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What is known about the protective factors that promote LGBTI+ youth wellbeing? A scoping review protocol

Background: There is much concern at the substantial vulnerabilities experienced by lesbian, gay, bisexual, transgender and intersex (LGBTI+) youth as a consequence of discrimination, stigmatisation and marginalisation. Recent research highlights the importance of understanding factors that can promote wellbeing for this population. This paper presents a protocol for a scoping review which aims to systematically map and synthesise the extent and nature of the peer-reviewed, published and unpublished academic literature on the protective factors that promote wellbeing for sexual and gender minority young people. Methods: In accordance with the methodological framework for scoping reviews, the following six stages will be undertaken: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting results and (6) consultation. The PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the review process. Key inclusion criteria will use the Population, Concept, Context approach, with two reviewers independently conducting the screening and extraction stages across five databases. Identified protective factors will be collated, summarised and categorised iteratively by one reviewer in consultation with the review team. Stakeholder consultation is a key strength of the scoping review process and will be complemented by the public patient involvement of LGBTI+ young people with expertise by experience. Conclusions: The scoping review has the potential to inform policy, practice and future research through enhanced understandings of the complex interplay of factors that promote wellbeing for sexual minority, gender minority and intersex youth. This first stage of the research process will inform the development of a larger research project. The findings will be disseminated through a peer reviewed publication, a conference presentation and by sharing the findings with key stakeholders, including LGBTI+ young people.


Introduction
It is accepted that there is "no health without mental health" 1 , with the World Health Organization (WHO) describing mental health as "a state of wellbeing" 2 . While the concept of wellbeing is contested, it is used extensively throughout the literature with less clarity about how this is defined 3,4 . This scoping review is informed by the WHO's holistic conceptualisation of wellbeing 2 . This encompasses a dynamic process that includes: life satisfaction, purpose and meaning; experiencing equilibrium, vitality and self-efficacy; alongside a sense of contribution 2 . Furthermore, the WHO's Ottawa Charter of Health Promotion situates individuals within their wider cultural and social environment, emphasising the importance of addressing the ecological context in order to strengthen the person 5 . As such, social justice is a necessary pre-requisite for health 5 . This conceptualisation facilitates a move beyond implicit understandings of a dichotomy of mental wellness and mental illness 3,4 . However, these binary understandings may be part of a wider public discourse where mental health has become synonymous with mental ill-health, as distinct from positive mental health or the relationship between mental health and social wellbeing 3-6 . Such understandings may be informed by a clinical and pathologised framing of mental health as referring solely to difficulties and concerns requiring diagnosis and treatment with resultant stigmatisation 2-4,7-9 . Research regarding attitudinal changes in the wider Irish population identified greater reluctance to openly share information about mental health concerns in personal and professional relationships 7-9 . Furthermore, over half the Irish population would not wish others to know if they had a mental health difficulty 6 . In response, improved mental health and wellbeing have been identified as central to mental health promotion in Ireland with the launch of Connecting for Life: Ireland's national strategy to reduce suicide 2015-2020 10 . The Strategy outlines protective factors, such as help-seeking and social connectedness; however, the under-development of research into protective factors for mental health, particularly for populationspecific target groups, is acknowledged 10 .
While Connecting for Life adopts a whole-population approach, it identifies specific priority groups, notably those vulnerable to suicide including lesbian, gay, bisexual, transgender, intersex, questioning, queer, asexual, and non-binary (LGBTI+) populations 10 . The acronym LGBTI+ comprises three dimensions: sexual orientation, gender identity and sex development.
Sexual orientation refers to identification, behaviour and attraction, with suggestions of a higher life-time prevalence of same-sex behaviour and attraction than identification, and a higher reported prevalence of bisexual people, particularly bisexual women 11 . Gender identity refers to someone's internal sense of their gender as male, female or non-binary, and may not accord with the sex ascribed at birth 11 . As such, those who identify as transgender and non-binary also have a sexual orientation and may be heterosexual, lesbian/gay, bisexual or asexual 11 . Intersex refers to the spectrum of variations of sex development that occur within humanity 12 . Likewise, those who identify as intersex also have a gender identity and sexual orientation.
The wellbeing of LGBTI+ populations has generated considerable research interest over many decades, often identifying vulnerability to psychological distress, self-harm and suicide, both nationally and internationally 10, 13 . This is often contextualised through Minority Stress Theory 14 , highlighting the consequence of stigmatisation, marginalisation and discrimination on the wellbeing of LGBTI+ populations [13][14][15] . Particular concern has been expressed in relation to LGBTI+ youth with noted mental health disparities [16][17][18][19] . These concerns also extend to the Irish context 10,20-22 .
There is a tendency to focus on resultant deficits, with sparse literature on strengths-based approaches which promote and protect LGBTI+ wellbeing 23,24 . This may assume that, because of the marginalisation of sexual minority, gender minority and intersex youth, these young people are automatically 'at risk' 25,26 . Researchers have cautioned against this continued representation which may inadvertently portray young LGBTI+ lives as a trajectory, assuming self-harm and suicidality 27,28 . It has been emphasised that the research taken to indicate heightened mental health risk fails to emphasise that the vast majority of those who identify as LGBTI+ report positive experiences of mental health and social wellbeing 13,[25][26][27][28][29] . Such generalised and universalising approaches may not recognise the range of mental health promoting factors available to LGBTI+ populations, including young people 29,30 . Furthermore, researchers have emphasised that the dominant research focus on

