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Associations between school-related factors and mental health among transgender and gender diverse youth
Abstract
Transgender and gender diverse youth (TGD) report high rates of mental health concerns. However, there is reason to expect that among TGD youth there is variation in mental health experiences related to specific aspects of gender identity. Furthermore, although certain school characteristics are related to improved mental health for sexual minority youth, it is unclear whether the same school characteristics are associated with improved mental health for TGD youth and whether gender identity moderates the associations between school characteristics and mental health. Using baseline data from Project AVANT, a longitudinal study of TGD youth ages 14–18 years in the United States (N = 252), we report on several mental health outcomes (i.e., depression, anxiety, nonsuicidal self-injury, and PTSD), with attention to differences by gender identity. Secondly, we examined associations of three protective school-related factors (i.e., school-connectedness, presence of a Gay-Straight or Gender-Sexuality Alliance [GSA], and state mandated protections for sexual and gender minority students) with TGD youth mental health. TGD youth reported elevated levels of anxious and depressive symptoms, with nonbinary youth assigned female at birth reporting higher mean depressive symptoms relative to transgender females. Among the aggregate sample of TGD youth, 69.9% reported clinically significant anxiety, 57.9% reported clinically significant depression, 56.7% reported nonsuicidal self-injury, and 46.4% met screening criteria for posttraumatic stress disorder. Despite a small effect size, greater school-connectedness was significantly associated with fewer mental health concerns and gender identity moderated the association between school-connectedness and number of anxiety symptoms. Gender identity also moderated the association between presence of a GSA and number of anxious symptoms, depressive symptoms, and clinically significant depression, respectively. No significant associations of state-level protections and mental health outcomes were detected. Findings highlight the importance of improving mental health and fostering GSA-engagement and school-connectedness among TGD youth. Implications for school psychologists are discussed.
... among individuals seeking gender specific medical treatment [13,14]. Among youth up to 25 years old, prevalence ranges from 2.9 to 9% in general population surveys [15,16] increasing to [41][42][43][44][45][46][47][48][49][50][51][52][53].4% in gender-diverse youth populations [17,18]. However, among youth seeking care at gender clinics, about 11-25.6% ...
... Depressive symptoms were analyzed in a total of fourteen studies, with thirteen of them comparing nonbinary and transgender youth [35,36,38,39,[44][45][46][47][48][49][50][51][52]. Among these thirteen studies, seven also included cisgender youth for comparative analysis [38,44,45,[49][50][51][52]. ...
... Eight studies reported measures of anxiety symptoms, seven of these studies compared non-binary and transgender individuals [35,36,38,39,46,47,52], with two of them additionally including cisgender individuals for comparison [38,52]. One study compared non-binary and cisgender individuals [53]. ...
Background
Non-binary identities are increasingly recognized within the spectrum of gender diversity, yet there is a dearth of research exploring the mental health challenges specific to this population. Therefore, this systematic review and meta-analysis aimed to comprehensively assess the mental health outcomes of non-binary youth in comparison to their transgender and cisgender peers.
Methods
A systematic search was conducted to identify relevant studies across three electronic databases (PubMed, Scopus, Web of Science) covering the period from inception to October 2023. The meta-analysis was performed employing a random-effects model. Inclusion criteria encompassed studies comparing non-binary youth with transgender or cisgender youth, providing data on mental health outcomes such as general mental health, depressive and anxiety symptoms, self-harm and suicidality.
Results
Twenty-one studies, meeting the inclusion criteria and originating from six different countries, were included in the analysis. The sample encompassed 16,114 non-binary, 11,925 transgender, and 283,278 cisgender youth, with ages ranging from 11 to 25 years. Our meta-analysis revealed that non-binary youth exhibit significantly poorer general mental health compared to both transgender (d = 0.24, 95% CI, 0.05–0.43, p =.013) and cisgender youth (d = 0.48, 95% CI, 0.35–0.61, p <.001), indicating a more impaired general mental health in non-binary youth. Regarding depressive symptoms, when comparing non-binary and cisgender individuals, a moderate and significant effect was observed (d = 0.52, 95% CI, 0.41–0.63, p <.001). For anxiety symptoms, a small but significant effect was observed in the comparison with cisgender individuals (d = 0.44, 95% CI, 0.19–0.68, p =.001). Furthermore, non-binary individuals exhibited lower rates of past-year suicidal ideation than transgender peers (OR = 0.79, 95% CI, 0.65–0.97, p =.023) and higher rates of lifetime suicidal ideation than cisgender youth (OR = 2.14, 95% CI, 1.46–3.13, p <.001).
Conclusion
Non-binary youth face distinct mental health challenges, with poorer general mental health, elevated depressive and anxiety symptoms compared to cisgender, and similar rates of self-harm and suicidal behavior compared to transgender individuals. These findings underscore the urgent need for targeted interventions, including gender-affirming mental health support, to address the specific needs of non-binary youth.
... Twelve studies from this SLR covered systemic challenges existing within schooling settings that impede the support and wellbeing of transgender and gender diverse students (Allen et al., 2020;Durbeej et al., 2021;Hatchel et al., 2018;Heath & Keene, 2023;Horton, 2023;Jadva et al., 2021;Jones, 2023;Parodi et al., 2022;Perez-Brumer et al., 2017;Reisner et al., 2020;Sava et al., 2021;and Turban et al., 2021). These barriers operate at a broader societal level and include institutional policies, practices, and resources that lack adequate support for gender diversity (Jadva et al., 2021). ...
... Structural barriers manifest as limitations in inclusive school policies, such as inadequate gender affirming healthcare access, absence of tailored mental health services for transgender individuals, restrictive or non-existent guidelines for gender transitioning, insufficient or unsafe restroom facilities, and the absence of supportive spaces within schools (Parodi et al., 2022;Sava et al., 2021). These barriers often reinforce societal norms, stereotypes, and discrimination against transgender and gender diverse youth, hindering their ability to access appropriate resources, feel accepted, and thrive within the educational environment. ...
... These barriers often reinforce societal norms, stereotypes, and discrimination against transgender and gender diverse youth, hindering their ability to access appropriate resources, feel accepted, and thrive within the educational environment. As such, Hatchel et al. (2018) and Parodi et al. (2022) stress the necessity of mental health services specifically designed to address the unique challenges faced by transgender and gender diverse students. Jadva et al. (2021) in their study with 3713 LGBT participants including 594 transgender and 467 non-binary individuals, demonstrated that transgender and nonbinary youth were four times more likely to experience self-harm when compared to their cisgender peers. ...
Introduction: This systematic literature review (SLR) investigates the effects school environments have on the mental health outcomes of transgender and gender diverse students. Current literature highlights the need to support the mental health of transgender
and gender diverse students in school, however the research synthesizing the existing research is limited. This SLR brings together existing literature exploring the school experience
and mental health outcomes for this cohort in schools.
Methods: The review followed PRISMA Guidelines and included JBI quality appraisal tools of included studies. Four electronic databases were used, with literature searches conducted on 31 July 2023. Included studies were assessed against predetermined inclusion/exclusion criteria, with included studies written in English, no date or geographical limitations, online full-text availability, peer-reviewed, and relevant to the research question. Abstract, full-text
review, and quality appraisal were conducted by two independent reviewers. Collected data were synthesized using a revised and three-levelled socio-ecological framework and further
thematic analysis within the three categories.
Results: 15 studies were included for final synthesis with four using qualitative methodologies, and 11 being cross-sectional studies. The final synthesis comprised three themes, exploring structural level, interpersonal level and individual level barriers to optimal mental health outcomes for transgender and gender diverse students in school settings. Findings highlight and support previous findings of an alarmingly high rate of mental health concerns, including
self-harm, suicide and suicidal ideation in transgender and gender diverse youth in school settings.
Conclusions: The current literature highlights the need to explore how denominational affiliations of school environments affect the experiences, challenges and mental health outcomes of transgender and gender diverse youth. Further research needs to comprehensively unpack the unique structural, interpersonal and individual needs of transgender and gender diverse youth in these diverse school environments, to then provide adequate and affirming
support enhancing their overall health and wellbeing.
... More than one third (n = 13) of the 33 included articles addressed internalized psychopathology such as depression and/or anxiety [12,14,[53][54][55]57,58,60,64,66,68,69,71,76]. The included contributions also addressed other mental health outcomes and/or problematic behavior such as attention deficit and/or hyperactivity disorder (ADHD) and conduct disorder (CD) [53], autism spectrum disorder (ASD) [53,63,66,73], eating disorders [53,66], trauma, harassment, bullying, and victimization [55,57,58,66,69,76,79], adverse childhood experiences (ACEs) [56,71], substance use [9,26,58,71,80], and sex trading [67]. ...
... More than one third (n = 13) of the 33 included articles addressed internalized psychopathology such as depression and/or anxiety [12,14,[53][54][55]57,58,60,64,66,68,69,71,76]. The included contributions also addressed other mental health outcomes and/or problematic behavior such as attention deficit and/or hyperactivity disorder (ADHD) and conduct disorder (CD) [53], autism spectrum disorder (ASD) [53,63,66,73], eating disorders [53,66], trauma, harassment, bullying, and victimization [55,57,58,66,69,76,79], adverse childhood experiences (ACEs) [56,71], substance use [9,26,58,71,80], and sex trading [67]. A few of the included articles (n = 8) also involved resilience factors [12,14,54,57,58,60,61,76]. ...
... Moyer and colleagues [64] also found high rates of depression, anxiety, and suicidal ideation among TGD adolescents. Similarly, Parodi and colleagues [69] found that, among TGD adolescents, anxiety was the most common mental health concern, followed by depression, non-suicidal self-injury, and PTSD, respectively. Comparing rates of depressive symptoms among TGD and cisgender Thai adolescents, Cheung and colleagues [55] found that the highest burden of depression affected gender nonconforming girls, followed by gender nonconforming boys, gender-conforming girls, and gender-conforming boys, respectively. ...
