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Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach

Lookup NU author(s): Professor Eileen KanerORCiD, Dr Ruth McGovernORCiD, Dr Emma Geijer Simpson, Liam SpencerORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Globally, research indicates that LGBTQ+ young people have elevated rates of poor mental health in comparison with their cisgender heterosexual peers. The school environment is a major risk factor and is consistently associated with negative mental health outcomes for LGBTQ+ young people. The aim of this UK study was to develop a programme theory that explained how, why, for whom, and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ young people, through participation with key stakeholders. Online realist interviews were conducted in the UK with (1) LGBTQ+ young people aged between 13–18 years attending secondary schools (N = 10); (2) intervention practitioners (N = 9); and (3) school staff (N = 3). A realist retroductive data analysis strategy was employed to identify causal pathways across different interventions that improved mental health outcomes. The programme theory we produced explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils’ mental health. We found that context factors such as a ‘whole-school approach’ and ‘collaborative leadership’ were crucial to the delivery of successful interventions. Our theory posits three causal pathways that might improve mental health: (1) interventions that promote LGBTQ+ visibility and facilitate usualising, school belonging, and recognition; (2) interventions for talking and support that develop safety and coping; and (3) interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety. Our theoretical model suggests that providing a school environment that affirms and usualises LGBTQ+ identities and promotes school safety and belonging can improve mental health outcomes for LGBTQ+ pupils.

Publication metadata

Author(s): McDermott E, Kaley A, Kaner E, Limmer M, McGovern R, McNulty F, Nelson R, Geijer-Simpson E, Spencer L

Publication type: Article

Publication status: Published

Journal: International Journal of Environmental Research and Public Health

Year: 2023

Volume: 20

Issue: 5

Online publication date: 28/02/2023

Acceptance date: 22/02/2023

Date deposited: 01/03/2023

ISSN (print): 1661-7827

ISSN (electronic): 1660-4601

Publisher: MDPI AG


DOI: 10.3390/ijerph20054274


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Funder referenceFunder name
SPHRNational Institute for Health Research (NIHR)
SPHRNational Institute for Health Research (NIHR)
SPHRNational Institute for Health Research (NIHR)
School for Public Health Research