Amendments from Version 1
The protocol has been revised following peer review. In response to the suggestion of major revisions, careful consideration has been given to the following: inclusion of grey literature; the stakeholder consultation; the use of the LGBTI+ acronym; definitions and operationalisation of concepts of wellbeing and mental health; timeframes for the search; inclusion criteria regarding age; and the rationale for choice of scoping review. The protocol has been amended to include dissertations and theses, which may be published or unpublished, alongside peer reviewed journal articles. Further information has been included about the stakeholders and the purpose of the consultations. Regarding self-descriptors used by sexual minority, gender minority and intersex youth, the protocol has made it more explicit that there are a broad range and wide variation across a spectrum of identifies, orientations and expressions. The parameters around the conceptualisation of wellbeing as a construct has been elaborated. The reasoning underpinning the inclusion of mental health as an integral component of wellbeing has been outlined. This facilitated further refining of the research question, inclusion and exclusion criteria and the search strategy. The Concept from the Population -Concept -Context has been defined as 'protective factors that promote wellbeing.' Consideration was given to placing timeframes on the search. In keeping with the scoping review methodology, the search will be conducted from journal inception and map changes across time. The suggestion that studies with participants where the mean age falls within the specified age range has been adopted and the inclusion and exclusion criteria revised to reflect this. While scoping reviews do not include quality assessment or risk of bias, the rationale for the choice of this methodology as the most appropriate for this under researched topic have been expanded. The strengths of the scooping review methodology have been made more explicit.
Any further responses from the reviewers can be found at the end of the article REVISED mental health risk for LGBTI+ youth does not identify interventions or suggest solutions 23,24 . As a result, this representation may unintentionally stigmatise sexual minority, gender minority and intersex young people, with a subsequent decrease in help-seeking 21,31 . The national and international literature suggesting substantial vulnerabilities highlights the importance of understanding factors that are protective for this population 10,13,21 .
The current research imbalance and emphasis on mental health disparities has been acknowledged 10,13,31 . Health and social policies are integral to promoting the social acceptance of LGBTI+ people with stark differences noted between countries and over time 32 . In particular, marked contrasts are evident amongst countries formerly colonised by Britain in relation to decriminalisation of homosexuality 32 . This can be seen in the Irish context, where despite its history of colonisation, there has been significant progress since 1993 following decriminalisation 33 . The rapid recognition of LGBTI+ rights was markedly enhanced in 2014 when the Irish Government become a signatory to the Declaration of Intent on the International Day Against Homophobia and Transphobia 34 . This commitment informed legislative and policy measures including: a referendum and subsequent changes to the constitution to provide for marriage equality; legislation on gender recognition for adults; and the introduction of policy, including the publication of the LGBTI+ National Youth Strategy as part of the programme for government [35][36][37] . The strategy was the first of its kind in a global context, with three overarching goals with the third of these prioritising the development of the research and data environment 37 . This acknowledges the dearth of research internationally and the urgent need for Irish-specific studies to ensure policy and practice is evidence-informed in relation to promoting LGBTI+ youth wellbeing 37 .
It is within this context that this scoping review is being undertaken.