Although capable of mobilizing significant resilience factors to face stigma and discrimination, transgender and gender diverse (TGD) children and adolescents tend to suffer from more adverse mental health outcomes compared to their cisgender counterparts. The minority stressors that this population faces are mainly due to the gender-based pressure to conform to their assigned gender. This systematic review was aimed at assessing the potential mental health issues that affect the TGD population. The literature search was conducted in three databases; namely, Scopus, PubMed, and Web of Science, based on the PRISMA guidelines. The 33 articles included in the systematic review pointed out how TGD children and adolescents experience high levels of anxiety and depression, as well as other emotional and behavioral problems, such as eating disorders and substance use. Resilience factors have been also pointed out, which aid this population in facing these negative mental health outcomes. The literature review highlighted that, on the one hand, TGD individuals appear to exhibit high levels of resilience; nonetheless, health disparities exist for TGD individuals compared with the general population, which are mainly attributable to the societal gender pressure to conform to their assigned gender. Considerations for research and clinical practice are provided.
... Recent longitudinal findings have also highlighted the salience of social support and family functioning as factors that buffer the association between lower levels of exposure to gender minority stressors and alcohol use 29 . Further, support from educational and trans communities has been identified as salient for transgender youth 30 , and greater school-connectedness has also been linked to fewer mental health concerns among GD adolescents 31 . Finally, youth whose gender was affirmed-as operationalized by chosen name use across four contexts-reported better mental health than youth who used chosen names in fewer contexts 32 . ...
... Professional development for educators and staff should focus on disseminating knowledge on supporting gender-inclusive strategies in the classroom and creating a community of care 55 . Research has also shown that GSAs in schools are associated with improved well-being among gender diverse youth 31 . Providing funding for active GSAs and supporting students in initiating new clubs or peer groups where they have previously not existed is recommended as a key step in augmenting the health and wellbeing of gender diverse youth. ...
Few studies have disentangled differences in victimization exposures and mental health symptoms among gender diverse subgroups, nor considered the role of potential protective factors in ameliorating the impact of victimization on gender diverse youths’ mental health. Here we report findings from a secondary data analysis, in which we address this gap by analyzing cross-sectional survey data ( N = 11,264 in the final analytic sample) from a population-based survey of youth in participating school districts in a large Midwestern U.S. county. Relative to cisgender youth with gender conforming expression, transgender youth and cisgender youth with nonconforming gender expression are more likely to experience victimization and severe mental health concerns. Additionally, school-connectedness moderates the association between bias-based harassment and depression for cisgender youth with gender nonconforming expression, and family support/monitoring buffers the association of peer victimization with suicide attempts among transgender youth. Findings highlight the need to better understand factors which may confer protection among gender diverse adolescents, so that in turn appropriate supports across key contexts can be implemented.
... When LGBTQ students feel a sense of belonging at school, they are less likely to drink alcohol, 30 use illicit drugs, 31 and suffer from anxiety and posttraumatic stress disorder symptoms. 32 At the administrative level, antiharassment policies are associated with lower odds of victimization and suicidality. 33 Few studies have examined how LGBTQ-specific policies affect the wellbeing of transgender adolescents at school, 34,35 and even fewer have used state-level legislation to do so. ...
... For example, numerous studies have found that LGBTQ students who report that their school has a positive climate are less likely to report depressive symptoms. 32,48,49 Our study serves as a call to investigate other possible benefits of explicit guidance. ...
Purpose: Policies have been shown to bear a considerable influence on transgender health. The few studies that have examined policy-related health outcomes in adolescent transgender populations have rarely included policies that directly affect them. Our study explores associations between four state-level policies and six health outcomes in a sample of transgender adolescents. Methods: Our analytic sample consisted of adolescents residing in 14 states that used the 2019 Youth Risk Behavior Survey's optional gender identity question in their surveys (n = 107,558). Chi-square analyses were performed to examine differences between transgender and cisgender adolescents in demographic variables and suicidal ideation, depression status, cigarette use, binge drinking, grades in school, and perceptions of school safety. Multivariable logistic regression models were run for transgender adolescents only to examine associations between policies and health outcomes, adjusting for demographics. Results: Transgender adolescents comprised 1.7% (n = 1790) of our sample. Compared with cisgender adolescents, transgender adolescents were more likely to experience adverse health outcomes in chi-square analyses. Multivariable models indicated that transgender adolescents who lived in a state that had explicit transgender guidance in their antidiscrimination laws were less likely to experience depressive symptoms, and those who lived in a state with positive or neutral athlete guidance were less likely to report past 30-day cigarette use. Conclusion: Our study is one of the first to show protective associations between affirming transgender-specific policies and health outcomes in transgender adolescents. Findings could have important implications for policymakers and school administrators.
... Dajches, 2022) and among transgender and gender diverse youth (M age = 16.70; Parodi et al., 2022). ...
Compared to their heterosexual counterparts, sexual minority youth are disproportionally affected by suicidality, anxiety, depression, and other health disparities. The minority stress model claims that certain coping mechanisms such as receiving social support can act as a buffer against minority stress. In the current study, we tested whether LGBQ+ (e.g., lesbian, gay, bisexual) television exposure can effectively act within this role. Using a cross-sectional survey of sexual minority late adolescents (18–23 years old, N = 417), we found that LGBQ+ television exposure was not a significant moderator between minority stress and mental health outcomes. However, there were positive direct effects of LGBQ+ television exposure on resilience and identity affirmation. We provide tentative conclusions regarding the role of LGBQ+ television exposure on sexual minority youths’ identities and their propensity to persist in the face of adversity.
... Evidence-based public health policy responses are required to address the dire HR-QoL inequities documented in this study among LGBTQA2S+ young people. Strategic top-down public health documents, including preventive [50] and adolescent-focused [51] policies, should include firm language to direct resources to address these disparities, without shying away from lending credence to LGBTQA2S+ specific interventions and activities, including the provision of safe and timely gender-affirming care for trans young people [23,52,53] and cultivation of inclusive school environments for all LGBTQA2S+ young people [54][55][56]. In accordance with the axioms of public health purported in the Ottawa Charter for Health Promotion [57], public health practitioners should enable LGBTQA2S+ young people to increase control over and improve their health. ...
Purpose
This study was guided by three research aims: firstly, to examine the longitudinal trends of health-related quality of life (HR-QoL) among gender and sexuality diverse (LGBTQA2S+) young people through adolescence (ages 14–19); secondly, to assess longitudinal associations between poor mental health and HR-QoL among LGBTQA2S+ young people through adolescence; and thirdly, to examine differences in HR-QoL among LGBTQA2S+ young people during early adolescence (ages 14 and 15) depending on select school-, peer-, and parent-level factors.
Methods
This study used three of nine available waves of data from a large population-level, probability sample-based, longitudinal cohort study, namely the K′ cohort: children aged 4–5 years old at time of study enrolment followed-up biennially (~ 61% retention rate). HR-QoL weighted means and standard deviations were calculated using Child Health Utility 9D (CHU-9D) scores for LGBTQA2S+ participants at ages 14 and 15 (Wave 6), ages 16 and 17 (Wave 7), and ages 18 and 19 (Wave 8). To strategically identify policy-relevant modifiable behavioural factors suitable for prevention and early intervention, non-parametric Wilcoxon signed-rank tests tested differences in mean CHU-9D ranks at ages 14 and 15 (Wave 6) between groups (gender identity: trans vs. cis; identity-level sexuality: gay, lesbian, bisexual, or other diverse sexuality vs. heterosexual; group-level sexuality: sexually diverse vs. not sexually diverse) and selected school factors (school acceptance, belonging, freedom of expression), peer factors (peer relationship quality, trust, respect), and family factors (parental acceptance, understanding, trust), with Hedge’s g correction statistics computed for effect sizes. Longitudinal associations between gender, sexuality, and poor mental health (depressive symptoms, anxiety, symptoms, self-harm thoughts/behaviour, and suicidal thoughts/behaviour) and HR-QoL were tested using mixed-effects models with random intercepts and random slopes for nested clustering (participants within postcodes).
Results
HR-QoL disparities disproportionately affecting LGBTQA2S+ groups relative to their cisgender, heterosexual peers, were well-established by age 14 to 15 relatively steeper reductions in HR-QoL were observed throughout adolescence among all LGBTQA2S+ groups, with HR-QoL widening the most for trans participants. Poor mental health was significantly associated with HR-QoL declines. LGBTQA2S+ participants with positive school- and parent factors related to feelings of acceptance, belonging, and freedom of self-expression, reported significantly higher HR-QoL during early adolescence.
Conclusion
Evidence-based public health policy responses are required to address the dire HR-QoL inequities among LGBTQA2S+ young people, particularly trans young people. Prioritising the promotion of school- and family-based interventions which foster LGBTQA2S+ inclusivity, acceptance, and a sense of belonging from early adolescence through young adulthood, represents a feasible, evidence-based, and cost-effective response to address these HR-QoL disparities
... These risk factors become more pronounced when studied in transgender and gender nonconforming youth, as they exhibit higher rates of distress, depression, anxiety and suicidal thought (Moyer et al., 2019). In addition to these challenges, other research has shown an increased risk of developing conditions such as post-traumatic stress disorder, eating disorders, autism spectrum disorder, bipolar disorder, self-harm, social isolation and a higher likelihood of reporting past experiences of emotional abuse, suicide attempts, and less family support compared to cisgender women and men (Katz-Wise et al., 2018;Parodi et al., 2022;Stewart et al., 2021). ...
Aim
To understand the factors that contribute to the risk of suicide among lesbian, gay, bisexual, transgender, queer, intersex and asexual (sexual minorities) youth.
Background
The increase in the likelihood of suicide has made it an urgent issue in public health, particularly among young people, where it now ranks as the fourth leading cause of death. This issue becomes even more significant when focusing on sexual minorities.
Methods
A cross‐sectional study was performed in targeted young individuals (15–29 years). Several variables were assessed, including suicide risk, self‐esteem, presence and severity of depressive symptoms, perceived social support and self‐reported levels of anxiety and depression.
Results
Statistically significant disparities were observed in suicide risk, presence of depressive symptoms and self‐reported levels of anxiety and depression, all of which were more pronounced in sexual minority youth compared to heterosexual cisgender individuals. Likewise, statistically significant differences were noted concerning self‐esteem and family support, both of which were lower in sexual minority youth.
Conclusion
This study has identified risk factors, such as anxiety, depression and limited social support, as well as protective factors, like higher self‐esteem and self‐concept. Understanding and addressing all these factors are essential in reducing the elevated rates of suicide among sexual minority youth. Consequently, evidence‐based interventions such as Gender and Sexuality Alliances, which empower and create safe spaces for sexual minority youth, possess substantial potential for effectively addressing this issue.
