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Gender non-conformity in childhood and adolescence and mental health through to adulthood: a longitudinal cohort study, 1995–2018

Published online by Cambridge University Press:  05 July 2023

Simone Mahfouda ,
Murray Maybery Open the ORCID record for Murray Maybery [Opens in a new window] ,
Julia Moore Open the ORCID record for Julia Moore [Opens in a new window] ,
Yael Perry Open the ORCID record for Yael Perry [Opens in a new window] ,
Penelope Strauss Open the ORCID record for Penelope Strauss [Opens in a new window] ,
Florian Zepf  and
Ashleigh Lin
Simone Mahfouda*
Affiliation:
Telethon Kids Institute, Nedlands, Australia
Murray Maybery
Affiliation:
University of Western Australia, Perth, Australia
Julia Moore
Affiliation:
Perth Children's Hospital, Nedlands, Australia
Yael Perry
Affiliation:
Telethon Kids Institute, Nedlands, Australia
Penelope Strauss
Affiliation:
Telethon Kids Institute, Nedlands, Australia
Florian Zepf
Affiliation:
Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany German Center for Mental Health (DZPG) Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
Ashleigh Lin
Affiliation:
Telethon Kids Institute, Nedlands, Australia
*
Corresponding author: Simone Mahfouda; Email: simone.mahfouda@telethonkids.org.au
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Abstract

Background

Few studies have examined associations between gender non-conformity (GNC) in childhood or adolescence and mental health outcomes later in life. This study examined associations between (1) GNC and mental health over multiple time points in childhood and adolescence, and (2) GNC in childhood and/or adolescence and mental health in adulthood.

Method

Second generation participants from the Raine Study, a longitudinal cohort from Perth, Western Australia. Data were collected between 1995 and 2018, comprising seven waves: ages 5 (N = 2236), 8 (N = 2140), 10 (N = 2048), 14 (N = 1864), 17 (N = 1726), 22 (N = 1236) and 27 (N = 1190) years. History of GNC, v. absence of this history, was based on responses to item 110 from the Child Behaviour Checklist (CBCL)/Youth Self Report (YSR) (‘wishes to be of opposite sex’). The CBCL/YSR were used to measure internalising and externalising symptoms. Items 18 (‘deliberate self-harm [DSH] or attempts suicide’) and 91 (‘talks/thinks about killing self’) were used as measures of suicidal ideation (SI) and DSH. For adults, Depression, Anxiety and Stress Subscales and Kessler Psychological Distress Scale assessed mental health.

Results

Child and adolescent GNC was associated with elevated internalising and externalising behaviours and increased odds of DSH. A history of GNC was also associated with vulnerability for severe psychological distress in adulthood in some symptom scales.

Conclusion

GNC over the child and adolescent period is associated with significant emotional and behavioural difficulties, and psychological distress. A history of GNC in childhood and/or adolescence also predicts poorer mental health in adulthood on multiple symptom domains.

Keywords

Gender non-conforminglongitudinalmental healththe Raine Studytrans
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 16 , December 2023 , pp. 7756 - 7765
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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References