Study rationale
The scoping review is part of a broader PhD mixed-methods project. This first stage of the research process will locate the study within the literature to inform the future development of the qualitative and quantitative aspects of the project 38,39 . As far as we can determine there is no existing peer reviewed or published synthesis of the research on protective factors for LGBTI+ youth wellbeing. This is surprising, given the extensive research focus, over several decades, on LGBTI+ mental health disparities, with specific attention given to youth mental health risk 10,13,16-22 . The limited research focus on protective factors that promote LGBTI+ wellbeing is noteworthy given that a decade has passed since Haas and colleagues drew attention to the issue 13 . This group of researchers specifically recommended that studies should be conducted on potentially protective factors, including those that mitigate mental health risk and promote resilience for sexual and gender minority populations 13 .

Scoping review objectives
A scoping review was chosen in order to ascertain the breadth of work conducted in this field [40][41][42][43] . In line with current recommendations, the overarching objective is to collect and synthesise the quantitative, qualitative and mixed-methods academic literature on the protective factors for sexual minority, gender minority and intersex youth wellbeing. The review aims to map the concepts, themes and types of available evidence within the existing national and international literature 40 . The purpose of this scoping review is to make available the progress of this field of study, the characteristics of those studies undertaken to date, the various domains assessed, and the specific outcome measures used 40 . Furthermore, this review will identify the extent and nature of the academic literature, including research deficits and knowledge gaps 41 . The scoping review has the potential to inform policy, practice and future research, particularly through mapping a course forward to guide the planning and the commissioning of future research 43 . A key strength of the scoping review framework is the priority placed on stakeholder consultation as part of the methodological framework 40,41,43 . This suggests that both the process and results are strengthened through the contribution of those with research, policy and practice knowledge or expertise of the topic 40,41,43 . A potential benefit of scoping reviews is that they can address topics considered important in the policy context 42,43 . The project is aligned to the Irish LGBTI+ National Youth Strategy and the specific objective to "develop research into the factors that support positive mental health for LGBTI+ young people" (p.31) 37 . Stakeholders involved in the development and implementation of the Strategy will be invited to contribute to the consultation process. This will be complemented by consultation within broader LGBTI+ networks internationally. Furthermore, Daudt, van Mossel and Scott suggest that suitable stakeholders should be invited to be part of the research team 43 . The study team includes members from within LGBTI+ communities with research, policy and practice backgrounds. The consultation will be enhanced by engaging LGBTI+ youth with expertise by experience via focus groups 44-46 .
The following research question will be considered: What is the extent (that is the size and breadth), range (variation and topic), and nature (characteristics, design, focus) of the evidence on the topic: 'protective factors -LGBTI+ -youth -wellbeing'?

Protocol design
Scoping reviews are defined as "a systematic approach to map evidence on a topic and identify main concepts, theories, sources and knowledge gaps" (p 467) 47 . They assist in charting outcomes across settings and contexts, identifying where research is well-established and where there are gaps in the literature 42 . The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the review process 47 . The methodological framework will be followed as outlined by Arksey and O'Malley and Levac, Colquhoun and O'Brien 40,41 . This consists of six stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting results and (6) consultation 40,41 . While the sixth stage is considered optional within the framework, the authors concur with and Levac, Colquhoun and O'Brien that this process should be prioritised 41 . This process offers the potential to enhance understandings of the complex interplay of protective factors for for sexual minority, gender minority and intersex youth 44-46 .
These stages of the scoping review will be discussed in further detail below.

Stage 1: identifying the research question
Through an initial review of the literature, alongside consultation with key stakeholders within LGBTI+ research networks, the overarching research question is: what is the extent, range, and nature of the peer-reviewed academic qualitative, quantitative and mixed-methods evidence regarding LGBTI+ youth wellbeing? This question has been revised or refined through informal the consultation with key stakeholders, consistent with iterative and reflexive approach underpinning scoping reviews 40,41,43 .