Implications for the Profession
Given sexual minorities vulnerability, healthcare pros, especially nurses, must grasp suicide risk factors. They can help by educating, offering care, assessing risk and fighting stigma. This guarantees safety and access to mental health services for at‐risk individuals from sexual minorities.
Reporting Method
The reporting follows the STROBE checklist.
Patient Contribution
People who were invited to participate voluntarily completed a range of questionnaires.
... Accurately gathering this information in mindful ways is especially important to understanding the unique needs of transgender and gender diverse (TGD) individuals, or individuals who have a gender identity that is different from the assumed gender based on sex assigned at birth (Parodi et al., 2022;Rafferty et al., 2018). Given this community has had to manage increasing hostility and public scrutiny alongside a record-breaking introduction of anti-transgender bills in 2023 alone (Mallory & Redfield, 2023), it is more essential than ever that healthcare providers appropriately and mindfully interact with and understand the needs of TGD adolescents. ...
Not enough is known about the labels that transgender and gender diverse (TGD) individuals – and especially adolescents and young adults – use to describe their sexual orientation. This is likely due to a historical conflation of sexual orientation and gender identity, where both researchers and the public have failed to examine the ways that these constructs differ. Consequentially, there are few statistics about TGD young people’s sexual orientations. The present study aims to help address this gap by examining the sexual orientation labels 208 TGD young people (13–22 years old) used at time of an assessment for readiness to start gender affirming hormones. Results indicate that the vast majority of youth in the sample used non-heterosexual orientation labels, with the most commonly endorsed label being “bisexual”. Fischer’s exact tests reveal that participants who affirmed a male/transmasculine gender were more likely to use the label “heterosexual” compared to female/transfeminine and non-binary young people. Findings underscore the importance of mindful sexual orientation and gender identity demographic information collection for TGD young people.
... These disparities are more pronounced for sexual minority cisgender women compared to cisgender men (Ross et al., 2018). Sexual minority gender diverse individuals assigned female at birth (i.e., those who identify outside of the gender binary; e.g., nonbinary) may also be affected by larger disparities in depression and anxiety, but this remains unclear given mixed findings across studies (Conn et al., 2023;Newcomb et al., 2020;Parodi et al., 2022). Theory posits that the added stressors experienced by sexual minorities as a result of the stigmatization of nonheterosexuality (referred to as sexual minority stress) underlie these disparities (Brooks, 1981;Meyer, 2003), and a substantial literature has demonstrated associations between sexual minority stress and anxiety and depression. ...
Background: While studies have linked sexual minority stress with anxious/depressed affect, few studies have prospectively examined how mechanistic processes linking minority stress and anxious/depressed affect unfold in near-real time. Furthermore, studies of mechanisms have focused exclusively on rumination and proximal minority stressors (e.g., internalized stigma). This limits our understanding of other potential mechanisms, such as decreases in the use of reappraisal and reflection, strategies associated with reducing anxious/depressed affect. Method: We used data from a 30-day ecological momentary assessment study with 429 sexual minority women and gender diverse sexual minorities assigned female at birth to determine whether concurrent and prospective event-level associations between minority stress and anxious/depressed affect were mediated by changes in six emotion regulation strategies, perceived coping efficacy, and proximal stressors. Results: In partially lagged analyses, when individuals experienced enacted or internalized stigma, they reported increased rumination and expressive suppression on the same day, which predicted increases in anxious/depressed affect into the next day. Decreases in reappraisal also mediated partially lagged associations between internalized stigma and anxious/depressed affect. Fully lagged mediation was only demonstrated for rumination as a mechanism linking internalized stigma with anxious/depressed affect. We found concurrent evidence for other mechanisms (i.e., perceived coping efficacy, reflection, internalized stigma, and rejection sensitivity). Conclusions: Results provided support for the roles of rumination and expressive suppression as mechanisms of linking minority stress and anxious/depressed affect. The concurrent evidence for other mechanisms suggests that future research with more temporal resolution is necessary to determine the temporality and directionality of these associations.
... Schools are a critical site in the formative development of adolescents and, moreover, academic achievement is a significant determinant of health and wellbeing across the lifespan (László et al., 2019). While negative perceptions of school climate are more often reported than positive perceptions among LGBTQ+ young people (Day et al., 2018) promising evidence suggests positive school climate can promote mental health among LGBTQ+ young people (Parodi et al., 2022). Despite these preliminary findings (Ullman 2021(Ullman , 2022, high-quality, epidemiological research investigating the moderating role of school climate on minority stressor-related mental health effects remains largely absent from the literature. ...
Introduction
Population‐level, nationally representative data on the prevalence of minority stressors and traumatic events, mental ill‐health effects, and the preventative utility of school climate, among gender and sexuality diverse young people in Australia, is significantly lacking. In this study, we estimated the prevalence and distribution of minority stressors and traumatic events among young people by sexuality identity (gay/lesbian, bisexual, other sexuality, heterosexual), sexuality diversity (sexuality diverse, not sexuality diverse), and gender identity (transgender, cisgender) and assessed associations with mental ill‐health and the moderating role of school climate factors.
Methods
Using Wave 8 (2018) follow‐up data from a population‐level, nationally representative longitudinal cohort study, the sample comprised 3037 young people aged 17–19 years in Australia. Prevalence ratios for minority stressors and traumatic events were calculated for gender and sexuality diverse categories using logistic regression models. Linear regression models were used to test associations between traumatic events and minority stressors, and mental ill‐health. Multivariate linear regression tested school climate factors as effect modifier between minority stressors and mental ill‐health among sexuality diverse young people.
Results
Rates of traumatic events and minority stressors were highest among bisexual and gay/lesbian young people and were significantly associated with mental ill‐health among all gender and sexuality diverse young people. Highest mental ill‐health effects were observed among trans young people. Among sexuality diverse young people, positive and negative feelings toward school climate were associated with decreased and increased mental ill‐health, respectively. After accounting for sexuality diversity, positive overall school climate appeared protective of mental ill‐health effects of sexuality‐based discrimination.
Discussion
Minority stressors, traumatic events, and associated mental ill‐health are prevalent among gender and sexuality diverse young people in Australia, especially trans, bisexual, and gay/lesbian young people. Promotion of affirmative, safe, and inclusive school climate demonstrates significant promise for the prevention and early intervention of mental ill‐health among gender and sexuality diverse young people.
... Transgender and gender-diverse (TGD) youth are a marginalized group that faces a higher burden of mental health challenges as a result of systematic oppression (Bochicchio et al., 2021;Hisle-Gorman et al., 2021;Newcomb et al., 2020;Parodi et al., 2022). Given such health disparities, screening measures need to be applicable and relevant to their lived experiences. ...
This study examines differences in score profiles on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for transgender and gender-diverse (TGD) youth in a clinical setting. Data were collected from youth receiving services at a gender care clinic in the Midwestern United States. Inclusion criteria were youth that identify as transgender, nonbinary, or another gender-diverse identity label between the ages of 6 and 18 and received services between October 2017 and November 2021. The analytic sample (N = 177) included 51.4% transmasculine, 17.5% transfeminine, 22.6% nonbinary/gender-expansive, and 8.5% questioning youth. 88.1% of youth were White. Wilcoxon signed-rank tests compared differences in mean T scores when using male versus female scoring templates for YSR and CBCL separately. Statistically significant differences were found on the majority of scales, particularly for TGD adolescents. For example, significant differences were found on the YSR for 10 of 11 scales for transmasculine and transfeminine youth ages 11–18 and 9 of 11 scales for nonbinary/gender-expansive youth. McNemar’s test revealed significant differences in the number of clinical range scores for transmasculine YSR respondents on Anxious/Depressed, Somatic Complaints, Thought Problems, and Internalizing scales. For CBCL comparison of clinical significance, significant differences were found for Anxious/Depressed, Attention Problems, and Total Problems scales for transmasculine youth ages 12–18. Selecting a scoring template is contextually relevant; however, template selection appears to matter less when examining clinical relevance. Results suggest that clinicians using the CBCL and YSR with TGD youth have flexibility in scoring template selection.
... Transgender and/or nonbinary (TNB) individuals have a gender identity that is different from their sex assigned at birth (Parodi et al., 2022;Rafferty et al., 2018), including individuals with both binary identities (e.g., transgender girls/women, transgender boys/men) and nonbinary identities (e.g., nonbinary, genderqueer; Lowry et al., 2018). Notably, some individuals who meet the definition of transgender do not align themselves with that label, instead labeling their gender simply as girl, boy, or nonbinary. ...
Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SOI across 3 months (T1-T2) and 1.5 years (T1-T4) among 183 TNBY (baseline age 14-17 years; 83.6% White, 16.9% Hispanic/Latinx) who participated in a longitudinal US study. Participants completed online surveys including measures of GI and SOI. The most common gender identity selected at T1 (with or without another gender identity) was nonbinary (56.3%), and more than half (57.4%) of youth identified with a plurisexual identity (e.g., bisexual, pansexual). GI fluidity from T1-T2 was 13.2% and from T1-T4 was 28.9%. It was equally common to move toward a nonbinary gender identity as toward a binary gender identity. SOI fluidity was more common (30.6% from T1-T2; 55.8% from T1-T4) than GI fluidity. Shifts toward plurisexual identities were more common than shifts toward monosexual identities (e.g., straight, gay). Findings highlight the need to assess changes in GI and SOI in research and clinical practice to address the unique needs of TNBY accurately and effectively.
... In contrast, other clinical and non-clinical studies found no evidence for elevated rates of internalizing conditions in non-binary youth compared to binary youth (e.g., Aparicio-García et al., 2018;Fontanari et al., 2020;Rusow et al., 2022;Tordoff et al., 2022; Table S1). Furthermore, some studies highlight that there may be differences between AFAB and AMAB non-binary adolescents, highlighting the need to take the birth-assigned sex into account (McKay & Watson, 2020;Parodi et al., 2022;Rimes et al., 2019;Thoma et al., 2019). ...
