Self-reported Rates of Abuse, Neglect, and Bullying Experienced by Transgender and Gender-Nonbinary Adolescents in China | Adolescent Medicine | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Bullying in other parts of the world
    Frederick Rivara, MD, MPH | University of Washingtoni=
    We know that in the West, transgender and gender-nonbinary adolescents experience greater rates of bullying than the rest of their peers. This is the first study to extend these findings to China, and the negative effects on the mental health of these youth.
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Original Investigation
    Public Health
    September 6, 2019

    Self-reported Rates of Abuse, Neglect, and Bullying Experienced by Transgender and Gender-Nonbinary Adolescents in China

    Author Affiliations
    • 1National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
    • 2Department of Psychiatry, University of Oxford, Oxford, United Kingdom
    • 3Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
    • 4Beijing LGBT Center, Beijing, China
    • 5Department of Psychiatry and Mental Health Institute, Second Xiangya Hospital, Central South University, Chinese National Clinical Research Centre on Mental Disorders, Changsha, China
    • 6First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
    • 7Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
    • 8Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
    JAMA Netw Open. 2019;2(9):e1911058. doi:10.1001/jamanetworkopen.2019.11058
    Key Points español 中文 (chinese)

    Question  What are the rates of abuse, neglect, and bullying and their association with poor mental health experienced by Chinese transgender and gender nonbinary adolescents?

    Findings  In this national survey study of 385 transgender and gender-nonbinary adolescents, 296 respondents reported experiencing parental abuse or neglect and 295 respondents reported experiencing abuse or bullying from classmates or teachers. Reporting experiences of bullying or abuse from classmates or teachers was significantly associated with increased risk of suicidal ideation.

    Meaning  Greater access to appropriate mental health care may be helpful to address the high rates of mental health issues and abuse, neglect, and bullying experienced by Chinese transgender and gender-nonbinary adolescents.


    Importance  This is the first comprehensive national study reporting the rates of abuse, neglect, and bullying from family and classmates or teachers among Chinese transgender and gender-nonbinary adolescents and identifying risk factors associated with poor mental health in this population.

    Objective  To assess the rates of abuse, neglect, and bullying and their association with poor mental health among Chinese transgender and gender nonbinary adolescents.

    Design, Setting, and Participants  This national survey study used an online self-selecting survey conducted between January 1, 2017, and September 29, 2017, in China. Eligibility criteria included reporting being aged 12 to 18 years and being transgender or gender nonbinary. Data analysis was performed from March 25 to 28, 2019.

    Main Outcomes and Measures  The main outcome was self-reported poor mental health, including depressive symptoms, anxiety symptoms, and suicidal ideation. Depressive symptoms were measured using the Center for Epidemiological Studies Depression 9-item scale. Anxiety symptoms were measured using the 7-item General Anxiety Disorder scale. Suicidal ideation was measured using standardized questions adapted from previous Chinese studies. Abuse, neglect, and bullying were measured using specifically designed questions.

    Results  Of 564 responses collected, 385 respondents (mean [SD] age, 16.7 [1.2] years) met inclusion criteria, including 109 (28.3%) transgender adolescent boys, 167 (43.4%) transgender adolescent girls, and 109 (28.3%) gender-nonbinary adolescents. Among 319 respondents who reported that their parents were aware of their gender identity, 296 (92.8%) reported having experienced parental abuse or neglect. Among the full cohort, 295 respondents (76.6%) reported having experienced abuse or bullying owing to being transgender or gender nonbinary in school from classmates or teachers. There were 173 respondents (44.9%) with Center for Epidemiological Studies Depression 9-item scale scores indicating they were at risk of major depressive disorder, and 148 respondents (38.4%) had 7-item General Anxiety Disorder scale scores indicating they were at risk of an anxiety disorder. In univariate analysis, reporting experiences of bullying from a classmate or teacher was significantly associated with suicidal ideation (odds ratio, 1.68 [95% CI, 1.04-2.70]; P = .03), but the association was no longer statistically significant after controlling for level of educational attainment, aversion to assigned sex, and depressed mood at the onset of puberty (odds ratio, 1.63 [95% CI, 0.97-2.73]; P = .06).

    Conclusions and Relevance  In this survey study, transgender and gender-nonbinary adolescents in China reported high rates of abuse, neglect, and bullying at home and in school and high rates of symptoms associated with poor mental health. This study highlights the importance of reducing home- and school-based abuse, neglect, and bullying of transgender and gender-nonbinary adolescents in China to improve mental health outcomes; however, broader change in the social environment may be required to address the prejudice and stigma aimed at gender minorities.