The Mediating Impact of School Stress on Transgender Adolescents’ Elevated Suicidality

Introduction: Existing literature documents increased rates of school stress and violence (e.g., bullying, cyberbullying, missed school due to safety concerns) among transgender adolescents (Pedro & Esqueda, 2017), likely due to these youth’s nonconformity to gender expression norms and expectations (Toomey, McGuire, & Russell, 2012). Further, suicidality has been documented at elevated rates among transgender adolescents compared to cisgender peers (Perez-Brumer, Day, Russell, & Hatzenbuehler, 2017). Identification of salient intervention points to prevent suicidality among these adolescents is needed.

Method: The IRB-approved study relied on a national sample of youth (aged 12–24) recruited from an LGBTQ youth-focused suicide crisis prevention service provider during an 18-month period. After crisis contact, youth were transferred to a brief survey of demographic and contact information. Eligible adolescents (non-heterosexual identity, aged 12-24, and provided consent to participate) were contacted for study participation. Overall, 33% of youth referred to the study completed (n = 657). For the current analysis, 68 respondents were dropped due to incomplete information on measured items which included questions on sociodemographic information, stress at school, and suicidality (item adapted from the Colombia Suicide Severity Rating scale). Sample size for analysis was 589 adolescents. Descriptive statistics were analyzed followed by a mediation analysis using ordinary least squares regression.

Results: The analytic sample consisted of 263 (44.7%) transgender adolescents and 326 (55.4%) cisgender adolescents. Mean age was 17.6 years old (SD = 3.1 years). Mean number of stressful school experiences reported was 3.6 (SD = 2.9) out of 13. Nearly one-fifth of adolescents reported lifetime attempt of suicide (N = 107, 18.2%). Transgender adolescents had a higher proportion of lifetime suicide attempt (22.4%, N = 59) than their cisgender peers (14.7%, N = 48). Bivariate analyses showed that transgender adolescents had significantly greater suicidality (B =.71, p < .001), and reported significantly more stressful school experiences (B = 1.57, p < .001) than their cisgender peers. Tests for mediation using 5000 bootstraps reveled that reports of stress in school attenuated the relationship between gender identity and suicidality by 27.3%.

Conclusion: Study results reveal the influential role that school environments have on the mental health of transgender adolescents relative to their non-heterosexual cisgender peers. The impact of school environment may be even greater on transgender adolescents’ mental health in comparison to general populations of adolescents. Our data suggest that reducing stress encountered by transgender students in school may positively impact their mental health.