Stage 2: identifying relevant studies
In order to identify relevant studies, the search strategy will be underpinned by key inclusion criteria based on the PRISMA checklist for scoping reviews using the Population, Concept, Context (PCC) screening criteria 47 : • P -Population: sexual minority, gender minority, intersex and non-binary youth • C -Concept: protective factors that promote wellbeing • C -Context: any country (or region) with broadly comparable social acceptance measures With the limited research attention given to the topic, the scoping review will focus on published and unpublished, academic, peer reviewed research literature including quantitative, qualitative, and mixed-methods publications. Additionally, review articles will be included, such as: evidence syntheses, systematic reviews, and meta-analyses using quantitative, qualitative, and mixed-methods approaches, scoping reviews, narrative reviews, rapid reviews, and realist reviews. The authors are aware of the wealth of grey literature. However, it is well-documented that assessment of study quality and risk of bias are not considered to be part of the scoping review process, which is to describe the breadth and nature of the evidence 42,48 . To ensure that some grey literature is included, academic dissertations will be included along with peer reviewed journal articles. Three key repositories will be searched including the Networked Digital Library of Theses and Dissertations, Electronic Theses Online Service and DART Europe. Other types of publication will be excluded from the search (i.e., book chapters, conference abstracts, reports, policy briefs etc.) or publications in a language other than English.
Careful consideration has been given to search timeframes, particularly in light of the rapid changes that have occurred across the cultural and social landscape within the past ten years. However, a core function of a scoping review is to determine the coverage of a body of literature on a given topic 40,41,43,48 . Furthermore, Meyer's publication of Minority Stress Theory in 2003 continues to have resonance 14,30 . On this basis, no time limits will be placed on the initial search and the literature from journal inception will be scoped. It is anticipated that assessing the timeline of publications on this topic, will enable these changes to be mapped 40-43 .
The scoping review will consider all research with sexual minority, gender minority and intersex youth 49 . This study recognises that the LGBTI+ acronym has particular resonance in the Irish context, with its use evolving iteratively through consultative policy-making processes 37 . However, there are wide variations in sexuality, gender identity and diverse sex development, and how this is expressed in relation to identities and orientations, particularly for youth 49 . The use of the LGBTI+ acronym reflects the authors' understanding of this diversity and ways of expressing these variations across a wide spectrum. While the search strategy has been informed by the work of Lee, Ylioja and Lackey, care has been taken to ensure that the search terms do not simply replicate their work 49 . As such, the search strategy has been specifically tailored for this scoping review with deliberately wide search parameters using a broad spectrum of self-descriptors and related terms (see Extended data) 50 .
Studies with LGBTI+ populations aged between 10 and 24 years will be included, consistent with the National Youth Strategy definition of youth 51 . A criterion for inclusion is that the study specifically targets young people. While it is recognised that some highly relevant studies may have a mix of eligible/ineligible participants, this review will include studies where the mean age falls within the specified age range, that is, between 10 and 24 years.
A holistic view of wellbeing underpins this review in accordance with the WHO 2,5 . This acknowledges that while the dominant research focus has been on mental health risk, many of these studies will also include information about protective. This construct is further informed by the systematic review conducted by Wilson and Cariola and their recommendation of the need for strengths-based research into "resilience and protective factors for sexual and gender minority youth…across microsystems and macrosystems" (pp206-207) 30 . They emphasise the importance of exploring the environmental, community and interpersonal characteristics of LGBTI+ youth "leading happy well-adjusted lives" (p206) 30 . While the available frames of reference for LGBTI+ youth via the twin tropes of: "victims in need of tolerance and inclusion" and "just like everyone else" are problematised 28 , this approach may inform more nuanced understandings of such protective factors for times of compromised wellbeing 30 . Furthermore, the authors concur that Minority Stress Theory may provide a framework for exploring sexual minority, gender minority and intersex youth understandings of mental health promotion strategies and interventions 30 . This is consistent with Connecting for Life which identified different protective factors for adolescent and adult populations, for example, help-seeking was positively associated with youth wellbeing 10 .
In light of the continued criminalisation of homosexuality in some parts of the world, with an impact on research and obtaining data, the context will be limited to countries and regions where there are broadly comparable measures of social acceptance of LGBTI+ populations as measured by the Global Acceptance Index 32 . While this may limit generalisablity, the rapid pace of change, as can be seen in the example of Ireland, may generate interest and be relevant to countries and regions where there is less acceptance 32 .
Search strategy. The search strategy was developed in consultation with the subject liaison librarian. A preliminary search was undertaken to establish whether existing scoping reviews had been conducted on the topic or in relation to protective factors for LGBTI+ youth wellbeing. A search for any reviews already conducted or aligning with the topic was undertaken across the Cochrane Database of Systematic Reviews, Campbell Collection, Epistemonikos and JBI Evidence Synthesis. When this yielded no results, the Database of Abstracts of Reviews of Effects from the National Institute for Health Research and PROSPERO, an international database of systematic reviews regarding health and social wellbeing, were subsequently searched. When no systematic, scoping or any other type of review was identified, an initial keyword search was piloted across three electronic databases: PubMed, PsycINFO and ASSIA. This informed further review of the search strategy with informal consultation undertaken with key stakeholders and LGBTI+ young people to ensure that deliberately broad keywords and search terms were included. The LGBTI+ acronym refers to those self-identifying as lesbian, gay, bisexual, transgender, intersex, questioning, queer, asexual and non-binary (LGBTI+). However, this umbrella terms is not limited to these forms of self-identification. This approach recognises the varied range of terms used to refer to sexual minority, gender minority and intersex populations with 67 LGBTI+ self-identifiers, and related terms used in the search strategy 49 . To identify relevant studies, the following terms for sexual and gender minorities will be searched including, but not limited to (Title/Abstract LGBTI OR LGBTQ OR lesbian OR gay OR bisexual OR asexual OR pansexual OR transgender OR intersex OR non-binary OR queer OR "sexual minority" OR "gender minority" OR homosexuality OR bisexuality), combined using AND with terms used for those aged 10-24 years including (Title/Abstract youth OR young person OR "young people" OR "young adult" OR adolescent OR adolescence OR teen OR teenage OR teenager OR juvenile OR minors OR "emerging adult"), combined using AND with terms for protect including (Keyword resilient OR "protective factor"), combined using AND with terms for wellbeing including (key wellness OR wellbeing OR "mental health" OR "quality of life" OR "happiness with life" OR "lifesatisfaction" The authors further revised and refined the search strategy through a MeSH database, main subjects, thesaurus terms, keywords and index headings and to identify databases for inclusion. An electronic search strategy will be used to identify databases of the published, peer-reviewed literature. Based on the pilot search, six electronic databases have been selected, containing academic, peer-reviewed journals for systematic searching from inception with relevance to medicine, nursing, psychology, allied health, social sciences and education including: PubMed, CINAHL, PsycINFO, ASSIA, ERIC International (Proquest) and Academic Search Complete. The search strategy for PubMed database can be found in the online supplementary material (see Extended data) 50 .

