and rejection that increase the likelihood of depression. Gay and bisexual men are more likely to have major depression and bipolar disorder than heterosexual men. Transgender youth are nearly four times more likely to experience depression, as compared to their non-transgender peers. Compared to LGBTQ+ youth with highly accepting families, LGBTQ+ youth with less accepting families are more than three times likely to consider and attempt suicide. As compared to individuals with a level of certainty in their gender identity and sexuality (such as LGB-identified and heterosexual students), youth who are questioning their sexuality report higher levels of depression and worse psychological responses to bullying and victimization. 31% of LGBTQ+ older adults report depressive symptoms. LGBTQ+ older adults experience LGBTQ+ stigma and ageism that increase their likeliness to experience depression. Post-traumatic stress disorder LGBTQ+ individuals experience higher rates of trauma than the general population, the most common of which include intimate partner violence, sexual assault and hate violence. Compared to heterosexual populations, LGBTQ+ individuals are at 1.6 to 3.9 times greater risk of probable PTSD. One-third of PTSD disparities by sexual orientation are due to disparities in child abuse victimization. Suicide As compared to heterosexual men, gay and bisexual men are at a greater risk for suicide, attempting suicide, and dying of suicide. In the United States, 29% (almost one-third) of LGBT youth have attempted suicide at least once. Compared to heterosexual youth, LGB+ youth are twice as likely to feel suicidal and over four times as likely to attempt suicide. Transgender individuals are at the greatest risk of suicide attempts. One-third of transgender individuals (both in youth and adulthood) has seriously considered suicide and one-fifth of transgender youth has attempted suicide. LGBT+ youth are four times more likely to attempt suicide than heterosexual youth. Youth who are questioning their gender identity and/or sexuality are two times more likely to attempt suicide than heterosexual youth. Bisexual youth have higher percentages of suicidality than lesbian and gay youth. As compared to white transgender individuals, transgender individuals who are African American/black, Hispanic/Latinx, American Indian/Alaska Native, or Multiracial are at a greater risk of suicide attempts. 39% of LGBTQ+ older adults have considered suicide. Substance abuse In the United States, an estimate of 20-30% of LGBTQ+ individuals abuse substances. This is higher than the 9% of the U.S. population that abuse substances. In addition, 25% of LGBTQ+ individuals abuse alcohol compared to the