Mental Health Inequalities in Gender Minority Young Adults

Gender minority young people (trans, nonbinary, gender non-conforming, and intersex individuals) are at elevated risk of mental health problems, yet the longitudinal evidence on how those risks develop and vary across intersecting identities and social contexts remains limited. Most existing research is cross-sectional, uses binary gender measures that exclude nonbinary people, and draws on data that predates the current generation of gender minority youth. This project sets out to address those gaps using three large UK longitudinal datasets and an intersectional analytical framework.

Collapsing diversity into binary groups produces estimates that don't correspond to anyone's actual experience.

The Research

The project uses data from Understanding Society, the Millennium Cohort Study, and COSMO but restricted to young people aged 16–18 to enable a consistent set of outcome measures, including binge drinking within the self-harm category. Outcomes include common mental health difficulties (anxiety and depression), self-harm, and potentially substance use, with autism and ADHD treated as demographic variables rather than outcomes.

A key methodological challenge is category construction. Standard survey measures of gender identity often rely on binary male/female responses, and more detailed categories face small cell sizes that limit statistical inference. Lived experience advisors contributed directly to decisions about how to categorise gender identity groups, balancing the need to represent diversity against the practical constraints of the data. This included extended discussion about whether intersex should be treated as a separate category (the group concluded it was not feasible given the low numbers and the need to categorise individuals by identified gender, with appropriate acknowledgement of this limitation), and how to group gender non-conforming identities without erasing the diversity within that category.

Sociodemographic factors available across all datasets were identified and mapped, with particular attention to how country of the UK, area-level characteristics, and other contextual variables might help explain variation in gender minority mental health outcomes. Three workstreams are proposed for the broader project: expanding to additional datasets (including OxWell, COSMOS, BeWell, and RICH), scoping the feasibility of geographic variation analyses, and examining the role of sociodemographic and community-level factors.

My Involvement

I contributed to this project as a lived experience advisor, working directly with the research team on methodological decisions. This included substantive input on the age restriction, the gender identity categorisation approach, and how limitations in the data should be acknowledged and communicated.