Background: Sexually and gender diverse adolescents worldwide are at heightened risk of experiencing mental health issues, including depression, anxiety, and suicidal behaviours. To date, however, no studies have used nationally representative data to explore the prevalence of sexual and gender diversity and associated mental health issues among adolescents in Indonesia and Vietnam.
Methods: Data were drawn from the National Adolescent Mental Health Surveys, nationally representative household surveys of mental health among adolescents aged 10–17 years in Indonesia and Vietnam. Questions about gender identity and romantic/sexual attraction were only asked to those aged 12–17. Weighted logistic regression analyses were used to assess the associations between (1) gender identity and (2) sexual orientation and past 12-month depressive symptoms, anxiety symptoms, and suicidal ideation.
Results: Of 4,300 adolescents in the Indonesia sample and 4,376 adolescents in the Vietnam sample, 5.3% and 5.9% respectively reported gender diverse identities, while 9.4% and 12.6% respectively reported sexually diverse orientations. In Indonesia, gender diverse adolescents had significantly increased odds of past 12-month depressive symptoms (aOR: 2.95; 95% CI: 1.17–4.35), anxiety symptoms (aOR: 1.88; 95% CI: 1.24–2.85), and suicidal ideation (aOR: 6.16; 95% CI: 2.73–13.89) as compared to their cisgender peers. Sexually diverse adolescents had significantly increased odds of depressive symptoms (aOR: 2.64; 95% CI: 1.51–4.62), anxiety symptoms (aOR: 2.02; 95% CI: 1.41–2.89), and suicidal ideation (aOR: 3.41; 95% CI: 1.25–9.29) as compared to their heterosexual peers. In Vietnam, gender diverse adolescents only had increased odds of anxiety symptoms (aOR: 1.58; 95% CI: 1.13–2.22), whereas sexually diverse adolescents had increased odds of depressive symptoms (aOR: 2.58; 95% CI: 1.36–4.92), anxiety symptoms (aOR: 1.58; 95% CI: 1.14–2.19), and suicidal ideation (aOR: 2.84; 95% CI 1.13–7.14).
Conclusions: In Indonesia and Vietnam, a considerable proportion of adolescents report gender diverse identities or sexually diverse orientations. Given that sexually and gender diverse adolescents are at increased risk of depression, anxiety, and suicidal ideation, it is critical that appropriate, culturally safe mental health and psychosocial support services are available to provide targeted assistance to these young people.
Supplementary Information: The online version contains supplementary material available at 10.1186/s13034-025-00921-5.
Keywords: Adolescent; Gender identity; Indonesia; LGBT; Mental health; Sexual orientation; Vietnam.