Stage 3: study selection
The search results will be stored in an electronic referencing system and duplicates removed. Studies will be included for abstract screening if they meet the criteria for Population, Concept, Context as outlined 47 . Two reviewers will initially screen a small portion of the available evidence independently, to ensure the inclusion and exclusion criteria is clear, firstly screening by title and abstract, with discussion until there is complete agreement regarding inclusion. A third reviewer will be consulted until there is consensus regarding the inclusion and exclusion criteria. Abstracts will subsequently be assessed by two reviewers, independently, with discussion afterward until there is agreement. If a consensus cannot be reached further discussion will take place with a third reviewer until there is an agreed decision to include or exclude the study for analysis. Study selection will be based on a priori inclusion and exclusion criteria as outlined in Table 1 below 47 . A copy of the screening template is available as Extended data 50 .
Queries for discussion will be recorded using a written template (see Extended data) 50 . A table with excluded studies and reasons for exclusion will be generated based on this a priori criteria. The study team will be consulted throughout this process of selecting sources of evidence. The final step includes citation searching of the studies where the reference lists of the included articles will be reviewed using the citation function of Google Scholar to search for additional studies, supplemented by reference searching 40,41,43,47 .

Stage 4: charting the data
The data extraction process in scoping reviews is referred to as 'charting' the data 40,41,43,47 . A data extraction tool will be developed and piloted by the research team to provide a written overview of the key information to be captured in a summary table 47 . This will record the following information: author(s); year of publication; country where study was conducted; aims/purpose of the study; methodology/methods; study population and sample size; outcomes and key findings in relation to the scoping review questions. The project lead will complete a full-text review and extract the data according to the summary table. All variables will be identified including assumptions and simplifications. The summary table will be tested by the study team to check a random sample of the completed data extracted. Consultation will take place with the study team throughout this process. This will establish processes for obtaining and confirming data. Where there is disagreement, the study team will be consulted until there is a decision to include or exclude a study. It is anticipated that completion of the summary table will be an iterative and reflexive process 40,41,43,47 .

