# Gender minority stress, resilience, and mental health in clinic-referred transgender and gender-diverse adolescents: a network analysis

## TL;DR

This study explores how stress from being transgender or gender-diverse affects mental health in adolescents, highlighting the role of non-affirmation and the need for societal support.

## Contribution

The study applies network analysis to examine the interplay between gender minority stress, resilience, and mental health in a clinical sample of transgender and gender-diverse adolescents.

## Key findings

- Non-affirmation was the most central construct in the network, strongly linked to internalized transphobia and negative future expectations.
- Resilience factors like pride and community connectedness showed limited centrality in the mental health network.
- Distal stressors like rejection and victimization indirectly influenced mental health through more central stressors.

## Abstract

Transgender and gender-diverse (TGD) adolescents experience elevated rates of depression, anxiety, and suicidality compared to cisgender peers. These outcomes are largely hypothesized to be linked to social stigma and gender minority stress. Resilience constructs like identity pride and community connectedness may buffer these stressors, but their role, especially in clinical populations, remains underexplored. This study investigates the interplay between gender minority stress, resilience, and mental health in clinic-referred Dutch TGD youth through network analysis.

A sample of 172 Dutch TGD adolescents was assessed using commonly employed measures of gender minority stress, resilience, and mental health. Network analysis was conducted to examine network structure and centrality of these constructs. Among the 172 clinic-referred Dutch participants (mean age = 15.70, SD = 0.79), 86.0% (n = 148) were assigned female at birth, 14.0% (n = 24) were assigned male at birth, and 9.9% (n = 17) of the total sample identified as non-binary and genderqueer (NBGQ).

Among the participants, 41.7% scored within the clinical range for internalizing problems, and 32.7% exhibited scores indicative of mild to severe depression. Non-affirmation, an established construct in gender minority stress literature, emerged as the most central construct in the network, with strong associations to internalized transphobia and negative expectations for future events. Distal gender minority stressors, such as gender-related rejection and victimization, were less central within the network, but indirectly influenced mental health via pathways involving the more central stressors. Resilience constructs, specifically pride and community connectedness, showed limited centrality.

The findings highlight the substantial psychological vulnerabilities of Dutch TGD adolescents and underscore the importance of addressing non-affirmation, internalized transphobia, and negative expectations for future events in clinical settings to mitigate mental health challenges among TGD youth. The study also emphasizes the necessity of societal-level interventions, such as raising awareness about the value of affirming gender identity. Future research should explore the nuanced distinctions within and between different gender minority stressors and their specific impacts on TGD youth.

The online version contains supplementary material available at 10.1186/s13034-026-01031-6.