Social Exclusion and Mental Health Among Trans-Identified Adolescents: Results from a Representative Sample

Background/Purpose: A growing number of studies indicate trans-identified individuals experience various forms of discrimination and victimization due to their gender minority status, and that these experiences are correlated with psychological distress. Trans-identified youth are significantly more likely than their cisgender peers to experience mistreatment in their homes, schools, and communities, and are more likely to report associated mental health problems such as depressive symptoms and suicidality. Despite this knowledge, little is known about how other contextual factors related to social exclusion, such as gaps in resources/supports and disconnectedness, may be linked to the mental health challenges of trans-identified youth, or how these experiences compare to their cisgender peers. This study compares the self-reported experiences of mental health problems between trans-identified and cisgender adolescents, and identifies the degree to which various indicators of social exclusion are associated with these experiences.

Methods:  Our study used data from the Dane County Youth Assessment, a county representative sample of approximately 12,000 high school students surveyed in a Midwestern state at regular 5-year intervals. Exploratory analyses were conducted using descriptive statistics, correlations, mean differences tests, and a series of ordinary least squares (OLS) and logistic regressions to assess differences in the social exclusion experiences (e.g. parental support, school connection, neighborhood connection, experiences of harassment, and social activity involvement) and mental health problems (e.g. self-reported long-term mental health problems, current anxiety symptoms, depressive symptoms, suicidality and self-harm, self-esteem, and current mental health treatment) of transgender and cisgender youth.

Results: Trans-identified adolescents reported multiple forms of social exclusion, including lower levels of parental, school, and neighborhood support and greater experiences of harassment. High levels of long-term mental health problems (depression, anxiety, eating disorders) were indicated, as trans youth were nearly twice as likely to report past-month suicidal ideation, five times more likely to report a past-year suicide attempt, and four times more likely to report past-year self-harm than cisgender adolescents. Results also revealed that transgender status was positively associated with current anxiety symptoms and negatively associated with self-esteem, controlling for all covariates. In addition, while experiences with social exclusion accounted for differences in anxiety and self-esteem symptoms between trans and cisgender adolescents, they did not fully account for differences in mental health problems that suggest more severe concerns. Specifically, trans-identified adolescents remained twice as likely to report a long-term eating disorder, past-year suicide attempt or past-year self-harm, and three times more likely to report past-month suicidal ideation than their cisgender peers, accounting for all variables related to social exclusion.

Conclusions/Implications:This study reiterates prior research findings linking transgender identity and psychological distress, and provides new information about trans-identified adolescents experiences with social exclusion across a variety of domains. Results indicate that while mental health disparities between transgender and cisgender adolescents may be partially explained by experiences of social exclusion, disparities related to more severe mental health outcomes remain. Findings also suggest the need to develop social protection and inclusion policies/practices that help to support trans-identified youth, and to ensure access to high-quality, trans-informed adolescent mental health care.