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Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: findings from Trans Pathways

  • Penelope Strauss (a1), Angus Cook (a2), Sam Winter (a3), Vanessa Watson (a4), Dani Wright Toussaint (a5) and Ashleigh Lin (a5)...



Trans and gender diverse (TGD) young people worldwide experience high rates of poor mental health; however, these rates were unknown in Australia. In addition, how negative life events affect the mental health of TGD young people has been largely unexplored.


This paper reports on novel mental health findings of Trans Pathways, the largest study ever conducted in Australia with trans (transgender) and gender diverse young people (N = 859; aged 14–25 years). The study was an anonymous online cross-sectional survey undertaken in 2016. Logistic and linear regression models were used to test associations between mental health outcomes and negative life experiences.


TGD young people in Australia experience high levels of mental distress, including self-harming (79.7%), suicidal thoughts (82.4%), and attempting suicide (48.1%). Three in four participants had been diagnosed with depression and/or anxiety (74.6% and 72.2%, respectively). Many TGD young people had been exposed to negative experiences such as peer rejection (89.0%), precarious accommodation (22.0%), bullying (74.0%), and discrimination (68.9%). Most poor mental health outcomes were associated with negative experiences. The strongest associations were found for precarious accommodation and issues within educational settings. For example, participants with a prior suicide attempt were almost six times more likely to have experienced issues with accommodation, including homelessness.


The current results highlight the urgent need for better mental health care and provide insight into areas for targeted mental health interventions. These findings are pertinent for clinicians working with trans young people and wider society.


Corresponding author

Author for correspondence: Penelope Strauss, E-mail:


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Adams, N, Hitomi, M and Moody, C (2017) Varied reports of adult transgender suicidality: synthesizing and describing the peer-reviewed and gray literature. Transgender Health 2, 6075.
Australian Bureau of Statistics (2007) National Survey of Mental Health and Wellbeing: Summary of Results. cat. no. 4326.0. ABS: Canberra, Australia.
Australian Bureau of Statistics (2014) Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. cat. no. 3238.0. ABS: Canberra, Australia.
Australian Bureau of Statistics (2016) Australian Demographic Statistics, Dec 2015. cat. no. 3101.0. ABS: Canberra, Australia.
Bouman, WP, Claes, L, Brewin, N, Crawford, JR, Millet, N, Fernandez-Aranda, F and Arcelus, J (2017) Transgender and anxiety: a comparative study between transgender people and the general population. International Journal of Transgenderism 18, 1626.
Bradlow, J, Bartram, F, Guasp, A and Jadva, V (2017) School Report: The Experiences of Lesbian, Gay, Bi and Trans Young People in Britain's Schools in 2017. Stonewall; Centre for Family Research, University of Cambridge.
Cohen-Kettenis, PT, Steensma, TD and de Vries, ALC (2011) Treatment of adolescents with gender dysphoria in the Netherlands. Child and Adolescent Psychiatric Clinics of North America 20, 689700.
Collier, K, van Beusekom, G, Bos, H and Sandfort, T (2013) Sexual orientation and gender identity/expression related peer victimization in adolescence: a systematic review of associated psychosocial and health outcomes. Journal of Sex Research 50, 299317.
Flores, AR, Herman, JL, Brown, TNT and Conron, KJ (2017) Age of Individuals Who Identify as Transgender in the United States. Los Angeles, CA: The Williams Institute.
Gordon, AR, Conron, KJ, Calzo, JP, White, MT, Reisner, SL and Austin, SB (2018) Gender expression, violence, and bullying victimization: findings from probability samples of high school students in 4 US school districts. Journal of School Health 88, 306314.
Hillier, L, Jones, T, Monagle, M, Overton, N, Gahan, L, Blackman, J and Mitchell, A (2010) Writing Themselves in 3 (WTi3). Melbourne, Australia: Australian Research Centre in Sex, Health and Society, La Trobe University.
Hyde, Z, Doherty, M, Tilley, PJM, McCaul, KA, Rooney, R and Jancey, J (2014) The First Australian National Trans Mental Health Study: Summary of Results. Perth, Australia: School of Public Health, Curtin University.
Inch, E (2016) Changing minds: the psycho-pathologization of trans people. International Journal of Mental Health 45, 193204.
Jones, T (2015) Policy and Gay, Lesbian, Bisexual, Transgender and Intersex Students. Cham: Springer International Publishing.
Jones, T and Hillier, L (2013) Comparing trans-spectrum and same-sex-attracted youth in Australia: increased risks, increased activisms. Journal of LGBT Youth 10, 287307.
Jones, T, Smith, E, Ward, R, Dixon, J, Hillier, L and Mitchell, A (2016) School experiences of transgender and gender diverse students in Australia. Journal of Sex Education 16, 116.
Kroenke, K, Spitzer, R and Williams, J (2001) The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.
Lawrence, D, Johnson, S, Hafekost, J, Boterhoven De Haan, K, Sawyer, M, Ainley, J and Zubrick, S (2015) The Mental Health of Children and Adolescents. Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Australian Government: Canberra, Australia.
McDermott, E, Hughes, E and Rawlings, V (2017) The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study. Journal of Public Health 40, e244e251.
Mustanski, B and Liu, R (2013) A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. Archives of Sexual Behavior 42, 437448.
Olson, KR, Durwood, L, Demeules, M and McLaughlin, KA (2016) Mental health of transgender children who are supported in their identities. Pediatrics 137, 18.
Reisner, SL, Vetters, R, Leclerc, M, Zaslow, S, Wolfrum, S, Shumer, D and Mimiaga, MJ (2015) Mental health of transgender youth in care at an adolescent urban community health center: a Matched Retrospective Cohort Study. Journal of Adolescent Health 56, 274279.
Reisner, SL, Poteat, T, Keatley, J, Cabral, M, Mothopeng, T, Dunham, E, Holland, CE, Max, R and Baral, SD (2016) Global health burden and needs of transgender populations: a review. The Lancet 338, 412436.
Rider, GN, McMorris, BJ, Gower, AL, Coleman, E and Eisenberg, ME (2018) Health and care utilization of transgender and gender nonconforming youth: a population-based study. Pediatrics 141, e20171683.
Roberts, A, Rosario, M, Slopen, N, Calzo, JP and Bryn Austin, S (2013) Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: an 11-year longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry 52, 143152.
Rood, B, Reisner, S, Surace, F, Puckett, J, Maroney, M and Pantalone, D (2016) Expecting rejection: understanding the minority stress experiences of transgender and gender-nonconforming individuals. Transgender Health 1, 151164.
Smith, E, Jones, T, Ward, R, Dixon, J, Mitchell, A and Hillier, L (2014) From Blues to Rainbows: Mental Health and Wellbeing of Gender Diverse and Transgender Young People in Australia. Melbourne, Australia: The Australian Research Centre in Sex, Health and Society.
Spitzer, R, Kroenke, K, Williams, J and Lowe, B (2006) A brief measure for assessing generalized anxiety disorder – The GAD-7. Archives of Internal Medicine 166, 10921097.
Taliaferro, LA, McMorris, BJ, Rider, GN and Eisenberg, ME (2018) Risk and protective factors for self-harm in a population-based sample of transgender youth. Archives of Suicide Research 23, 203221.
Telfer, M, Tollit, M and Feldman, D (2015) Transformation of health-care and legal systems for the transgender population: the need for change in Australia. Journal of Paediatrics and Child Health 51, 10511053.
Testa, RJ, Hendricks, ML, Goldblum, P and Bradford, J (2012) Effects of violence on transgender people. Professional Psychology: Research and Practice 43, 452459.
Testa, RJ, Michaels, MS, Bliss, W, Rogers, ML, Balsam, KF and Joiner, T (2017) Suicidal ideation in transgender people: gender minority stress and interpersonal theory factors. Journal of Abnormal Psychology 126, 125136.
Travers, R, Bauer, G, Pyne, J, Bradley, K, Gale, L and Papadimitriou, M (2012) Impacts of Strong Parental Support for Trans Youth. Children's Aid Society of Toronto & Delisle Youth Services: Toronto.
Veale, JF, Watson, RJ, Peter, T and Saewyc, EM (2017) Mental health disparities among Canadian transgender youth. Journal of Adolescent Health 60, 4449.
Vrouenraets, LJJJ, Fredriks, AM, Hannema, SE, Cohen-Kettenis, PT and de Vries, MC (2015) Early medical treatment of children and adolescents with gender dysphoria: an empirical ethical study. Journal of Adolescent Health 57, 367373.
Winter, S, Diamond, M, Green, J, Karasic, D, Reed, T, Whittle, S and Wylie, K (2016) Transgender people: health at the margins of society. The Lancet 388, 390400.


Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: findings from Trans Pathways

  • Penelope Strauss (a1), Angus Cook (a2), Sam Winter (a3), Vanessa Watson (a4), Dani Wright Toussaint (a5) and Ashleigh Lin (a5)...


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