1. Hooker, Amber L.

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SCHOOLS ARE CHARGED with providing a safe and supportive place to learn, but school environments can be cruel and unsafe for victims of bullying.1,2 Young people who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are more likely to be bullied in schools than their heterosexual counterparts.3 Nurses can play an essential role in recognizing and referring sexual minority youths enduring this victimization. Awareness and recognition of the warning signs combined with accessibility of resources available is key in intervening for positive outcomes.


A prevalent problem

The 2017 National School Climate Survey, conducted by GLSEN, found that about 87% of LGBTQ students experienced harassment or assault in 2017 based on personal characteristics, including sexual orientation.4 In addition, approximately 70% of LGBTQ students experienced verbal harassment and 29% experienced physical harassment at school.4 Adolescent students in sexual minorities are more likely to be threatened or injured with a weapon on school property than heterosexual students.5


Along with being physically or verbally harassed, students may experience cyberbullying. In fact, the 2017 National School Climate Survey found that about 49% of students had experienced cyberbullying in the past year.4


Further, school staff may be part of the problem. A recent study found that more than half of students who identify as LGBT, questioning, or intersex have heard homophobic comments from staff within their schools.6 Another study found that about 64% of reports to school staff went unaddressed and that one in four students was told to change his or her behavior and to "not act so gay."4 The 2017 National School Climate Survey found that progress in reducing levels of victimization experienced by LGBTQ youth or increasing access to key school support slowed in 2017.4 Among the most common reasons LGBTQ students did not report victimization to school staff were doubts that effective intervention would occur and fears that reporting would make the situation worse.4


Health effects

Many victims of bullying also experience the typical stressors connected with adolescence, such as social and academic pressures.7 These combined factors may lead to mental health issues including depression, anxiety, self-harm, and suicidality.7 Approximately half of all sexual minority youth who are bullied experience symptoms of depression and anxiety.8 Further, research has shown that over half of all sexual minority youth have harmed themselves, up to three-quarters have had thoughts of suicide, and approximately a quarter have attempted suicide.7 The CDC's 2018 Youth Risk Behavior Survey found that about 48% of gay, lesbian, and bisexual students seriously considered attempting suicide, 38% planned how they would attempt suicide, 23% attempted suicide, and 7.5% were injured in a suicide attempt one or more times in the 12 months before the survey.9 Another study found that students who experienced high levels of victimization were at greater risk for major depressive disorder and posttraumatic stress disorder than those who experienced low levels.10


What can nurses do?

Nurses should learn about the incidence, prevalence, and warning signs of bullying, such as withdrawn behavior and other indicators of anxiety or depression. (See Online resources for bullying.) Mental health consequences can lead to self-harm and suicide. Physical signs and symptoms may include headache, abdominal discomfort, and visible bruises or other injuries.11 Along with physical signs, bullying victims are more likely to experience absenteeism, low educational aspirations, poor academic achievement, and poor psychological well-being.4


School nurses are most likely to see some of these signs. However, nurses working in EDs, urgent care, primary care, or even medical-surgical units should also be on alert for these indicators. Once bullying has been identified, it should be discussed with the patient and, if the patient consents, the parents or guardian. Nurses and healthcare providers should report bullying to appropriate agencies and institutions, including the student's school and police if appropriate. Nurses interacting with the patient should be aware of bullying and reporting laws specific to their state as well as school policies on these issues.


To advocate for LGBTQ students, nurses can take every opportunity to effect change, including through voting, working with professional organizations, speaking with legislators, and enacting legislation. Most states have policies specific to bullying; however, in many states those policies do not include LGBTQ-specific language. Nurses should locate their legislature's website and familiarize themselves with current and proposed legislation affecting schools in their state.

Table Online resourc... - Click to enlarge in new windowTable Online resources for bullying

Lastly, nurses must take every opportunity to educate the public about the effects of bullying and the disproportionate prevalence in LGBTQ youth. Take advantage of opportunities to speak with the media, appear on television, or participate in an online venue to discuss the issues. Additionally, nurses can call out this problem publicly by taking action such as submitting articles for publication in nursing journals, writing letters to the editor, and participating in blogs.


Future directions

The manner in which we protect, support, and care for LGBTQ youth will influence their future. Data show that LGBTQ youth experience bullying at a significantly higher rate than heterosexual youth. Advocacy at all levels will help to combat this problem and allow these students to mature and flourish. They deserve a supportive environment in order to achieve their goals and to feel safe. Nurses are well positioned to make a difference for LGBTQ youth.




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