Abstract
BACKGROUND: Transgender youth report more mental health problems than their cisgender peers, but little is known about their mental health during and after the COVID-19 pandemic. We studied symptoms of anxiety and depression among cis- and transgender youth before, during, and after the pandemic using large nationwide samples. METHODS: Data from the Finnish School Health Promotion survey from years 2019, 2021 and 2023 (461,249 students in total; mean age 15.7, SD 1.3) were used. Self-reports covered official gender, gender identity, symptoms of anxiety (Generalized Anxiety Disorder Scale-7 ≥10) and depression (Patient Health Questionnaire-2 ≥3). Categories of cisgender boy (officially boy; gender identity boy; N = 214,423), transfeminine youth (officially boy; gender identity girl, both, neither, or it varies; N = 5,069), cisgender girl (officially girl; gender identity girl; N = 224,753), and transmasculine youth (officially girl; gender identity boy, both, neither, or it varies; N = 14,508) were formed. RESULTS: In all timepoints, proportion of those with anxiety or depression was higher among transfeminine youth compared with cisgender boys and among transmasculine youth compared with cisgender girls. In all groups anxiety and depression increased significantly from 2019 to 2021 (ORs 1.4-1.8, p < 0.0001), with no significant differences in these changes between cis- and transgender groups. From 2021 to 2023, anxiety (OR 0.91, p = 0.015) and depression (OR 0.77, p < 0.0001) decreased among transmasculine youth but increased among cisgender girls (ORs 1.11 [p < 0.0001] and 1.07 [p < 0.0001], interactions p < 0.0001). Among transfeminine youth, generalized anxiety symptoms decreased from 2021 to 2023, whereas they remained at the level observed in 2021 among cisgender boys (interaction p = 0.0025). CONCLUSIONS: In Spring 2023, we found still increasing mental health problems among cisgender girls, while among transgender youth the post-pandemic developments were more positive. KEY MESSAGES: • Post-pandemic, we found further increases in mental health symptoms in cisgender youth, while among transgender youth the development seemed more promising. • Transgender youth experience more anxiety and depression than their cisgender peers, thus gender diversity deserves still more attention in educational, social, and health care services.