Depression and anxiety among young gender- and sexuality-diverse adolescents

Importance Gender- and sexuality-diverse (GSD) youths are at increased risk of depression and anxiety compared with their cisgender and heterosexual counterparts. Little is known about the risks for younger GSD adolescents (<15 years).

Objective To estimate the prevalence and odds of depression and anxiety for younger GSD adolescents.

Design, Setting, and Participants This cross-sectional study collected baseline data across 3 separate cohorts of year (grade) 8 students (August through September 2019; August through November 2020; and April 2021 through March 2022) in the Future Proofing Study, an Australian prospective study. All year 8 students from 134 secondary participating schools across Australia were invited to participate in the survey. Data were analyzed in April 2025.

Exposures Gender diversity and sexuality diversity status. Main Outcomes and Measures Self-reported depression symptoms were assessed using the Patient Health Questionnaire for Adolescents, and anxiety symptoms were assessed using the Spence Children’s Anxiety Scale.

Results The sample comprised 6388 adolescents (mean [SD] age, 13.9 [0.5] years); 5842 (91.5%) were born in Australia, 5982 (93.7%) spoke English at home, and 5009 (78.4%) lived in a 2-parent home. Sex at birth included 3329 (52.1%) female, 2968 (46.5%) male, 33 (0.5%) unsure, 51 (0.8%) prefer not to report, and 6 (0.1%) another. There were 6019 cisgender respondents (95.0%), 209 gender-diverse respondents (3.3%), and 109 prefer not to report about gender (1.7%); sexuality identity included 4472 heterosexual respondents (70.0%), 767 sexuality-diverse respondents (12.0%), 559 respondents (8.8%) unsure, 296 prefer not to report (4.6%), and 294 respondents (4.6%) missing these data. Of the 6388 adolescents in the sample, 3745 (58.6%) reported depression (2780 [43.5%] mild to moderate, 965 [15.1%] clinical levels), and 1888 (29.6%) reported anxiety (958 [15.0%] mild to moderate, 930 [14.6%] clinical levels). Larger proportions of GSD adolescents reported clinical levels of depression (gender diverse: 59.3% vs 13.3%, P <.001; sexuality diverse: 43.4% vs 10.1%, P <.001) and anxiety (gender diverse: 48.8% vs 13.1%, P <.001; sexuality diverse: 35.3% vs 10.9%, P <.001) than cisgender and heterosexual counterparts, respectively. Larger proportions of GSD adolescents faced greater demographic individual, psychosocial, and contextual adversities. In multivariable multinomial logistic models, GSD status was associated with higher odds of clinical-level depression (gender-diverse odds ratio [OR], 5.68 [95% CI, 3.46-9.33]; sexuality-diverse OR, 6.49 [95% CI, 4.66-9.03]) and anxiety (gender-diverse OR, 3.49 [95% CI, 2.46-4.95]; sexuality-diverse OR, 3.07 [95% CI, 2.40-3.93]) compared with cisgender and heterosexual peers.

Conclusions and Relevance In this cross-sectional study, higher prevalence and risk of greater depression and anxiety symptoms were evident among younger GSD adolescents. To improve their mental health, prevention and interventions addressing identity-specific stressors and broader contextual risk and protective factors should be initiated by early adolescence.