Emotional Distress, Bullying Victimization, and Protective Factors Among Transgender and Gender Diverse Adolescents in City, Suburban, Town, and Rural Locations

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Purpose: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. Methods: Data come from a statewide school-based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. Findings: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. Conclusions: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population.

Original languageEnglish (US)
Pages (from-to)270-281
Number of pages12
JournalThe Journal of Rural Health
Issue number2
StatePublished - Mar 1 2019



  • adolescence
  • bullying
  • mental health
  • social environment
  • transgender

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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