Mental distress, substance use rampant among gender-nonconforming youth
Gender nonconformity in high school students is associated with mental distress and substance use, according to a recent study.
“Developing support systems within schools for gender-nonconforming students may be an important avenue to improving mental health and reducing substance use in this population. Providing safe spaces and school staff contacts who are knowledgeable and supportive of gender-nonconforming youths may also help to buffer stresses of the school environment,” said researchers.
Using a validated measure, researchers assessed gender expression in 6,082 high school students (50 percent female), of whom majority (87.6 percent) identified as heterosexual. The remaining participants identified as gay or lesbian (2.5 percent), bisexual (5.6 percent), or were unsure (4.3 percent). [JAMA Pediatr 2018;doi:10.1001/jamapediatrics.2018.2140]
High gender nonconformity was observed in only 8.4 percent of the total sample and was more prevalent in males than in females (13 percent vs 4 percent). While the trends varied greatly according to sex, ethnicity and sexual identity, there was a trend toward decreasing gender nonconformity with increasing grade. Most of the participants demonstrated low gender nonconformity (79.7 percent).
When taken as a continuous variable, gender nonconformity showed strong and direct associations with feelings of sadness and hopelessness in both males and females, as did suicidal thoughts. While the correlation of gender nonconformity with suicidality was linear, that with hopelessness and sadness peaked near the middle of the nonconformity scale.
This was further confirmed in categorical analyses, which showed that female students with moderate vs low gender nonconformity were significantly more likely to feel sad and hopeless (adjusted prevalence ratio [APR], 1.22; 95 percent CI, 1.05–1.41), seriously consider attempting suicide (APR, 1.41; 1.14–1.74), and make a suicide plan (APR, 1.52; 1.22–1.89; p<0.05 for all).
Moderate gender nonconformity resulted in similar levels of sadness and hopelessness in males (APR, 1.55; 1.25–1.92; p<0.05), but greater suicidal ideation and behaviours (seriously considering attempting suicide: APR, 1.72; 1.16–2.56; making a suicide plan: APR, 1.79; 1.17–2.73; attempting suicide: APR, 2.78; 1.75–4.40; p<0.05 for all) were instead associated with a high degree of gender nonconformity.
Gender nonconformity also influenced substance use patterns. In females, only alcohol consumption patterns were significantly affected by high vs moderate gender nonconformity (APR, 1.37; 0.94–2.02; p<0.05).
However, high vs low gender nonconformity in males was associated with significant elevations in the nonmedical use of prescription drugs (APR, 1.81; 1.23–2.67), cocaine (APR, 2.84; 1.80–4.47), methamphetamine (APR, 4.52; 2.68–7.61), heroin (APR, 4.59; 2.48–8.47) and injection drugs (APR, 8.05; 4.41–14.70; p<0.05 for all).
“Female students reporting high gender nonconformity may be less (or no more) likely to report suicidal thoughts than more gender-conforming female students in part because of the association between masculinity and a reticence to report mental health symptoms,” explained researchers.
“Conversely, male students reporting greater gender nonconformity may be more likely to disclose suicidal thoughts and attempts than male students who conform more strongly to conventional masculinity norms in part because they are not inhibited by masculine conventions that equate sharing mental distress with weakness.”
In the present study, researchers utilized a 7-point gender nonconformity scale, which was then used to categorize participants based on their scores in the aforementioned measure: lower scores indicated higher levels of gender conformity.
“School staff may benefit from professional development on gender diversity to support students who are gender nonconforming more competently. Health education that is inclusive of discussions about gender and the variety of ways that it is expressed may be useful to decrease stigma for gender nonconforming youths,” said researchers.