Youth Mental Health & Wellbeing

Authors: Simpson, A., Van Rensburg, M., Ding, L., & Rydzewska, E.
Date of publication: 2024
Journal: Research in Autism Spectrum Disorders

Summary: This UK study aims to better understand mental health outcomes experienced by gender diverse autistic individuals by comprehensively reviewing the currently available research. Twelve studies were deemed eligible and were included in the review.

The researchers noted that previous research has shown that both the gender diverse population and the autistic population experience a higher rate of mental health conditions compared to the general population.

The 12 studies that were reviewed found that individuals who are both autistic and gender diverse appear to be a minority group at higher risk of experiencing depression, anxiety and suicidality than either their cisgender autistic or gender diverse non-autistic counterparts.

You can read the full study here

Authors: Day, M., & Brömdal, A.
Date of publication: 2024
Journal: International Journal of Transgender Health

Summary: This Australian study comprehensively evaluated 15 research papers to investigate the broad range of challenges that transgender and gender diverse youth experience within the school system. In addition to increased mental health concerns, it has been established that low school attendance rates, school dropout and a lack of quality education are all issues faced by transgender and gender-diverse youth which perpetuates cycles of disadvantage and discrimination well into adulthood.

There are a number of barriers faced by transgender and gender diverse youth throughout their school experience:

Interpersonal - School culture, bullying/harassment, incorrect pronouns, binary gender classification viewed as norm

Structural – Policies/Procedures, unsupportive systemic culture, lack of staff training, outdated policies, cisgender-based rules and curriculum

Individual – Personal characteristics, ideas and values conflicting with gender identity, misconceptions

The study also highlighted concerns around the experience of transgender and gender diverse youth in schools with religious affiliations. The often-incompatible belief systems reinforce a dichotomous view of gender and may come with a higher exposure to anti-transgender messaging and reduced inclusivity.

The review suggests that training for school staff, creating safe spaces (e.g. gender affirming bathrooms/locker rooms) gender affirmation (e.g. using chosen names) and incorporating gender diversity education into the curriculum are ways in which systems and individuals can positively contribute to the outcomes for transgender and gender diverse youth in schools.

You can read the full study here

Authors: Wurm, M., Högström, J., Tillfors, M., Lindståhl, M & Norell, A.
Date of publication: 2024
Journal: Scandinavian Journal of Psychology

Summary: This is a Swedish study that looked at data from a school-based survey of 3067 Swedish youth. The gender identities reported were girl (1544 students) boy (1482 students) and other (41 students). The aim was to explore the prevalence of Transgender and gender diverse (TGD) youth in the general population as well as health outcomes of TGD youth and cisgender boys and girls.

This study found that TGD youth and cisgender girls scored worse than cisgender boys on scales of anxiety, social anxiety, depression, insomnia, self-harm, and pain. TGD youth were found to experience higher rates of insomnia and musculoskeletal pain than both cisgender boys and girls. The higher rates in TGD and cisgender girls is due to the higher stress experienced by these populations, known as minority stress. Minority stress is chronic stressors directly related to a person’s minority status, for example, being misgendered, getting funny looks or experiencing violence. These increased rates of stress place TGD youth at higher risk of health-related problems compared to their cisgender peers.

In addition to health outcomes, this study found that a higher percentage (1.3%) of youth identified as something other than their assigned gender than is indicated by medical and legal sources, suggesting that not all TGD youth come into contact with health care providers for help.

You can read the full study here

Authors: Kimber, B., Oxlad, M & Twyford, L.
Date of publication: 2024
Journal: International Journal of Transgender Health

Summary: This Australian review explored the effect that microaggressions have on the mental health of trans and gender-diverse people. Microaggressions are defined as brief statements or behaviours that communicate hostile or derogatory messages towards a member/s of a minority group. This review explores the effect that exposure to these microaggressions have on the mental health of the trans and gender-diverse population.

Trans and gender-diverse people experience unique environmental microaggressions which impact their participation in daily life in multiple areas including family, friend and romantic relationships, the workplace and healthcare settings. These may look like verbal/non-verbal attacks intended to hurt the person they’re directed at, unintentional subtle statements that demean one’s identity or excluding or invalidating one’s thoughts, feelings or emotions.

