Adolescent gender diversity: sociodemographic correlates and mental health outcomes in the general population

Background: Gender diversity in young adolescents is understudied outside of referral clinics. We investigated gender diversity in an urban, ethnically diverse sample of adolescents from the general population and examined predictors and associated mental health outcomes. Methods: The study was embedded in Generation R, a population-based cohort of children born between 2002 and 2006 in Rotterdam, the Netherlands (n = 5727). At ages 9–11 and 13–15 years, adolescents and/or their parents responded to two questions addressing children’s contentedness with their assigned gender, whether they (a) ‘wished to be the opposite sex’ and (b) ‘would rather be treated as someone from the opposite sex’. We defined ‘gender-variant experience’ when either the parent or child responded with ‘somewhat or sometimes true’ or ‘very or often true’. Mental health was assessed at 13–15 years, using the Achenbach System of Empirically Based Assessment. Results: Less than 1% of the parents reported that their child had gender-variant experience, with poor stability between 9–11 and 13–15 years. In contrast, 4% of children reported gender-variant experience at 13–15 years. Adolescents who were assigned female at birth reported more gender-variant experience than those assigned male. Parents with low/medium educational levels reported more gender-variant experience in their children than those with higher education. There were positive associations between gender-variant experience and symptoms of anxiety, depression, somatic complaints, rule-breaking, and aggressive behavior as well as attention, social, and thought problems. Similar associations were observed for autistic traits, independent of other mental difficulties. These associations did not differ by assigned sex at birth. Conclusions: Within this population-based study, adolescents assigned females were more likely to have gender-variant experience than males. Our data suggest that parents may not be aware of gender diversity feelings in their adolescents. Associations between gender diversity and mental health symptoms were present in adolescents.