Since 2010, more than 613,000 people have pledged to combat bullying of lesbian, gay, bisexual and transgender (LGBT) teens as part of the "It Gets Better" campaign. And a new Northwestern Medicine study has found that most adolescents would agree that it does, in fact, get better. But not all.

Discrimination, harassment and assault of LGBT youths is still very much a problem for about a third of adolescents, the study found. What's more, it's often very severe, ongoing and leads to lasting mental health problems such as major depression and post-traumatic stress disorder (PTSD).

"We tend to think that society is evolving but we can't just accept this narrative that 'it gets better' and think it gets better for everyone," said Brian Mustanski, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and director of the new Northwestern Institute for Sexual and Gender Minority Health and Wellbeing.

Mustanski was happy to see that the majority of the 248 youths in the study (84.6 percent) experienced decreasing levels of victimization over the four years. But 10.3 percent experienced significant increases in bullying, and 5.1 percent maintained high levels of victimization over the four years. Mustanski was struck by just how severe the treatment was.

"With bullying, I think people often assume 'that's just kids teasing kids,' and that's not true," Mustanski said. "If these incidents, which might include physical and sexual assaults, weren't happening in schools, people would be calling the police. These are criminal offenses."

Mustanski is the lead author of the study published on Jan. 21 in The American Journal of Public Health, which was innovative because it looked at not only the number of victimizations teens were experiencing but how severe they were and how they changed over time.

"You can't equate someone giving you a dirty look with someone physically assaulting you," Mustanski said. "Victimizations that are more severe are going to have bigger effects. We scored them in a way that represented that, and we saw they had a profound effect on mental health rates over time."

The LGBT youths who were at the highest risk for mental health problems were those who experienced moderate harassment (i.e. having something thrown at them) that increased over time or adolescents who continually experienced high levels of victimization (i.e. physical or sexual assault) over the course of the four years.

Accumulation of victimizations was the key difference in Mustanski's study from previous research that focused on a single period of time. While a single incident can have an impact on a young person, Mustanski's study found that an adolescent's depression and PTSD was exacerbated when these assaults built up over time. And even youths who began high school getting severely bullied but were lucky enough to see that lessen over time were still at a higher risk for PTSD.

"Some of the symptoms someone needed to get a PTSD diagnosis were re-imagining or having flashbacks to a traumatic event," Mustanski said, citing a hypothetical example of an LGBT youth who was repeatedly assaulted for his sexual orientation over time.

"If that's your experience for several years of high school, you can imagine how scarring that would be," Mustanski said.

The study in 2007 began examining Chicago youths who identified as LGBT or reported having same-sex attraction. It assessed the teens' mental health at baseline and in seven interviews over four years and found that females were more likely to be in the group that was getting victimized less over time than men. Boys experienced physical and verbal assault more than girls, Mustanski said.

"We were happy to see that for most kids, the levels of victimization were lower overall or decreasing over time. But we were struck by how severe it was for some of these kids who were getting highly victimized over their four years of high school," Mustanski said.

Overall, he said it is important to note that the majority of targeted LGBT youths are doing well and are "resilient," but for the group of adolescents getting severely victimized, something drastic needs to be done.

He hopes the study's findings will help schools clearly see these patterns of LGBT bullying so they can intervene with policies and programs to help prevent the behavior and provide coping mechanisms for those who are being targeted.

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