Clinical research on transgender and gender-nonconforming (TGNC) adolescents has focused on binary individuals or often not differentiated among gender identities. Recent studies suggest that a considerable proportion of TGNC adolescents identify as non-binary and that these youth report more internalizing problems as well as different transition-related medical treatment wishes than binary adolescents. However, the results are inconclusive, and data for the German-speaking area are lacking. Therefore, the present study aimed to assess the percentage of binary and non-binary gender identities in a German sample of clinically referred TGNC adolescents and examine associations of gender identity with internalizing problems and transition-related medical treatment wishes. The sample consisted of 369 adolescents (11–18 years, Mage = 15.43; 305 birth-assigned female, 64 birth-assigned male) who attended the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS) between 2013 and 2019. Gender identity and treatment wishes were assessed using study-specific items and internalizing problems using the Youth Self-Report. In total, 90% (n = 332) of the sample identified as binary and 10% (n = 37) as non-binary. Having a non-binary gender identity was significantly associated with more internalizing problems and with wishing for no transition-related medical treatment or only puberty-suppressing hormones. The results underscore that non-binary adolescents represent a specifically vulnerable subgroup within TGNC adolescents with unique mental health needs and treatment wishes. Future research should differentiate among various gender identities. In clinical practice, it is crucial to create an inclusive space for non-binary youth and provide mental health care if needed.
... A possible explanation for the unexpected findings is that SAAB could be a factor in psychological distress. Research indicates that AFAB individuals show higher rates of psychological distress and if AFAB individuals are oversampled, this can obscure subgroup differences based on gender identity(Parodi et al., 2022;Rimes et al., 2019). Previous research also indicates that a significantly greater proportion of individuals AFAB may participate in TGNC research(Todd et al., 2019), and some researchers have suggested oversampling individuals AMAB to correct for this and diversify the participant sample(Kyweluk et al., 2018). ...
The presence of minority stress has been well documented among members of the transgender and gender non-conforming community, as has the effect of resilience on buffering the impact of minority stress on their psychological distress. Little attention has been given to transgender and gender non-conforming people who identify as asexual. This study examined the relationships among minority stressors, resilience, and psychological distress among individuals holding the intersecting identities of transgender and gender non-conforming and asexual. Data were collected from 300 adults using various listservs and social media platforms. Significant
differences in harassment & discrimination χ2(2) = 7.27, p = .026 were reported by individuals holding an intersecting asexual and transgender and gender non-conforming identity. Post hoc analysis using Kruskal-Wallis tests did not reveal any significant differences. Therefore, while there may be a significant difference in harassment & discrimination, it is unclear where that difference lies. Multiple regression results revealed that vigilance and gender expression minority stress were significant positive predictors of psychological distress, F(11, 258) = 10.21, p < .001, f2 = .43; the overall model accounted for approximately 30% (R2 = .30) of the total variance in psychological distress. Resilience was a significant negative predictor of psychological distress but did not moderate the relationship between minority stress, gender identity, and psychological distress. Implications for practice and research are discussed.
... Авторы демонстрируют позитивное влияние социальной поддержки (семья, школа) в снижении симптомов депрессии и большей удовлетворённости жизнью и профилактике коморбидных психических заболеваний. (Simons et al. [12], Parodi et al. [13]). ...
Objective : to identify potentially reversible clinical and socio-demographic factors influencing the social adaptation of patients with gender incongruence (GI). Materials and methods : a retrospective analysis of 926 patient records with MtF and FtM GI was performed. Results : among the patients who applied, 44.38% were MtF, 55.62% were FtM. The mean age was 24.0 years (from 13 to 65 years). The educational level of patients is mainly represented by higher (44.2%) and specialized (22.3%) education, 43% of persons lived in the village, 57% - in urban areas. The majority of those who applied grew up in a complete family (82.02%). The first manifestations of GI started mainly in the prepubertal (26.4%) and parapubertal (61.6%) period (up to 13 years). The average age of accepting oneself as a transgender person was 17.0 years. Steps to reduce dysphoria and receive specialized care are usually taken after the age of 20. 83.1% of transgender patients had depressive episodes, and a third (38.5%) had autoaggression. Additional psychiatric diagnoses were present in 24.5% of patients and are represented by 3 groups of diseases: group 1 (6.2%) — potentially reversible neurotic disorders; group 2 (14.1%) — background mental illnesses that are not the cause of GI; group 3 (4.3%) — other mental states with “ideas of sex change”. Conclusions : improvement of social adaptation and prevention of emotional and psychological experiences in persons with GI, assistance is possible at several levels: family, educational institutions, medical community, patient organizations.
... This finding is consistent with a mounting literature base highlighting associations between restrictive trans-specific state laws/policies and transgender adults' health outcomes (Blosnich et al., 2016;Du Bois et al., 2018;. We expand this work considerably by identifying a significant association between states' trans-specific policy climate and an outcome exclusive to transgender adolescents, which has not been consistently documented previously (Parodi et al., 2022). It is possible that trans-specific adolescent mental health providers are less likely to reside-or to endorse a trans-specific specialty online-in states with more prohibitive trans-specific laws/policies. ...
Objective: Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States. Factors associated with variability in transgender-specific mental health provider availability across states—especially at the macro-social level—have yet to be identified, hindering efforts to address these shortages. To remedy this gap, we queried whether transgender-specific adolescent mental health provider availability varied by states’ transgender-specific policy climate.
Method: We quantified states’ policy climate by factor-analyzing tallies of the presence/absence of 33 transgender-specific state laws/policies in six domains: parental/relationship recognition, nondiscrimination, education, healthcare, criminal justice, and identity documentation. We then tested whether states’ transgender-specific policy climate was associated with rates of transgender-specific adolescent mental health providers—identified via Psychology Today—per transgender adolescent in all 50 states and the District of Columbia.
Results: Transgender-specific adolescent mental health provider availability was substantially lower in states with more restrictive laws/policies for transgender people (rate ratio=0.65, 95% CI [0.52, 0.81], p=0.00017), controlling for state-level conservatism, religiosity, and urbanicity. States’ transgender-specific policy climate was unrelated to rates of adolescent Attention-Deficit/Hyperactivity Disorder-specialty providers, Oppositional Defiant Disorder-specialty providers, and youth mental health provider shortages broadly, providing evidence for result specificity.
Conclusions: Transgender adolescents appear to have access to considerably fewer transgender-specific mental health providers in states with more restrictive laws/policies for transgender people, which may compound their already high mental health burden in these contexts. Intervention and policy efforts are needed to address these shortages, particularly in states with increasingly prohibitive laws/policies targeting transgender adolescents.
... Another recent study examined the associations between state-level SGM nondiscrimination laws, and other school related protective factors, with the mental health of GMY. Unexpectedly, GMY who lived in states with these nondiscrimination laws did not report better mental health, relative to peers who resided in states without the laws (Parodi et al., 2022). The presence or absence of SGM-specific policies at the state-level may be an important visible representation of acceptance or stigma towards SGM individuals. ...
While research that investigates the importance of school-level promotive factors (e.g., teacher support) for sexual and gender minority youth (SGMY) well-being has proliferated, less research has focused on state-level climate and policy implications for gender minority youth-specific experiences. This study investigated the impact of two youth-specific SGM state-level laws (i.e., “anti-LGBT laws” and conversion therapy bans) on social transition experiences (i.e., name/pronoun use and using desired bathroom/locker rooms) of GMY (n = 4000) aged 13–17. Through a series of multivariable regression models, it was determined that the absence of laws that restricted rights for sexual and gender minority people was associated with greater use of the correct name and correct pronouns for transgender youth. These differences were further explained by binary gender identity (transgender binary or nonbinary) status, region, and age in multivariable models. Findings highlight the importance of enacting more uniform protections for SGMY, especially to protect transgender youth that live in the southern region of the U.S.
Abstract
There is a growing understanding and attention that strong support is critical for the well-being and mental health of sexual and gender diverse (SGD) young people, especially given the increasing research evidence indicating that they are experiencing greater rates of discrimination and bullying, which in turn is likely to contribute to their mental health problems, such as emotional distress and suicidality. However, limited knowledge remains about how we, as adults, can foster the healthy development of SGD young people. This chapter focuses on the roles of parents/caregivers and families and the great potential they have to contribute to the healthier development of SGD young people. In particular, we address the powerful benefits of incorporating a social-emotional learning perspective into the practical implications and recommendations of “what we can do as parents/caregivers and families.”
Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field’s current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21–32%), and among GM was 46% (95% CI 36–56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges’ g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.
Purpose of Review
In recent years, there has been a drastic increase in legislation across US states that aims to ban gender-affirming care (GAC) for transgender and nonbinary (trans) youth. We synthesized the literature on bans on GAC, its impacts on medical and mental health providers, trans communities, particularly trans youth and their caregivers (e.g., parents/families), and provided recommendations for future research and advocacy.
Recent Findings
We highlight several adverse impacts of legislation banning GAC, including: an increase in professional tensions for medical and mental health providers that work with trans youth and worse mental health outcomes for trans youth and their caregivers due to loss of autonomy in accessing evidence-based GAC.
Summary
Bans on GAC undermine evidenced-based practices and are resulting in negative health effects for trans communities and youth. Research evidence highlights the need to examine effects of bans at the intersections of gender identity, socioeconomic status, race, and ethnicity.
Introduction
Mental ill-health, substance use and their co-occurrence among sexuality diverse young people during earlier adolescence is relatively understudied. The preventive utility of positive school climate for sexuality diverse adolescents’ mental health is also unclear, as well as the role of teachers in conferring this benefit.
Method
Using Wave 8 ‘B Cohort’ data from the Longitudinal Study of Australian children ( N = 3127, M age = 14.3), prevalence ratios and odds ratios were used to assess prevalence and disparities in mental ill-health and substance use, and multinomial logistic regression for co-occurring outcomes, among sexuality diverse adolescents relative to heterosexual peers. Logistic regression was used to assess associations between school climate and teacher self-efficacy with sexuality diverse adolescents’ mental health.
Results
Mental ill-health prevalence ranged from 22% (suicidal thoughts/behaviour) to 46% (probable depressive disorders) and substance use between 66% (cigarette use) and 97% (alcohol use). Sexuality diverse participants were significantly more likely to report self-harm and high levels of emotional symptoms in co-occurrence with cigarette, alcohol and/or cannabis use. For each 1-point increase in school climate scores as measured by the Psychological Sense of School Membership scale, there was 10% reduction in sexuality diverse adolescents reporting high levels of emotional symptoms, probable depressive disorder, self-harm thoughts/behaviour and suicidal thoughts/behaviour. For each 1-point increase in lower perceived (worse) teacher self-efficacy scores as measured by four bespoke teacher self-efficacy items, odds of sexuality diverse adolescent-reported suicidal thoughts/behaviour increased by 80%.
