Abstract
INTRODUCTION: Gender and sexual minority adolescents experience greater stress and report worse sleep outcomes compared to their cisgender and/or heterosexual peers. Understanding how minority stress and resilience factors are linked to sleep health provides levers for improving sleep within these populations. METHODS: Using a cross-sectional survey of LGBTQ+ adolescents in the US conducted in 2017 (n = 11,282; M(age) = 15.6 years; 65% white), we compared gender/sex and sexuality subgroups' trouble falling asleep and conducted linear regressions relating trouble falling asleep to minority stress (i.e., violent victimization, bias-based victimization, and family rejection) and resilience (i.e., familial warmth, family acceptance, gender-affirming environments, teacher support, trusted adult at school, and presence of a gender-sexuality alliance [GSA]) factors for both gender and sexual minority adolescents. RESULTS: We found small but significant differences in sleep across gender/sex categories, with gender minorities and youth assigned female at birth having worse sleep than cisgender sexual minorities and youth assigned male at birth, respectively. Further, violent LGBTQ+ victimization and gender expression-based victimization were associated with more trouble falling asleep, and familial warmth was associated with less trouble falling asleep for both groups. For cisgender sexual minorities, family rejection and gender-based victimization were also linked with worse sleep while presence of a GSA and a trusted adult at school were linked with better sleep. For gender minorities, gender-segregated restroom use was also linked with better sleep. CONCLUSIONS: Victimization prevention, increased access to school supports, and improved family connectedness may help enhance LGBTQ+ youth sleep quality and overall health.