Best practices to measure gender identity in young adults with serious mental health conditions
Kathryn Sabella, Ian A. Lane, Murron O'Neill
Background: Almost 80% of nonbinary and transgender adults are between the ages of 18 and 29 (Wilson & Meyer, 2021). Research suggests that gender diverse young adults face an increased risk substance use, homelessness, suicide, and poor mental health (Healthy People, 2020; The GenIUSS Group, 2014).
Researchers and service providers should measure participant gender identities in an inclusive and respectful way. Gender identity nonverification or misclassification can lead to shame, embarrassment, anxiety, and sadness (Burke & Stets, 2015). While measures of gender identity on population-based surveys are increasingly diversified, stakeholder input varies and there is no “gold standard” (Holzberg et al., 2018).
Objectives: A longitudinal survey of young adults (ages 16-25) with serious mental health conditions (SMHC) was used to:
Methods: Between 2017 and 2022, 279 young adults (ages 16-26) with SMHC from across the United States participated in a longitudinal quantitative study to describe their school, training, and work activities and explore if and how those activities were correlated with various demographic and psychosocial covariates. Participants received a web-based survey (via REDCap) at baseline and every 4 months for up to 20 months.
Young adult staff members with lived experience of an SMHC participated in study design and led all data collection activities. As a result of this participatory approach, the study team utilized a set of gender identity measures that were inclusive of diverse gender identities (The GenIUSS Group, 2014). Questions at each timepoint asked participants to identify with one or more diverse gender identities (i.e., binary and non-binary), allowed them to select multiple gender identities, and asked separately whether they identify as transgender. Participants were also asked how they prefer to be asked about their gender identity.
Researchers and service providers should measure participant gender identities in an inclusive and respectful way. Gender identity nonverification or misclassification can lead to shame, embarrassment, anxiety, and sadness (Burke & Stets, 2015). While measures of gender identity on population-based surveys are increasingly diversified, stakeholder input varies and there is no “gold standard” (Holzberg et al., 2018).
Objectives: A longitudinal survey of young adults (ages 16-25) with serious mental health conditions (SMHC) was used to:
- Assess if within-subject gender identities change over time
- Pilot and obtain feedback on inclusive, gender diverse demographic questions
Methods: Between 2017 and 2022, 279 young adults (ages 16-26) with SMHC from across the United States participated in a longitudinal quantitative study to describe their school, training, and work activities and explore if and how those activities were correlated with various demographic and psychosocial covariates. Participants received a web-based survey (via REDCap) at baseline and every 4 months for up to 20 months.
Young adult staff members with lived experience of an SMHC participated in study design and led all data collection activities. As a result of this participatory approach, the study team utilized a set of gender identity measures that were inclusive of diverse gender identities (The GenIUSS Group, 2014). Questions at each timepoint asked participants to identify with one or more diverse gender identities (i.e., binary and non-binary), allowed them to select multiple gender identities, and asked separately whether they identify as transgender. Participants were also asked how they prefer to be asked about their gender identity.
Original question (asked at Baseline only)
How would you describe yourself?
Male; Female; Transgender; Do not identify as female, male, or transgender
How would you describe yourself?
Male; Female; Transgender; Do not identify as female, male, or transgender
Revised question #1 (asked at each timepoint):
How would you describe yourself? (Check all that apply)
Male; Female; Genderqueer; Gender non-conforming; Gender fluid; Gender non-binary; Prefer to describe_____
Revised question #2 (asked at each timepoint):
Transgender is an umbrella term that refers to people whose gender identity, expression, or behavior is different from those typically associated with their assigned sex at birth. Do you identify as transgender?
Yes; No; Prefer not to say
How would you describe yourself? (Check all that apply)
Male; Female; Genderqueer; Gender non-conforming; Gender fluid; Gender non-binary; Prefer to describe_____
Revised question #2 (asked at each timepoint):
Transgender is an umbrella term that refers to people whose gender identity, expression, or behavior is different from those typically associated with their assigned sex at birth. Do you identify as transgender?
Yes; No; Prefer not to say
RESULTS: While 51% of respondents retained a traditional gender identity at every timepoint throughout our study, 49% responded that their gender identity had changed at one or more follow-up timepoints or they selected multiple response options at a single timepoint.
CONCLUSION: Young adults with SMHC may identify with more than one gender identity at any given time and their gender identity may change over time. While many young adults prefer gender to be asked with an open-ended answer, utilizing a close-ended question with multiple response options does seem viable. Answer categories should be as inclusive as possible and not be exclusive to sex categories of “male” and “female”. Researchers and service providers should continually monitor their gender questions to ensure the accurate representation of gender diverse young adults.
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Most endorsed our wording of the gender identity question. Additional recommendations:
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