Discussion
Mental ill-health, substance use and especially their co-occurrence, are highly prevalent and pose significant and inequitable health and well-being risks. Schools represent a potential site for focusing future prevention efforts and educating and training teachers on sexuality diversity is a promising pathway towards optimising these.
This paper examines the relationship between social transitions, mental health, and family support among transgender youth using data from the United States Transgender Survey. We use retrospective panel data to compare changes in mental health among transgender youth who initiate social transitions compared to those who initiate social transitions a year later. We find that social transitions are associated with a higher risk of suicide attempt and running away from home among transgender youth who live in unsupportive families, whereas supportive family environments mitigate, and in some cases, virtually eliminate these risks. Some of these disparities can be attributed to higher incidences of exposure to gender identity change efforts and limited access to hormone therapy in unsupportive family environments, as compared to supportive ones. These results demonstrate the importance of family support for the mental health of transgender youth at key life stages, and that family support increases access to affirming health care.
Background:
Return to school is key for community re-integration after a traumatic brain injury (TBI). School support facilitates and ensure a successful transition back to school. However, access to school services is not uniform among U.S. children.
Objective:
To describe school services for children with TBI from minoritized backgrounds and highlight population-specific risk factors and facilitators for accessing services.
Methods:
Narrative review of the literature including studies on return to school after a mild-complicated, moderate, or severe TBI, among children enrolled in the U.S. school system. We describe receipt of services, enabling and risk factors, and outcomes, for minority children.
Results:
There is a gap in knowledge regarding return to school among minoritized children with TBIs. Studies have few participants from racial and ethnic minority backgrounds, or low income or rural communities. Transgender and non-binary youth are not represented in present research efforts. Studies highlight larger barriers to receipt of school services among minority children and additional barriers associated with their minority status.
Conclusion:
Diversity in the U.S pediatric population is increasing. Minoritized populations are at increased risk for TBI and poor outcomes. Research focused on the needs of these populations is required to optimize school return after TBI hospitalization and overall post-discharge care.
Understanding publication trends on topics pertaining to LGBTQ+ students within school psychology literature is necessary to reveal areas of limited research as well as to identify evidence-supported school-based strategies for this student population. Students who identify as lesbian, gay, bisexual, transgender, queer/questioning, plus (LGBTQ+) are frequent targets of bullying and are at heightened risk for an array of adverse outcomes, including anxiety, depression, school dropout, and suicidal thoughts and behaviors. The present study reviewed nine key school psychology journals for literature pertaining to LGBTQ+ students to reveal historical publication trends across time. Seventy-six total articles were inventoried and categorized by journal, year of publication, primary topic, and article type—empirical or conceptual. All empirical articles were further categorized by age range of participants, participant group of focus, and whether or not the article had an intervention focus. Historical trends were reviewed regarding all categories. Findings revealed an increase in the overall frequency of publications over time, as well as an increase in research focused on the topic of school climate and a decrease in focus on the topics of bullying and mental health. Furthermore, although we noted increases in intervention-focused articles, articles that included younger student participants, and articles that separately analyzed unique subsets of LGBTQ+ participants across time, these types of articles continue to make up a minority of the LGBTQ+ student-focused school psychology literature base. Additionally, our review revealed very few articles examining the experiences of Black and Indigenous people of color (BIPOC). Discussion focused on findings in relation to recent calls by national school psychology organizations for school psychologists to increase our knowledge of the unique needs of the LGBTQ+ student population and to appreciate the intersection of identities within.
Objective: Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States. Factors associated with variability in transgender-specific mental health provider availability across states – especially at the macro-social level – have yet to be identified, hindering efforts to address these shortages. To remedy this gap, we queried whether transgender-specific adolescent mental health provider availability varied by states’ transgender-specific policy climate.
Method: We quantified states’ policy climate by factor-analyzing tallies of the presence/absence of 33 transgender-specific state laws/policies in six domains: parental/relationship recognition, nondiscrimination, education, healthcare, criminal justice, and identity documentation. We then tested whether states’ transgender-specific policy climate was associated with rates of transgender-specific adolescent mental health providers – identified via Psychology Today – per transgender adolescent in all 50 states and the District of Columbia.
Results: Transgender-specific adolescent mental health provider availability was substantially lower in states with more restrictive laws/policies for transgender people (rate ratio = 0.65, 95% CI [0.52, 0.81], p = .00017), controlling for state-level conservatism, religiosity, and urbanicity. States’ transgender-specific policy climate was unrelated to rates of adolescent Attention-Deficit/Hyperactivity Disorder-specialty providers, Oppositional Defiant Disorder-specialty providers, and youth mental health provider shortages broadly, providing evidence for result specificity.
Conclusions: Transgender adolescents appear to have access to considerably fewer transgender-specific mental health providers in states with more restrictive laws/policies for transgender people, which may compound their already high mental health burden in these contexts. Intervention and policy efforts are needed to address these shortages, particularly in states with increasingly prohibitive laws/policies targeting transgender adolescents.
The increase in prevalence and visibility of sexually gender diverse (SGD) populations illuminates the need for greater understanding of the ways in which current laws, systems, and programs affect their well-being. Individuals who identify as lesbian, gay, bisexual, asexual, transgender, non-binary, queer, or intersex, as well as those who express same-sex or -gender attractions or behaviors, will have experiences across their life course that differ from those of cisgender and heterosexual individuals. Characteristics such as age, race and ethnicity, and geographic location intersect to play a distinct role in the challenges and opportunities SGD people face.
This paper aims to summarise peer-reviewed literature into the mental health of transgender young people within a secondary schooling environment. A scoping review was conducted using literature across four databases. The search was limited to English language peer-reviewed articles that reported upon the association between school factors and the mental health outcomes of transgender young people in secondary schools. The review resulted in seven relevant studies, which reported numerous school factors related to mental health outcomes for transgender young people. The factors that related to mental health of transgender young people in schools include peer victimisation and bullying, perceived safety and a sense of school belonging or connectedness. Clinical and practical implications are provided for policy makers, educational institutions and school mental healthcare professionals. It is recommended that future research is needed to investigate the mental health services provided within the schooling environment.
Purpose
Transgender populations experience health inequities that underscore the importance of ensuring access to high quality care. We thematically summarize the health care experiences of transgender youth living in the southeast United States to identify potential barriers and facilitators to health care.
Design and methods
Transgender youth recruited from community settings in an urban area of the southeast United States participated in individual interviews (n = 33) and focus groups (n = 9) about protective factors. We conducted a thematic analysis of data from 42 participants who described their experiences seeking and receiving health care.
Results
Participants reported a wide range of gender identities. The individual interview sample was majority Black (54.5%) and the mean age was 21.7 years and focus group participants were all white and the mean age was 16.8 years. Participants described numerous barriers to health care, including limited availability of gender affirming care, logistical challenges, such as gatekeeping and cost, concerns about confidentiality in relation to sexual behavior and gender identity, and inadequate cultural competency among providers regarding gender-affirming care. Facilitators included intake procedures collecting chosen pronouns and names and consistent use of them by providers, and open communication, including active listening.
Conclusions
Findings underscore the need for a multi-component approach to ensure both transgender- and youth-friendly care.
Practice implications
Providers and office staff may benefit from transgender cultural competency trainings. In addition, clinic protocols relating to confidentiality and chosen name and pronoun use may help facilitate access to and receipt of quality care.
Purpose: We examined whether the relationship between minority stressors (victimization and discrimination) and suicide attempts (SAs) was moderated by gender identity-specific protective state policies in a sample of transgender and gender diverse (TGD) adults.
Methods: TGD adults (n = 133) were recruited online and completed questionnaires.
Results: Protective state policies moderated the relationship between minority stressors and SAs, with a significant positive association between minority stressors and SAs at low, but not medium and high, policy scores.
Conclusion: A lack of protective state policies may be a risk factor in the relationship between minority stressors and SAs among TGD individuals.
Extracurricular groups can promote healthy development, yet the literature has given limited attention to indirect associations between extracurricular involvement and mental health or to sexual and gender minority youth. Among 580 youth (Mage = 15.59, range = 10–20 years) and adult advisors in 38 Gender‐Sexuality Alliances (GSAs), multilevel structural equation models showed that greater engagement in GSAs over the school year predicted increased perceived peer validation, self‐efficacy to promote social justice, and hope (baseline adjusted). Through increased hope, greater engagement indirectly predicted reduced depressive and anxiety symptoms at the year’s end (baseline adjusted). GSAs whose members had more mental health discussions and more meetings reported reduced mental health concerns. Findings suggest how groups addressing issues of equity and justice improve members’ health.
Transgender and gender diverse (TGD) people are disproportionately impacted by various health issues and associated risk factors, but little is known about differences in these outcomes between gender identities within the TGD population. This study characterized the health of a diverse sample of TGD youth and young adults. Data were taken from the baseline visit of two longitudinal studies in the Chicago area, RADAR (N = 1079, M age = 20.8 years) and FAB 400 (N = 488, M age = 19.57 years), which are cohorts of young sexual and gender minorities assigned male at birth (AMAB) and assigned female at birth (AFAB), respectively. There was a combined sample of 214 TGD (128 AFAB, 86 AMAB) individuals across cohorts. We examined differences between gender identities in self-reported health and related psychosocial variables, and compared TGD youth and their cisgender sexual minority peers from their cohort of origin on all variables. Among TGD youth, we found high rates of depression and suicidality (ideation, plan, attempt), violence (trauma, victimization, childhood sexual abuse), and substance use (cigarette, alcohol, illicit drug use). With the exception of depression, transgender women and non-binary AMAB youth reported worse health outcomes than transgender men and non-binary AFAB youth. Non-binary AMAB youth reported the highest rates of certain outcomes, including traumatic experiences and suicidal ideation. TGD youth generally reported worse outcomes than cisgender sexual minority youth; these differences were less pronounced among AFAB youth. Findings point to the diversity of experiences within the TGD population and critical needs for intervention approaches to mitigate health disparities.
