Respect Diversity + Inclusion

Study finds more gender-diverse youth in Appalachia, underscores need for support

“We have a lot of studies that suggest gender-diverse youth are two to four times as likely to experience depression and thoughts of self-harm as their cisgender peers.”
Gender diversity.

Story at a glance

  • Previous research on gender-diverse youth in rural Appalachia did not accurately capture this population due to limited questions and a lack of first-person data, according to the study.

  • To address this knowledge gap, researchers at West Virginia University conducted an online survey among seventh through 12th grade students.

  • More than 7 percent of those surveyed identified as gender-diverse, or having a gender identity that does not fully align with their sex assigned at birth.

New research published in JAMA Pediatrics found more than 7 percent of youth living in a rural region in Appalachia report a gender identity that does not fully align with the sex they were assigned at birth.  

A previous study that did not collect data from youth themselves found 1 percent of those in West Virginia identified as transgender. But because many gender-diverse youth do not identify with the word transgender, this count potentially underestimated the true prevalence of gender diversity, researchers noted.

As such, authors hypothesize the use of a more inclusive gender diversity question contributed to a higher proportion of youth identifying as gender-diverse in their study. Research also shows youth do not identify as transgender due to external influences like social media or their peers. 

Compared with non-gender diverse youth, these individuals are at an increased risk of depression and suicidality, and also face greater health care barriers in rural regions. These can include discrimination and a lack provider training on LGBTQ+ concerns. 

Studies on gender-diverse youth in rural areas are generally rare, researchers explained, adding that having a gender identity that doesn’t match one’s sex at birth (such as identifying as transgender or nonbinary) is part of the normal human experience and is not a medical concern. 

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Social stigma or prejudice, in addition to distress surrounding one’s gender identity — defined as gender dysphoria — can contribute to the heightened mental health risks in this population.

“We have a lot of studies that suggest gender-diverse youth are two to four times as likely to experience depression and thoughts of self-harm as their cisgender peers, or young people whose sex assigned at birth and gender identity fully align,” said study co-author Kacie Kidd of West Virginia University in a statement.

“This is an area where we need to do more research. We need to better understand how to support these young people, especially now that we are increasingly recognizing that they are here and would likely benefit from the support.”

Youth in grades seven through 12 completed the online survey and represented a total of 16 different Appalachian public schools. Of the 2,921 youth participants, 2,822 answered both the gender identity and sex assigned at birth questions, while 202 were gender-diverse.

Among gender-diverse youth in the survey, more reported nonbinary than binary identites, while racial and ethnic minorities were more likely to be gender-diverse. 

“There are few resources available for [gender-diverse youth] and their families in rural Appalachia, especially for racial and ethnic minority Appalachians who are often further marginalized through invisibility and assumed racial homogeneity,” authors wrote. 

“We suspect that many of the young people in rural Appalachia who shared their gender-diverse identities with us in this study may benefit from additional support, especially if they do not feel seen and supported at home and in their community,” Kidd added. 

The findings outline the importance of school and community support systems for gender-diverse youth in addition to improved access to mental health care, researchers concluded.