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Article

Associations of Gender Dissatisfaction with Adolescent Mental Distress and Sexual Victimization

by
Qiguo Lian
,
Xiayun Zuo
,
Chunyan Yu
,
Chaohua Lou
,
Xiaowen Tu
* and
Weijin Zhou
NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China
*
Author to whom correspondence should be addressed.
Children 2022, 9(8), 1221; https://doi.org/10.3390/children9081221
Submission received: 28 June 2022 / Revised: 4 August 2022 / Accepted: 10 August 2022 / Published: 12 August 2022
(This article belongs to the Special Issue Development of Sex Education in China)
Review Reports Versions Notes

Abstract

:
Gender dissatisfaction is often linked to adverse health outcomes and is an under-researched area of adolescent health. The aim of our study was to examine the associations of gender dissatisfaction with adolescent mental distress and sexual victimization. We conducted a cross-sectional study in April 2019 using a computerized self-administered questionnaire to collect data on the gender dissatisfaction, mental distress, and sexual victimization among Chinese adolescents. We used multivariate logistic models to estimate sex-stratified adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the associations of gender dissatisfaction with mental distress and sexual victimization. Our study involved 538 female and 556 male students from grades 7 to 11. Among the female students, gender dissatisfaction was significantly associated with depression (AOR, 2.04, 95%CI, 1.17–3.58), anxiety (AOR, 2.13, 95%CI, 2.00–2.27), suicidal ideation (AOR, 2.36, 95%CI, 2.02–2.76), sexting victimization (AOR, 1.67, 95%CI, 1.11–2.51), and nonphysical sexual harassment (AOR, 1.72, 95%CI, 1.08–2.76). Among the male students, gender dissatisfaction was significantly associated with oral-–genital contact (AOR, 5.86, 95%CI, 2.74–12.54), attempted sexual assault (AOR, 9.63, 95%CI, 6.91–13.42), and completed sexual assault (AOR, 14.71, 95%CI, 1.16–187.33). Our findings suggest gender dissatisfaction is associated with adolescent mental distress and sexual victimization, underscoring the importance of implementing comprehensive sexual education with gender perspectives in China.

1. Introduction

Gender (i.e., the societally shared beliefs that apply to individuals based on their biological sex [1]) can shape human health behaviors and outcomes and is an essential part of comprehensive sexual education (CSE) [2]. For example, there is evidence that masculinity in adolescent boys is associated with the perpetration of violence [3,4], and femininity in adolescent girls suggests an increase in depression [5]. One aspect of gender linked to adverse adolescent health outcomes is gender dissatisfaction. The term currently refers to a discrepancy between an individual’s biological sex and gender identity, and is a risk factor for gender dysphoria [6]. There is little research on gender dissatisfaction, and existing studies have used different measurement items and reported varied prevalence ranging from 2.4% to 6.5% in adolescents [7,8]. Adolescents with gender dissatisfaction often experience increased social stress resulting from discrimination [9], bullying, and harassment victimization [10].
It has been well-documented that social stressors, including harassment and discrimination, have a powerful effect on health [11]. Research on health disparities among marginalized groups indicates that social and minority stress is particularly detrimental to mental health [12]. Discrimination is associated with depression among ethnic minority adolescents [13] and suicidality among sexual minority adolescents [14]. Gender minority youths reported increased sexual victimization [15]. Given that adolescents with gender dissatisfaction often have experiences that overlap heavily with gender minority peers [1,16], they may also be at higher risk for poor mental health and sexual victimization. However, there is little known about the associations between gender dissatisfaction, mental health, and sexual victimization among Chinese adolescents [17,18].
To address this research gap, we conducted a study to describe the prevalence of gender dissatisfaction and examine its association with mental health and sexual victimization among Chinese adolescents. We hypothesized that gender dissatisfaction would be associated with mental health and sexual victimization in both adolescent boys and girls.

