Understanding and preventing mental ill-health, substance use, and their co-occurrence among gender and sexuality diverse young people in Australia

Abstract

The primary objective of this thesis was to advance the understanding and prevention of mental ill-health, substance use, and their co-occurrence, among LGBTQA+ young people in Australia. There are significant gaps in knowledge in this area, including lack of contemporary estimates of the prevalence mental ill-health and substance use among LGBTQA+ youth and limited evidence-based prevention approaches for this population. To address these gaps, this thesis proposed four research aims: firstly, to investigate the epidemiology of mental ill-health, substance use, and their co-occurrence among LGBTQA+ young people, with a focus on population-based data (Chapters 3 and 6) and data specific to trans young people (Chapters 4 and 5); secondly, to examine associations between minority stressors and traumatic events with mental ill-health, substance use, and their co-occurrence among LGBTQA+ young people (Chapters 4, 5, and 7); thirdly, to identify school-level protective factors for mental ill-health and substance use among LGBTQA+ young people (Chapters 4 to 8); and lastly, to advance current approaches toward preventing mental ill-health and substance use among LGBTQA+ young people (Chapters 9 to 11). A range of rigorous research methodologies were employed, including sophisticated cross-sectional and longitudinal analysis of unique epidemiological datasets, systematic review and qualitative inquiry and interpretation. Key findings included highlighting the magnitude of disparities in mental ill-health and substance use experiences by LGBTQA+ young people, compared to their cisgender, heterosexual peers, and identifying promising preventative interventions that are tailored to the unique experiences of LGBTQA+ youth. Suggestions for future research, particularly relating to future epidemiological work in this field, and the opportunity for researchers to explore the preventative utility offered by school peers and staff for LGBTQA+ young people, are also discussed.