The kids are not all right. Almost 40 percent of young people between the ages of 13 and 24 who identify as LGBTQ+ have seriously considered suicide in the last year. That number is even higher for transgender and gender-nonbinary youth, 54 percent of whom have seriously considered suicide in that same time frame, and 29 percent of whom have attempted it. That's according to a new groundbreaking report from the LGBTQ+ advocacy nonprofit the Trevor Project, which polled more than 34,000 young people in 2018 to compile the largest ever survey on LGBTQ+ youth mental health in America.

The thousands of young people involved tell a familiar yet urgent story: LGBTQ+ youth are particularly vulnerable to mental health crises and suicide, and society hasn't found enough ways to assist them. Even as acceptance for queer people is seemingly on the rise, social conditions are leading to dire mental health outcomes. And the political discourse in the US isn't helping—76 percent of the youth surveyed said the current climate was affecting their mental well-being. "There is not something about being LGBTQ that is leading to mental health and suicide disparities, it's the way that LGBTQ youth are treated and stigmatized," says Amy Green, the director of research at the Trevor Project, who oversaw the survey.

That stigmatization comes from friends, family, health care professionals, and the culture at large. The survey asked kids whether they were out to an adult at school, and found that less than half were. Young people were most likely to have disclosed their sexual orientation or gender identity to an LGBTQ+ friend, and more than half disclosed to their parents.

The survey also found that one of the most harmful things that can happen to an LGBTQ+ child is when someone they come out to tries to persuade or pressure them into changing their identity—either through overt conversion therapy or more subtle suggestions. Sixty-seven percent of LGBTQ+ youth reported that someone had tried to convince them to change their sexual orientation or identity. That's two thirds of the total respondents. And of that majority, 23 percent said they had later attempted suicide. More than half of trans and nonbinary youth who underwent conversation therapy later attempted suicide, according to the survey. Only 8 percent of LGBTQ+ youth who did not face pressure to change their sexual orientation or identity attempted suicide, suggesting a direct correlation between the two.

The Trevor Project survey provides insight into how LGBTQ+ kids want to be reached in times of crisis. Seventy-six percent of the youth prefer digital means of accessing help.

"If you are one of those people that a child is coming out to so early, if they are trusting you with that information, your initial reaction is important. It determines whether they'll thrive or really struggle and consider something like suicide or another negative outcome," says Michelle Birkett of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University. Birkett was not involved with the Trevor Project's report but has done similar research and says the new survey is particularly significant because of the dearth of data around the topic of LGBTQ+ mental health, particularly when it comes to transgender young people.

The survey also provides insight into how LGBTQ+ kids want to be reached in times of crisis. Seventy-six percent prefer digital means of accessing help, saying they'd be extremely likely to contact an intervention group during a crisis if that group offered a way to get in touch digitally—by text, chat, or IM. The Trevor Project has a 24-hour service to address this need, allowing people to text or chat with a Trevor staffer at any time. An overwhelming majority of the young people polled—81 percent—also noted that having a safe social networking space online is extremely valuable to them.

"We see this over and over again in our studies as well," says Birkett. "Youth prefer to reach out digitally. It's just where they feel most comfortable going."

Birkett notes that it's particularly important for young people to be able to find online safe spaces that are not tailored for adults. Many online communities for LGBTQ+ people are geared toward dating or sex, which is valuable, but not as important during the coming-of-age years when youth most need help navigating coming out.