Depression not increased by gender identity changes in adolescents

Though gender identity is susceptible to change among youths who identify as a sexual and gender minority (SGM), such changes are not associated with change in depressive symptoms, according to new data.

A new study from a team of multinational investigators published in JAMA Network Open show approximately 1 in 5 SGM youths aged 15 - 21 years old reported a gender identity change of time. Though SGM youths generally reported higher levels of depressive symptoms at baseline, instances of gender identity change were not linked to increases nor change in such symptoms. The findings warrant further research into the impact of gender identity variability and overall adolescent and adult health.

Led by Andre Gonzales Real, MD, MSc, of the department of human development and family sciences at The University of Texas of Austin, investigators sought to examine the frequency of self-reported gender identity changes in a longitudinal sample of SGM youths, and whether gender identity changes were linked to their depressive symptoms. For a significantly majority of the population, gender identity is a stable aspect of the self, investigators wrote; it remains less understood how changes to it impacts an individual over time.

“The current study assesses trajectories of gender identity in youths from a community-based sample, aged 15 to 21 years, over 4 assessment points, examining variability or changes in gender identity over time,” Real and colleagues wrote. “Given that TGD youths often seek hormone therapy to treat gender dysphoriaand because exposure to lesbian, gay, bisexual, and transgender (LGBT) violence is associated with the mental health of TGD youths, our analyses account for hormone and puberty blocker use and exposure to LGBT violence.”

Investigators conducted the cohort analysis through a quarter of 9-month waves from a longitudinal community-based trial across 2 large cities in the US between November 11 - June 2015. Included participants were youths who self-identified as SGM from community-based agencies and college groups designated for SGM youth members.

The analysis used the Beck Depression Inventory for Youth (BDI-Y) to interpret depressive symptoms in participants, while gender identity variability was measured as the number of times participants’ gender identity changed. Gender identity trajectories and the potential association between variability and depressive symptoms over time were interpreted by hierarchical linear models.

The participant pool included 366 SGM youths; mean participant age was 18.61 years old, and 49.4% were assigned male sex at birth.

Investigators identified 4 trajectories of gender identity among the population: cisgender across all 4 waves (n = 274); transgender or gender diverse (TGD) across all waves (n = 32); initially cisgender but TGD by wave 4 (n = 28); and initially TGD but cisgender by wave 4 (n = 32).

The team noted that 18.3% of trial participants reported a different gender identity over a period of approximately 3.5 years. Another 28 (7.7%) participants transitioned >2 times.

While patients who transitioned from cisgender to TGD reported greater levels of depression compared to the cisgender group at baseline (P = .03), there was no statistically significant difference once exposure to lesbian, gay, bisexual and transgender violence was taken into account.

Indeed, the team found gender identity variability was not associated with an individual change in depressive symptoms, nor the level of depressive symptoms based on BDI-Y (P = .33).

“These findings differ from clinical samples where the majority of TGD youths consistently identified as TGD, but complement recent longitudinal work revealing that while gender identity is stable for the majority of youths, shifts in gender identity are not uncommon and should not be considered abnormal,” investigators wrote. “Our findings empirically support the idea that gender identity can be fluid or in development for some youths.”

Real and colleagues concluded their findings suggest a pattern of common and normal gender identity exploration among some youths in adolescent development; an acknowledgement of their trend by health care clinicians can help to support against risk of increased or new depression or anxiety that a TGD youth may be susceptible to due to LGBTQ-related violence or stigma.

“Health care clinicians should pay particular attention to youths transitioning to TGD identities; additional support in this process can help mitigate the adverse effects of exposure to LGBT violence from peers or family rejection,” investigators wrote. “Moreover, delays in providing care can result in more stress for these youth.”

References

^{Gonzales Real A, Lobato MIR, Russell ST. Trajectories of Gender Identity and Depressive Symptoms in Youths. JAMA Netw Open. 2024;7(5):e2411322. doi:10.1001/jamanetworkopen.2024.11322}