Stage 5: collating, summarising and reporting the results
The PRISMA-ScR checklist for reporting scoping reviews will be used 47 . A rationale for collating the results will describe the methods and the use of this information in any data synthesis will be outlined 47 . The methods of handling and summarising the charted data will be described 47 . The selection of sources of evidence will be outlined using a flow diagram 47 . The characteristics of sources of evidence will be described and cited, with the results synthesised and summarised 47 . It is anticipated that there will be variation in study design and method. A general interpretation will be provided along with potential implications and limitations of the scoping review 47 . This will be enhanced by public patient involvement (PPI) through focus groups with LGBTI+ young people.
Patient and public involvement. Involvement of young people in research processes is increasingly emphasised by researchers, policy makers and practitioners [45][46] . The provision within the framework for a consultation stage aligns with the objectives of the study and recognises LGBTI+ youth expertise, the social and cultural capital within youth networks and youth agency regarding their mental health and wellbeing [45][46] . PPI approaches recognise that the inclusion, engagement and participation of young people in research is both child-centred and rights-based 46 . Focus groups will use interactive participatory approaches to share the findings from the scoping review to explore LGBTI+ young people's understandings, meanings and interpretations 45 . In Ireland, it is acknowledged that some young people are seldom-heard, including sexual and gender minority youth 44 . Baker and Beagan call for collaboration that promotes 'learning with' LGBTI+ communities 53 . This recognises that young people can and should be more involved in all stages of the research process, not just in providing data to researchers 44-46 . The preliminary findings from the stage 5 framework will inform the consultation 41 . This will inform further synthesis of the review.

Dissemination and ethics
Ethical approval has been granted from the UCD Humanities Research Ethics Committee to undertake consultations on the scoping review findings with stakeholders and to conduct focus groups with young people (Ref#: HS-19-80-Ceatha-Campbell ). It is hoped that the involvement of sexual minority, gender minority and intersex youth will provide insights into research dissemination with these populations of young people, their families and with professionals in health, social care and education 46 . The research team anticipate that the results will be disseminated through a peer reviewed publication, a conference presentation and presentations to the key stakeholders, including LGBTI+ youth.

Discussion
To our knowledge, this will be the first scoping review exploring the protective factors that promote the wellbeing of sexual minority, gender minority and intersex youth, including young people who self-identify as LGBTI+. Drawing on Arksey and O'Malley's methodological framework, the search strategy will map the established quantitative, qualitative and mixedmethods evidence of the protective factors currently considered, identify research gaps and provide recommendations 40 . The PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist will be used throughout the review process in order to ensure transparency and enhancing the potential for replication 47 . Stakeholder consultation is a key strength of the scoping review process and will engage with a range of people with expertise in research, policy and practice 41,43 . This will be complemented by PPI with sexual minority, gender minority and intersex youth through interactive, participatory focus groups 45 . This offers a unique opportunity to include LGBTI+ young people with expertise by experience in the research process 46 . A recognised limitation of scoping reviews is that they do not assess the quality of studies, like the more traditional systematic review. However, a scoping review methodology has the capacity to collect a great quantity of different types of literature. This is of particular relevance when there is little known or published about a topic area. This scoping review has the potential to ascertain the work conducted in the field, map the available literature and identify key concepts 43 . This could inform the design of future full systematic reviews on this subject area by demonstrating the breadth and nature of the literature to date 43,48 .

Wellbeing
We agree with the suggestion that it would be helpful to define wellbeing and how this will be operationalised in the introduction. Revising the protocol has provided an opportunity to make this more explicit in order to help establish the boundaries of the review. We accept that wellbeing is contested . Our use of the term draws from the holistic framing by the WHO . This is further complemented by situating individuals within an ecological model where health is premised on social justice . To operationalise this construct we have drawn on the work of Wilson and Cariola

Mental health
We view mental health as an integral component of wellbeing. This approach is premised on our understandings that mental health is not binary; that anyone may experience times when their mental health may be compromised and that this does not preclude times of wellbeing . This holistic conceptualisation attempts to move away from clinical and pathologized framing of mental health which can be stigmatising . Careful consideration has been given regarding articles including articles related to mental health diagnoses and sequalae. Again, building on Wilson and Cariola's review, this has been operationalised using Minority Stress Theory . As such, the scoping review will include articles which refer to mental health and then specifically review to determine whether there is any reference to factors that mitigate minority stress including, but not limited to: interpersonal, community-based or policy measures, alongside measures of resilience.
To operationalise this, we have developed a flow chart of inclusion and exclusion criteria and further revised the screening tool (see ) .

Extended data
Prior systematic review We are aware of the systematic review by Johns et al on transgender youth and protective factors . We have been using this study as a reference when piloting the search strategy to ensure that the search captures key articles, reviews such as this.
We again thank the peer reviewer for their review. We very much appreciate the feedback and believe that the revised protocol has been strengthened by addressing these suggestions which will be beneficial throughout the scoping review process. Dooris  using the mean age falling within the specified age range (as well as a criterion that specifies the study targets young people specifically, so as not to inadvertently include a study targeting adults that happens to recruit a young population).