Compared with their cisgender counterparts, transgender individuals face both structural-level discrimination and health disparities across health domains. We used recent population-level data to examine associations between state-level policy ratings regarding transgender people and transgender health (poor physical and mental health days, health behaviors, and health care utilization). We hypothesized more inclusive and protective state-level policies would predict better health of transgender individuals. The sample (N=1116) was approximately half white (n=572, 51.2%) and half transgender women (n=551, 49.3%). More transgender-inclusive and protective state-level policies predicted better health in three of four health domains. Policy and research implications are discussed.
Importance
The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes.
Objective
To examine the associations of GNC with mental distress and substance use among high school students.
Design, Setting, and Participants
Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts.
Main Outcomes and Measures
Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students).
Results
Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70).
Conclusions and Relevance
This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students.
Transgender youth peer relations is understudied when compared to lesbian, gay, and bisexual youth (LGB). Likewise, transgender youth of color (YOC) are also understudied given the difficulties associated with accessing the sample. This study examines the relations among peer victimization, school belonging, and mental health with an ethnically diverse sample of transgender adolescents (N = 4778). Invariance testing and structural equation modeling were employed to explore these relations as well as the potential moderating role of ethnic minority status. Findings demonstrate that an alarming number of transgender youth were exposed to victimization and that victimization predicted mental health issues like suicidal ideation. Furthermore, analyses showed that peer victimization was associated with diminished school belonging. School belonging was associated with better mental health and appeared to mediate the relation between victimization and mental health issues. Ethnic minority status did not moderate these associations. Implications for research are discussed. © 2018 Springer Science+Business Media, LLC, part of Springer Nature
Transgender and gender variant (GV) youth experience elevated risk for poor health and academic outcomes due mainly to social experiences of stigma and discrimination. To supplement the growing evidence on health risks encountered by transgender/GV youth, we identified factors theorized to be protective for these youth across all four levels of Bronfenbrenner’s socioecological model (individual, relationship, community, societal). We conducted a systematic search of peer-reviewed research. The articles included in this review were published in peer-reviewed journals in English or Spanish between 1999 and 2014, analyzed data from a sample or subsample of transgender or GV participants with a mean age between 10 and 24 years, and examined the relationship of at least one theorized protective factor to a health or behavioral outcome. Twenty-one articles met inclusion criteria. Transgender/GV youth in included articles ranged from 11 to 26 years of age, were racially/ethnically diverse, and represented varied gender identities. Within these articles, 27 unique protective factors across four levels of the ecological model were identified as related to positive health and well-being. Self-esteem at the individual level, healthy relationships with parents and peers at the relationship-level, and gay-straight alliances at the community level emerged as protective factors across multiple studies. Our findings underscore the relative lack of research on transgender/GV youth and protective factors. Novel recruitment strategies for transgender/GV youth and better measurement of transgender identities are needed to confirm these protective relationships and identify others. Growth in these areas will contribute to building a body of evidence to inform interventions.
Background: Gay-straight alliances (GSAs) have potential to facilitate conversations on transgender and gender-diversity issues among members. We examined how frequently GSA members discussed transgender and gender-diversity topics within GSAs, whether GSAs varied from one another in the extent to which these conversations occurred, and identified factors that distinguished which members and GSAs discussed such topics more often than others.
Methods: Participants were 295 members of 33 high school GSAs in the state of Massachusetts who completed surveys that assessed their experiences within their GSA.
Results: On average, youth discussed transgender and gender-diversity issues with some regularity, but this varied significantly across GSAs and among youth within each GSA. Youth who had transgender friends, perceived a more respectful GSA climate, and accessed more information/resources and engaged in more advocacy within the GSA reported more frequently discussing transgender and gender-diversity issues. Also, GSAs with transgender members, whose members collectively perceived a more respectful climate, accessed more information/resources and did more advocacy, and who reported lower socializing or support discussed transgender and gender-diversity issues more frequently than other GSAs.
Conclusions: This information could inform GSA programming to facilitate more transgender and gender-diversity topic discussions and ensure that members feel encouraged to participate in them.
Purpose of review:
This review examines the recent literature on biological factors that influence sex differences in posttraumatic stress disorder (PTSD) during childhood and adolescence, focusing on neurobiological, hormonal, and genetic factors that may increase risk in girls.
Recent findings:
More than 60% of children and adolescents are exposed to traumatic events, and many develop PTSD. There is increasing recognition of gender differences in PTSD, with women having double the rates of the disorder compared to men. These gender differences in symptoms and their underlying neurobiology appear to emerge during adolescence, although it is still unclear which biological mechanisms may play key roles in the development of sex difference. The literature on gender effects in children and adolescents is still in the early stages, and more prospective and longitudinal work is needed; however, estrogen appears to play a key role in increasing risk for PTSD in girls, which emerges in adolescence.
PurposeGender nonconformity, that is, transgressing conventionally “masculine” vs. “feminine” characteristics, is often stigmatized. Stigmatization and discrimination are social stressors that raise risk of adverse mental and physical health outcomes and may drive health inequities. However, little is known about the relationship between such social stressors and health-related quality of life (HRQOL). This paper aimed to examine associations between perceived gender nonconformity and HRQOL in a cohort of U.S. adolescents and young adults. Methods
Using data from 8408 participants (18–31 years) in the U.S. Growing Up Today Study (93% white, 88% middle-to-high income), we estimated risk ratios (RRs) for the association of gender nonconformity (three levels: highly gender conforming, moderately conforming, and gender nonconforming) and HRQOL using the EuroQol questionnaire (EQ-5D-5L). Models were adjusted for demographic characteristics, including sexual orientation identity. ResultsGender nonconformity was independently associated with increased risk of having problems with mobility [RR (95% confidence interval): 1.76 (1.16, 2.68)], usual activities [2.29 (1.67, 3.13)], pain or discomfort [1.59, (1.38, 1.83)], and anxiety or depression [1.72 (1.39, 2.13)], after adjusting for sexual orientation and demographic characteristics. Decrements in health utility by gender nonconformity were observed: compared to persons who were highly gender conforming, mean health utility was lower for the moderately gender conforming [beta (SE): −0.011 (.002)] and lowest for the most gender nonconforming [−0.034 (.005)]. Conclusions
In our study, HRQOL exhibited inequities by gender nonconformity. Future studies, including in more diverse populations, should measure the effect of gender-related harassment, discrimination, and violence victimization on health and HRQOL.
Attention toward who can use which gender binary, multi-stall bathroom has brought to the forefront, once again, the ways in which youth are supported or marginalized. No study has documented sexual and gender minority youths' experiences with and perspectives about bathrooms. We collected qualitative data in 2014–2015. Participants were 25 lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth, aged 14–19, in the United States and Canada. Their comments describe first- and second-hand bathroom experiences, identify advocacy efforts, and highlight the roles of peers and adults in making bathrooms safe (or not). Youth emphasized the importance of gender-neutral bathrooms in fostering a sense of safety and inclusivity. Adult support and gay-straight alliances (GSAs) were important contributors to a welcoming environment and fostered advocacy efforts for gender-neutral bathrooms. We encourage purposeful inclusivity of youths' voices when enacting bathroom-specific policies and legislation that directly influence their health and well-being.
Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsistencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as “school connectedness” or “connections at school” in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6–12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools.
Prior studies show a strong association between gay–straight alliances (GSAs) and the well-being and safety of sexual minority students at school. However, nearly all existing literature has relied on cross-sectional data. Using data from the first 2 panels of a multisite longitudinal study on risk and protective factors for suicide among lesbian, gay, bisexual, and questioning (LGBQ) youth in 3 U.S. cities, we examined the influence of presence of and participation in a GSA on perceptions of safety at school, homophobic bullying experiences, and psychosocial adjustment (depression and self-esteem) in 327 LGBQ students across 2 school years. LGBQ students who had GSAs in their schools or were members of GSAs in the prior year showed no differences in psychological adjustment, but they reported perceptions of more school safety and less homophobic bullying in the following school year. Further, changes in GSA presence (gaining a GSA) and changes in participation (from nonparticipation to participation) were independently associated with stronger perceived safety in the subsequent school year. This study provides the first prospective evidence of the lasting positive role of GSAs for high school students, and documents that changes in GSA presence and participation are associated with safety at school. Education policy and practice implications are discussed.
Psychological research with transgender and gender nonconforming (TGNC) people is a relatively new field with great promise to advance our understanding of this population’s needs and develop, implement, and evaluate corresponding interventions to reduce their health disparities and promote psychosocial adjustment, mental health, and well-being. After a brief review of the history of research with TGNC people, this article discusses several issues to ensure that research with this population is culturally competent and meaningful. This includes issues to consider for participant recruitment, data collection, working with institutional review boards, and distribution of research findings. We conclude with a discussion of gaps in the literature and corresponding opportunities for future psychological research with TGNC people.
BACKGROUND
Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common. OBJECTIVE
The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure. DESIGNWe compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5. PARTICIPANTSA convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White. MEASURESThe PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences. KEY RESULTSThe PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912– 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849–1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527–0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550–0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report. CONCLUSIONS
The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.
Research in various populations has shown that, starting early in childhood, individuals often demonstrate resilience in the face of stress and adversity. Against the experience of minority stress, LGBT people mount coping responses and most survive and even thrive despite stress. But research on resilience in LGBT populations has lagged. In this commentary, I address 2 broad issues that I have found wanting of special exploration in LGBT research on resilience: First, I note that resilience, like coping, is inherently related to minority stress in that it is an element of the stress model. Understanding resilience as a partner in the stress to illness causal chain is essential for LGBT health research. Second, I explore individual- versus community-based resilience in the context of minority stress. Although individual and community resilience should be seen as part of a continuum of resilience, it is important to recognize the significance of community resilience in the context of minority stress.
Despite its widespread use, there has been limited examination of the underlying factor structure of the Psychological Sense of School Membership (PSSM) scale. The current study examined the psychometric properties of the PSSM to refine its utility for researchers and practitioners using a sample of 504 Australian high school students. Results from exploratory and confirmatory factor analyses indicated that the PSSM is a multidimensional instrument. Factor analysis procedures identified three factors representing related aspects of students’ perceptions of their school membership: caring relationships, acceptance , and rejection.
