Family and school environment as mediators in mental health outcomes among gender-diverse youth: insights from the Adolescent Brain Cognitive Development Study.

BACKGROUND

Gender-diverse (GD) youth are at heightened risk for adverse mental health outcomes; however, the modifiable factors mediating this relationship remain poorly understood. This study examines how family and school environments mediate the relationship between GD identities and mental health outcomes in adolescents.

METHODS

This study employed a cross-sectional analysis of Year 3 data from the Adolescent Brain Cognitive Development (ABCD) Study. GD was identified using a two-step method based on sex assigned at birth and current gender identity. Multivariate linear and logistic regressions were applied to investigate the association between GD and mental health outcomes, including externalizing and internalizing symptoms, suicidal behavior, and psychotic-like experiences (PLEs). Mediation analyses were conducted using structural equation models to examine the mediating roles of family and school environments in the relationship between GD and mental health outcomes.

RESULTS

Of 8,290 participants (mean age 12.5 years, 49% female, 58% White), 258 (3.1%) were identified as GD. GD youth exhibited a 3- to 5-fold increased risk for internalizing, externalizing problems, PLEs, and suicidal behaviors, and experienced worse family and school environments. Mediation analyses showed that adverse family and school environments could explain over 75% of the association with externalizing problems and 10–35% of the association with internalizing problems, PLEs, and suicidal behaviors. Family environment was the primary mediator for externalizing, internalizing symptoms, and suicidal behaviors, while school environment was the key mediator for PLEs.

CONCLUSIONS

In this cross-sectional study of GD adolescents, these findings highlight the critical role of family and school environments in shaping the mental health outcomes of GD adolescents. Interventions aimed at improving these environments may serve as an effective strategy to reduce mental health disparities in this vulnerable population. CLINICAL TRIAL NUMBER: Not applicable.