(PS6-32) Mental Health Mediates the Relationship between Transgender Youth Affirmation at School and Academic Outcomes

Background: Transgender youth in the United States (US) face increasing discriminatory policies and harassment, while the Netherlands (NL) is considered an international gold standard for affirming policy and care. There is a dearth of research investigating the impacts of trans youth discrimination on academic achievement. This topic is critical, as academic achievement is a predictor of both life satisfaction (Bücker et al., 2018) and socioeconomic stability (Sirin, 2005). A 3-stage international Delphi panel developed a set of questions capturing day-to-day experiences of trans youth at home, in the community, and at school (Transgender Youth Perceptions of Environmental Supports [TYPES]; van der Miesen et al., 2025). The TYPES school questions capture trans youth feelings of safety and affirmation at school. The TYPES was co-developed in both Dutch and English.

Methods: In 2022-2023, 179 transgender youth (n_US=103, n_NL=76) ages 11-16 completed the TYPES and the ASEBA Youth Self-Report (YSR). The youth’s parent(s)/caregiver(s) reported on their child’s autism and ADHD diagnostic statuses, given the common intersection of gender diversity and neurodivergence. In this study, academic outcomes were tested across each of the 9 school-related TYPES items (general linear models), while considering the covariates of: country of residence, gender, assigned sex, and autism and ADHD statuses (t-tests). Finally, the relationships between academics (YSR), affirmation at school (TYPES), and internalizing symptoms (YSR) were investigated via mediation analyses.

Results: There were no differences in academics by autism or ADHD, or by assigned sex. Boys self-reported stronger academics than girls (p=.006), but there were no differences between non-binary youth and boys or girls. US youth self-reported stronger academics than Dutch youth (p< .001). All subsequent analyses therefore controlled for gender and country.

Based on the TYPES, youth in schools with peers who were less supportive of trans students (p=.003) and who felt less comfortable using the school bathroom of their choice (p=.003) reported poorer academics. Youth whose classmates were less likely to use their chosen name and pronouns trended toward poorer academics (p=.075); importantly, this TYPES item had reduced variability indicating that the study sampled youth in more supportive school settings.

Mediation analyses investigated whether self-reported internalizing (int) symptoms mediates the relationship between each school-related TYPES item (i) and academic outcomes. Internalizing symptoms partially mediated the relationship between peer support and academics (p_i=.026, p_int=.001), and fully mediated the relationship between comfort using a preferred bathroom and academics (p_i=.068, p_int=.003) and peers using chosen name and pronouns and academics (p_i=.385, p_int< .001).


Conclusion: Results suggest that trans youth academic achievement may be impacted by experience of affirmation at school via mental health distress. Future research should more closely examine mechanisms specific to trans youth influencing academic achievement. Cross-national research may allow for identification of novel approaches for supporting trans youth at school.