Mental Health of Transgender and Gender Diverse Youth

Abstract

Transgender and gender diverse (TGD) children and adolescents are an increasingly visible yet highly stigmatized group. These youth experience more psychological distress than not only their cisgender, heterosexual peers but also their cisgender, sexual minority peers. In this review, we document these mental health disparities and discuss potential explanations for them using a minority stress framework. We also discuss factors that may increase and decrease TGD youth's vulnerability to psychological distress. Further, we review interventions, including gender-affirming medical care, that may improve mental health in TGD youth. We conclude by discussing limitations of current research and suggestions for the future. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 19 is May 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Stress of being outed to parents, LGBTQ family support, and depressive symptoms among sexual and gender diverse youth

“…The relation between the stress of being outed to parents and LGBTQ family support is likely to vary across sexual and gender identities. For instance, SGDY who identify as transgender, nonbinary, bisexual, pansexual, queer, or asexual may exhibit greater stress after learning their identities have been outed to their parents, which may manifest through greater perceptions of parental rejection or invalidation of their identities (e.g., Simon et al, 2022;McCurdy et al, 2023; for a review, see Wittlin et al, 2023). Consequently, the indirect association of outed stress to parents and depressive symptoms through LGBTQ family support may be stronger for SGDY who identify with non-cisgender and emerging sexual identities (e.g., pansexual or queer).…”

“…Research has also shown important nuances across sexual and gender identities in LGBTQ family support. For instance, compared to their cisgender peers, transgender and nonbinary youth often receive less LGBTQ family support and report higher amounts of physical, verbal, and mental abuse following the disclosure of their identity to their parents and caregivers (Grossman et al., 2021; for a review, see Wittlin et al., 2023). Although some studies have been inconsistent in finding differences in family support between lesbian, gay, and bisexual youth (Ryan et al., 2010), recent findings report that youth are increasingly identifying with more expansive labels (e.g., pansexual, queer, ace), which are significant predictors of family rejection (Gamarel et al., 2020; Simon et al., 2022; Watson et al., 2020).…”

Promoting Gender-Affirming Care: Challenging Conflation and Embracing Complexity

“…Yet, the current inflection point in the nation's history can either draw us closer to those ideals or drive us further away from them. In many states, access to gender-affirming care remains limited, hindering the well-being and happiness of transgender and gender-diverse youth, at the precipice and subject to higher rates of mental health challenges and suicidal ideation (Tan et al, 2019; Wittlin et al, 2022). These youth need proper care and treatment that will address their needs and allow them to embrace and revel in their full humanity.…”

“…According to the Human Rights Campaign, a record 70 such bills have been passed into law this year alone, with the most aggressive states being the Republican-led states of Florida, Texas, Tennessee, and North Dakota. Furthermore, these policy positions are in conflict with the reality of empirical data that shows that queer and gender-diverse youth are at particular risk for mental health issues and suicidal ideation (Tan et al, 2019; Wittlin et al, 2022). Given what we know about beliefs versus logic, the importance of rhetorical framing (i.e., simple versus complex) of a problem, and the specific issues of sex and gender in modern science one can surmise that such aggressive public policy action is based at least in part on the interference of belief with the logical evaluation of empirical evidence on sex and gender.…”

Trends in the youth risk behavior survey: Areas of great concern

“…The disparity in mental wellness among LGBTQ+ youth is increasingly documented (Trevor Project, 2022) particularly among TGD (transgender and gender diverse) youth. A recent review of research notes the consistent reports of high rates of internalizing disorders among TGD youth comparted to cisgender peers (Wittlin et al, 2023). In discussion of these findings, Wittlin and colleagues note that TGD adolescents are an increasingly stigmatized group.…”