TOPLINE:

Gender- and sexuality-diverse (GSD) adolescents had substantially higher odds of clinical-level depression and anxiety than their cisgender and heterosexual peers in a new study from Australia.

METHODOLOGY:

• Investigators conducted a cross-sectional analysis of 2019-2022 data from the Future Proofing Study for more than 6000 year-8 students (mean age, 14 years) from 134 Australian secondary schools.
• Depression severity was assessed using the Patient Health Questionnaire for Adolescents, with symptom scores categorized as none, mild-to-moderate, or clinical level.
• Anxiety was evaluated using the Eight-item Spence Children’s Anxiety Scale-Short Form, with symptoms classified as normal or none, elevated or mild-to-moderate, or clinical level based on gender-specific thresholds.
• Primary variables were self-reported gender diversity (94% cisgender and 3% gender-diverse) and sexuality diversity (70% heterosexual, 12% sexuality-diverse, and 9% unsure).

TAKEAWAY:

• Of the total group, 43.5% reported having mild-to-moderate depression and 15% had clinical-level depression; additionally, 15% of adolescents had elevated anxiety and another 15% had clinical-level anxiety).
• GSD vs cisgender and heterosexual adolescents reported higher rates of clinical-level depression (gender-diverse: 59% vs 13%; sexuality-diverse: 43% vs 10%; P < .001 for both) and anxiety (gender-diverse: 49% vs 13%; sexuality-diverse: 35% vs 11%; P < .001 for both).
• Gender-diverse vs cisgender adolescents were more likely to have clinical-level depression (adjusted odds ratio [aOR], 5.7) and anxiety (aOR, 3.5; 95% CI, 2.46-4.95).
• Sexuality-diverse vs heterosexual youth also had higher odds of clinical-level depression and anxiety (aORs, 6.5 and 3.1, respectively).

IN PRACTICE:

The findings underscore “the urgent need for multifaceted mental health interventions and prevention from early adolescence,” the investigators wrote.

“Strategies must address identity-specific stressors and broader risks through bullying prevention, family support, adaptive social media use, improved school climate and connectedness, and accessible health services,” they added.

SOURCE:

This study was led by Sarita Bista, PhD, Children’s Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia. It was published online on December 29 in JAMA Network Open.

LIMITATIONS:

Small absolute numbers of GSD adolescents restricted interaction tests and finer subgroup comparisons and limited the capture of gender diversity — as “unsure” was an option only for sex at birth and not current gender. Most gender-diverse adolescents were also sexuality-diverse, but heterosexual gender-diverse youths were too few for a separate analysis of intersecting diversity.

DISCLOSURES:

The Future Proofing Study was funded by the National Health and Medical Research Council (NHMRC), Ramsay Health, and General Pants Co. Four investigators reported receiving grants from the NHMRC, and five reported receiving grants from the Medical Research Future Fund. Additional disclosures are listed fully in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.