Although family relationships play a crucial role in the well being of lesbian, gay, bisexual, transgender and queer (LGBTQ) adolescents, few programs tackle stigma and discrimination within families, in part because of a lack of evidence on what works, researchers say.

Studies are “urgently” needed to address this question on individual, interpersonal and community levels, the authors of a research review write in Journal of Adolescent Health.

“School-based bullying against LGBTQ youth has received a lot of attention from policy-makers and the public, but what’s missing is a discussion of the bullying and rejection that many gay or gender-nonconforming kids experience from their parents or caregivers,” said lead study author Caroline Parker of Columbia University in New York.

LGBTQ youth face higher risks for depression, suicide, substance use and homelessness, and those risks follow them into adulthood.

“Science shows that this type of bullying increases the risk for attempted suicide, mental health problems, drug use and homelessness,” Parker told Reuters Health in an email. “There’s an urgent need to develop policies and schemes to foster supportive homes and family environments.”

The current study developed after the researchers conducted another study about HIV and young black men who have sex with men in New York City, Parker noted. They noticed that many of men were homeless when they were teenagers, and many described being rejected and sometimes bullied by their caregivers.

For the new study, they searched three large databases of scientific literature to find publications about interventions, programs and policies that address family-based stigma and discrimination against LGBTQ youth.

The team found nine studies that met their criteria and only one that included outcome results. That one was an intervention that sought to foster attachments between parents and their lesbian, gay and bisexual children to reduce depression and suicide. It showed reductions in both conditions, but was based on only 10 participants, so the results were not statistically meaningful enough to prove what works.

“Our initial idea for this paper was an extensive ‘systematic review’ . . . but I quickly realized that there just wasn’t very much good science to gather,” Parker said.

Nonetheless, there are programs on offer, mainly by city governments and nongovernmental organizations, the study team points out.

Groups such as CAMBA and PFLAG support families of LGBTQ youth, and New York City’s Unity Project posts public service announcements in the subways, Parker noted. The Family Acceptance Project in San Francisco and Project CHANGE in New York City promote pro-acceptance and work alongside social service departments, schools, child welfare and faith-based communities. Researchers should evaluate these groups and programs, she said.

In future research, Parker’s team would like to develop targeted interventions that are sensitive to social factors such as culture, religion, race and class. They also want to focus on large-scale social change.

“Many parents of LGBTQ kids would jump at the chance to attend support groups, but that type of opportunity may not reach the parents and caregivers of youth in the most toxic home environments,” she said.

Programs may also be more effective if they speak to a specific category of youth, such as gender non-conforming versus sex non-conforming, or different religions and geographic locations, said Amy Adamczyk of the City University of New York, who wasn’t involved in the study.

“Religious parents who have good intentions and want to better understand their youth may not really understand why their kid is acting or appearing in gender non-conforming ways,” said Adamczyk, who is author of the book “Cross-National Public Opinion about Homosexuality: Examining Attitudes across the Globe.”

Religion-based support that can celebrate these differences may help parents who know few LGBTQ individuals and may not be aware of the challenges their child is facing or how to help, she said. Studies show that having an LGBTQ friend and popular media exposure are the two major factors in breaking down stigma.

“Attitudes have become substantially more liberal in the last 20 years in the U.S.,” Adamczyk said in a phone interview. “It’s incredible how quickly attitudes have liberalized for both young and old people. Even grandma changed her views!”

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