(NEW YORK) — Youth who identify as LGBTQ+ reported higher rates of poor mental health and experiencing suicidal thoughts and behaviors than their cisgender and heterosexual peers, a new U.S. survey found.

In 2023, more than three in five LGBTQ+ — lesbian, gay, bisexual, transgender, questioning or another non-heterosexual identity — high school students said they experienced persistent feelings of sadness or hopelessness, and more than half reported having poor mental health, according to the latest results of the Youth Risk Behavior Survey, published Tuesday morning by the Centers for Disease Control and Prevention (CDC).

“Across all of those outcomes that we looked at, experience of violence, poor mental health and suicidal thoughts and behaviors, we do see this really significant disparity between LGBTQ+ young people and their cisgender and heterosexual peers,” Dr. Kathleen Ethier, director of the CDC’s division of adolescent and school health, told ABC News. “That has been the case for a while.”

The Youth Risk Behavior Survey is conducted every other year and surveys thousands of high school-age children from public and private schools between grades 9 and 12 across all 50 states and the District of Columbia.

Ethier said 2023 was the first year that a question on transgender identity was included in the national survey “and so it’s the first time that we’re really able to look at that group as a whole, and the findings are quite stark, as they have been in previous years.”

LGBTQ+ students were more likely than their peers to report experiencing persistent feelings of sadness or hopelessness, poor mental health and suicidal thoughts and behaviors, according to the survey.

In 2023, 65% said they experienced persistent feelings of sadness and hopelessness during the past year compared to 31% of cisgender and heterosexual peers, according to the survey. Additionally, 53% said they experienced poor mental health during the last 30 days in comparison to 21% of their peers, they survey said.

The report also found that 41% of LGBTQ+ youth seriously considered attempting suicide in the past year and one in five — 20% — did attempt suicide.

LGBTQ+ students were also at higher risk of substance use than their peers. In 2023, LGBTQ+ high school students said they were about twice as likely to have ever used illicit drugs and prescription opioids.

The report found that 26% of LGBTQ+ students said they drank alcohol in the past 30 days compared to 21% of cisgender and heterosexual students. Additionally, 25% of LGBTQ+ students said they used marijuana compared to 14% of their peers.

It also found that 18% of LGBTQ+ students reported having ever misused prescription opioids and 15% reported having ever used illicit drugs. Comparatively, 8% of cisgender and heterosexual students said they had used or misused illicit drugs or prescription opioids.

Additionally, LGBTQ+ students were more likely than cisgender and heterosexual students to currently be misusing prescription opioids — such as codeine, Vicodin, OxyContin, Hydrocodone or Percocet — with 7% of LGBTQ+ youth saying they had misused these drugs in the past 30 days compared to 3% of cisgender and heterosexual students.

What’s more, LGBTQ+ youth were more likely to experience violence, according to the survey. Nearly three in 10 LGBTQ+ students said they were bullied at school and nearly two in 10 missed school because of safety concerns.

In the report, the CDC said schools that have put policies and practices in place in place to support LGBTQ+ youth have seen improved mental health and fewer suicidal thoughts and behaviors among this population as well as among heterosexual and cisgender youth.

“We also know how to make things better for LGBTQ+ young people, and so we know that there are things that their schools could be doing to make them feel safer and more supported, and that when their schools do that, not only do LGBTQ+ young people do better, but their heterosexual peers do better as well,” Ethier said. “And so, we are really focused on making sure that we can do everything that we can do to get those effective policies and practices out there for schools and so that they can create better environments for those young people.”

The report also had some positive findings regarding the general U.S. teen population including a decrease in teen girls saying they experienced persistent sadness and hopelessness between 2021 and 2022 and a decrease in reported attempted suicide among Black youth.

“We’re not out of the woods, yet. We clearly have more work to do,” Ethier said. “But what this tells us is that when we focus in on an issue for young people, when we come together, we do what young people need us to do, we can really make a difference and improve their health and well-being.”

If you or someone you know is struggling with thoughts of suicide – free, confidential help is available 24 hours a day, 7 days a week. Call or text the national lifeline at 988.

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