Under the Hood

Gender Nonconforming Teens Face Higher Risk Of Mental Distress, Drug Abuse

High school students who identify as gender nonconforming have a higher likelihood of experiencing mental health problems, suicidal behavior, and substance abuse, according to a new study.

The study titled "Nonconforming Gender Expression and Associated Mental Distress and Substance Use Among High School Students" was published in the journal JAMA Pediatrics on Sept. 24.

More than 6,000 American students were recruited from three large urban high school districts located in California and Florida. More than half of those surveyed (55 percent) were Hispanic, around 19 percent were black, and around 16 percent were white.

As expected, a majority of the students (4 in 5) reported conforming to traditional gender expectations. Nevertheless, more teenagers than ever before were identifying as gender nonconforming due to growing visibility, particularly in the United States.

"Gender nonconformity is gender expression that differs from societal expectations for feminine or masculine appearance and behavior," explained study author Michelle Johns, a health scientist in the division of adolescent and school health at the Centers for Disease Control and Prevention.

Nonconformity, she said, was an area of adolescent health that was often linked to negative health outcomes. For instance, a report from earlier this year revealed how those who presented as transgender or nonconforming before turning 18 have a higher risk of facing mental health struggles such as anxiety, depression, and attention-deficit disorders.

The new study found nonconforming students had a higher likelihood of experiencing sadness, hopelessness, and suicidal thoughts. They were also found to have a higher risk of suicidal behavior and substance abuse.

According to an accompanying editorial, these poor outcomes are often a result of stigma and not feeling accepted by one's family members and friends. Since individuals of this age group spend most of their time at school, whether or not the institution adequately addressed bullying and discrimination is important.

Compared to their gender-conforming counterparts, girls who described themselves as masculine had a 22 percent higher risk of feeling sad and hopeless. Meanwhile, at 55 percent, the same risk was more than double among boys who described themselves as feminine.

The risk of alcohol and drug use was estimated to be around 20 percent for highly nonconforming boys. But the figures varied among highly nonconforming girls with the risk of cocaine use estimated to be 7.5 percent while alcohol use was close to 40 percent.

It should be noted the portion of participants who were minorities was larger than average, which means these figures may not be a strong reflection of numbers across the country. 

"However, these findings suggest that developing support systems within schools and other school-based interventions, such as safe spaces and supportive/knowledgeable staff for gender nonconforming students, may be an important avenue to improving mental health and reducing substance use in this population," Johns said.

If you have thoughts of suicide, confidential help is available for free at the National Suicide Prevention Lifeline. Call 1-800-273-8255. The line is available 24 hours, every day.

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