2. Materials and Methods

Study Design and Participants

In coordination with local educational authorities, we conducted a cross-sectional study in Minle county, Gansu province. We undertook an anonymous self-reported computer-based survey powered by Sawtooth Ci3 (Sawtooth Software, Provo, UT, USA) in 1 primary school (4 classes in grade 5 and 4 classes in grade 6), 1 junior high school (7 classes in grade 7 and 6 classes in grade 8), and 1 senior high school (6 classes in grade 10 and 6 classes in grade 11) in April 2019.
We included all students attending the three schools during the survey and excluded the students who were absent from school during the survey or refused to participate. Of the 1614 students, 39 declined to participate, leading to a response rate of 91.6%. Given that gender dissatisfaction was only measured in senior and junior students, we excluded all students from primary school, resulting in an analytical sample of 1094.
The present study followed the reporting guidelines in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross-sectional studies (eTable).

3. Measures

Gender dissatisfaction was measured by the item: “Does your assigned sex bother you (i.e., a boy wants to be a girl or vice versa)?” Response options were “usually”, “often”, “rarely”, and “never”. Students were categorized into two groups of gender dissatisfaction: yes (usually, often) and no (rarely, never), as in previous studies [7,19].
Depression was measured by the Patient Health Questionnaire-2 (PHQ-2), which collects the frequency of little interest or pleasure in doing things or feeling down, depressed, or hopeless over the past two weeks. Anxiety was measured by the Generalized Anxiety Disorder-2 (GAD-2), which collects the frequency of feeling nervous, anxious, or on edge and unable to stop or control worrying over the last 2 weeks. PHQ-2 and GAD-2 were validated in adolescents [20], and the Cronbach’s coefficients of the two scales were 0.7253 and 0.7963, respectively. The score of each item of PHQ-2 and GAD-2 is 0 (never), 1 (several days), 2 (more than half the days), and 3 (almost every day), and each scale ranges from a score of 0 to 6. The recommended cut-points for each scale, when used as screeners for major depressive disorder and generalized anxiety disorder, is a score of 3 or greater [20,21]. Suicidal ideation was measured by the item: “Did you ever seriously consider attempting suicide?” Response options were “yes” and “no.”
We measured a set of 6-item adolescent sexual victimization experiences, including sexting victimization, nonphysical sexual harassment, breast or genital touch, oral–genital contact, attempted sexual assault, and completed sexual assault (Table 1). These items were adopted from our previous study [22].
The demographic characteristics assessed in our study included sex (female or male), ethnicity (Han or non-Han), grade (7, 8, 10, or 11), parental marital status (intact or separated/divorced), parental education attainment (junior high school or lower, senior or vocational high school, or college and above). We also measured relationships with classmates; options included harmonious (good) or nonharmonious (average, bad, or rarely communicate with others).

4. Statistical Analysis

Complete case analyses were used. First, we computed descriptive statistics for the demographic characteristics by sex. Differences in the distribution of the demographic characteristics by sex were tested using chi-square (χ2) statistics. Second, we estimated the sex-stratified prevalence of gender dissatisfaction, mental distress, and sexual victimization, then we examined the bivariate associations of sex with these variables using χ2 statistics. Third, given that gender dissatisfaction, mental distress, and a few indicators of sexual victimization varied by sex, all associations of gender dissatisfaction with mental distress and sexual victimization used were stratified by sex and adjusted for ethnicity, grade, parental marital status, parental higher education attainment, and relationships with classmates in logistic models. We also considered the potential school clustering in estimating the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the multivariate associations.
All the data analyses were conducted using Stata/SE 15.1 (StataCorp LLC, College Station, TX, USA), and all statistical tests were considered to be statistically significant if 2-sided p < 0.05.

