Mental health outcomes of transgender and gender diverse students in schools: a systematic literature review

Abstract

Introduction This systematic literature review (SLR) investigates the effects school environments have on the mental health outcomes of transgender and gender diverse students. Current literature highlights the need to support the mental health of transgender and gender diverse students in school, however the research synthesizing the existing research is limited. This SLR brings together existing literature exploring the school experience and mental health outcomes for this cohort in schools. Methods The review followed PRISMA Guidelines and included JBI quality appraisal tools of included studies. Four electronic databases were used, with literature searches conducted on 31 July 2023. Included studies were assessed against predetermined inclusion/exclusion criteria, with included studies written in English, no date or geographical limitations, online full-text availability, peer-reviewed, and relevant to the research question. , full-text review, and quality appraisal were conducted by two independent reviewers. Collected data were synthesized using a revised and three-levelled socio-ecological framework and further thematic analysis within the three categories. Results 15 studies were included for final synthesis with four using qualitative methodologies, and 11 being cross-sectional studies. The final synthesis comprised three themes, exploring structural level, interpersonal level and individual level barriers to optimal mental health outcomes for transgender and gender diverse students in school settings. Findings highlight and support previous findings of an alarmingly high rate of mental health concerns, including self-harm, suicide and suicidal ideation in transgender and gender diverse youth in school settings. Conclusions The current literature highlights the need to explore how denominational affiliations of school environments affect the experiences, challenges and mental health outcomes of transgender and gender diverse youth. Further research needs to comprehensively unpack the unique structural, interpersonal and individual needs of transgender and gender diverse youth in these diverse school environments, to then provide adequate and affirming support enhancing their overall health and wellbeing.