Promoting inclusivity and acceptance of diverse sexual and gender identities in schools: a Rapid Realist Review of universal interventions to improve mental health.

BackgroundSexual minority and trans young people are more likely to experience depression, anxiety, self-harm and suicidality than their heterosexual or cisgender peers. Improving inclusivity and acceptance of diverse sexual and gender identities, through universal interventions in schools, could prevent these mental health problems. We reviewed evidence, and developed a conceptual framework, to explain which universal interventions work, for whom, in which contexts, and why. MethodsWe conducted a Rapid Realist Review, with a systematic search of published, peer-reviewed and grey literature. We included reports from a call for evidence and website searches. Data were extracted in Context-Mechanism-Outcome (CMO) configurations. CMOs were developed and refined through discussions with experts by lived experience including young people, teachers, school governors and policy representatives FindingsWe included 53 studies, and classified interventions into five themes: Gay-Straight Alliances or similar student clubs (e.g. pride clubs), inclusive anti-bullying and harassment policies, inclusive curricula, workshops, and staff training. These interventions have the potential to reduce mental health problems among sexual minority and trans young people by reducing discrimination, bullying and feelings of unsafety, exclusion and marginalisation. The interventions appear to work best when teaching staff and school leaders are properly trained, and the school climate and community are supportive. Interventions may be less effective for boys and trans and bisexual students. InterpretationOur findings provide guiding principles for schools to develop interventions to improve the mental health of sexual minority and trans students. These findings should encourage primary research to confirm, refute or refine our programme theories.