Investigating whether mental health inequality between LGBTQ+ and cisgender-heterosexual adolescents varies across schools, and identifying school-level predictors of variation

In a rapid realist review conducted by Schlief and colleagues, overall school climate (e.g. policy, culture, values, relationships), school connectedness (e.g. whether students feel belonging, acceptance and inclusion), bullying, and discrimination emerged as potential modifiable risk factors which may explain the mental health inequalities between LGBTQ+ and heterosexual/cisgender adolescents in schools. However, most existing studies were conducted in North America, with small samples and limited adjustment for confounders. As far as we know, no study has investigated whether the inequality in LGBTQ+ mental health varies between schools, or the predictors of this variation. Identifying modifiable characteristics of the school environment that are associated with this variation can inform the development of interventions to prevent or reduce inequality.