5. Results

The descriptive statistics for all demographic characteristics are provided in Table 2. Among the 1094 participants aged 14.42 years (SD = 1.58), 49.18% were girls and 50.82% were boys. Ethnicities were 97.99% Han and 2.01% non-Han. Grade levels were 36.47% in grade 7, 30.62% in grade 8, 16.73% in grade 10, and 16.18% in grade 11. Male students were more prevalent in the lower grades than female students. For parental status, 89.49% reported their parental marital status was intact, and 56.63% reported their parental education attainment was junior high school or lower. In terms of their relationship with classmates, most students (67.73%) reported being harmonious.
Table 3 presents the prevalence of gender dissatisfaction, mental distress, and sexual victimization by sex. The prevalence of gender dissatisfaction was 29.62%, with a much higher prevalence among female students (44.24%) than male students (15.47%). Overall, 9.96% of students reported depressive symptoms, 8.41% reported anxiety disorders, and 19.20% seriously considered attempting suicide. Female students were more likely to report depression and suicidal ideation than male students. With respect to the prevalence of sexual victimization, 17.55% of participants reported sexting victimization (16.36% of girls vs. 18.71% of boys, p = 0.307), 23.40% reported nonphysical sexual harassment (20.07% of girls vs. 26.62% of boys, p = 0.011), 8.78% reported breast or genital touching (5.02% of girls vs. 12.41% of boys, p < 0.001), 1.74% reported oral–genital contact (1.30% of girls vs. 2.16% of boys, p = 0.278), 2.83% reported attempted sexual assault (3.53% of girls vs. 2.16% of boys, p = 0.171), and 1.65% reported completed sexual assault (1.49% of girls vs. 1.80% of boys, p = 0.685).
Table 4 shows the results of the logistic regression, examining associations of gender dissatisfaction with mental distress and sexual victimization among male and female students, respectively. Among female students, gender dissatisfaction was associated with mental distress, including depression (AOR, 2.04; 95%CI, 1.17–3.58; p = 0.012), anxiety (AOR, 2.13; 95%CI, 2.00–2.27; p < 0.001), and suicidal ideation (AOR, 2.36; 95%CI, 2.02–2.76; p < 0.001). We observed similar results among male students for mental distress.
With regard to sexual victimization, gender dissatisfaction was associated with sexting victimization (AOR, 1.67; 95%CI, 1.11–2.51; p = 0.013) and nonphysical sexual harassment (AOR, 1.72; 95%CI, 1.08–2.76; p = 0.023) among female students. However, among male students, gender dissatisfaction was associated with additional sexual victimization indicators, including oral–genital contact (AOR, 5.86; 95%CI, 2.74–12.54; p < 0.001), attempted sexual assault (AOR, 9.63; 95%CI, 6.91–13.42; p < 0.001), and completed sexual assault (AOR, 14.71; 95%CI, 1.16–187.33; p = 0.038).

