Burke Sarah M, Kroeze Daniëlle B A, Kiewiet S Lucette, Ballering Aranka V
Department of Psychiatry, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
Department of Plastic Surgery, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
EClinicalMedicine. 2025 Jul 28;86:103359. doi: 10.1016/j.eclinm.2025.103359. eCollection 2025 Aug.
Knowledge of diversity in gender identity and gender roles in the general population is limited. This study aimed to report the prevalence estimates of gender identity and gender roles among the adult general population, stratified by age and sex.
In the third general assessment of the prospective Dutch Lifelines Cohort Study, conducted between 2019 and 2023, sex and current gender identity were assessed using a self-reported categorical item, in which participants aged 18 years and older could indicate their sex assigned at birth (male or female) and current gender identity (man or woman), or select the option with a free-text field. Two separate dimensional measures assessed adherence to feminine and masculine gender roles. Using a cross-sectional study design, we describe the distribution of gender identities and adherence to gender roles, stratified by age and sex as registered by the municipality. Differences herein are assessed via independent t-tests and ANOVA.
A total of 63,190 participants (mean age = 55.4 years [SD = 12.6]) were included in the study. Most participants identified as cisgender (36,835 [58.6%; 95% CI = 58.2-58.9] cisgender women; 25,893 [41.2%; 95% CI = 40.8-41.6] cisgender men). 66 (0.11%; 95% CI = 0.08%-0.13%) participants identified as non-cisgender. Among cisgender participants registered as males, masculine gender role scores increased across age groups, with younger individuals (18-30 years) scoring lower (M = 9.3, SD = 1.2) than older individuals (71-97 years; M = 9.7, SD = 1.0; = 35.5; < 0.0001; η = 0.008 [95% CI = 0.006-0.010]). A similar pattern was observed for adherence to feminine gender roles among cisgender participants registered as females, where younger individuals (M = 9.1, SD = 1.2) scored lower than older individuals (M = 9.7, SD = 1.0; = 137.2; < 0.0001, η = 0.018 [95% CI = 0.016-0.021]). Cisgender participants registered as male reported stronger adherence to masculine roles (M = 9.6, SD = 1.0), than their female counterparts to feminine roles (M = 9.3, SD = 1.2; t27.7; < 0.0001, Cohen's = 0.218 [95% CI = 0.202-0.234]).
Although effect sizes are small, younger and female individuals indicate greater diversity in gender roles than older and male individuals, respectively. This shows that diversity in gender role adherence is common. A limitation of this study is the relatively older sample, which limits representation of younger individuals and may affect generalizability. These findings have implications for clinical practice and policy, as recognizing gender role diversity could help healthcare providers tailor interventions and assessments. Given the small but meaningful effect sizes, continued research on gender roles and their health impact across age groups is warranted to inform gender-sensitive policies.
The Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen (UMCG), Groningen University, the Provinces in the North of the Netherlands (Drenthe, Friesland, Groningen) and ZonMw (The Netherlands Organization for Health Research and Development).
一般人群中性别认同和性别角色的多样性知识有限。本研究旨在报告成年普通人群中按年龄和性别分层的性别认同和性别角色的患病率估计。
在2019年至2023年进行的荷兰生命线队列前瞻性研究的第三次综合评估中，使用自我报告的分类项目评估性别和当前性别认同，18岁及以上的参与者可以表明其出生时被指定的性别（男性或女性）和当前性别认同（男性或女性），或选择自由文本字段选项。两个独立的维度测量评估对女性和男性性别角色的遵循情况。采用横断面研究设计，我们描述了按市政当局登记的年龄和性别分层的性别认同分布以及对性别角色的遵循情况。通过独立t检验和方差分析评估其中的差异。
共有63190名参与者（平均年龄 = 55.4岁[标准差 = 12.6]）纳入研究。大多数参与者被认定为顺性别者（36835名[58.6%；95%置信区间 = 58.2 - 58.9]顺性别女性；25893名[41.2%；95%置信区间 = 40.8 - 41.6]顺性别男性）。66名（0.11%；95%置信区间 = 0.08% - 0.13%）参与者被认定为非顺性别者。在登记为男性的顺性别参与者中，男性性别角色得分随年龄组增加，较年轻个体（18 - 30岁）得分较低（M = 9.3，标准差 = 1.2），低于较年长个体（71 - 97岁；M = 9.7，标准差 = 1.0；F = 35.5；p < 0.0001；η = 0.008 [95%置信区间 = 0.006 - 0.010]）。在登记为女性的顺性别参与者中，对女性性别角色的遵循情况也观察到类似模式，较年轻个体（M = 9.1，标准差 = 1.2）得分低于较年长个体（M = 9.7，标准差 = 1.0；F = 137.2；p < 0.0001，η = 0.018 [95%置信区间 = 0.016 - 0.021]）。登记为男性的顺性别参与者报告对男性角色的遵循更强（M = 9.6，标准差 = 1.0），高于登记为女性的顺性别参与者对女性角色的遵循（M = 9.3，标准差 = 1.2；t = 27.7；p < 0.0001，科恩d = 0.218 [95%置信区间 = 0.202 - 0.234]）。
尽管效应量较小，但较年轻个体和女性个体分别表明在性别角色上比年长个体和男性个体具有更大的多样性。这表明性别角色遵循的多样性很常见。本研究的一个局限性是样本相对较年长，这限制了年轻个体的代表性，可能影响普遍性。这些发现对临床实践和政策有影响，因为认识到性别角色多样性有助于医疗保健提供者调整干预措施和评估。鉴于效应量虽小但有意义，有必要继续研究不同年龄组的性别角色及其对健康的影响，以为性别敏感政策提供信息。
荷兰卫生、福利和体育部、荷兰经济事务部、格罗宁根大学医学中心（UMCG）、格罗宁根大学、荷兰北部省份（德伦特省、弗里斯兰省、格罗宁根省）和荷兰卫生研究与发展组织（ZonMw）。
