LGBTQ youth are simultaneously experiencing universal and identity-specific stressors as a result of COVID-19.
Participants voiced concerns about being confined at home with unsupportive family members and the inability to access supportive resources. They also highlighted the usefulness of synchronous and asynchronous textbased platforms. Many LGBTQ youth are turning to LGBTQ-specific online contexts to seek support and community. Concerted efforts are required to provide necessary support for LGBTQ youth during the pandemic.
The COVID-19 pandemic has exacerbated social and health inequities within society [1] . Although economic and health risks to LGBTQ populations have been acknowledged, attention has focused on adults [2] . Physical distancing may result in decreased positive and increased negative social interactions and employment and housing uncertainty for LGBTQ youth [3] . As researchers and service providers, we are surprised by limited attention to the consequences of the pandemic for LGBTQ youth.
LGBTQ youth have greater odds of poor mental health and wellbeing relative to their non-LGBTQ peers; outcomes are directly related to experiences of discrimination, victimization, and rejection from their family, peers, and communities [4] . We contend that LGBTQ youth are likely to be uniquely impacted as a result of the physical distancing implemented to contain the spread of COVID-19. Physical distancing may simultaneously result in confinement to unsupportive home environments and isolation from developmentally important social connections and identity-based resources; circumstances are associated with compromised mental health (e.g., depression, suicidality) and likelihood to engage in health risk behaviors (e.g., substance use, self-harm) [3, 4] . Yet, LGBTQ youth may be more likely than their non-LGBTQ peers to seek resources and community online [5, 6] . Thus, we examined youth's experiences during mandatory physical distancing via a national online program for LGBTQ youth.
Hosted by CenterLink, Q Chat Space (qchatspace.org) is a national online LGBTQþ center offering 10 90-minute, professionally facilitated, synchronous chat-based support groups for LGBTQ youth (aged 13e19 years) each week. Although authors are evaluating the Q Chat Space program as part of a larger study (forthcoming), we took the opportunity to assess LGBTQ youth's experiences with the COVID-19 pandemic by conducting a secondary data analysis of 31 chat transcripts that coincided with state-based "social distancing" orders and school closures in the U.S. (3/23/2020e4/10/2020). Most chats focused on non-COVID-19 topics (e.g., coming out, HIV/AIDS awareness), although some facilitators asked related questions. For example, "What has your experience with sheltering-in-place and social distancing been like?" Attendance for each chat ranged from 2 to 30 youth (M ¼ 11.3), with 159 unique participants identified in the analyzed transcripts. Q Chat Space participation is anonymous; therefore, sociodemographic characteristics are unavailable. This study was approved by the University of Maryland Institutional Review Board.
Transcripts were rapidly reviewed using qualitative content analysisdan approach effective for analyzing data for a specific research question [7] . In total, 149,127 words of chat data were reviewed for COVID-19erelated content (812 pages). Two coders reviewed COVID-19 data "line by line" to identify initial codes and categories, followed by data review and consensus building among the six-person research team to establish final themes. Final themes were refined to ensure accuracy and consistency.
Participants discussed COVID-19erelated stressors likely to be universal among youth. However, experiences were imbued with LGBTQ-specific intrapersonal, interpersonal, and structural challenges (see Table 1 ).
Concern for mental health was highlighted owing to pandemic restrictions. Some comments likely reflect COVID-19 experiences generally (e.g., boredom), whereas feeling "stircrazy" and isolated could exacerbate mental health concerns for a vulnerable population. Youth reported stress, frustration, anxiety, depression, and general struggles with mental health. Comments frequently referenced loss of routine and ongoing difficulties with sleep and schoolwork. Several youth shared that having free time to "just think" led to rumination regarding their sexuality and/or gender, which was burdensome. However, youth also identified positive aspects of opportunities to think about their identity without outside intrusions.
Youth expressed confusion and anxiety about the uncertainty of when school would resume. Of particular concern was loss of extracurricular activities (e.g., theater, graduation). Unsurprisingly, LGBTQ youth expressed concern about being "stuck at home with unsupportive parents," some of whom are "super religious and homophobic." Many grieved the loss of "safe spaces." Those only able to disclose their LGBTQ identity at school had lost access to friends, gender and sexuality alliances (GSAs), and supportive staff; resulting in having nowhere to express themselves. Alternatively, some youth described freedom from "transphobic and homophobic people in real life for a while."
Youth described reduced access to in-person services owing to pandemic-related closures. Although some had therapists, youth were hesitant to engage in telebehavioral health owing to fear parents would overhear conversations. Youth also voiced concern about inhibited access to community-based LGBTQ youth organizations and individuals who provided support (e.g., staff, mentors, "chosen family").