The authors found that the majority of the studies reviewed identified that trans and gender diverse people experienced a range of adverse mental health outcomes such as emotional exhaustion, stress, anxiety, suicidal ideation/attempts as well as overall decreased quality of life due these microaggressions.

The authors raised concerns around the lack of trans and gender-diverse specific measures, with many studies relying on dated measures or measures that lack generalizability. Amongst other conclusions, the authors suggest the development of measures that have been validated in trans and gender-diverse populations.

You can read the full study here

Authors: Nunes-Moreno, M., Furniss, A., Cortez, S., Davis, S, M., Dowshen, N., Kazak, A, E., Nahata, L., Pyle, L., Reirden, D, H., Schwartz, B., Sequeira, M, G., Nokoff, N, J.
Date of publication: 2024
Journal: LGBT Health

Summary: This study analysed paediatric medical data over a ten-year period to find out the most common reasons for admission to the emergency department or inpatient ward amongst transgender and gender-diverse (TGD) youth. The authors defined TGD patients as those with a diagnosis of gender dysphoria and they then compared this data with patients who did not have a diagnosis of gender dysphoria. In addition to this, the authors analysed whether access to gender-affirming hormone therapy (GAHT) or Gonadotropin-releasing hormone agonist (GnRHa) decreased suicidality amongst TGD youth.

The authors found that TGD youth had a higher risk of being admitted to the emergency department or inpatient unit for suicidality and other mental health related diagnoses than those who did not have a diagnosis of gender dysphoria. The authors also found that for TGD youth, a prescription for GAHT reduced the risk of an ED or inpatient admission for suicidality compared to TGD youth who did not have a prescription. They did not find a significant reduction in admissions amongst TGD youth with a GnRHa prescription.

You can read a summary only of the study here

Authors: Anderson, A, M., Mallory, A, B., Alston, A, D., Warren, B, J., Morgan, E., Bridge, A, J &Ford, L, J.
Date of publication: 2024
Journal: Archives of Suicide Research

Summary: This US study explored the rates of suicide risk amongst transgender and gender-diverse (TGD) young people and examined any associations between that risk and sociodemographic factors such as sexual orientation, race/ethnicity, experiences of homelessness and poverty.

The authors noted the importance of making a distinction between gender identities, as much of the previous research in this area use collective group comparisons which lacks understanding of the diversity within in this population. As such, they have included not only trans woman and trans man, but also assigned female at birth genderqueer/non-binary and assigned male at birth genderqueer/non-binary.

The study highlighted the elevated suicide risk in many TGD populations, across a range of sociodemographic contexts, for example, there was a strong association found between homelessness and suicide outcomes. Given that TGD youth are more likely to have had a period of homelessness (family rejection and being forced out of the home often leading to homelessness) this are important yet concerning findings.

You can read a summary only of the study here

Authors: Abela, D., Lea, S & Patlamazoglou, L.
Date of publication: 2024
Journal: International Journal of Transgender Health

Summary: This Australian study used interviews to explore the experiences of 16 trans and gender-expansive (TGE) teenagers aged 14-17 years old. They found that two themes emerged from these interviews: (1) Oppression and psychological wellbeing, and (2) Navigating social constraints and self-expression.

The authors define oppression to mean the stigma, invalidation and discrimination that TGE teens experience and the responses received were complex, revealing difficulties with self-esteem, body image, sense of safety, increased stress, fatigue, suicidal ideation and depressive symptoms. Alongside the increased challenges the participants identified, the pressure to conform to binary standards was significant and negatively impacted many areas of their lives.

The study went on to find that TGE youth are highly adaptive in response to oppressive contexts with participants citing coping strategies such as avoidance, creation of affirming environments and strategic disclosure.

The researchers highlight that safe spaces which are free from judgment are necessary to foster authentic self-expression and alleviate the psychological impact of oppression.

You can read the full study here

Authors: Soulliard, Z, A., Le, P, T & Yamasaki, V.
Date of publication: 2024
Journal: The Journal of Treatment and Prevention

Summary: 148 transgender and nonbinary (TNB) participants completed an online survey in this American study which aims to explore what, if any associations there are between gender identity pride, body appreciation and intuitive eating.

