Gender Identity Exploration Is Not Associated With Depressive Symptoms

Changes in gender identity among adolescents and young adults (AYA) are not associated with depressive symptom changes, suggesting that the exploration of gender identity is a normal aspect of pubescent development among some individuals, according to study findings published in JAMA Network Open.

While many individuals have a stable gender identity that does not fluctuate over time, people who are transgender and gender diverse (TGD) individuals can experience gender fluctuation as they discover their identity. However, relatively few studies have evaluated these gender journeys among AYA and whether gender instability is associated with depressive symptoms.

To address this knowledge gap, investigators used data from a longitudinal community-based study to explore whether and how often young people who self-identified as sexual and gender minority (SGM) AYA experienced changes in self-reported gender identity, and whether gender identity variability was associated with depressive symptoms. The longitudinal study assessed trajectories of gender identity among AYA (aged 15 to 21 years) in the United States at 4 time points over 9 months between November 2011 and June 2015. Depressive symptoms were evaluated with the Beck Depression Inventory for Youth, while gender identity variability was defined as the number of times participants changed their gender identity via self-report over the study period.

The investigators included data from 366 AYA who identified as SGM. Participants had a mean (SD) age of 18.61 (1.71) years, 50.6% were assigned female at birth, and 40.7% were Latino. Gender trajectory patterns were categorized into 4 groups based on gender identity status across the study waves:

1. participants who identified as cisgender across all study waves (n=274);
2. participants who identified as TDG across all waves (n=32);
3. participants who initially identified as cisgender, but identified as TGD by wave 4 (n=28);
4. and participants who initially identified as TGD, but identified as cisgender by wave 4 (n=32).

Hormone therapy was reported by 62.50% of the participants in the TGD group, 21.43% of the cisgender to TGD group, and 3.13% of the TGD to cisgender group. The use of puberty blockers was reported by 13.04% of participants who identified as non-cisgender.

The investigators found that 18.3% of AYA reported at least 1 change in gender identity over the 3.5-year study period, and 7.7% changed their identity more than twice across the waves. At baseline, the cisgender to TGD group reported higher levels of depression, relative to the cisgender group (P =.03). However, once the investigators took exposure to lesbian, gay, bisexual, and transgender (LGBT) violence into account, then there was no longer a statistically significant difference between the groups (P =.16).

The investigators also observed that gender identity variability was not associated with the level of depressive symptoms (P =.33) or within-person change in depressive symptoms (P =.75).

“Changes in gender identity were not associated with depressive symptoms, suggesting that gender identity exploration is a normal part of adolescent development for some youths,” the investigators concluded, adding, “The group of youths who reported the most change in gender identities were among those with the lowest level of depressive symptoms.”

Study limitations include reliance on self-reported gender identity and a lack of data regarding which individuals met the criteria for gender dysphoria.

This article originally appeared on Psychiatry Advisor