Nonbinary youths report worse depressive symptoms than binary transgender youths
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Key takeaways:
- Nonbinary gender youths have higher scores for internalizing problems than binary transgender youths.
- The likelihood for self-harm is higher for nonbinary than binary youths.
Nonbinary youths report more depression and are more likely to attempt self-harm than binary transgender youths, according to study findings published in LGBT Health.
“Our study suggests that, at least at the time of hormone readiness assessment, nonbinary adolescents are facing higher levels of psychosocial distress and challenges, including depression and self-harm. As such, they likely require more support from the people and systems in their lives, including their families, friends, and providers,” Coleen R. Williams, PsyD, attending, clinical psychologist with the Gender Multispecialty Service at Boston Children’s Hospital and an instructor of psychology at Harvard Medical School, told Healio. “While our research focused on adolescents, this may be true across the lifespan, and providers working with nonbinary individuals of all ages should consider that they may need additional support.”
Williams and colleagues conducted a retrospective study with data from 534 individuals aged 14 to 18 years who attended a gender-affirming care readiness assessment from 2018 to June 2022 and completed the Youth Self-Report to assess psychiatric symptoms. Gender identity was obtained from an electronic medical chart review from 2018 to 2021 and was self-reported by participants who completed the Youth Self Report in 2022. Syndrome scales that were included in the study were total problems, internalizing problems and externalizing problems. Mental health-related scales assessed in the study included anxiety problems, depressive problems and somatic problems. Risk for self-harm and suicidality were determined from responses to individual questions.
Of the study group, 479 youths identified as binary male or binary female and 55 identified as nonbinary. In multivariate analysis adjusted for age and sex assigned at birth, nonbinary youths had higher scores on the internalizing problems (beta = 4.4; 95% CI, 1.39-7.41) and depressive problems scales (beta = 4.24; 95% CI, 1.46-7.02) than binary adolescents. Nonbinary participants were also more likely to report self-harm than binary adolescents (adjusted OR = 2.79; 95% CI, 1.31-5.95). There were no differences for other outcomes in multivariate analysis.
“The experiences of nonbinary people are truly unique to them, and medical and mental health professionals need to consider the ways their experiences are different,” Williams said. “Transgender, nonbinary, and other gender-diverse people are not a homogeneous group.”
When caring for nonbinary people, providers should strive to understand and connect with each person’s needs and experiences, according to Williams. In addition to using a person’s affirmed name and pronouns, Williams said providers should infuse gender-affirming language that recognizes both binary and nonbinary gender-diverse youths into their practice. Williams said providers must also remember that nonbinary people experience higher levels of gender-minority stress and need to think about how to reduce that stress and make their care more inclusive.
Williams added that a lot more studies focusing specifically on nonbinary people are needed.
“I’d love to see more research on factors associated with strength and resiliency for nonbinary individuals to help us support them in healthcare settings,” Williams said. “It would also be wonderful to see research that centers on experiences of euphoria and joy for nonbinary individuals. Honestly, I’d just like to see more transgender health research explicitly consider nonbinary experiences.”
For more information:
Coleen R. Williams, PsyD, can be reached at coleen.williams@childrens.harvard.edu.
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