Much of the research available currently focuses on negative body image and disordered eating, however the authors of the current study suggest that this does not highlight the individual resilience and strengths among the TNB community which act as protective factors against disordered eating. Intuitive eating does not label food as good or bad and is a form of adaptive eating in which someone eats in response to internal hunger cues rather than based on any diet. Previous research has identified positive associations between intuitive eating, self-esteem and overall wellbeing.

The authors found that increased gender identity pride (defined as “a feeling of value and acceptance for one’s TNB identity”) led to increased intuitive eating through an increased sense of body appreciation. These are important findings in capturing the rang of experiences among TNB adults and supporting identity-affirming interventions for this community.

You can read the summary only of the study here

Authors: Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H.
Date of publication: 2018
Journal: The Journal of Adolescent Health

Summary: This US study looked at the relationship between the use of a gender diverse young person’s chosen name and their mental health amongst 129 gender diverse young people aged 15-21 years. The researchers used the use of the chosen name as an indicator that a young person’s gender identity was being supported. They examined use across four contexts (at home, at school, at work, with friends) and how this was associated with depression, suicidal thoughts and suicidal behaviour. They controlled for other factors that might be significant (e.g. age) and found that chosen name use in more contexts was associated with lower depression, suicidal thinking, and suicidal behaviour. Depression, suicidal thinking, and suicidal behaviour were lowest when chosen names could be used in all four contexts. The researchers recommended that friends, parents, teachers, health care providers, and education and medical institutions could support the mental health of gender diverse young people by using their chosen name.

You can read the full study here

Authors: Strauss, P., Cook, A., Winter, S., Watson, V., Wright Toussaint, D., Lin, A.
Date of publication: 2017
Publisher: Telethon Kids Institute (Perth, Australia)

Summary: Trans Pathways is the largest study ever conducted of the mental health and care pathways of gender diverse young people in Australia (859 participants). It is also the first Australian study to incorporate the views of parents and guardians of trans young people (194 participants). Trans Pathways showed that gender diverse young people are at very high risk for poor mental health, self-harming and suicide attempts. Around 3 in every 4 gender diverse young people reported experiencing anxiety or depression. Four out of 5 gender diverse young people had ever engaged in self-harm, and almost 1 in 2 gender diverse young people had ever attempted suicide (48%).

Gender diverse young people found it difficult to access health services with 60% feeling isolated from medical and mental health services, and 42% having reached out to a service provider who did not understand or respect their gender identity. Problems with health services included a lack of education about gender diversity, not knowing where to refer gender diverse clients, and transphobia. Many gender diverse young people had experienced negative situations that affected their mental health such as peer rejection, bullying, issues with school, university or TAFE, and a lack of family support. Participants reported using music and art, peers and friends, activism, social media and pets to make themselves feel better and take care of the mental wellbeing. Trans Pathways included a list of recommendations for governments and health providers, as well as guidance for schools, parents, peers and gender diverse young people.

You can read a summary of this research or the full report here

Authors: Strauss P., Cook A., Winter S., Watson V., Wright Toussaint D., Lin A.
Date of publication: 2019
Journal: Psychological Medicine

Summary: In this Australian study the researchers report on the mental health findings of Trans Pathways, the largest study ever conducted in Australia with 859 gender diverse young people. They found that gender diverse young people experience high levels of mental distress, including self-harming (79.7%), suicidal thoughts (82.4%), and suicide attempts (48.1%). Three in four participants had been diagnosed with depression (74.6%) and/or anxiety (72.2%). Many young people had been exposed to negative experiences such as peer rejection (89.0%), unstable accommodation (22.0%), bullying (74.0%), and discrimination (68.9%). Most poor mental health outcomes were associated with negative experiences.

The researchers found some particularly strong associations between poor mental health outcomes and certain life experiences such as unstable accommodation and issues within educational settings. For example, young people with a prior suicide attempt were almost six times more likely to have experienced issues with accommodation, including homelessness. They conclude that there is an urgent need for better mental health care and targeted mental health interventions for gender diverse young people.