Purpose
Sexual and gender minority youth (SGMY) are more likely than their cisgender and heterosexual peers to use substances and to be bullied, yet it is unknown whether the absence/presence of youth- and LGBTQ-specific equity laws drive these disparities. The purpose of this study was to extend previous research focused on adult- and LGBTQ-specific structural factors (e.g., same-sex marriage laws) to determine whether the youths’ structural environment (i.e., state-level LGBTQ youth-focused equity laws) was associated with bullying and recent alcohol use, binge drinking, and cigarette use among SGMY.
Procedures
We utilized data from the LGBTQ National Teen Survey, collected in 2017 (N = 8,841 sexual and gender minority youth). Linear regression analyses examined the association between bullying and substance use and between state-level LGBTQ youth-focused equity laws (individually and as a composite variable) and bullying and substance use.
Findings
SGMY living in states with LGBTQ equity laws were less likely to experience bullying. Findings regarding the relation between LGBTQ equity laws and substance use were mixed, such that LGBTQ equity laws were associated with a higher likelihood of binge drinking and alcohol use, and a lower likelihood of cigarette use.
Conclusions
Findings highlight the role of state-level equity laws in reducing bullying and substance use disparities for SGMY. Yet, given the finding that equity laws were associated with a higher likelihood of binge drinking, it is important to continue to explore how the structural environment shapes SGMY health.
Objective:
To present a topical review of minority stressors contributing to psychosocial and physical health disparities in transgender and gender expansive (TGE) adolescents.
Methods:
We conducted a topical review of original research studies focused on distal stressors (e.g., discrimination; victimization; rejection; nonaffirmation), proximal stressors (e.g., expected rejection; identity concealment; internalized transphobia), and resilience factors (e.g., community connectedness; pride; parental support) and mental and physical health outcomes.
Results:
Extant literature suggests that TGE adolescents experience a host of gender minority stressors and are at heightened risk for negative health outcomes; however, limited research has directly applied the gender minority stress framework to the experiences of TGE adolescents. Most research to date has focused on distal minority stressors and single path models to negative health outcomes, which do not account for the complex interplay between chronic minority stress, individual resilience factors, and health outcomes. Research examining proximal stressors and resilience factors is particularly scarce.
Conclusions:
The gender minority stress model is a helpful framework for understanding how minority stressors contribute to health disparities and poor health outcomes among TGE adolescents. Future research should include multiple path models that examine relations between gender minority stressors, resilience factors, and health outcomes in large, nationally representative samples of TGE adolescents. Clinically, adaptations of evidence-based interventions to account for gender minority stressors may increase effectiveness of interventions for TGE adolescents and reduce health disparities in this population of vulnerable youth.
Importance
In the past decade, many states have implemented policies prohibiting private health insurers from discriminating based on gender identity. Policies banning discrimination have the potential to improve access to care and health outcomes among gender minority (ie, transgender and gender diverse) populations.
Objective
To evaluate whether state-level nondiscrimination policies are associated with suicidality and inpatient mental health hospitalizations among privately insured gender minority individuals.
Design, Setting, and Participants
In this cohort study, difference-in-differences analysis comparing changes in mental health outcomes among gender minority enrollees before and after states implemented nondiscrimination policies in 2009-2017 was conducted. A sample of gender minority children and adults was identified using gender minority–related diagnosis codes obtained from private health insurance claims. The present study was conducted from August 1, 2018, to September 1, 2019.
Exposure
Living in states that implemented policies banning discrimination based on gender identity in 2013, 2014, 2015, and 2016.
Main Outcomes and Measures
The primary outcome was suicidality. The secondary outcome was inpatient mental health hospitalization.
Results
The study population included 28 980 unique gender minority enrollees (mean [SD] age, 26.5 [15] years) from 2009 to 2017. Relative to comparison states, suicidality decreased in the first year after policy implementation in the 2014 policy cohort (odds ratio [OR], 0.72; 95% CI, 0.58-0.90; P = .005), the 2015 policy cohort (OR, 0.50; 95% CI, 0.39-0.64; P < .001), and the 2016 policy cohort (OR, 0.61; 95% CI, 0.44-0.85; P = .004). This decrease persisted to the second postimplementation year for the 2014 policy cohort (OR, 0.48; 95% CI, 0.41-0.57; P < .001) but not for the 2015 policy cohort (OR, 0.81; 95% CI, 0.47-1.38; P = .43). The 2013 policy cohort experienced no significant change in suicidality after policy implementation in all 4 postimplementation years (2014: OR, 1.19; 95% CI, 0.85-1.67; P = .31; 2015: OR, 0.94; 95% CI, 0.73-1.20; P = .61; 2016: OR, 0.82; 95% CI, 0.65-1.03; P = .10; and 2017: OR, 1.29; 95% CI, 0.90-1.88; P = .18). Mental health hospitalization rates generally decreased or stayed the same for individuals living in policy states vs the comparison group.
Conclusions and Relevance
Implementation of a state-level nondiscrimination policy appears to be associated with decreased or no changes in suicidality among gender minority individuals living in states that implemented these policies from 2013 to 2016. Given high rates of suicidality among gender minority individuals in the US, health insurance nondiscrimination policies may offer a mechanism for reducing barriers to care and mitigating discrimination.
Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth. Using minority stress theory and the interpersonal theory of suicide, this study aims to better understand suicide risk among transgender youth. The present study examines the influence of intervenable risk factors: interpersonal and environmental microaggressions, internalized self-stigma, and adverse childhood experiences (ACEs), and protective factors: school belonging, family support, and peer support on both lifetime suicide attempts and past 6-month suicidality in a sample of transgender youth ( n = 372). SPSS 22 was utilized to examine the impact of the independent variables on both suicidality and lifetime suicide attempt through two separate logistic regressions. Fifty six percent of youth reported a previous suicide attempt and 86% reported suicidality. Logistic regressions indicated that models for both lifetime suicide attempts and suicidality were significant. Interpersonal microaggressions, made a unique, statistically significant contribution to lifetime suicide attempts and emotional neglect by family approached significance. School belonging, emotional neglect by family, and internalized self-stigma made a unique, statistically significant contribution to past 6-month suicidality. Results have significant practice and policy implications. Findings offer guidance for practitioners working with parents and caregivers of trans youth, as well as, for the creation of practices which foster interpersonal belonging for transgender youth.
We examined whether students' experiences in their Gender-Sexuality Alliances (GSAs) over the school year predicted positive development or thriving in the form of higher relative levels of hope at the end of the school year and whether GSA experiences also promoted resilience by attenuating the link between victimization and lower relative levels of hope among 366 student members of 38 GSAs (Mage = 15.53 years; 85% sexual minority; 55% cisgender female; 72% White). Our findings indicated that, when considered one at a time, students' perceptions of receiving more social-emotional support, receiving more information and resources, and undertaking more advocacy in their GSA throughout the school year predicted higher relative levels of hope at the end of that school year (adjusted for students' initial hope at the beginning of the year). When considering all three GSA-based experiences concurrently, receiving more information and resources in their GSA had a unique predictive association with hope and it reduced the extent to which reported experiences of victimization at school predicted diminished hope at the end of the year. There was a similar, though statistically non-significant, moderating trend for advocacy.
Background:
Transgender, nonbinary, and gender nonconforming (TNG) young people are a diverse group, including young people with gender identities beyond the gender binary. Whereas nonbinary youth experience disparities in victimization and mental health, school belonging, support, and resources have not been well described.
Methods:
We conducted an online survey of TNG young people (ages 12-22) in Wisconsin to assess school belonging, safety, support, and resources. We compared responses among participants with nonbinary versus binary identities using mulvariate analysis of variance, multivariate analysis of covariance, chi-square and logistic regression analysis.
Results:
A total of 287 TNG young people met inclusion criteria (average age 18.2 ± 2.5 years). More than 40% of participants identified as nonbinary. Nonbinary participants were less likely to be out to teachers, but more likely to utilize supportive staff as a resource compared to binary-identified TNG peers. There were no significant differences in school safety and belonging.
Conclusions:
Most school experiences do not vary significantly between TNG young people with binary versus nonbinary gender identities, though nonbinary young people are less likely to be out at school. Future research should examine factors that impact whether nonbinary young people share their gender identity and access school support services.
Purpose:
Currently, there is a lack of nationwide data examining the mental health of transgender and nonbinary youth. Furthermore, relatively little is known about how the mental health of transgender and nonbinary youth compares to that of their cisgender lesbian, gay, bisexual, queer, and questioning peers or differences within subgroups of transgender and nonbinary youth. The goal of the present study was to better understand the mental health of transgender and nonbinary youth.
Methods:
We analyzed responses from a national quantitative cross-sectional survey of more than 25,000 lesbian, gay, bisexual, transgender, queer, and questioning youth, aged between 13 and 24 years, in the U.S.
Results:
Transgender and nonbinary youth were at increased risk of experiencing depressed mood, seriously considering suicide, and attempting suicide compared with cisgender lesbian, gay, bisexual, queer, and questioning youth. Controlling for sexual orientation-based or gender identity-based experiences of perceived discrimination and physical threats or harm reduced the disparities but did not fully account for them. Within-group analyses highlighted particularly increased risk for negative mental health outcomes among transgender males and nonbinary youth assigned male at birth.
Conclusions:
Findings point to the need to directly address the needs of transgender and nonbinary youth in prevention and intervention programs and to advance policies that reduce discrimination and victimization based on sexual orientation or gender identity.
Introduction:
Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population.
Methods:
Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously.
Results:
Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one's community protected against depression and suicidality; teacher connectedness buffered risk of substance use.
Conclusions:
Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse-friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use.
Inclusive policies that attend to sexual orientation and gender identity (SOGI) are associated with more supportive school environments for lesbian, gay, bisexual, and transgender (LGBT) youth. We use the 2013-2015 California Healthy Kids Survey (n = 113,148) matched with principal reports of school policies from the 2014 California School Health Profiles to examine differential effects of SOGI-focused policies for LGB and transgender youth. SOGI-focused policies had a direct association with less truancy, and moderated the association between sexual orientation/gender identity and other school outcomes. SOGI-focused policies were associated with more positive experiences and perceptions of school climate for LGB youth and, to a lesser extent, transgender youth. Findings underscore the importance of inclusive policies, especially those that address the unique needs of transgender students.
