National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.
Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom.
JAMA Netw Open. 2020 Oct 1;3(10):e2022796. doi: 10.1001/jamanetworkopen.2020.22796.
Transgender or gender nonconforming (TGNC) adolescents face a wide range of physical and mental health concerns. However, there has been no school-based study to explore the prevalence and mental health status of these adolescents in mainland China.
To assess the mental well-being of TGNC adolescents in China by comparing them with their cisgender peers.
DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional survey study. Of the 12 354 adolescents who completed the questionnaire, 246 did not specify to which sex they identified and were therefore excluded from further analysis. Therefore, a total of 12 108 adolescents were included from 18 secondary schools in Suzhou city, China, from June 2019 to July 2019. Participants provided consent and answered questions on sex assigned at birth and gender identity.
All participants completed questionnaires, including the Patient Health Questionnaire for the measurement of depressive symptoms, a generalized anxiety disorder screening, the Pittsburgh Sleep Quality Index, and a self-harm and suicide risk checklist. The frequency of being bullied at school was also measured. Participants who reported their perceived gender as the opposite of their assigned sex at birth were classified as transgender, those who identified as neither male nor female were classified as nonbinary, and those who were not sure about their perceived gender were classified as questioning. All of these participants were categorized as TGNC adolescents.
A total of 12 108 adolescents (mean [SD] age, 15.8 [1.0] years; 6518 [53.8%] assigned male at birth [AMAB]) participated in the study. Of the 6518 participants AMAB in the sample, 5855 (89.8%) were classified as cisgender boys, 208 (3.2%) as transgender girls (transgender youth who perceive their current gender identity to be female), 138 (2.1%) as nonbinary youth AMAB, and 317 (4.9%) as questioning youth AMAB. Of the 5590 participants assigned female at birth (AFAB), 4142 (74.1%) were classified as cisgender girls, 861 (15.4%) as transgender boys (transgender youth who perceive their current gender identity to be male), 112 (2.0%) as nonbinary youth AFAB, and 475 (8.5%) as questioning youth AFAB. Compared with cisgender adolescents, TGNC adolescents reported significantly higher health concerns including lower overall health (t11 872 = -7.36; P < .001), poorer sleep (t11 683 = 10.49; P < .001), higher depression and anxiety symptoms (t11 830 = 12.43 and t11 847 = 11.47, respectively; P < .001), and higher rate of self-harm and suicide ideation (t11 860 = 12.22; P < .001). The TGNC youth who were AMAB were also more likely to be bullied at school than cisgender boys (transgender girls: odds ratio [OR], 2.34 [95% CI, 1.64-3.33]; nonbinary youth AMAB: OR, 1.97 [95% CI, 1.23-3.16]; and questioning youth AMAB: OR, 1.95 [95% CI, 1.43-2.67]). The TGNC groups also reported significantly greater amounts of thoughts of self-harm (transgender girls: OR, 3.06 [95% CI, 2.24-4.19]; transgender boys: OR, 4.06 [95% CI, 3.47-4.74]; nonbinary youth AMAB: OR, 2.86 [95% CI, 1.93-4.23]; nonbinary youth AFAB: OR, 3.71 [95% CI, 2.46-5.59]; questioning youth AMAB: OR, 2.61 [95% CI, 1.98-3.44]; and questioning youth AFAB: OR, 3.35 [95% CI, 2.70-4.16]), thoughts of suicide (transgender girls: OR, 3.93 [95% CI, 2.88-5.38]; transgender boys: OR, 3.71 [95% CI, 3.10-4.21]; nonbinary youth AMAB: OR, 3.13 [95% CI, 2.11-4.63]; nonbinary youth AFAB: OR, 3.78 [95% CI, 2.50-5.71]; questioning youth AMAB: OR, 2.53 [95% CI, 1.93-3.33]; and questioning youth AFAB: OR, 3.94 [95% CI, 3.17-4.88]), suicide plan formation (transgender girls: OR, 4.44 [95% CI, 2.88-6.83]; transgender boys: OR, 2.66 [95% CI, 2.03-3.50]; nonbinary youth AMAB: OR, 5.36 [95% CI, 3.22-8.93]; nonbinary youth AFAB: OR, 4.06 [95% CI, 2.25-7.30]; and questioning youth AFAB: OR, 2.36 [95% CI, 1.63-3.43]), deliberate self-harm during the last month (cisgender girls: OR, 1.49 [95% CI, 1.33-1.68]; transgender girls: OR, 2.74 [95% CI, 1.93-3.91]; transgender boys: OR, 3.06 [95% CI, 2.57-3.66]; nonbinary youth AMAB: OR, 2.56 [95% CI, 1.66-3.94]; nonbinary youth AFAB: OR, 3.06 [95% CI, 1.95-4.81]; questioning youth AMAB: OR, 2.14 [95% CI, 1.56-2.92]; and questioning youth AFAB: OR, 2.53 [95% CI, 2.00-3.01]), and attempts of suicide (transgender girls: OR, 4.35 [95% CI, 2.88-6.56]; transgender boys: OR, 2.92 [95% CI, 2.26-3.76]; nonbinary youth AMAB: OR, 3.94 [95% CI, 2.36-6.55]; nonbinary youth AFAB: OR, 3.06 [95% CI, 1.67-5.63]; questioning youth AMAB: OR, 2.61 [95% CI, 1.73-3.94]; and questioning youth AFAB: OR, 1.93 [95% CI, 1.33-2.81]) compared with cisgender boys.
