Department of Human Development and Family Sciences, The University of Texas at Austin.
Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
JAMA Netw Open. 2024 May 1;7(5):e2411322. doi: 10.1001/jamanetworkopen.2024.11322.
Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to understand how transitions in self-reported gender identity are associated with mental health.
To examine whether and how often youths changed self-reported gender identities in a longitudinal sample of sexual and gender minority (SGM) youths, and whether trajectories of gender identity were associated with depressive symptoms.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from 4 waves (every 9 months) of a longitudinal community-based study collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) between November 2011 and June 2015. Eligible participants included youths who self-identified as SGM from community-based agencies and college groups for SGM youths. Data analysis occurred from September 2022 to June 2023.
Gender identity trajectories and gender identity variability.
The Beck Depression Inventory for Youth (BDI-Y) assessed depressive symptoms. Gender identity variability was measured as the number of times participants' gender identity changed. Hierarchical linear models investigated gender identity trajectories and whether gender identity variability was associated with depressive symptoms over time.
Among the 366 SGM youths included in the study (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth), 4 gender identity trajectory groups were identified: (1) cisgender across all waves (274 participants ), (2) transgender or gender diverse (TGD) across all waves (32 participants), (3) initially cisgender but TGD by wave 4 (ie, cisgender to TGD [28 participants]), and (4) initially TGD but cisgender by wave 4 (ie, TGD to cisgender [32 participants]). One in 5 youths (18.3%) reported a different gender identity over a period of approximately 3.5 years; 28 youths varied gender identity more than twice. The cisgender to TGD group reported higher levels of depression compared with the cisgender group at baseline (Β = 4.66; SE = 2.10; P = .03), but there was no statistical difference once exposure to lesbian, gay, bisexual, and transgender violence was taken into account (Β = 3.31; SE = 2.36; P = .16). Gender identity variability was not associated with within-person change in depressive symptoms (Β = 0.23; SE = 0.74; P = .75) or the level of depressive symptoms (Β = 2.43; SE = 2.51; P = .33).
These findings suggest that gender identity can evolve among SGM youths across time and that changes in gender identity are not associated with changes in depressive symptoms. Further longitudinal work should explore gender identity variability and adolescent and adult health.
人们越来越关注经历性别认同转变的青少年的心理健康问题。需要有实证证据来了解自我报告的性别认同转变与心理健康之间的关系。
在一个对性少数群体（SGM）青少年进行的纵向样本中，检查青少年是否以及多久改变一次自我报告的性别认同，以及性别认同轨迹是否与抑郁症状相关。
设计、地点和参与者：这项队列研究使用了 2011 年 11 月至 2015 年 6 月期间在美国 2 个大城市（一个在东北部，一个在西南部）的一个基于社区的纵向研究的 4 个波次（每 9 个月一次）的数据。合格的参与者包括来自社区机构和 SGM 青少年团体的自认为是 SGM 的青少年。数据分析于 2023 年 9 月至 6 月进行。
性别认同轨迹和性别认同变化性。
采用贝克青少年抑郁量表（BDI-Y）评估抑郁症状。性别认同变化性的衡量标准是参与者的性别认同改变的次数。分层线性模型调查了性别认同轨迹，以及随着时间的推移，性别认同变化性是否与抑郁症状有关。
在研究中包括的 366 名 SGM 青少年中（平均[SD]年龄，18.61[1.71]岁；181[49.4%]出生时被指定为男性，185[50.6%]出生时被指定为女性），确定了 4 个性别认同轨迹群体：（1）所有波次均为顺性别（274 名参与者）；（2）所有波次均为跨性别或性别多样化（TGD）（32 名参与者）；（3）最初为顺性别，但第 4 波次时为 TGD（即，顺性别到 TGD[28 名参与者]）；（4）最初为 TGD，但第 4 波次时为顺性别（即，TGD 到顺性别[32 名参与者]）。大约 3.5 年内，18.3%的青少年报告了不同的性别认同；28 名青少年的性别认同变化超过了两次。与顺性别群体相比，从顺性别到 TGD 的群体在基线时报告了更高水平的抑郁（β=4.66；SE=2.10；P=.03），但考虑到女同性恋、男同性恋、双性恋和跨性别暴力的暴露后，差异无统计学意义（β=3.31；SE=2.36；P=.16）。性别认同变化性与抑郁症状的个体内变化（β=0.23；SE=0.74；P=.75）或抑郁症状的水平（β=2.43；SE=2.51；P=.33）均无关。
这些发现表明，SGM 青少年的性别认同可以随着时间的推移而演变，而且性别认同的改变与抑郁症状的改变无关。进一步的纵向研究应该探讨性别认同变化性与青少年和成人的健康问题。