Introduction: Transgender and gender non-conforming (TGNC) people in the United States face disproportionate rates of mental health disorders, including suicidality, depression, anxiety, and substance use disorders than the general population. Patients' experiences utilizing mental healthcare is a determinant in their care-seeking behaviors and treatment success. Aim/question: The purpose of this integrative review is to better understand the firsthand mental healthcare experiences of TGNC persons. Method: The authors sought to locate recent English-language articles that described the mental healthcare experiences of TGNC persons. To do so, only articles that conducted data collection with a TGNC sample were considered for review. Results: Seven articles met criteria for review. Four themes emerged that depicted experiences of health promotion (welcoming environments, staff knowledge and response) and health prevention (enacted stigma, racial disparities and intersectional insensitivity). Discussion: Themes indicated that TGNC persons have mixed experiences (excellent to harmful/damaging) when receiving mental healthcare. There is room for healthcare provider growth in skills to increase TGNC cultural competency. Implications for practice: Mental healthcare providers and nurses would benefit from interventions to promote TGNC culturally competent care, including in-service training or continuing education for the current work force as well as incorporating TGNC content into pre-licensure educational curricula.
Purpose:
Transgender and gender-nonconforming (TGNC) adolescents and young adults experience mental health problems, including anxiety and depression, at an elevated rate as compared to their cisgender counterparts. A growing literature suggests that vulnerability to psychiatric problems in TGNC individuals results from social discrimination and minority stress.
Methods:
The sample consisted of adolescent TGNC patients (N = 109) who completed behavior health screening questionnaires as standard of care at their first clinical visit to an interdisciplinary gender program within a pediatric academic medical center in a metropolitan Midwestern city. Binary logistic regressions were used to assess whether the likelihood that participants met clinical diagnostic criteria for Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) was predicted by gender identity appearance congruence, proximal forms of minority stress (e.g., negative expectations of the future related to gender identity; internalized transphobia) and community connectedness (i.e., resilience) .
Results:
Overall, 33% (n = 36) of the sample met diagnostic criteria for MDD and 48% (n = 53) met diagnostic criteria for GAD. Those with high levels of internalized transphobia were significantly more likely to meet diagnostic criteria for both MDD and GAD. Those with low levels of gender identity appearance congruence were significantly more likely to meet diagnostic criteria for MDD but not GAD.
Conclusion:
There are several unique factors that may predict mental illness among TGNC youth. Understanding these factors may offer opportunities for targeted clinical and structural interventions.
This Policy Statement was reaffirmed August 2023
As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.
Purpose
Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations.
Methods
Data come from a statewide school‐based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments.
Findings
Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students.
Conclusions
Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population.
Background:
Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions.
Methods:
Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date.
Results:
Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4-82) to 144 (95% CI 36-1248). The corresponding range for suicidal ideation was 25 (95% CI 14-45) to 54 (95% CI 18-218).
Conclusions:
TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.
Purpose: This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth.
Methods: Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior.
Results: After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression , suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts.
Conclusion: For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group.
Transgender and gender non-conforming (TGNC) populations, including those who do not identify with gender binary constructs (man or woman) are increasingly recognized in health care settings. Research on the health of TGNC people is growing, and disparities are often noted. In this review, we examine 77 studies published between January 1, 1997 and March 22, 2017 which reported mental health outcomes in TGNC populations to (a) characterize what is known about mental health outcomes and (b) describe what gaps persist in this literature. In general, depressive symptoms, suicidality, interpersonal trauma exposure, substance use disorders, anxiety, and general distress have been consistently elevated among TGNC adults. We also used the minority stress model as a framework for summarizing existing literature. While no studies included all elements of the Minority Stress Model, this summary gives an overview of which studies have looked at each element. Findings suggest that TGNC people are exposed to a variety of social stressors, including stigma, discrimination, and bias events that contribute to mental health problems. Social support, community connectedness, and effective coping strategies appear beneficial. We argue that routine collection of gender identity data could advance our understanding mental health risk and resilience factors among TGNC populations.
Purpose:
Research suggests that transgender and gender nonconforming (TGNC) youth may be at greatly increased risk of high-risk health behaviors compared with cisgender youth, but existing studies are limited by convenience samples and small numbers. This study uses a large school-based sample of adolescents to describe the prevalence of TGNC identity, associations with health risk behaviors and protective factors, and differences across birth-assigned sex.
Methods:
This study analyzes existing surveillance data provided by 9th and 11th grade students in Minnesota in 2016 (N = 81,885). Students who were transgender, genderqueer, genderfluid, or unsure about their gender identity (TGNC) were compared with those who were not, using χ(2) and t-tests. Outcome measures included four domains of high-risk behaviors and experiences and four protective factors.
Results:
The prevalence of TGNC identity was 2.7% (n = 2,168) and varied significantly across gender, race/ethnicity, and economic indicators. Involvement in all types of risk behaviors and experiences was significantly higher, and reports of four protective factors were significantly lower among TGNC than cisgender youth. For example, almost two-thirds (61.3%) of TGNC youth reported suicidal ideation, which is over three times higher than cisgender youth (20.0%, χ(2) = 1959.9, p < .001). Among TGNC youth, emotional distress and bullying experience were significantly more common among birth-assigned females than males.
Conclusions:
This research presents the first large-scale, population-based evidence of substantial health disparities for TGNC adolescents in the United States, highlighting numerous multilevel points of intervention through established protective factors. Health care providers are advised to act as allies by creating a safe space for young people, bolstering protective factors, and supporting their healthy development.
Purpose:
This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14-18 and 19-25).
Methods:
A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey.
Results:
Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups.
Conclusions:
Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable.
In 2015, the American Psychological Association adopted Guidelines for Psychological Practice with Transgender and Gender Nonconforming Clients in order to describe affirmative psychological practice with transgender and gender nonconforming (TGNC) clients. There are 16 guidelines in this document that guide TGNC-affirmative psychological practice across the lifespan, from TGNC children to older adults. The Guidelines are organized into five clusters: (a) foundational knowledge and awareness; (b) stigma, discrimination, and barriers to care; (c) lifespan development; (d) assessment, therapy, and intervention; and (e) research, education, and training. In addition, the guidelines provide attention to TGNC people across a range of gender and racial/ethnic identities. The psychological practice guidelines also attend to issues of research and how psychologists may address the many social inequities TGNC people experience.
This review provides an update on the growing body of research related to the mental health of transgender youth that has emerged since the 2011 publication of the Institute of Medicine report on the health of lesbian, gay, bisexual, and transgender people. The databases PubMed and Ovid Medline were searched for studies that were published from January 2011 to March 2016 in English. The following search terms were used: transgender, gender nonconforming, gender minority, gender queer, and gender dysphoria. Age limits included the terms youth, child, children, teenager*, and adolescen*. The combined search produced 654 articles of potential relevance. The resulting abstracts went through a tiered elimination system, and the remaining 15 articles, which presented quantitative data related to the prevalence of transgender youth and their mental health, were included in the present review. In addition to providing new estimates of the number of young people who identify as transgender (.17%-1.3%), studies since 2011 have shown that transgender youth have higher rates of depression, suicidality and self-harm, and eating disorders when compared with their peers. Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents. Recent research has demonstrated increased rates of psychiatric morbidity among transgender youth compared to their peers. Future work is needed to understand those youth who identify as gender nonbinary, improve methods to capture and understand diverse gender identities and related health disparities, and delineate the social determinants of such disparities.
So far, every example in this book has started with a nice dataset that’s easy to plot. That’s great for learning (because you don’t want to struggle with data handling while you’re learning visualisation), but in real life, datasets hardly ever come in exactly the right structure. To use ggplot2 in practice, you’ll need to learn some data wrangling skills. Indeed, in my experience, visualisation is often the easiest part of the data analysis process: once you have the right data, in the right format, aggregated in the right way, the right visualisation is often obvious.
Purpose:
This study investigates depression and anxiety in gender minority (i.e., transgender and/or gender nonconforming) compared with nongender minority (cisgender) young adults.
Methods:
Data were from the Growing Up Today Study, a national cohort of U.S. young adults. A two-step method (maternal-reported natal sex in 1996 cross-classified with participant-reported current gender identity in 2010) was used to identify gender minority and nongender minority respondents (n = 7,831; mean age = 26 years). Differences in past week depressive symptoms and anxious symptoms were examined cross-sectionally by gender identity. Gender minority and nongender minority respondents were compared using age-adjusted logistic regression models.
Results:
In gender minorities, the prevalence of depressive and anxious symptoms meeting clinical cutoffs was 52% and 38%, respectively, compared with nongender minorities (27% and 30% in females and 25% and 14% in males; p < .01).
Conclusions:
Gender identity is an understudied social determinant of mental health. Surveillance efforts to monitor mental health disparities should include survey questions to assess gender identity in epidemiologic research. Research and interventions to understand and ameliorate mental health disparities by gender identity are needed.
Schools are a critical development context for adolescents. Most research focuses on individual students and their development, but a focus on the climate of schools is crucial for analyzing policy innovations as well as student wellbeing. This chapter focuses on the school experiences of lesbian, gay, bisexual, and transgender (LGBT) students, a group for whom school safety is a pressing concern. Drawing from Rogers' (2003) theory of diffusion of innovation, it identifies planned, structural changes in school policies that create positive change in school LGBT climates and for LGBT students. It discusses strategies for measuring individual- and school-level safety and climate, and provides empirical illustrations. The chapter concludes with a discussion of contemporary policy innovations and advocacy efforts that are consistent with an emphasis on improving school climates.
Rationale
Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma.
Objective
This critical review aims to integrate the literature on stigma towards transgender people in the US.
Results
This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations.
Conclusion
Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted.
DOI: http://dx.doi.org/10.1016/j.socscimed.2015.11.010
The Psychological Sense of School Membership (PSSM) scale has been used widely to measure adolescent perceptions of sense of school belonging in research investigating associations between the relational quality of educational contexts and motivational and achievement outcomes. Previous research examining the factor structure of the PSSM scale consistently identifies a factor named perception of rejection that consists of only negatively worded items. This study extends previous research by considering potential method effects associated with negatively worded items. Exploratory and confirmatory factor analyses of a diverse U.S. high school sample (N = 890) identified three substantive factorsidentification and participation in school, perception of fitting in among peers, and generalized connection to teachers. Our investigation determined the presence of method effects in this scale, and such method effects are best represented with a common negative wording factor.
Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap.
A retrospective cohort study of electronic health record data from 180 transgender patients aged 12-29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes.
The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p < .05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.
Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.
Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.