Gender nonconformity and common mental health problems: A meta-analysis

Abstract

We tested the association between gender nonconformity and common mental health outcomes, including generalized anxiety symptoms, depressive symptoms, self-esteem, self-harm attempts, and suicide attempts using an exhaustive meta-analysis. PsycInfo, ProQuest Central, EBSCOhost, and PubMed were searched for eligible articles using either cross-sectional or longitudinal designs on 11th July 2024. A total number of 1975 articles were identified and selected following PRISMA. Twenty-five, 48, 32, seven, and nine studies were included on generalized anxiety symptoms, depressive symptoms, self-esteem, self-harm attempts, and suicide attempts, reaching a total sample size of 142,069, 188,681, 27,488, 47,523, and 25,573, respectively. Meta-analyses were performed using a random-effects model stratified by mental health outcomes. We found that higher levels of gender nonconformity were associated with higher levels of generalized anxiety (r = 0.06) and depressive symptoms (r = 0.11), lower levels of self-esteem (r = 0.18), and increased risk of self-harm (r = 0.17) and suicide attempts (r = 0.14). Gender nonconformity had stronger links to generalized anxiety symptoms, depressive symptoms, and self-esteem in men than in women. Behaviors-based gender nonconformity showed stronger links to depressive symptoms and self-esteem compared to traits-based gender nonconformity. The effect size for the association between gender nonconformity and depressive symptoms was significantly larger in adolescent samples than in childhood samples. There was no significant moderation by sexual orientation. While gender nonconformity is robustly associated with a range of common mental health problems, the magnitude of this association varies depending on the specific mental health outcomes considered and sex. Interventions to mitigate mental health differences and improve overall well-being among individuals who display greater gender nonconformity are needed.