6. Discussion

In this study, we found that self-reported gender dissatisfaction was prevalent and associated with mental distress and sexual victimization among Chinese adolescents. To the best of our knowledge, this is one of few studies, if any, to examine the associations of gender dissatisfaction with adverse health outcomes in adolescents. Many existing studies focused on its descendants, including gender dysphoria [9,17,23].
Few epidemiological studies on gender dissatisfaction and gender dysphoria among adolescents have been published [7,8]. The prevalence in our study was much higher than findings from other studies. In a Dutch study, the prevalence of gender dysphoria was 2.4% in boys and 3.3% in girls aged 10 years [8]. In another Dutch study with similar measure (“I wish to be of the opposite sex”), the prevalence was 6.5% in adolescents with autism spectrum disorder (ASD) and 3.1% in adolescents without ASD [7]. The apparent differences indicate the differences in the cultural understanding of social gender and a need for more local studies on this topic.
Female students reported a threefold higher prevalence of gender dissatisfaction than male students. Period-related problems [24], including dysmenorrhea and premenstrual syndrome, and masculinity, which is favorably valued in our society, may both have contributed to the sex difference in gender dissatisfaction. We also found that gender dissatisfaction was linked to mental distress, including depression, anxiety, and suicidal ideation, among both adolescent girls and boys. Our findings are inconsistent with those of other studies on gender nonconformity (GNC). These studies suggested similarities and differences in the associations between GNC and mental distress among adolescent girls and boys [1,25]. The minority stress model offers a useful lens through which to understand mental disparities among marginalized populations [26]. Although the model was originally conceptualized for sexual minorities, it has been applied to gender-variant youth [27], including adolescents with gender dissatisfaction in our study. The model specifies that minorities’ exposure to social environmental stressors confers cumulative psychological stress, resulting in potential mental distress [28].
Associations between gender dissatisfaction and sexual victimization varied by sex. Among female students, the prevalence of sexting victimization and nonphysical sexual harassment was higher among students with gender dissatisfaction; other categories of sexual victimization did not vary by gender dissatisfaction. However, among male students, the prevalence of oral–genital contact, attempted sexual assault, and completed sexual assault was higher among students with gender dissatisfaction. In general, adolescents with gender dissatisfaction are at disproportionately higher risks of sexual victimization compared with their peers. The minority stress model also might explain possible causes for sexual victimization vulnerability among adolescents with gender dissatisfaction [29]. Although we did not measure substance use in our study, research shows that gender-minority adolescents are at elevated risk of substance use than their peers [1,30]. Increased substance use may occur as a coping mechanism in response to experiences of social and minority stress [1,31]. The mechanisms to cope with minority stress, according to the minority stress model, may contribute to a higher risk of sexual victimization among marginalized adolescents [15]. In addition, social environments may impact sexual victimization among gender dissatisfaction adolescents. Greater perceived inclusion of sexual- and gender-minority people on campus was associated with significantly lower odds of experiencing sexual assault victimization at college after controlling for sexual orientation, gender identity, race and ethnicity, and year in school in the USA, suggesting that creating an inclusive climate for sexual- and gender-minority individuals may reduce their prevalence of sexual assault [12].
Our findings underscore the need for providing CSE that honors gender equality, free gender expression, and gender diversity during middle school years or earlier, hence having important implications for the implementation of CSE. Our study highlights health disparities in gender dissatisfaction, mental distress, and sexual victimization among adolescents in China. Our finding informs the need to increase awareness of gender diversity among parents, practitioners, and the larger educational community and to create an inclusive climate for gender diversity by strengthening CSE in China, specifically targeting mental distress and sexual victimization among adolescents with gender dissatisfaction. With support from UNESCO and UNFPA, we conducted a large-scale survey on the implementation of CSE from 2014 to 2015 and found that only around 40% of the students received education on sexual orientation and gender identity or reflected on gender inequalities [32]. Developing support systems within schools and families for adolescents with gender dissatisfaction may be an important avenue for improving mental health and reducing sexual victimization in this subpopulation [33]. CSE that is inclusive of discussions about gender, gender identity, and gender expression may be useful in decreasing the stigma for adolescents with gender dissatisfaction [34].
Our findings also have important implications for sexual victimization research, particularly for future studies examining the link between gender dissatisfaction and sexual victimization, which may disproportionately affect adolescent boys in China. Although we conducted several studies on sexting in vocational and college students in Shanghai [35,36,37], no study in China, to the best of our knowledge, has investigated the national prevalence of sexting and its risk factors. More studies are needed to reach a consensus on the definition and measurement of sexting in the Chinese context.

7. Limitations

Our study has some limitations. First, our findings apply only to adolescents who attend school, and adolescents with gender dissatisfaction may be more likely to drop out of school or be absent from school [38]. Second, it is possible that students who are willing to report gender dissatisfaction may also be more willing to reveal stigmatized mental health symptoms and sexual victimization experiences, which could inflate the estimated associations between gender dissatisfaction and outcomes studied herein [1]. Third, our study is cross-sectional, which hinders the ability to establish causality. Future longitudinal studies can be designed to better assess a causal relationship between gender dissatisfaction and health outcomes in adolescents. Furthermore, we could not examine how gender dissatisfaction changes over time may affect the outcomes studied herein. Fourth, our findings from adolescents in Minle county may not be generalizable to all Chinese adolescents.

8. Conclusions

We reported an increased odds of mental distress and sexual victimization among adolescent girls and boys with gender dissatisfaction in a sample of China. CSE programs that are inclusive of gender diversity in students may help reduce the adverse health outcomes of gender dissatisfaction among adolescents.

Author Contributions

Conceptualization, X.T.; methodology, X.Z.; software, C.Y.; validation, C.Y.; formal analysis, Q.L.; investigation, Q.L., X.Z., C.Y. and W.Z.; resources, W.Z.; data curation, X.Z. and C.Y.; writing—original draft preparation, Q.L.; writing—review and editing, all authors; visualization, C.Y.; supervision, C.L.; project administration, W.Z.; funding acquisition, W.Z. and C.L. All authors have read and agreed to the published version of the manuscript.

Funding

The study was funded by the National Key Technology Research and Development Program of China (2012BAI32B02), National Science and Technology Infrastructure Program of China (2013FY110500), and Innovation-oriented Science and Technology Grant from NHC Key Laboratory of Reproduction Regulation (CX2017–05). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Shanghai Institute of Planned Parenthood Research (2012–01).