Many youth are capitalizing on extant online services during physical distancing. One youth indicated that Q Chat Space's "text thing is a game changer for folks who don't want to be overheard." This suggests online, text-based platforms may be particularly useful to LGBTQ youth during this timedreinforced by the popularity among youth of chat platforms to maintain connections and build community (e.g., TrevorSpace, Discord Servers). Youth also discussed increased consumption of digital media (e.g., video, games, music), particularly identity-specific online content: "[I've been] watching and reading a lot of LGBTQþ YouTube channels and blogs." They frequently exchanged content recommendations. Although experiencing restricted access to "chosen family" and other supportive individuals, youth are maintaining connections through social media and similar platforms. Despite (or perhaps because of) current stressors, LGBTQ youth appear to be engaging in mutual support online.
Despite contributing notably to their stress, youth acknowledged the importance of physical distancing: "flattening the curve to minimize death is the most important thing right now." Comments reflect experiences likely typical of all youth (e.g., adapting to online schooling, missing friends); however, conversations were also fraught with statements highlighting experiences unique to LGBTQ youth, for example, confinement with parents who are unaffirming of youth's LGBTQ identities.
Results showcase youth's use of online text-based chat platforms to seek formal and informal LGBTQ-specific support. Q Chat Space has seen the average number of youth participants double since physical distancing took effect, suggesting LGBTQ youth are seeking identity-specific online resources during the crisis. The Trevor Project reports engagement with their 24/7 crisis services have also doubled (The Trevor Project email communication April 21, 2020). Q Chat Space's professional facilitators have used responsive program adaptations, including (1) flexibility regarding session topics; (2) encouraging youth to continue their activities via online platforms (e.g., video chats with friends); and (3) reinforcing positive aspects of youth's daily life and encouraging longer term thinking (beyond current circumstances).
Limitations of the present study include the use of a small sample limited to youth who were motivated to engage in an online platform for LGBTQ youth. We also use data from chats that were not explicitly designed to capture the experience of LGBTQ youth during the COVID-19 crisis. Future work is needed to better understand how the COVID-19 pandemic is uniquely impacting LGBTQ youth. Still, our findings highlight the need for synchronous, LGBTQ-specific, text-based programming to enhance youth's safety while support seeking when isolated at home. Given the potential for longer term physical and social distancing orders, a concerted effort is required to support LGBTQ youth during the COVID-19 pandemic.
This work was supported, in part, by the University of Maryland Prevention Research Center cooperative agreement U48DP006382 from the Centers for Disease Control and Prevention (CDC). Any interpretations and opinions expressed herein are solely those of the authors and may not reflect those of the CDC. J.N.F. also acknowledges support from the Eunice Kennedy Shriver National Center for Child Health and Human Development grant P2CHD041041, Maryland Population Research Center. N.D.W. acknowledges support from the Southern Regional Education Board. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Table 1 Quotes showcasing youth experiences of intrapersonal, interpersonal, and structural challenges and online support and resources Intrapersonal challenges "Well it's stressful, no one outside of this chat uses my name or pronouns, im not aloud to dress femininely at all, i haven't slept in a whole day, I once again didn't eat anything today, and im slowly losing my mind." "Just trying to keep a structure so that I don't get depressed lol" "Like since my school moved to digital classes i've started feeling waaaaaaay more isolated" "I don't like that social distancing bc sometimes depression be like that anyway but i'm definitely stressed" "I'm realizing how much I rely on human interaction to keep me mentally healthy. I'm relying more on other positive coping techniques and working on finding new ones." "I've gotten calls and texts/messages from people I have not spoken to in a while, and people are like. really struggling." "Found out recently that i get to start hrt essentially as soon as this virus is over so thats something amazing" Interpersonal challenges "Sry my parents still don't call me Skyler or she and i have not been to school in 2 weeks so im sorry if it takes a minute" "I'm kinda stuck at home with unsupportive parents right now" "Stressfuldealing with super religious and homophobic parents and siblings has been a not-so-Great experience, But I really know it's best to stay in so." "None are supportive, theyre very religious. i love them anyway though" "I mean [a]t least we don't have to deal with transphobic and homophobic people in real life for a while.I mean unless anybody lives with biogoted people" "I have to start online school for the rest of the year-my school is shut down until next school year. Man everything is so hectic right now" "My current mentor is my poetry teacher. I miss her and my classmates very much" Structural challenges "[Before COVID] I was having a bad day because I had gotten into a fight with my bio family and when I was crying [program staff member] talked to me and hugged me and ever since then we would hug everyday but now we can't because of the stupid coronavirus" "Are people struggling to see their chosen family because of Covid 19? Yeah, obligatory support isn't really support." "I spend time with my friends who are trans, but I couldn't this year because of quarantine:(" "i would do therapy over the phone but im scared my mom will overhear stuff):" "the text thing is a game changer for folks who don't want to be overheard!" "yea my only therapist was the one at school but now all of this happened" Online support and resources "I have met digitally with my group from school which wasn't too bad, though it was an adjustment to some of the technology" "My queer youth center near me also has been great. They always do a checkin with ur name pronouns highlight and lowlight of the day. They closed they have been doing that on instagram stories and reposting ones that the youth post. So that has really helped." "I can text and video chat with my chosen fam. but were having an online celebration for my 7 months of sobriety mark" "I'm certainly learning a lot about technology thru this. It's an interesting way to connect"