You can read the full study here

Authors: Durwood, L., Eisner, L., Fladeboe, K., Ji, C. G., Barney, S., McLaughlin, K. A., & Olson, K. R.
Date of publication: 2021
Journal: Journal of Youth and Adolescence

Summary: This US study examined the levels of symptoms of depression and anxiety in 265 gender diverse young people aged 3 to 15 years and how they were associated with family, peer, school and state-level (calculated using the number of supportive trans-related policies and laws in place in the child’s state) support. Young people in the study had socially transitioned (i.e., were being supported to live openly as the gender they identify with). Parents completed measures on their child’s mental health and levels of family, peer and school support.

Parents who reported higher levels of family, peer, and school support for their child's gender identity also reported fewer depression and/or anxiety symptoms. The researchers found state-level support was not meaningfully linked to the child’s mental health. Peer and school support, however, acted as buffers for the child’s mental health. The researchers concluded that even among young people who are supported by their parents to transition socially, parents report better wellbeing when they also see more support for the child's gender identity from family, peers, and schools. This research suggests schools play an important part in supporting gender diverse children’s wellbeing.

You can read a summary of the study only here

Authors: Hill A.O., Lyons A., Jones J., McGowan I., Carman M., Parsons M., Power J., Bourne A.
Date of publication: 2021
Publisher: Australian Research Centre in Sex, Health and Society, La Trobe University (Melbourne, Australia)

Summary: In this Australian study 6,418 LGBTQA+ young people aged between 14 and 21 years took part in a national survey investigating their health and wellbeing. Amongst gender diverse participants, 90% had experienced high or very high psychological distress in the previous four weeks, 54% had self-harmed, 71% had thought about suicide and 14% had attempted suicide in the preceding 12 months. 38% of all participants reported having attempted suicide at some point in their life.

When reporting on affirming their gender identity and daily challenges:

Less than three-quarters (74.8%) of trans and gender diverse participants had ever affirmed their gender identity socially, compared to the 97.4% that reported ever wanting to affirm their gender identity socially.
One-fifth (22.5%) of trans and gender diverse participants had ever affirmed their gender identity legally, compared to the 75.2% that reported ever wanting to affirm their gender identity socially.
Less than one-quarter (29.4%) of trans and gender diverse participants had ever affirmed their gender identity medically, compared to the 72.3% that reported ever wanting to affirm their gender identity medically.
Over seven-tenths (71.7%) of all participants had faced issues relating to toilet access in the past 12 months.
Over three-fifths (61.4%) of participants avoided using the toilets, 59.5% felt uncomfortable or unsafe accessing toilets, and more than one-third (38.5%) had limited how much they ate or drank to avoid having to go to the toilet in the past 12 months.
The vast majority (86.8%) of participants had been misgendered by others in the past 12 months.
Most (67.9%) participants reported feeling uncomfortable or unsafe in their educational setting because of their gender or sexual identity.

The report concludes that despite legal and social changes and advances, a great many LGBTQA+ young people experience challenges in their everyday life, often as a consequence of, or associated with, experiences of stigma, discrimination and violence.

You can read the full report here

Summary: This Australian study provides a snapshot of what is known of the current mental health and wellbeing outcomes of LGBTIQ+ people in Australia by bringing together numerous Australian studies. The researchers highlight that while many lesbian, gay, bisexual, transgender, intersex, queer people and other sexuality and gender diverse (LGBTIQ+) people live healthy and happy lives, research has demonstrated that a disproportionate number experience poorer mental health outcomes and have higher risk of suicidal behaviours than their peers. These health outcomes are directly related to experiences of stigma, prejudice, discrimination and abuse on the basis of being LGBTIQ+. Of note, they found that for gender diverse teens and adults:

Suicide attempts and suicidal ideation

Gender diverse people aged 14-25 are fifteen times more likely to attempt suicide compared to the general population.
48.1% of gender diverse people aged 14 to 25 reported that they had attempted suicide in their lifetime.
35% of gender diverse people aged 18 and over reported that they had attempted suicide in their lifetime.
28% of gender questioning young people between 14 and 21 years reported that they had attempted suicide.
41% of gender diverse people aged 18 years and over reported thoughts of suicide or self-harm in the last two weeks.

Self-harm

Gender diverse people aged 18 and over are six and a half times more likely to engage in self-harm compared to the general population.
53% of gender diverse people aged 18 and over reported having self-harmed in their lifetime, while 11% reported they were currently self-harming.
79.7% of gender diverse people aged 14 to 25 reported having self-harmed in their lifetime.