Achenbach, T. M. (1991). Manual for the youth self-report and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M., Mcconaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101(2), 213.CrossRefGoogle ScholarPubMed
Achenbach, T. M., & Ruffle, T. M. (2000). The child behavior checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatrics in Review, 21(8), 265–271.CrossRefGoogle ScholarPubMed
Aitken, M., Vanderlaan, D. P., Wasserman, L., Stojanovski, S., & Zucker, K. J. (2016). Self-harm and suicidality in children referred for gender dysphoria. Journal of the American Academy of Child and Adolescent Psychiatry, 55(6), 513–520.CrossRefGoogle ScholarPubMed
Becerra-Culqui, T. A., Liu, Y., Nash, R., Cromwell, L., Flanders, W. D., Getahun, D., … Millman, A. (2018). Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics, 141(5), e20173845.CrossRefGoogle ScholarPubMed
Bennett, D. S., Borczon, E., & Lewis, M. (2019). Does gender nonconforming behavior in early childhood predict adolescents’ depressive symptoms? Sex Roles, 81(7), 521–528.CrossRefGoogle ScholarPubMed
Calzo, J. P., & Blashill, A. J. (2018). Child sexual orientation and gender identity in the adolescent brain cognitive development cohort study. Jama Pediatrics, 172(11), 1090–1092.CrossRefGoogle ScholarPubMed
Chen, D., Tishelman, A., Edwards-Leeper, L., & Stancin, T. (2019). Introduction: Advancing the practice of pediatric psychology with transgender youth. Clinical Practice in Pediatric Psychology, 7(3), 211.CrossRefGoogle Scholar
Chodzen, G., Hidalgo, M. A., Chen, D., & Garofalo, R. (2019). Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. Journal of Adolescent Health, 64(4), 467–471.CrossRefGoogle ScholarPubMed
Cohen-Kettenis, P. T., Owen, A., Kaijser, V. G., Bradley, S. J., & Zucker, K. J. (2003). Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. Journal of Abnormal Child Psychology, 31(1), 41–53.CrossRefGoogle ScholarPubMed
De Graaf, N. M., Cohen-Kettenis, P. T., Carmichael, P., De Vries, A. L., Dhondt, K., Laridaen, J., … Steensma, T. D. (2018). Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: A clinical comparison study between four clinics. European Child and Adolescent Psychiatry, 27(7), 909–919.CrossRefGoogle ScholarPubMed
De Graaf, N. M., Steensma, T. D., Carmichael, P., Vanderlaan, D. P., Aitken, M., Cohen-Kettenis, P. T., … Zucker, K. J. (2020). Suicidality in clinic-referred transgender adolescents. European Child and Adolescent Psychiatry, 31, 1–17.Google ScholarPubMed
De Vries, A. L., Steensma, T. D., Cohen-Kettenis, P. T., Vanderlaan, D. P., & Zucker, K. J. (2016). Poor peer relations predict parent-and self-reported behavioral and emotional problems of adolescents with gender dysphoria: A cross-national, cross-clinic comparative analysis. European Child and Adolescent Psychiatry, 25(6), 579–588.CrossRefGoogle ScholarPubMed
Diamond, L. M. (2020). Gender fluidity and nonbinary gender identities among children and adolescents. Child Development Perspectives, 14(2), 110–115.CrossRefGoogle Scholar
Drummond, K. D., Bradley, S. J., Peterson-Badali, M., Vanderlaan, D. P., & Zucker, K. J. (2018). Behavior problems and psychiatric diagnoses in girls with gender identity disorder: A follow-up study. Journal of Sex and Marital Therapy, 44(2), 172–187.CrossRefGoogle ScholarPubMed
Eisenberg, M. E., Gower, A. L., Mcmorris, B. J., Rider, G. N., Shea, G., & Coleman, E. (2017). Risk and protective factors in the lives of transgender/gender nonconforming adolescents. Journal of Adolescent Health, 61(4), 521–526.CrossRefGoogle ScholarPubMed
Foley, D. L., Goldston, D. B., Costello, E. J., & Angold, A. (2006). Proximal psychiatric risk factors for suicidality in youth: The great smoky mountains study. Archives of General Psychiatry, 63(9), 1017–1024.CrossRefGoogle ScholarPubMed
Hammond, C. (2003). How education makes us healthy. London Review of Education, 1(1), 61–78.CrossRefGoogle Scholar
Henderson, E. R., Blosnich, J. R., Herman, J. L., & Meyer, I. H. (2019). Considerations on sampling in transgender health disparities research. Lgbt Health, 6(6), 267–270.CrossRefGoogle ScholarPubMed
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the depression anxiety stress scales (Dass-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239.CrossRefGoogle Scholar
Holt, V., Skagerberg, E., & Dunsford, M. (2016). Young people with features of gender dysphoria: Demographics and associated difficulties. Clinical Child Psycholology and Psychiatry, 21(1), 108–118.CrossRefGoogle ScholarPubMed
Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 9, 31.CrossRefGoogle ScholarPubMed
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, , S. L., … Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The Phq-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.CrossRefGoogle ScholarPubMed
Liang, K.-Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73(1), 13–22.CrossRefGoogle Scholar
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (Dass) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343.CrossRefGoogle ScholarPubMed
Macmullin, L. N., Aitken, M., Nabbijohn, A. N., & Vanderlaan, D. P. (2019). Self-harm and suicidality in gender-nonconforming children: A Canadian community-based parent-report study. Psychology of Sexual Orientation and Gender Diversity, 7(1), 76–90.CrossRefGoogle Scholar
Mak, J., Shires, D. A., Zhang, Q., Prieto, L. R., Ahmedani, B. K., Kattari, L., … Goodman, M. (2020). Suicide attempts among a cohort of transgender and gender diverse people. American Journal of Preventive Medicine, 59(4), 570–577.CrossRefGoogle ScholarPubMed
Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006). Validity of the brief patient health questionnaire mood scale (Phq-9) in the general population. General Hospital Psychiatry, 28(1), 71–77.CrossRefGoogle ScholarPubMed
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674.CrossRefGoogle ScholarPubMed
Newnham, J. P., Evans, S. F., Michael, C. A., Stanley, F. J., & Landau, L. (1993). Effects of frequent ultrasound during pregnancy: A randomised controlled trial. The Lancet, 342(8876), 887–891.CrossRefGoogle ScholarPubMed
Nock, M. K., Green, J. G., Hwang, I., Mclaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., … Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. Jama Psychiatry, 70(3), 300–310.CrossRefGoogle ScholarPubMed
Nolan, I. T., Kuhner, C. J., & Dy, G. W. (2019). Demographic and temporal trends in transgender identities and gender confirming surgery. Translational Andrology and Urology, 8(3), 184.CrossRefGoogle ScholarPubMed
Olson, J., Schrager, S. M., Belzer, M., Simons, L. K., & Clark, L. F. (2015). Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. Journal of Adolescent Health, 57(4), 374–380.CrossRefGoogle ScholarPubMed
Olson, K. R., Durwood, L., Demeules, M., & Mclaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223.CrossRefGoogle ScholarPubMed
Peterson, C. M., Matthews, A., Copps-Smith, E., & Conard, L. A. (2017). Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suicide and Life-Threatening Behavior, 47(4), 475–482.CrossRefGoogle ScholarPubMed
Rabasco, A., & Andover, M. (2020). Suicidal ideation among transgender and gender diverse adults: A longitudinal study of risk and protective factors. Journal of Affective Disorders, 278, 136–143.CrossRefGoogle ScholarPubMed
Reilly, M., Desousa, V., Garza-Flores, A., & Perrin, E. C. (2019). Young children with gender nonconforming behaviors and preferences. Journal of Developmental and Behavioral Pediatrics, 40(1), 60–71.CrossRefGoogle ScholarPubMed
Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, , E., … Baral, S. D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388(10042), 412–436.CrossRefGoogle ScholarPubMed
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science and Medicine, 90, 24–31.CrossRefGoogle ScholarPubMed
Roberts, A. L., Rosario, M., Slopen, N., Calzo, J. P., & Austin, S. B. (2013). Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: An 11–year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 52(2), 143–152.CrossRefGoogle ScholarPubMed
Robles, R., Fresán, A., Vega-Ramírez, H., Cruz-Islas, J., Rodríguez-Pérez, V., Domínguez-Martínez, T., & Reed, G. M. (2016). Removing transgender identity from the classification of mental disorders: A Mexican field study for Icd-11. The Lancet Psychiatry, 3(9), 850–859.CrossRefGoogle ScholarPubMed
Rogers, A., Delay, D., & Martin, C. L. (2017). Traditional masculinity during the middle school transition: Associations with depressive symptoms and academic engagement. Journal of Youth and Adolescence, 46(4), 709–724.CrossRefGoogle ScholarPubMed
Rood, B. A., Reisner, S. L., Surace, F. I., Puckett, J. A., Maroney, M. R., & Pantalone, D. W. (2016). Expecting rejection: Understanding the minority stress experiences of transgender and gender-nonconforming individuals. Transgender Health, 1(1), 151–164.CrossRefGoogle ScholarPubMed
