Gender identity and expression in relation to depression and anxiety in racial and ethnic minority youth: Evaluations of intersectionality in a population-based study.

INTRODUCTION: Transgender and gender non-conforming (TGNC) youth experience higher rates of depression and anxiety. Risk for these outcomes in racial and ethnic minority populations remains unclear. This study aimed to examine disparities in depression and anxiety at the intersection of race and ethnicity and TGNC status in a population-based sample.METHODS: Data were from the 2019 Minnesota Student Survey. Students (n = 119,648) completed questions about their race, ethnicity, gender identity and expression, depression, and anxiety.RESULTS: Within racial and ethnic groups, TGNC youth generally had greater risk for depression and anxiety. Significant associations for gender minority identity ranged from OR = 2.25 for Black youth who do not identify as male to OR = 5.08 for non-minority ethnicity youth who do not identify as female. For perceived gender expression in cisgender youth, significant associations ranged from OR = 1.17 for Black youth assigned female at birth and OR = 1.17 for other-minority ethnicity youth assigned female at birth to OR = 1.46 for non-minority ethnicity youth assigned female at birth and OR = 1.46 for American Indian/Alaskan Native youth assigned male at birth. Within-TGNC-youth comparisons yielded a few racial/ethnic differences relative to White peers. Significant differences ranged from OR = 0.53 to OR = 1.41 for cisgender females.LIMITATIONS: The cross-sectional data limits our ability to test causation.CONCLUSIONS: Multiple-minority youth were not universally at increased risk for depression and anxiety, indicating an intersectional framework is important for understanding risk for these outcomes in TGNC youth. Future research identifying potential risk and protective factors is needed to advance screening and treatment strategies for multiple-minority TGNC youth populations.