Emotional and behavioural difficulties in gender minority compared to cisgender adolescents: identity specific findings from a contemporary national study

Abstract

Background: Gender minority adolescents are more likely to report emotional and behavioural difficulties compared to their cisgender peers. However, little is known about these experiences for adolescents with specific gender minority identities. Methods: Cross-sectional data were obtained from the 2021/22 Student Health and Well-being survey, a national survey of 11–16-year-olds in Wales, UK. Emotional and behavioural difficulties were measured using the Strengths and Difficulties Questionnaire. Gender identity and assigned sex at birth were self-reported. Multivariable linear regressions with robust standard errors were used to examine associations between gender identity and emotional and behavioural difficulties, adjusting for age, ethnicity, household-level affluence and correction for multiple testing. Results: Of the 122,766 participants, 2.0% (2,455) identified as a person with a gender minority identity. Twenty-eight gender minority identities were self-reported, with the most prevalent being transgender boy and nonbinary assigned female at birth (both 0.6%). Young people assigned female at birth comprised 80% of gender minority adolescents. In the adjusted model, emotional and behavioural difficulties were reported most frequently by people who identified as non-binary (B = 7.66, 95% CI 7.25, 8.06) and another gender identity (B = 7.86, 95% CI 7.34, 8.38), then transgender (B = 5.05, 95% CI 4.58, 5.51), when compared to cisgender adolescents. Female sex assigned at birth was associated with more reported difficulties than male sex assigned at birth for adolescents with a transgender or cisgender identity, but not a nonbinary identity. Conclusions: In this population-based study, emotional and behavioural difficulties were reported most frequently by adolescents who identified as nonbinary and another gender identity, then transgender, then cisgender. Health and educational practitioners need to be aware that emotional and behavioural difficulties differ across gender minority identities.