Mental Health Disparities among Male, Female, and TGNC Youth with Nonconforming Gender Presentation

• In Event: Attitudes toward and experiences of transgender and gender diverse youth

Abstract

Literature Review: Transgender and gender non-conforming (TGNC) youth are at higher risk for poor mental health than their cisgender peers (e.g., Becerra-Culqui, Liu, Nash, et al., 2017). Among youth who identify as TGNC, category of gender expression (e.g., masculine, feminine, or both) is related to disparities in suicidal behavior, general physical health, and long-term mental health (Toomey, Syvertsen, & Shramko, 2018). Although gender is complex, measures of gender lack nuance, potentially masking the existence of non-conforming groups. The current study examined mental health outcomes for twelve categories of gender, only two of which were fully gender conforming.
Methods: Data came from the 2017 Oregon Healthy Teen Survey (N = 26,747 adolescents in grades 8 and 11). Youth reported gender identity (male, female, and TGNC) and gender presentation (masculine, equally masculine and feminine, feminine, and not sure). Outcomes included items related to general emotional and mental health, depressive symptoms, suicidal ideation, and suicide attempt.
Analytic Plan: All analyses were conducted in SAS Studio (version 3.7). Multiple regression was used to test whether gender identity, gender presentation, and the interaction between them significantly predicted general emotional and mental health, controlling for grade level, free/reduced lunch status, race/ethnicity, SES, and county. Logistic regression was used to test whether gender identity, gender presentation, and their interaction significantly predicted the probability that youth endorsed depressive symptoms, suicidal ideation, or suicide attempt. Odds ratios were calculated with the male/masculine group as the reference.
Results: Among males, 8.9% reported gender non-conforming (i.e., non-masculine) presentation, and 13.3% of females reported gender non-conforming (i.e., non-feminine) presentation. Youth reported TGNC gender identity at a higher rate than any other study with a population-based sample (5.5%). The TGNC/masculine group reported the highest level of general emotional and mental health among TGNC youth, which was higher than both the TGNC/feminine and the TGNC/equal group (p<.001). The TGNC/equal group reported the lowest levels of emotional and mental health (mean=1.9; SD=.14). The fully gender-conforming groups (female/feminine and male/masculine) reported the lowest probabilities of endorsing each outcome, and these levels were significantly lower than gender non-conforming groups. The male/masculine group had the lowest probability of reporting depressive symptoms, suicidal ideation, and suicide attempt, and the TGNC/equal group had the highest probability of endorsing each outcome. The TGNC/masculine group reported the lowest probability among TGNC youth on each of the three outcomes. Compared to the male/masculine group, the TGNC/equal group was 13.5 times more likely to endorse depressive symptoms (95% CI [10.1, 18.1], p<.001), 13.4 times more likely to endorse suicidal ideation (95% CI [10.3, 17.4], p<.001), and 12.3 times more likely to endorse suicide attempt (95% CI [9.2, 16.5], p<.001).
Conclusions: Youth who identify as male or female may also be considered gender non-conforming, a reality visible only with nuanced measurement that includes gender presentation. Future research that disambiguates the measurement of gender identity from presentation will allow for the development of programs and policies that more effectively support the mental health of all youth, especially those whose gender identities remain concealed.

Authors

• Linda Fenske, Oregon State University - Corvallis
  Presenting Author

• Shauna L Tominey, Oregon State University - Corvallis
  Non-Presenting Author

• G. John Geldhof, Oregon State University - Corvallis
  Non-Presenting Author