Results from a cohort study published in JAMA Network Open outline the relationship between psychosocial risk factors and mental health symptoms among Black and Latinx transgender youth (BLTY). Compared with their Black and Latinx cisgender peers, BLTY reported greater rates of depressive symptoms and suicidality. BLTY also reported greater incidence of harassment and victimization compared with cisgender youth.
Investigators extracted data from the 2015-2017 Biennial California Health Kids Survey, a self-reported assessment administered to 9th and 11th graders in the state of California. Surveyed schools were randomly selected and weighted to reflect the demographics of California’s secondary school population.
The survey asked students to self-report certain demographic characteristics, including gender, sexuality, and race/ethnicity. The survey also captured the presence of depressive symptoms and suicidal ideation using dichotomous “yes/no” questions. Psychosocial risk and protective factors were assessed using a battery of questions regarding school-based victimization and harassment.
Logistic regression models were used to calculate the relative risk for mental health symptoms among BLTY compared with their peers. Regression models were adjusted for school year, assigned sex at birth, and living arrangement. Descriptive statistics were used to generate weighted proportions and prevalence rates of mental health symptoms.
The study cohort comprised 19,780 participants, among whom 19,424 were Black and Latinx cisgender youth (weighted percentage: 98%), 104 were white transgender youth (weighted percentage: 0.7%), and 252 were BLTY (weighted percentage: 1.3%). Among BLTY, the estimated prevalence rates of depressive symptoms and suicidality were 50% (95% CI, 44-57%) and 46% (39-52%), respectively.
In fully adjusted regression models, BLTY had higher risk of depressive symptoms (adjusted odds ratio [aOR], 2.7; 95% CI, 2.0-3.7) and suicidality (aOR, 5.9; 95% CI, 4.3-8.0) compared to Black and Latinx cisgender youth. This difference was likely driven by higher rates of harassment and victimization experienced by BLTY compared with their Black and Latinx cisgender peers. Specifically, BLTY had greater odds of experiencing race-based harassment (aOR, 3.2; 95% CI, 2.4-4.5), gender-based harassment (aOR, 12.9; 95% CI, 9.3-17.9), and sexuality-based harassment (aOR, 7.8; 95% CI, 5.8-10.7). Compared to white transgender youth, however, BLTY experienced similar levels of harassment, victimization, and mental health symptoms.
Results from this study underscore the complex relationship between gender, race, and mental health symptoms among BLTY in the California school system. However, while psychosocial risk factors were more pronounced among transgender study participants, the observational study design prevents the assertion of causality. Additionally, the surveys only captured past-year mental health symptoms. Further research is necessary to better illustrate the experiences of BLTY.
“In [our] study, BLTY and White transgender youth had comparable high rates of mental health symptoms; however, BLTY had disproportionally higher rates than Black and Latinx cisgender youth,” the investigators wrote.
“The unique pattern of psychosocial risk and protective factors for these mental health symptoms among BLTY should be factored in clinical preventive services and school-based interventions to support them.”
Vance SR Jr, Boyer CB, Glidden DV, Sevelius J. Mental health and psychosocial risk and protective factors among Black and Latinx transgender youth compared with peers. JAMA Netw Open. 2021;4(3):e213256. doi:10.1001/jamanetworkopen.2021.3256