In a recent article published in JAMA Network Open, researchers performed a cross-sectional study among 1,231 transgender, nonbinary (TGNB), and cisgender youths in the United States (U.S.) to determine how gender identity moderated the association between social media use (SMU) and indicators of mental health.

This included internalizing and externalizing problems, such as depression, body image, and conduct issues.

Background

Many TGNB individuals experience gender dysphoria, a distressed state arising from the disconnect between one’s birth-assigned sex and self-perceived gender identity. They also experience minority stress amid a majority social environment fostered through societal processes that harass and discriminate against TGNB individuals. 

Social media activities can give TGNB individuals an outlet for portraying themselves how they see fit, build positive connections, and create support systems to protect their mental health. However, how TGNB youths use social media outside gender identity exploration is understudied.

There are concerns that SMU can adversely impact mental health, with some researchers suggesting that there is an association between time spent on social media and struggles with mental health. In this study, researchers considered the minority stress theory and hypothesized that whilst this trend may be true for cisgender youths, for TGNB youths SMU might be more protective and may not raise the risk for mental health.

About the study

In the present study, researchers used a Qualtrics panel to recruit transgender adolescent participants aged 10 to 17 who resided in the U.S. and readily filled out an online survey between May and August 2021. 

They chose this age group as representing U.S. youth because substantial gender identity development occurs during adolescence. The study participants self-reported their race and ethnicity, which included American Indian, Asian, Pacific Islander, Black, Hispanic, White, and mixed. 

The team used a patient health questionnaire (PHQ-8) to measure depression, with responses ranging from 1 (not at all) to 4 (nearly every day). They used the five-item Strengths and Difficulties Questionnaire (SDQ) to measure emotional and conduct problems. Furthermore, they used a five-point Likert scale to evaluate body image, with 1 and 5 indicating never shamed to always shamed. 

The study variables covered: social media use duration; age at the time of using the smartphone for the first time; whether the use was active or passive; how they compared social media sites; did they take intentional breaks from their smartphones; did they find SMU problematic; the digital well-being of schools attended; whether they cleaned or curated their social media feed or followers; and their mindfulness around SMU.

Finally, the team recruited seven adolescents as an advisory board from two focus groups to co-interpret the study findings allowing insider perspectives. The first and second focus groups comprised four cisgender adolescents aged 14 to 17 and three TGNB adolescents aged 14 to 16, respectively.

Results

The study had many important findings. First, compared to cisgender youth, TGNB youth had higher depression, emotional and conduct issues, and negative body image. However, their use of social media was associated with fewer mental health problems as they might be cautiously creating digital spaces free from the negative interactions that plagued them elsewhere, e.g., at school. 

Accordingly, cleaning and curating feeds lowered depression levels among TGNB youths but not for cisgender youths. Researchers hypothesize that this could be due to TGNB youths curating a safe space due to bullying and harassment. One participant talked about having more control over online space as they surrounded themselves with people having similar beliefs.

Further investigation is required into why the pattern was the opposite for cisgender youths. The researchers hypothesise that perhaps there was fear of offending peers by unfollowing them on social media, meaning that they benefited from a social media break rather than curating feeds.

Another observation that reinstated the delicate balance of gender identity-related risks and benefits of SMU in youth was that taking intentional technology breaks was markedly associated with increased depression and emotional issues for TGNB but not cisgender youths. 

Indeed, for TGNB youths, social media was a key avenue for social acceptance; thus, breaks were potentially detrimental to their mental health. For TGNB youths, attending a school with a strong media literacy program was associated with positive outcomes. It facilitated greater intentionality around SMU.

Conclusions

TGNB youths face everyday minority stress, but social media might actually confer protective effects for TGNB youths, and their parents and guardians could focus more on how social media can be a resource for their children rather than focusing on how screen time may be resulting in mental health struggles.
 
Likewise, policymakers and school personnel should design policies considering the differential associations of SMUs based on gender identity. Policies severely limiting SMU among youths may not be the best outcome for TGNB youths. Instead, schools should encourage school media literacy programs. 

Most importantly, pediatricians or doctors treating adolescents should consider asking them about the details of SMU. Their questions should go beyond screen time during consultations, and their approach should be more nuanced based on the patient's gender identity.

The study results suggested that while TGNB youths are at a higher risk for adverse mental health outcomes than cisgender youths, this higher risk is not associated with time spent on social media. 

On the contrary, SMU seemed to lower their mental health issues. Social media might even be protective for some TGNB youths, particularly when used appropriately. It highlights and emphasizes that while examining the associations between SMU and health, researchers should look specifically at gender identity. 

Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.