Urgent Need to Focus on Gender‐Diverse Adolescents in Mental Health Prevention Research: A Cross‐Sectional Comparative Study

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ABSTRACT Background and Aims Gender‐diverse adolescents—those whose gender identity differs from their assigned sex at birth or who do not conform to traditional binary gender norms—are at significantly higher risk for mental health issues, including suicidality and non‐suicidal self‐injury (NSSI). However, most prevention efforts remain focused on cisgender youth. This study aims to directly compare levels of emotional dysregulation, depressive symptoms, suicidality, and NSSI between gender‐diverse adolescents and their cisgender peers to inform gender‐sensitive prevention strategies. Methods This cross‐sectional analysis was conducted in a school‐based sample with participants aged 8–15 years. Gender identity was self‐reported through self‐categorization using a single item with three response options (female, male, diverse). Emotional dysregulation (DERS‐SF), depressive symptoms (PHQ‐9), suicidality (PSS), and NSSI (DSHI‐9) were assessed. Group comparisons between gender‐diverse adolescents ( n = 13), female‐identifying adolescents ( n = 1102), and male‐identifying adolescents ( n = 1045) were performed using Mann‐Whitney U, Fisher's exact, and χ² tests with Bonferroni‐adjusted p‐values. Results Compared to female‐identifying and male‐identifying adolescents, gender‐diverse adolescents showed significantly higher emotional dysregulation (vs. females: p < 0.001; vs. males: p < 0.001) and depressive symptom severity (vs. females: p < 0.001; vs. males: p < 0.001). Recent suicidality (past two weeks) was markedly elevated in gender‐diverse youth (vs. females: p < 0.001; vs. males: p < 0.001), although lifetime suicidality did not differ significantly. NSSI behaviors were consistently more severe in the gender‐diverse group, with significantly higher lifetime prevalence, greater frequency, and a broader range of methods (all comparisons p < 0.001 vs. both comparison groups). Conclusion Gender‐diverse adolescents exhibit substantially higher levels of emotional and behavioral distress compared to both female‐identifying and male‐identifying adolescents. These findings highlight the urgent need for inclusive mental health screening and targeted prevention programs that address the distinct psychological profiles and elevated risks within gender‐diverse youth populations.

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