Results of this cross-sectional survey study suggest poor mental health status among TGNC adolescents in China; in addition, findings suggest a compelling need for researchers, practitioners, and policy makers to address these mental health problems. Particular school-based interventions are recommended to support the mental health well-being of TGNC adolescents.
transgender 或性别不一致（TGNC）青少年面临广泛的身心健康问题。然而，在中国内地，还没有基于学校的研究来探索这些青少年的患病率和心理健康状况。
通过与顺性别同龄人进行比较，评估中国 TGNC 青少年的心理健康状况。
设计、地点和参与者：这是一项横断面调查研究。在完成问卷的 12108 名青少年中，有 246 名未指定他们认同的性别，因此被排除在进一步分析之外。因此，共有 12108 名来自中国苏州 18 所中学的青少年参与了 2019 年 6 月至 7 月期间的研究。参与者同意并回答了出生时分配的性别和性别认同问题。
所有参与者都完成了问卷，包括用于测量抑郁症状的患者健康问卷、广泛性焦虑障碍筛查、匹兹堡睡眠质量指数以及自我伤害和自杀风险检查表。还测量了在校被欺凌的频率。报告自己的性别与出生时分配的性别相反的参与者被归类为跨性别者，那些自我认同为非男非女的被归类为非二元性别者，那些不确定自己的性别认同的被归类为性别疑问者。所有这些参与者都被归类为 TGNC 青少年。
共有 12108 名青少年（平均[标准差]年龄 15.8[1.0]岁；6518 名[53.8%]分配为男性）参与了研究。在样本中，6518 名 AMAB 参与者中，5855 名（89.8%）被归类为顺性别男孩，208 名（3.2%）被归类为跨性别女孩（跨性别者认为自己目前的性别认同为女性），138 名（2.1%）被归类为非二元性别者 AMAB，317 名（4.9%）被归类为性别疑问者 AMAB。在 5590 名出生时分配为女性的参与者中（AFAB），4142 名（74.1%）被归类为顺性别女孩，861 名（15.4%）被归类为跨性别男孩（跨性别者认为自己目前的性别认同为男性），112 名（2.0%）被归类为非二元性别者 AFAB，475 名（8.5%）被归类为性别疑问者 AFAB。与顺性别青少年相比，TGNC 青少年报告了更高的健康问题，包括整体健康状况较差（t11872=-7.36；P<0.001）、睡眠质量更差（t11683=10.49；P<0.001）、抑郁和焦虑症状更严重（t11830=12.43 和 t11847=11.47，P<0.001），以及更高的自我伤害和自杀意念率（t11860=12.22；P<0.001）。跨性别男性青少年也比顺性别男孩更有可能在学校受到欺凌（跨性别女孩：比值比[OR]，2.34[95%可信区间[CI]，1.64-3.33]；非二元性别者 AMAB：OR，1.97[95%CI，1.23-3.16]；性别疑问者 AMAB：OR，1.95[95%CI，1.43-2.67]）。TGNC 群体还报告了更高的自杀念头（跨性别女孩：OR，3.06[95%CI，2.24-4.19]；跨性别男孩：OR，4.06[95%CI，3.47-4.74]；非二元性别者 AMAB：OR，2.86[95%CI，1.93-4.23]；非二元性别者 AFAB：OR，3.71[95%CI，2.46-5.59]；性别疑问者 AMAB：OR，2.61[95%CI，1.98-3.44]；性别疑问者 AFAB：OR，3.35[95%CI，2.70-4.16]），自杀念头（跨性别女孩：OR，3.93[95%CI，2.88-5.38]；跨性别男孩：OR，3.71[95%CI，3.10-4.21]；非二元性别者 AMAB：OR，3.13[95%CI，2.11-4.63]；非二元性别者 AFAB：OR，3.78[95%CI，2.50-5.71]；性别疑问者 AMAB：OR，2.53[95%CI，1.93-3.33]；性别疑问者 AFAB：OR，3.94[95%CI，3.17-4.88]），自杀计划形成（跨性别女孩：OR，4.44[95%CI，2.88-6.83]；跨性别男孩：OR，2.66[95%CI，2.03-3.50]；非二元性别者 AMAB：OR，5.36[95%CI，3.22-8.93]；非二元性别者 AFAB：OR，4.06[95%CI，2.25-7.30]；性别疑问者 AFAB：OR，2.36[95%CI，1.63-3.43]），以及过去一个月的故意自我伤害（顺性别女孩：OR，1.49[95%CI，1.33-1.68]；跨性别女孩：OR，2.74[95%CI，1.93-3.91]；跨性别男孩：OR，3.06[95%CI，2.57-3.66]；非二元性别者 AMAB：OR，2.56[95%CI，1.66-3.94]；非二元性别者 AFAB：OR，3.06[95%CI，1.95-4.81]；性别疑问者 AMAB：OR，2.14[95%CI，1.56-2.92]；性别疑问者 AFAB：OR，2.53[95%CI，2.00-3.01]），以及自杀企图（跨性别女孩：OR，4.35[95%CI，2.88-6.56]；跨性别男孩：OR，2.92[95%CI，2.26-3.76]；非二元性别者 AMAB：OR，3.94[95%CI，2.36-6.55]；非二元性别者 AFAB：OR，3.06[95%CI，1.67-5.63]；性别疑问者 AMAB：OR，2.61[95%CI，1.73-3.94]；性别疑问者 AFAB：OR，1.93[95%CI，1.33-2.81]）相比，顺性别男孩。
这项横断面调查研究的结果表明，中国 TGNC 青少年的心理健康状况较差；此外，研究结果表明，研究人员、从业者和政策制定者迫切需要解决这些心理健康问题。建议采取特定的基于学校的干预措施，以支持 TGNC 青少年的心理健康。