Stakeholders
Thank you for highlighting the need to describe and define the stakeholders who have been and will be invited to consult throughout the protocol development and scoping review process. Informed by the work of Levac and colleagues, we have provided further details of the purpose for the consultation and sought to specify the stakeholders invited to consult . Drawing on the recommendations of Daudt and colleagues, we have also clearly articulated that the study team includes suitable stakeholders .
Use of the LGBTI+ acronym In relation to the use of the LGBTI+ acronym, we welcome these suggestions. We are aware of the wide variations and how this is expressed in relation to identities and orientations regarding sex, gender and sexual orientation. This review is being conducted within the Irish policy context, with LGBTI+ being the preferred acronym . However, we wish to ensure that this review has international resonance. Thank you for drawing attention to the importance of ensuring that definitions of diversity of sexual orientations and gender identities should be expanded to encompass other expressions, including intersex identifications . We have made this more explicit throughout the protocol. Further, we have highlighted that the use of broad search parameters reflects our understanding of this diversity and ways of expressing these variations across a wide spectrum. While the work of Lee, Ylioja and Yackey was cited, this has now been made more explicit .
Refining the Research Question re: wellbeing Revising the protocol has provided an opportunity to ensure consistency and outline how constructs will be operationalised with regards to the research question. We now refer to 'protective factors' throughout the protocol. We have given consideration to the use of 'wellbeing' as the Primary Concept (C) and agree that this can be a vague term, however, it is used extensively throughout the literature. As such, much would be lost if the search did not include this term. However, we concur that the inclusion of the term 'wellbeing' needs to be specific in order to provide a more useful review. We have amended the Primary Concept to 'protective factors that promote wellbeing'. We have clarified that our use of the term 'wellbeing' draws from a holistic concept as outlined by the WHO , complemented by the Ottawa Charter for health promotion . We have drawn on the work of Wilson and Cariola and specifically outlined how these constructs will be operationalised within the inclusion and exclusion criteria. We welcome the question on the inclusion of mental health, which we view as an integral component of wellbeing. This approach is premised on our understandings that mental health is not binary; that anyone may experience times when their mental health may be compromised and that this does not preclude times of wellbeing . This holistic conceptualisation attempts to move away from clinical and pathologized framing of mental health which can be stigmatising . Again, building on Wilson and Cariola's review, this has been operationalised in the context of Minority Stress Theory . As such the scoping review will include articles which refer to mental health and then specifically screen to determine whether there is any reference to factors that mitigate minority stress including, but not limited to: interpersonal, community-based or policy measures, alongside measures of resilience. To operationalise this, we have developed a flow chart of inclusion and exclusion criteria and further revised the screening tool (see ) .

Extended data
Reference to the subject librarian The repeated references have been removed.

7.
Timeframe on the search We have given careful consideration as to whether to impose a timeframe on the search. One of the core functions of a scoping review is to determine the coverage of a body of literature on a given topic . While it is acknowledged that there have been rapid changes in the last decade, with the example of Ireland one of the most dramatic in this regard, assessing the timeline of publications on this topic will facilitate the mapping of these changes . Further, Wilson and Cariola recommend that Minority Stress Theory, published in 2003, may be useful in addressing research gaps .
Inclusion and exclusion criteria regarding age Thank you for the suggestion that we include a criterion that specifies the study targets young people and that the mean age of study participants should fall within the specified age range. This is very helpful. The inclusion and exclusion criteria have been amended to reflect these suggestions.

Risk of bias
A 'standardized risk of bias tool' would be appropriate for use with a systematic review, rather than a scoping review . Thus, assessment using a 'standardized risk of bias tool' is beyond the scope of this review. Further, these types of review have the potential to determine whether a systematic review is needed and the potential design of this. Daudt and colleagues suggest that scoping reviews may be a "necessary pre-requisite" for determining whether a full systematic review is required .

Repetition
The protocol has been edited to address the repetition in the writing.
Thank you for the review and the encouraging comments that the study is timely and important with implications for research, policy and practice. We very much appreciate the feedback and believe that the revised protocol has been strengthened by addressing these suggestions. These refinements and revisions will be beneficial throughout the scoping review process.