Informed Consent Statement

A week or so before the survey, we sent out passive consent letters to the parents or guardians of all subjects via their schools. The parents or guardians were required to return a signed form only if they did not want their child to participate in the survey. We obtained active consent from the subjects by asking all subjects if they agreed to participate at the very beginning of the survey.

Data Availability Statement

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Acknowledgments

The authors thank site coordinators at Minle Maternal and Child Health Hospital for their hard work. The authors also appreciate the cooperation of the students involved.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Lowry, R.; Johns, M.M.; Gordon, A.R.; Austin, S.B.; Robin, L.E.; Kann, L.K. Nonconforming Gender Expression and Associated Mental Distress and Substance Use among High School Students. JAMA Pediatr. 2018, 172, 1020–1028. [Google Scholar] [CrossRef]
  2. Haberland, N.; Rogow, D. Sexuality Education: Emerging Trends in Evidence and Practice. J. Adolesc. Health 2015, 56, S15–S21. [Google Scholar] [CrossRef]
  3. Santana, M.C.; Raj, A.; Decker, M.R.; La Marche, A.; Silverman, J.G. Masculine Gender Roles Associated with Increased Sexual Risk and Intimate Partner Violence Perpetration among Young Adult Men. J. Urban Health 2006, 83, 575–585. [Google Scholar] [CrossRef] [PubMed]
  4. Miller, E.; Culyba, A.J.; Paglisotti, T.; Massof, M.; Gao, Q.; Ports, K.A.; Kato-Wallace, J.; Pulerwitz, J.; Espelage, D.L.; Abebe, K.Z.; et al. Male Adolescents’ Gender Attitudes and Violence: Implications for Youth Violence Prevention. Am. J. Prev. Med. 2020, 58, 396–406. [Google Scholar] [CrossRef] [PubMed]
  5. Tolman, D.L.; Impett, E.A.; Tracy, A.J.; Michael, A. Looking Good, Sounding Good: Femininity Ideology and Adolescent Girls’ Mental Health. Psychol. Women Q. 2006, 30, 85–95. [Google Scholar] [CrossRef]
  6. Diagnostic and Statistical Manual of Mental Disorders: DSM-5TM, 5th ed.; American Psychiatric Publishing, Inc.: Arlington, VA, USA, 2013; pp. 1–947.
  7. Van der Miesen, A.I.R.; Hurley, H.; Bal, A.M.; de Vries, A.L.C. Prevalence of the Wish to be of the Opposite Gender in Adolescents and Adults with Autism Spectrum Disorder. Arch. Sex. Behav. 2018, 47, 2307–2317. [Google Scholar] [CrossRef] [PubMed]
  8. Coolidge, F.L.; Thede, L.L.; Young, S.E. The heritability of gender identity disorder in a child and adolescent twin sample. Behav. Genet. 2002, 32, 251–257. [Google Scholar] [CrossRef] [PubMed]
  9. Jackman, K.B.; Dolezal, C.; Levin, B.; Honig, J.C.; Bockting, W.O. Stigma, gender dysphoria, and nonsuicidal self-injury in a community sample of transgender individuals. Psychiatry Res. 2018, 269, 602–609. [Google Scholar] [CrossRef] [PubMed]
  10. McGuire, J.K.; Anderson, C.R.; Toomey, R.B.; Russell, S.T. School Climate for Transgender Youth: A Mixed Method Investigation of Student Experiences and School Responses. J. Youth Adolesc. 2010, 39, 1175–1188. [Google Scholar] [CrossRef] [PubMed]
  11. Pascoe, E.A.; Smart Richman, L. Perceived discrimination and health: A meta-analytic review. Psychol. Bull. 2009, 135, 531–554. [Google Scholar] [CrossRef]
  12. Williams, D.R.; Yan, Y.; Jackson, J.S.; Anderson, N.B. Racial Differences in Physical and Mental Health: Socio-economic Status, Stress and Discrimination. J. Health Psychol. 1997, 2, 335–351. [Google Scholar] [CrossRef] [PubMed]
  13. Ríos-Salas, V.; Larson, A. Perceived discrimination, socioeconomic status, and mental health among Latino adolescents in US immigrant families. Child. Youth Serv. Rev. 2015, 56, 116–125. [Google Scholar] [CrossRef]
