Tuesday, September 25, 2018

Study Points to Need for School-Based MH Care for Gender-Nonconforming Students

High school students who view their gender expression as nonconforming to societal expectations for feminine or masculine appearance and behavior may be more likely to experience mental distress and suicidal thoughts/behaviors, according to a study in JAMA Pediatrics. The study also found that among males, gender nonconformity is associated with substance use.

The findings “underscore the importance of implementing school-based programs to prevent substance use and promote mental health that are inclusive of gender-diverse students,” Richard Lowry, M.D., M.S., of the Centers for Disease Control and Prevention and colleagues wrote.

Lowry and colleagues analyzed data on 6,082 high school students in three large urban school districts who responded to the 2015 Youth Risk Behavior Survey (YRBS). As part of the YRBS, students were asked how they thought others at school would describe them on a scale of gender expression. Response options were “very feminine,” “mostly feminine,” “somewhat feminine,” “equally feminine and masculine,” “somewhat masculine,” “mostly masculine,” and “very masculine”. Based on a student’s response to this question and the question “What is your sex?”, a 7-point gender nonconformity scale was created categorizing students from most gender conforming (1, indicating very feminine female students and very masculine male students) to most gender nonconforming (7, indicating very masculine female students and very feminine male students).

The YRBS also measures a wide range of substance use behaviors, including tobacco, alcohol, and injection drug use, as well as various indicators of mental distress, from feeling sad and hopeless to suicidal thoughts and/or attempts.

Within this study population, 1 in 5 students reported either moderate (11.9%) or high (8.4%) levels of gender nonconformity. Among female and male students, gender nonconformity was associated with feeling sad and hopeless, as well as suicidal thoughts and/or behaviors. Among males (but not females) the likelihood that they had attempted suicide increased with increasing gender nonconformity. Additionally, the prevalence of nonmedical use of prescription drugs and the use of cocaine, methamphetamine, and injection drug use all increased with increasing gender nonconformity in males; substance use was not associated with gender nonconformity in females.

In an accompanying editorial, Ellen Selkie, M.D., M.P.H., a clinical lecturer in adolescent medicine at the University of Michigan, said clinicians should inquire of both patients and parents in a confidential manner about gender identity concerns. “When youth demonstrate gender nonconformity, a careful assessment not only of mental health and substance use, but also of social stressors, is necessary,” she wrote. “Furthermore, knowledge of resources for mental health treatment and safety for gender-nonconforming youth must be in a clinician’s toolkit.”

For related information, see the Psychiatric News article “Capitol Hill Forum Seeks to Demystify Gender Identity Dysphoria.”

(Image: iStock/noipornpan)


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