Abstract
IMPORTANCE: As the percentage of young people in the United States identifying as transgender and gender diverse increases, more youth face identity-linked social and structural stigma and discrimination. Little is known about the impact of stigma on psychotic-like experiences in gender diverse youth. OBJECTIVE: To assess the impact of bullying victimization and state-level policies on psychotic-like experiences among gender diverse youth. DESIGN: In this prospective cohort study, cross-sectional and longitudinal analyses were conducted using data collected between 2017-2022 across 17 states. SETTING: The Adolescent Brain Cognitive Development (ABCD) Study is a U.S. population-based longitudinal study that follows and deeply phenotypes adolescents from the age of 9 to 18. PARTICIPANTS: Cross-sectional analyses included data from 9,112 participants (mean age=13 ± 0.6) collected between 2019 and 2022. Longitudinal analyses comprised 4,529 participants with data collected across 5 waves between 2017 and 2022. EXPOSURES: Self-reported frequency of bullying victimization and data on annual state-level policies related to gender identity. MAIN OUTCOMES: Self-reported psychotic-like experiences and associated distress, measured by the Prodromal Questionnaire - Brief Child Version. RESULTS: Based on a dimensional measure of gender, 689 adolescents were identified as most gender diverse (i.e., least congruent with birth-assigned sex) and 8,240 as least gender diverse (i.e., most congruent with birth-assigned sex). Rates of bullying victimization and psychotic-like experiences were significantly elevated in the most vs. least gender diverse group, with bullying partially mediating the difference in psychotic-like experiences (indirect effect = 0.11, p < 2×10(-16); direct effect = 0.52, p < 1×10(-16)). Gender diverse adolescents exhibited greater sensitivity to the effects of bullying on psychotic-like experiences (interaction ß = 0.14, 95% CI [0.09, 0.19], p = 8.5×10(-08)). Moreover, the persistence of unsupportive legislation across 4 years was associated with significantly greater increases in psychotic-like experiences over time in gender diverse youth (interaction ß = 0.30, 95% CI [0.20, 0.40], p = 2.2×10(-8)). CONCLUSIONS: These findings indicate that bullying victimization and unsupportive legislation may explain greater and increasing rates of psychotic-like experiences in gender diverse youth.