  14. Haas, A.P.; Eliason, M.; Mays, V.M.; Mathy, R.M.; Cochran, S.D.; D’Augelli, A.R.; Silverman, M.M.; Fisher, P.W.; Hughes, T.; Rosario, M.; et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. J. Homosex. 2010, 58, 10–51. [Google Scholar] [CrossRef]
  15. Coulter, R.W.S.; Rankin, S.R. College Sexual Assault and Campus Climate for Sexual- and Gender-Minority Undergraduate Students. J. Interpers. Violence 2020, 35, 1351–1366. [Google Scholar] [CrossRef] [PubMed]
  16. Lian, Q.; Li, R.; Liu, Z.; Li, X.; Su, Q.; Zheng, D. Associations of nonconforming gender expression and gender identity with bullying victimization: An analysis of the 2017 youth risk behavior survey. BMC Public Health 2022, 22, 650. [Google Scholar] [CrossRef] [PubMed]
  17. Dhejne, C.; Van Vlerken, R.; Heylens, G.; Arcelus, J. Mental health and gender dysphoria: A review of the literature. Int. Rev. Psychiatry 2016, 28, 44–57. [Google Scholar] [CrossRef] [PubMed]
  18. Dank, M.; Lachman, P.; Zweig, J.M.; Yahner, J. Dating violence experiences of lesbian, gay, bisexual, and transgender youth. J. Youth Adolesc. 2014, 43, 846–857. [Google Scholar] [CrossRef] [PubMed]
  19. Strang, J.F.; Kenworthy, L.; Dominska, A.; Sokoloff, J.; Kenealy, L.E.; Berl, M.; Walsh, K.; Menvielle, E.; Slesaransky-Poe, G.; Kim, K.E.; et al. Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Arch. Sex. Behav. 2014, 43, 1525–1533. [Google Scholar] [CrossRef] [PubMed]
  20. Materu, J.; Kuringe, E.; Nyato, D.; Galishi, A.; Mwanamsangu, A.; Katebalila, M.; Shao, A.; Changalucha, J.; Nnko, S.; Wambura, M. The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: A cross-sectional study. BMC Psychiatry 2020, 20, 321. [Google Scholar] [CrossRef] [PubMed]
  21. Kroenke, K.; Spitzer, R.L.; Williams, J.B.; Löwe, B. An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics 2009, 50, 613–621. [Google Scholar] [CrossRef] [PubMed]
  22. Zhang, Y.; Zuo, X.; Mao, Y.; Lian, Q.; Luo, S.; Zhang, S.; Tu, X.; Lou, C.; Zhou, W. Co-occurrence subgroups of child sexual abuse, health risk behaviors and their associations among secondary school students in China. BMC Public Health 2021, 21, 1139. [Google Scholar] [CrossRef] [PubMed]
  23. Kaltiala-Heino, R.; Bergman, H.; Työläjärvi, M.; Frisén, L. Gender dysphoria in adolescence: Current perspectives. Adolesc. Health Med. Ther. 2018, 9, 31–41. [Google Scholar] [CrossRef] [PubMed]
  24. Rafique, N.; Al-Sheikh, M.H. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Med. J. 2018, 39, 67–73. [Google Scholar] [CrossRef] [PubMed]
  25. van Beusekom, G.; Baams, L.; Bos, H.M.W.; Overbeek, G.; Sandfort, T.G.M. Gender Nonconformity, Homophobic Peer Victimization, and Mental Health: How Same-Sex Attraction and Biological Sex Matter. J. Sex Res. 2016, 53, 98–108. [Google Scholar] [CrossRef] [PubMed]
  26. Meyer, I.H.; Schwartz, S.; Frost, D.M. Social patterning of stress and coping: Does disadvantaged social statuses confer more stress and fewer coping resources? Soc. Sci. Med. 2008, 67, 368–379. [Google Scholar] [CrossRef] [PubMed]
  27. Paul Poteat, V.; Scheer, J.R.; Mereish, E.H. Chapter Eight—Factors Affecting Academic Achievement among Sexual Minority and Gender-Variant Youth. In Advances in Child Development and Behavior; Liben, L.S., Bigler, R.S., Eds.; JAI: Tamil Nadu, India, 2014; Volume 47, pp. 261–300. [Google Scholar]
  28. Diamond, L.M. Chapter 11—Sexual-Minority, Gender-Nonconforming, and Transgender Youths. In Handbook of Child and Adolescent Sexuality; Bromberg, D.S., O’Donohue, W.T., Eds.; Academic Press: San Diego, CA, USA, 2013; pp. 275–300. [Google Scholar]