Mental health conditions

Gender diverse people aged 14 to 25 are over seven times more likely to experience and be diagnosed with depression compared to the general population.
Gender diverse people aged 18 and over are five and a half times more likely to experience and be diagnosed with depression compared to the general population.
57.2% of gender diverse people aged 18 and over reported having been diagnosed with depression in their lifetime.
74% of gender diverse people aged 14 to 25 reported having been diagnosed with depression in their lifetime.
Gender diverse people aged 14 to 25 are five and a half times more likely to be diagnosed with anxiety in their lifetime compared to the general population.
39.9% of gender diverse people aged 18 and over reported they had been diagnosed with an anxiety disorder in their lifetime.
72.5% of gender diverse people aged 14 to 25 reported they had been diagnosed with an anxiety disorder in their lifetime.
Gender diverse people aged 18 and over reported high or very high levels of psychological distress as follows: 75.8% of trans men, 65.6% of trans women and 74.9% of non-binary participants.
Gender diverse people aged 16 and over are nearly four times more likely to have experienced sexual violence or coercion compared to the general population.

The full report includes further breakdowns of statistics by gender identity, intersectionality (i.e. the ways in which different aspects of a person’s identity (race, disability, geographical location etc) can expose them to overlapping forms of discrimination and marginalisation and use of crisis support services.

You can read the full report here

Click here for a fact sheet on understanding suicide amongst transgender and gender diverse people.

Authors: Storr, R., Robinson, K., Davies, C., Nicholas, L., & Collison, A.
Date of publication: 2020
Publisher: Western Sydney University (NSW, Australia)

Summary: This Australian study was conducted with 13 same-sex attracted and gender diverse young people (SSAGD) aged 17-21 in NSW via interviews. It was conducted to contribute to positively addressing the increased inclusion of SSAGD young people in sport and physical activities. Young people in this research expressed a strong desire to participate in sport and physical exercise, however most had experienced numerous forms of discrimination, especially in PE at school. Of note, participants highlighted barriers to taking part in sport that were specifically related to their gender identity such as gendered sporting facilities (e.g. toilets and change rooms) and PE activities and sport being structured around sex and gender. The researchers provide practical recommendations for improving access to sports for SSAGD young people, including tackling violence and discrimination in sports and PE at school.

You can read the full report here

Authors: Dhanani, L.Y., Totton, R.R.
Date of publication: 2023
Journal: Sexuality Research and Social Policy

Summary: This US study investigated the health impacts on 113 gender diverse teenagers and young adults of consuming news related to legislation aimed at restricting the rights of gender diverse people. The researchers noted that much of the proposed legislation coverage related to restricting access to gender-affirming care. The researchers also investigated the health impacts on young people of having friends and family who support proposed anti-transgender legislation. They found that consuming news about anti-transgender legislation was linked to increased rumination (i.e. constant and repetitive thoughts about something) and increased physical health symptoms such as headaches, poorer sleep and stomach problems. They also found if young people felt that their support networks supported such proposed legislation this had an impact on a range of their health outcomes such as greater rumination, signs of depression, physical health symptoms and fear about telling others about their gender identity. Young people also reported other consequences of consuming this type of coverage such as making them less willing to access general health care.

You can read the full study here

Authors: Pham, A., Morgan, A. R., Kerman, H., Albertson, K., Crouch, J. M., Inwards-Breland, D. J., Ahrens, K. R., & Salehi, P.
Date of publication: 2020
Journal: The Journal of Adolescent Health

Summary: This US study aimed to understand how 23 gender diverse young people aged 13 to 19 years react to news stories about gender diverse people. The researchers found that general news coverage of the political climate concerning gender diverse people affected some young people’s gender transition and they sped up the process of progressing their transition due to fears that gender-affirming care may not be available in the future. They also found that negative news coverage had impacts on young people’s mental well-being (e.g. experiencing signs of depression and anxiety) and how safe they felt. Importantly, the researchers also found that positive news coverage of gender diverse people had positive impacts on young people such as feelings of happiness, hope, pride and a sense of community connection. They concluded that, given the varied impacts on young people from consuming this type of news, young people may benefit from increased support from those around them to help them cope with interpreting news.

