bullying victimization and psychotic-like experiences were significantly elevated in the most vs. least gender diverse group, with bullying partially mediating the difference in psychotic-like experiences (indirect effect = 0.11, p < 2×10 -16 ; direct effect = 0.52, p < 1×10 -16 ). Gender diverse adolescents exhibited greater sensitivity to the effects of bullying on psychotic-like experiences (interaction ß = 0.14, 95% CI [0.09, 0.19], p = 8.5×10 -08 ). Moreover, the persistence of unsupportive legislation across 4 years was associated with significantly greater increases in psychotic-like experiences over time in gender diverse youth (interaction ß = 0.30, 95% CI [0.20, 0.40], p = 2.2×10 -8 ). Conclusions These findings indicate that bullying victimization and unsupportive legislation may explain greater and increasing rates of psychotic-like experiences in gender diverse youth. KEY POINTS Question Do bullying and state-level policy related to gender identity contribute to mental health problems in gender diverse youth in the United States? Finding In this large U.S.-based sample of adolescents (ages 9-13), gender diverse adolescents reported more frequent experiences of bullying, which partially accounted for increased rates of subclinical psychotic-like experiences (PLEs). Between 2017 and 2022, gender diversity was associated with increasing PLEs only in states with consistently unsupportive policies; in all other states, PLE scores remained stable over time or decreased. Meaning Results suggest that PLEs in the context of gender diversity are partially attributable to the sociopolitical environment and that policy decisions at the state-level have far-reaching impacts on the mental health of youth in the United States.","journal":"medRxiv","year":2025,"id":587263,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9589,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":792916,"name":"Sarah L Zapetis","orcid":"0009-0006-3244-6973","position":1,"is_corresponding":false},{"id":1502989,"name":"Arianna Mordy","orcid":null,"position":2,"is_corresponding":false},{"id":1128827,"name":"Daisy López","orcid":"0000-0003-1066-7215","position":3,"is_corresponding":false},{"id":1502288,"name":"Vanessa Calderon","orcid":"0000-0002-2167-5248","position":4,"is_corresponding":false},{"id":1160889,"name":"Laura Adery","orcid":null,"position":5,"is_corresponding":false},{"id":1502289,"name":"Rachel M. Martino","orcid":"0000-0002-9146-7938","position":6,"is_corresponding":false},{"id":498105,"name":"Sarah E. Chang","orcid":"0009-0008-9986-1666","position":7,"is_corresponding":false},{"id":490353,"name":"Lucina Q. Uddin","orcid":"0000-0003-2278-8962","position":8,"is_corresponding":false},{"id":1502990,"name":"Carlos Cardenas-Iniguez","orcid":null,"position":9,"is_corresponding":false},{"id":1343801,"name":"Richard T. LeBeau","orcid":"0000-0002-6866-9793","position":10,"is_corresponding":false},{"id":420241,"name":"Natalie Ramos","orcid":"0000-0001-8688-9426","position":11,"is_corresponding":false},{"id":759812,"name":"Lauren C. Ng","orcid":"0000-0001-5988-008X","position":12,"is_corresponding":false},{"id":456199,"name":"Katherine H. Karlsgodt","orcid":"0000-0003-3332-4231","position":13,"is_corresponding":false},{"id":109354,"name":"Carrie E. Bearden","orcid":"0000-0002-8516-923X","position":14,"is_corresponding":false},{"id":502831,"name":"Dylan Hughes","orcid":"0009-0003-3759-2417","position":0,"is_corresponding":true}],"reference_count":38,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:59:36.020030Z","pmid":"41480027","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}