  29. McCauley, H.L.; Coulter, R.W.S.; Bogen, K.W.; Rothman, E.F. Chapter 14—Sexual Assault Risk and Prevention among Sexual and Gender Minority Populations. In Sexual Assault Risk Reduction and Resistance; Orchowski, L.M., Gidycz, C.A., Eds.; Academic Press: San Diego, CA, USA, 2018; pp. 333–352. [Google Scholar]
  30. Katz-Wise, S.L.; Sarda, V.; Austin, S.B.; Harris, S.K. Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents. PLoS ONE 2021, 16, e0250500. [Google Scholar] [CrossRef] [PubMed]
  31. Lowry, R.; Johns, M.M.; Robin, L.E.; Kann, L.K. Social Stress and Substance Use Disparities by Sexual Orientation among High School Students. Am. J. Prev. Med. 2017, 53, 547–558. [Google Scholar] [CrossRef]
  32. UNESCO Office Beijing. Implementation of Sexuality Education in Middle Schools in China; UNESCO: Paris, France; Beijing, China; UNFPA: Beijing, China, 2018. [Google Scholar]
  33. Wernick, L.J.; Kulick, A.; Inglehart, M.H. Influences of peers, teachers, and climate on students’ willingness to intervene when witnessing anti-transgender harassment. J. Adolesc. 2014, 37, 927–935. [Google Scholar] [CrossRef] [PubMed]
  34. Rands, K.E. Considering Transgender People in Education: A Gender-Complex Approach. J. Teach. Educ. 2009, 60, 419–431. [Google Scholar] [CrossRef]
  35. Zheng, Y.; Fang, Y.; Zhang, J.; Lian, Q.; Zuo, X.; Yu, C.; Lou, C.; Tu, X.; Li, L.; Hong, P. Association between sexting and mental health among secondary vocational school students. Chin. J. Sch. Health 2022, 43, 203–206 + 210. [Google Scholar]
  36. Lian, Q.; Zhu, W.; Zhang, H.; Pan, Y.; Min, M.; Shen, S.J.; Lu, M.; Lu, Z.; Zeng, Y.; Che, Y. The association between sexting and premarital sex among adolescents. Chin. J. Hum. Sex. 2015, 24, 101–103. [Google Scholar]
  37. Min, M.; Zhou, R.; Shen, J.; Lian, Q.; Zhang, H.; Zeng, Y.; Lu, M.; Lu, Z.; Zhu, H.; Che, Y. Sexting and influential factors among college students in Shanghai. Chin. J. Sch. Health 2016, 37, 1304–1307. [Google Scholar]
  38. Burton, C.M.; Marshal, M.P.; Chisolm, D.J. School absenteeism and mental health among sexual minority youth and heterosexual youth. J. Sch. Psychol. 2014, 52, 37–47. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Questionnaire items and analytic coding of sexual victimization.
Table 1. Questionnaire items and analytic coding of sexual victimization.
Sexual VictimizationQuestionnaire ItemAnalytic Coding
Receiving a sextHave you ever received nude or nearly nude pictures or videos via a cell phone?Yes vs. no
Nonphysical sexual harassmentHave you ever had been told dirty jokes or shown pornographic pictures, publications, supplies, etc.?Yes vs. no
Breast or genital touchHas someone ever touched your privates/breasts or forced you to touch their privates/breasts?Yes vs. no
Oral–genital contactHas someone ever stimulated your genitals with their mouth or forced you to stimulate their genitals with your mouth?Yes vs. no
Attempted sexual assaultHas someone ever attempted to have sex with you?Yes vs. no
Completed sexual assaultHas someone ever forced you to have sex with them?Yes vs. no
Table
Table 2. Demographic characteristics of all respondents by sex.
Table 2. Demographic characteristics of all respondents by sex.
Demographic GroupSexChi-Square
p-Value
Female, %
(n = 538)		Male, %
(n = 556)
Ethnicity
          Han98.3397.660.433
          Non-Han1.672.34
Grade
          732.9039.930.001
          829.3731.83
          1017.4716.01
          1120.2612.23
Parental marital status
          Intact88.4890.470.283
          Separated/divorced11.529.53