You can read a summary of the study only here

Authors: Lefevor, G. T., Boyd-Rogers, C. C., Sprague, B. M., & Janis, R. A.
Date of publication: 2019
Journal: Journal of Counseling Psychology

Summary: This US study looked at experiences of minority stress and health outcomes for non-binary college students compared with gender diverse students who identified as a binary gender (i.e., either male or female) and cisgender (i.e., not gender diverse) students. Minority stress theory suggests that members of a minority group experience unique stresses due to being ‘different’ to the mainstream culture. This difference can result in stressors such as stigma, prejudice, rejection and discrimination which, in turn, can cause physical and mental health difficulties. The researchers looked at data from 3,568 college students, of which 892 identified as non-binary.

They found that non-binary students were harassed, sexually abused, and subjected to traumatic events at higher rates than were either cisgender or binary transgender individuals. Approximately 50% of non-binary participants reported at least one of these events. The researchers also found that non-binary participants experienced more anxiety, depression, psychological distress, and eating concerns than did binary transgender and cisgender individuals and more social anxiety than did cisgender individuals. Non-binary participants also reported more frequent self-harm and suicidality than did any other group, with approximately 2/3 of participants having contemplated suicide and nearly 50% making a suicide attempt. The researchers concluded that a number of factors account for non-binary individuals experiencing negative events and having poorer health outcomes than their peers including others’ lack of knowledge about non-binary experiences and pronouns, poor access to legal and medical resources, and systemic discrimination.

You can read a summary of the study only here

Authors: Werner-Seidler, A., Maston, K., Calear, A.L., Batterham, P., Larsen, M.E., Torok, M., O’Dea, B., Huckvale, K., Beames, J.R., Brown, L., Fujimoto, H., Bartholomew, A., Bal, D., Schweizer, S., Skinner, S.R., Steinbeck, K., Ratcliffe, J., Oei, J., Venkatesh, S., Lingam, R., Perry, Y., Hudson, J.L., Boydell, K.M., Mackinnon, A., & Christensen, H. Date of publication: 2022 Journal: International Journal of Methods in Psychiatric Research Summary: The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. Young people are especially vulnerable to mental ill health, with around 75% of mental health problems emerging before the age of 25. However, reaching this group at scale remains a challenge. The Future Proofing Study aims to discover how we can use the devices in our pockets – smartphones – to deliver preventative interventions on a large scale. Studies of this size are commonplace for cardiovascular and cancer research but have never been attempted before for prevention of mental health problems. This world-first trial aims to predict and prevent anxiety and depression in thousands of Australian students aged 13–18, making it the largest study of its kind in the field of mental health. Of note, the researchers found that 3.2% of Year 8 students in their study identified as gender diverse. They also found that gender and sexuality diverse students were at significantly higher risk of poorer mental health due to stigma, discrimination, and victimisation at home, school, and in the community. You can read the full study here. You can find out more about the Future Proofing Study here and access a summary of findings here.

Authors: Watson, R. J., Veale, J. F., & Saewyc, E. M.
Date of publication: 2017
Journal: The International Journal of Eating Disorders

Summary: This Canadian study looked at the relationship between disordered eating and risk and protective factors for trans young people using health survey information from 923 participants aged 14-25 years. The researchers found high rates of eating disorders in this group. Nearly half of the 14-18 year olds and more than a third of the 19-25 year olds engaged in behaviours such as binge eating, fasting and using pills, laxatives or vomiting to lose weight. Binge eating and fasting were the most common behaviours, with both behaviours reported by around 35-45% of the participants. Vomiting was reported by almost 1 in 5 of the 14-18 year olds. When compared with figures from a similar study looking at eating disorders in the general youth population, the researchers found that 27% of young people reported binge eating (compared with 42% in this study by Watson and colleagues) and 5% reported vomiting to lose weight (compared with 18% in this study by Watson and colleagues).

The researchers found that enacted stigma (the higher rates of harassment and discrimination that trans young people face) was linked to a higher chance of reported past year binge eating and fasting or vomiting to lose weight. Importantly, they found several factors protected against disordered eating including family connectedness, school connectedness, caring friends, and social support. When participants reported having these factors in their life, they also reported lower chances of past year disordered eating. For 14-18 year olds, family connectedness was particularly linked with the lowest chance of disordered eating.

You can read the full study here

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