Contextualizing the well-being of transgender youth in Spain: indicators of lifestyles, developmental contexts, victimization at school, and mental health

Abstract

In recent years, the need to consider the gender identity in the theoretical and methodological frameworks of the research, as well as in the intervention, has been manifested. As an evidence of this growing interest in learning about the reality of transgender people, it is observed an exponential increase in publications of scientific research in the last 15 years. Undeniably, transgender people face severe victimization and discrimination episodes in a cis-hetero-patriarchal social system that affects their health and well-being, explained in depth from Ian Meyer's minority stress model and its subsequent updates. This has led research to focus on transgender health from a pathological perspective, in which topics such as risk behaviors or serious mental health problems stand out. Studying this area of health is undeniably crucial, but at the same time there is a lack of research on elements that build resilience or at least offer a more normalizing, positive, and complete view of transgender health. Regarding other methodological limitations, samples used in transgender studies are usually obtained with non-probabilistic sampling (such as snowball sampling or chain sampling). At the same time, few large-scale studies include questions in order to know the gender identity of the participants. It may happen that large studies manage to collect information on transgender people, but within the LGBT community, which allows us to have data, but not in a distinguished and clear way. Moreover, in the case of studies conducted with random and large samples, they come from Western and English-speaking countries, thus there is a tendency to generalize the results of people living in these contexts to countries whose legislation or sensitivity to gender diversity may be different. The purpose of this doctoral dissertation has been to bring to light an overview of the health and well-being of transgender adolescents in Spain. First, the utility of the two-step approach as a measure of gender identity in adolescence was assessed. Second, different dimensions of health were studied, covering lifestyles, mental health, and developmental contexts, considering the characteristics of transgender adolescents. Third, from the minority stress framework, the prevalence of involvement in bullying and cyberbullying episodes was estimated. Finally, an integrative model of the influence of perceived social support on the health-realted quality of life when victimization at school is experienced according to gender identity was explored. This thesis has been developed in the framework of the Health Behaviour in School-aged Children (HBSC) study, an international research collaboration with the World Health Organization (WHO) in which more than 50 countries participate conducting a survey cycle every four years. However, this thesis used only data obtained in Spain. The sample was selected using a random multistage stratified cluster sampling, taking into account the age of the participants, the type of habitat, and the type of school, in order to obtain a nationally representative sample of the Spanish population of adolescents between 11 and 18 years old. In the 2018 edition, 40,495 adolescents participated. For the current dissertation we had data from 17,678 young people between 15 and 18 years of age (those who answered both measures on sex and self-perceived gender identity). Of this group, 303 youth were identified as transgender adolescents. From the remaining 17,375 cisgender participants, resampling based on matching was used to facilitate sample equalization, taking into consideration the variables of age, country of birth, socioeconomic status, type of school, and type of habitat. The final sample comprised 303 transgender adolescents and 909 cisgender adolescents with a comparable profile. Thus, the final sample was 1,212 adolescents. The results obtained in this thesis showed that transgender adolescents reported worse health indicators in all areas assessed than cisgender adolescents, emphasizing poorer mental health, lower perception of social support, and more involvement in bullying and cyberbullying episodes. We hope this new contribution can serve to validate the experiences of transgender adolescents, can encourage scholar to conduct new research lines from a sensitive, positive, and strength-based approach, as well as we hope that this work will serve to detect areas of vulnerability and strength in order to develop evidence-based interventions and policies aimed to enhance their well-being.