(PS1-C53) Gender Identity and Expression in Relation to Depressive and Anxiety Symptoms in Racial and Ethnic Minority Youth: A Population-based Study

Gender minority individuals are at elevated risk for negative mental health outcomes, including depression and anxiety, compared with cisgender peers and thus have been recognized as a health disparity population. Despite longstanding recognition of this disparity, several limitations characterize the existing research in this area. First, past research has predominantly focused on White cis-gender adults. Relatively few studies have examined mental health outcomes among gender minority individuals in racial and ethnicity minority populations, also recognized as health disparity populations by the NIH. Examination of depression and anxiety in non-White gender minority individuals is needed to evaluate how multiple minority identities impact mental health outcomes. The relative lack of studies in this area focusing specifically on youth is another important limitation given that depression and anxiety tend to emerge before adulthood, and thus youth are at a particularly critical period of development for clinical intervention. The lack of studies with gender, racial, and ethnic minority youth likely exists in part because of the challenge of drawing large enough samples for adequately powered analysis. We address these limitations and challenges by analyzing data from the 2019 Minnesota Student Survey (MSS), a large population-based study of school-aged children in Minnesota (n = 125,375; M_age = 14.91, SD = 3.17; 50.1% assigned female at birth). In terms of racial and ethnic composition, the sample was 75.9% White, 8.6% Black, 7.2% Asian, 1.5%. American Indian or Alaskan Native, 0.3% Native Hawaiian or Other Pacific Islander, and 6.6% Multi-racial; and 9.3% Hispanic, 2.2% Somali, and 2.4% Hmong. The MSS assessed gender identity and gender expression non-conformity in youth in grades 8 and above and grades 9 and above, respectively. We compared rates of depression and anxiety among gender minority racial/ethnic minority youth compared with non-gender minority racial/ethnic minority peers, with age and use of free or reduced lunch covaried in all analyses. Across racial and ethnic minority groups, regardless of whether gender identity or gender expression was used to define gender minority status, gender minority status was generally associated with greater depressive and anxiety symptoms. For gender identity, significant associations ranged from OR = 2.39 for Somali youth to 4.34 for Hmong youth in the case of depression and OR = 2.68 for Somali youth to 4.24 for American Indian or Alaskan Native youth in the case of anxiety. For gender expression, significant associations ranged from OR = 1.44 for Somali youth to 1.73 for American Indian or Alaskan Native youth in the case of depression and OR = 1.40 for Asian youth to 1.80 for American Indian or Alaskan Native youth in the case of anxiety. These results suggest the need to use an intersectional lens when focusing on marginalized youth to understand how intersecting identities affect mental health outcomes. Continued research is also needed to identify potential factors that could be associated with and protect against depression and anxiety in multiple minority youth.