Ruble, D. N., Taylor, L. J., Cyphers, L., Greulich, F. K., Lurye, L. E., & Shrout, P. E. (2007). The role of gender constancy in early gender development. Child Development, 78(4), 1121–1136.CrossRefGoogle ScholarPubMed
Salbach-Andrae, H., Lenz, K., & Lehmkuhl, U. (2009). Patterns of agreement among parent, teacher and youth ratings in a referred sample. European Psychiatry, 24(5), 345–351.CrossRefGoogle Scholar
Selkie, E. (2018). Gender diversity and adolescent well-being. Jama Pediatrics, 172(11), 1010–1011.CrossRefGoogle ScholarPubMed
Simon, G. E., Coleman, K. J., Rossom, R. C., Beck, A., Oliver, M., Johnson, E., … Rutter, C. (2016). Risk of suicide attempt and suicide death following completion of the patient health questionnaire depression module in community practice. The Journal of Clinical Psychiatry, 77(2), 221.CrossRefGoogle ScholarPubMed
Simon, G. E., Rutter, C. M., Peterson, D., Oliver, M., Whiteside, U., Operskalski, B., & Ludman, E. J. (2013). Does response on the Phq-9 depression questionnaire predict subsequent suicide attempt or suicide death? Psychiatric Services, 64(12), 1195–1202.CrossRefGoogle ScholarPubMed
Sinclair, S. J., Siefert, C. J., Slavin-Mulford, J. M., Stein, M. B., Renna, M., & Blais, M. A. (2012). Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (Dass-21) in a nonclinical sample of us adults. Evaluation and the Health Professions, 35(3), 259–279.CrossRefGoogle Scholar
Spivey, L. A., & Prinstein, M. J. (2018). A preliminary examination of the association between adolescent gender nonconformity and suicidal thoughts and behaviors. Journal of Abnormal Child Psychology, 47, 707–716.CrossRefGoogle Scholar
Steensma, T. D., Mcguire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52(6), 582–590.CrossRefGoogle ScholarPubMed
Straker, L., Mountain, J., Jacques, A., White, S., Smith, A., Landau, L., … Eastwood, P. (2017). Cohort profile: The western Australian pregnancy cohort (Raine) study–generation 2. International Journal of Epidemiology, 46(5), 1384–1385.Google ScholarPubMed
Strang, J. F., Kenworthy, L., Dominska, A., Sokoloff, J., Kenealy, L. E., Berl, M., … Wallace, G. L. (2014). Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Archives of Sexual Behavior, 43(8), 1525–1533.CrossRefGoogle ScholarPubMed
Strauss, P., Cook, A., Winter, S., Watson, V., Toussaint, D. W., & Lin, A. (2020). Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: Findings from trans pathways. Psychological Medicine, 50(5), 808–817.CrossRefGoogle ScholarPubMed
Tabaac, A., Gordon, A., Reisner, S., Austin, S. B., & Charlton, B. (2019). Gender Identity In Longitudinal Research: Addressing Changes In Self-Reported Gender Identity In The Growing Up Today Study. Paper Presented At The Apha's 2019 Annual Meeting And Expo (Nov. 2–Nov. 6).Google Scholar
Tankersley, A. P., Grafsky, E. L., Dike, J., & Jones, R. T. (2021). Risk and resilience factors for mental health among transgender and gender nonconforming (Tgnc) youth: A systematic review. Clinical Child and Family Psychology Review, 24, 183–206.CrossRefGoogle ScholarPubMed
Turban, J. L., & Ehrensaft, D. (2018). Research review: Gender identity in youth: Treatment paradigms and controversies. Journal of Child Psychology and Psychiatry, 59(12), 1228–1243.CrossRefGoogle ScholarPubMed
Van Der Miesen, A. I., Nabbijohn, A. N., Santarossa, A., & Vanderlaan, D. P. (2018). Behavioral and emotional problems in gender-nonconforming children: A Canadian community-based study. Journal of the American Academy of Child and Adolescent Psychiatry, 57(7), 491–499.CrossRefGoogle ScholarPubMed
Verhulst, F. C., & Van Der Ende, J. (1992). Agreement between parents’ reports and adolescents’ self-reports of problem behavior. Journal of Child Psychology and Psychiatry, 33(6), 1011–1023.CrossRefGoogle ScholarPubMed
Wang, Y., Yu, H., Yang, Y., Drescher, J., Li, R., Yin, W., … Chen, R. (2020). Mental health status of cisgender and gender-diverse secondary school students in China. Jama Network Open, 3(10), E2022796. doi:10.1001/Jamanetworkopen.2020.22796.CrossRefGoogle ScholarPubMed
Zucker, K. J., Wood, H., & VanderLaan, D. P. (2014). Models of psychopathology in children and adolescents with gender dysphoria. In B. P. C. Kruekals, T. D. Steensma & A. L. C. de Vries (Eds.), Gender dysphoria and disorders of Sex development (pp. 171–192). New York: Springer.CrossRefGoogle Scholar
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