Urgent Need to Focus on Gender-Diverse Adolescents in Mental Health Prevention Research: A Cross-Sectional...

Gender-diverse adolescents-those whose gender identity differs from their assigned sex at birth or who do not conform to traditional binary gender norms-are at significantly higher risk for mental health issues, including suicidality and non-suicidal self-injury (NSSI). However, most prevention efforts remain focused on cisgender youth. This study aims to directly compare levels of emotional dysregulation, depressive symptoms, suicidality, and NSSI between gender-diverse adolescents and their cisgender peers to inform gender-sensitive prevention strategies.

This cross-sectional analysis was conducted in a school-based sample with participants aged 8-15 years. Gender identity was self-reported through self-categorization using a single item with three response options (female, male, diverse). Emotional dysregulation (DERS-SF), depressive symptoms (PHQ-9), suicidality (PSS), and NSSI (DSHI-9) were assessed. Group comparisons between gender-diverse adolescents (n = 13), female-identifying adolescents (n = 1102), and male-identifying adolescents (n = 1045) were performed using Mann-Whitney U, Fisher's exact, and χ² tests with Bonferroni-adjusted p-values.

Compared to female-identifying and male-identifying adolescents, gender-diverse adolescents showed significantly higher emotional dysregulation (vs. females: p < 0.001; vs. males: p < 0.001) and depressive symptom severity (vs. females: p < 0.001; vs. males: p < 0.001). Recent suicidality (past two weeks) was markedly elevated in gender-diverse youth (vs. females: p < 0.001; vs. males: p < 0.001), although lifetime suicidality did not differ significantly. NSSI behaviors were consistently more severe in the gender-diverse group, with significantly higher lifetime prevalence, greater frequency, and a broader range of methods (all comparisons p < 0.001 vs. both comparison groups).

Gender-diverse adolescents exhibit substantially higher levels of emotional and behavioral distress compared to both female-identifying and male-identifying adolescents. These findings highlight the urgent need for inclusive mental health screening and targeted prevention programs that address the distinct psychological profiles and elevated risks within gender-diverse youth populations.