Parental education attainment
          Junior high school or lower55.1858.030.560
          Senior or vocational high school25.4222.81
          College or above19.4019.16
Relations with classmates
          Harmonious68.4067.090.642
          Nonharmonious31.6032.91
Table
Table 3. The prevalence of gender dissatisfaction, mental distress, and sexual victimization by sex.
Table 3. The prevalence of gender dissatisfaction, mental distress, and sexual victimization by sex.
Variable of InterestSexChi-Square
p-Value
Female, %
(n = 538)		Male, %
(n = 556)
Exposure
            Gender dissatisfaction44.2415.47<0.001
Mental distress
            Depression11.908.090.036
            Anxiety9.857.010.091
            Suicidal ideation24.5414.03<0.001
Sexual victimization
            Receiving a sext16.3618.710.307
            Nonphysical sexual harassment20.0726.620.011
            Breast or genital touch5.0212.41<0.001
            Oral–genital contact1.302.160.278
            Attempted sexual assault3.532.160.171
            Completed sexual assault1.491.800.685
Table
Table 4. Sex-stratified associations of gender dissatisfaction with mental distress and sexual victimization.
Table 4. Sex-stratified associations of gender dissatisfaction with mental distress and sexual victimization.
OutcomeGender Dissatisfaction
NoYes
%%AOR (95%CI)p-Value
Female students
Mental distress
            Depression8.6715.972.04 (1.17–3.58)0.012
            Anxiety7.0013.452.13 (2.00–2.27)<0.001
            Suicidal ideation17.6733.192.36 (2.02–2.76)<0.001
Sexual victimization
            Sexting victimization13.3320.171.67 (1.11–2.51)0.013
            Nonphysical sexual harassment16.3324.791.72 (1.08–2.76)0.023
            Breast or genital touch3.676.721.72 (0.44–6.63)0.433
            Oral–genital contact0.672.103.22 (0.50–20.78)0.219
            Attempted sexual assault3.333.781.04 (0.59–1.84)0.886
            Completed sexual assault1.002.102.28 (0.49–10.50)0.292
Male students
Mental distress
            Depression7.4511.631.65 (1.04–2.62)0.033
            Anxiety6.609.301.52 (1.37–1.70)<0.001
            Suicidal ideation12.7720.932.00 (1.96–2.04)<0.001
Sexual victimization
            Receiving a sext16.6030.232.78 (1.66–4.63)<0.001
            Nonphysical sexual harassment24.4738.372.85 (2.83–2.86)<0.001
            Breast or genital touch11.2818.601.95 (0.95–3.99)0.069
            Oral–genital contact1.286.985.86 (2.74–12.54)<0.001
            Attempted sexual assault1.286.989.63 (6.91–13.42)<0.001
            Completed sexual assault0.648.1414.71 (1.16–187.33)0.038
Abbreviation: AOR, adjusted odds ratio (adjusted for ethnicity, grade, parental marital status, parental education attainment, and relationships with classmates, with no gender dissatisfaction being the referent group).
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Lian, Q.; Zuo, X.; Yu, C.; Lou, C.; Tu, X.; Zhou, W. Associations of Gender Dissatisfaction with Adolescent Mental Distress and Sexual Victimization. Children 2022, 9, 1221. https://doi.org/10.3390/children9081221

AMA Style

Lian Q, Zuo X, Yu C, Lou C, Tu X, Zhou W. Associations of Gender Dissatisfaction with Adolescent Mental Distress and Sexual Victimization. Children. 2022; 9(8):1221. https://doi.org/10.3390/children9081221

Chicago/Turabian Style

Lian, Qiguo, Xiayun Zuo, Chunyan Yu, Chaohua Lou, Xiaowen Tu, and Weijin Zhou. 2022. "Associations of Gender Dissatisfaction with Adolescent Mental Distress and Sexual Victimization" Children 9, no. 8: 1221. https://doi.org/10.3390/children9081221

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