Association between bullying, state-level policy and mental health symptoms in gender diverse youth

As the percentage of young people in the United States identifying as transgender and gender diverse increases, more youth face identity-linked social and structural stigma and discrimination. Little is known about the impact of stigma on psychotic-like experiences in gender diverse youth.

To assess the impact of bullying victimization and state-level policies on psychotic-like experiences among gender diverse youth.

In this prospective cohort study, cross-sectional and longitudinal analyses were conducted using data collected between 2017-2022 across 17 states.

The Adolescent Brain Cognitive Development (ABCD) Study is a U.S. population-based longitudinal study that follows and deeply phenotypes adolescents from the age of 9 to 18.

Cross-sectional analyses included data from 9,112 participants (mean age=13 ± 0.6) collected between 2019 and 2022. Longitudinal analyses comprised 4,529 participants with data collected across 5 waves between 2017 and 2022.

Self-reported frequency of bullying victimization and data on annual state-level policies related to gender identity.

Self-reported psychotic-like experiences and associated distress, measured by the Prodromal Questionnaire - Brief Child Version.

Based on a dimensional measure of gender, 689 adolescents were identified as most gender diverse (i.e., least congruent with birth-assigned sex) and 8,240 as least gender diverse (i.e., most congruent with birth-assigned sex). Rates of bullying victimization and psychotic-like experiences were significantly elevated in the most vs. least gender diverse group, with bullying partially mediating the difference in psychotic-like experiences (indirect effect = 0.11, p < 2×10^-16; direct effect = 0.52, p < 1×10^-16). Gender diverse adolescents exhibited greater sensitivity to the effects of bullying on psychotic-like experiences (interaction ß = 0.14, 95% CI [0.09, 0.19], p = 8.5×10^-08). Moreover, the persistence of unsupportive legislation across 4 years was associated with significantly greater increases in psychotic-like experiences over time in gender diverse youth (interaction ß = 0.30, 95% CI [0.20, 0.40], p = 2.2×10^-8).

These findings indicate that bullying victimization and unsupportive legislation may explain greater and increasing rates of psychotic-like experiences in gender diverse youth.