Association between bullying, state-level policy and mental health symptoms in gender diverse youth

Sep 28, 2026

Importance: As transgender and gender-diverse identities rise in the United States, youth increasingly confront identity-linked social stigma and structural discrimination. Objective: Assess how bullying victimization and state-level policies influence psychotic-like experiences among gender-diverse youth. Design: Prospective cohort study using 2017–2022 data from 17 states. Participants: Cross-sectional (n=9,112) and longitudinal (n=4,529) samples from the ABCD Study. Outcomes: Psychotic-like experiences and distress measured by PQ-BC. Results: Gender diversity and bullying were associated with elevated psychotic-like experiences; policy context shaped 2017–2022 trends.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

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medRxiv preprint doi: [https://doi.org/10.64898/2025.12.19.25342709](https://doi.org/10.64898/2025.12.19.25342709); this version posted December 27, 2025. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license . Title: Association between bullying, state-level policy and mental health symptoms in gender diverse youth Author list: Dylan E. Hughes, M.A.1, Sarah L. Zapetis, M. S.2, Arianna Mordy, M.A.1, Daisy Lopez, Ph.D.3, Vanessa Calderon, MPH, Ph.D.3, Laura Adery, Ph.D.3, Rachel Martino5, M.A., Sarah E. Chang, Ph.D.4, Lucina Q. Uddin, Ph.D.3, Carlos Cardenas-Iniguez, Ph.D.6, Richard T. Lebeau, Ph.D.1, Natalia Ramos, M.D. , MPH3, Lauren C. Ng, Ph.D.1, Katherine H. Karlsgodt, Ph.D.1, Carrie E. Bearden, Ph.D. 1,3 Affiliations: 1Department of Psychology, University of California, Los Angeles, Los Angeles, CA 2Department of Psychology, University of Southern California, Los Angeles, CA 3Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 4Department of Cognitive Science, University of California, San Diego, San Diego, CA 5Department of Psychology, Harvard University, Cambridge, MA 6Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles Corresponding Author: Dylan E. Hughes [Email:](Email: hughesdy@g.ucla.edu)[ ](Email: hughesdy@g.ucla.edu)[hughesdy@g.ucla.edu](Email: hughesdy@g.ucla.edu) 1285 Psychology Building Box 951563 Los Angeles, CA 90095 Total words: 3025 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: [https://doi.org/10.64898/2025.12.19.25342709](https://doi.org/10.64898/2025.12.19.25342709); this version posted December 27, 2025. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license . 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. medRxiv preprint doi: [https://doi.org/10.64898/2025.12.19.25342709](https://doi.org/10.64898/2025.12.19.25342709); this version posted December 27, 2025. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license . 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-lik

FAQs

What question does the study address about gender-diverse youth?

The study asks whether bullying and state-level policies related to gender identity contribute to mental health problems in gender-diverse youth in the United States.

What were the main findings regarding bullying and psychotic-like experiences?

Gender-diverse adolescents reported more frequent bullying experiences, and bullying partially accounted for higher rates of subclinical psychotic-like experiences.

How did state-level policy context affect changes from 2017 to 2022?

Between 2017 and 2022, psychotic-like experiences increased only in states with consistently unsupportive policies; in other states, scores stayed stable or decreased.

Sep 28, 2026

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