White James, Trinh Mai-Han, Reynolds Colleen A
Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK; and DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA.
BJPsych Open. 2023 Aug 1;9(5):e138. doi: 10.1192/bjo.2023.534.
Few population-based studies have compared the mental health of gender minority and cisgender adolescents.
To compare reports of psychological distress, behavioural and emotional difficulties, self-harm and suicide attempts between gender minority and cisgender adolescents.
Data came from the Millennium Cohort Study ( = 10 247), a large nationally representative birth cohort in the UK. At a 17-year follow-up, we assessed gender identity, psychological distress (Kessler K6 scale), behavioural and emotional difficulties (parent and child reports on the Strengths and Difficulties Questionnaire), self-harm in the previous year, suicide attempts, substance use, and victimisation including harassment and physical and sexual assaults. Multivariable modified Poisson and linear regression models were used. Attenuation after the inclusion of victimisation and substance use was used to explore mediation.
Of the 10 247 participants, 113 (1.1%) reported that they were a gender minority. Gender minority participants reported more psychological distress (coefficient 5.81, 95% CI 4.87-6.74), behavioural and emotional difficulties (child report: coefficient 5.60; 95% CI 4.54-6.67; parent/carer report: coefficient 2.60; 95% CI 1.47-3.73), self-harm including cutting or stabbing (relative risk (RR) 4.38; 95% CI 3.55-5.40), burning (RR 3.81; 95% CI 2.49-5.82), taking an overdose (RR 5.25; 95% CI 3.35-8.23) and suicide attempts (RR 3.42; 95% CI 2.45-4.78) than cisgender youth. These associations were partially explained by differences in exposure to victimisation.
Gender minority adolescents experience a disproportionate burden of mental health problems. Policies are needed to reduce victimisation and services should be adapted to better support the mental health of gender minority adolescents.
基于人群的研究中，很少有对性别少数群体和顺性别青少年的心理健康状况进行比较的。
比较性别少数群体和顺性别青少年在心理困扰、行为和情绪问题、自我伤害及自杀未遂方面的报告情况。
数据来自千禧队列研究（n = 10247），这是英国一个具有全国代表性的大型出生队列。在17岁随访时，我们评估了性别认同、心理困扰（凯斯勒K6量表）、行为和情绪问题（父母和孩子对长处和困难问卷的报告）、前一年的自我伤害、自杀未遂、物质使用以及包括骚扰、身体和性侵犯在内的受害情况。使用了多变量修正泊松回归模型和线性回归模型。纳入受害情况和物质使用后的衰减用于探索中介作用。
在10247名参与者中，113人（1.1%）报告自己是性别少数群体。与顺性别青少年相比，性别少数群体参与者报告了更多的心理困扰（系数5.81，95%置信区间4.87 - 6.74）、行为和情绪问题（孩子报告：系数5.60；95%置信区间4.54 - 6.67；父母/照顾者报告：系数2.60；95%置信区间1.47 - 3.73）、自我伤害，包括割伤或刺伤（相对风险（RR）4.38；95%置信区间3.55 - 5.40）、烧伤（RR 3.81；95%置信区间2.49 - 5.82）、过量服药（RR 5.25；95%置信区间3.35 - 8.23）以及自杀未遂（RR 3.42；95%置信区间2.45 - 4.78）。这些关联部分可由受害情况暴露的差异来解释。
性别少数群体青少年承受着不成比例的心理健康问题负担。需要制定政策以减少受害情况，并且服务应做出调整，以更好地支持性别少数群体青少年的心理健康。
