Tek Bir Risk Kategorisinin Ötesinde: Transgender Ergenlerde Zorbalık Mağduriyeti ile İntihar Düşünce ve Davranışlarının Grup İçi İlişkili Etmenleri

Abstract

Amaç: Transgender ergenler, cisgender akranlarına kıyasla belirgin biçimde yüksek zorbalık ve olumsuz ruh sağlığı sonuçları bildirmektedir; ancak mevcut araştırmaların büyük bölümü bu grubu homojen tek bir risk kategorisi olarak ele almıştır. Bu çalışmada, transgender ergen popülasyonu içinde zorbalık mağduriyeti ve ruh sağlığı sonuçlarıyla ilişkili sosyodemografik ve fiziksel sağlık etmenlerinin belirlenmesi amaçlanmıştır. Yöntem: 2023 ulusal Youth Risk Behavior Survey (YRBS) verilerinin ikincil analizi olarak yürütülen çalışmada, kendini transgender olarak tanımlayan 612 lise öğrencisi analiz örneklemini oluşturdu. Beş sonuç değişkeni incelendi: okulda zorbalık, elektronik zorbalık, süreğen üzüntü/umutsuzluk, intihar düşüncesi ve intihar girişimi. Ağırlık, tabaka ve birincil örnekleme birimi değişkenleri birlikte kullanılarak karmaşık örneklem tasarımı tanımlandı; transgender öğrenciler veri filtrelenmeden alt-popülasyon (domain) olarak belirlendi. Cinsiyet, sınıf düzeyi, ırk/etnisite, cinsel kimlik ve beden kitle indeksi (BKİ) eşzamanlı olarak girilerek, anket-ağırlıklı çok değişkenli lojistik regresyon modelleri kuruldu; modeller tam-vaka analizine dayandı (analitik n = 429–439). Bulgular: Ağırlıklı ulusal transgender prevalansı %3,3 (%95 GA 2,7–3,9) idi. Prevalanslar belirgin biçimde yüksekti: katılımcıların %42,6'sı okulda zorbalık, %33,8'i elektronik zorbalık, %71,0'ı süreğen üzüntü/umutsuzluk, %53,8'i intihar düşüncesi ve %25,7'si intihar girişimi bildirdi. Cinsel kimlik içselleştirme sonuçlarıyla ilişkiliydi: heteroseksüel transgender öğrencilere kıyasla biseksüel (aOR 6,23; p=0,001), gey/lezbiyen (aOR 4,94; p=0,017) ve cinsel kimliğini “başka bir şekilde” tanımlayan (aOR 7,17; p=0,001) öğrencilerde süreğen üzüntü/umutsuzluk olasılığı daha yüksekti; düzeltilmiş öngörülen olasılıklar sırasıyla %75, %71 ve %77 iken heteroseksüel grupta %37 idi. Siyahi transgender öğrencilerde okulda zorbalık bildirimi olasılığı daha düşüktü (aOR 0,17; p=0,008); bu tahmin küçük bir alt örnekleme (n=31) dayanmaktadır. Okulda zorbalık için yalnızca 11. sınıf, elektronik zorbalık için 10. ve 11. sınıf karşılaştırmaları 9. sınıfa kıyasla anlamlı biçimde düşüktü. BKİ'ye ilişkin önceki hipotez değişken düzeyinde desteklenmedi (ortak Wald testi hiçbir modelde anlamlı değildi); yalnızca obezite–okulda zorbalık karşılaştırması anlamlıydı (aOR 2,08; p=0,035). Sonuç: Transgender ergen popülasyonu heterojendir; cinsel kimlik, ırk/etnisite ve sınıf düzeyi sonuçlarla farklılaşan biçimde ilişkilidir. Bulgular, klinik ve okul sağlığı ortamlarında bireyselleştirilmiş risk değerlendirmesinin önemini desteklemektedir.

Keywords

• Ergen
• Zorbalık
• Cinsel ve Cinsiyet Azınlıkları
• İntihar Düşüncesi
• İntihar Girişimi
• Transgender Bireyler

Supporting Institution

Yoktur. Yazarlar bu çalışma için herhangi bir finansal veya kurumsal destek almamıştır.

Ethical Statement

Bu çalışma, 2023 ulusal Youth Risk Behavior Survey (YRBS) kapsamında kamuya açık, tamamen anonimleştirilmiş verilerin ikincil analizidir. Orijinal YRBS protokolü, ABD Hastalık Kontrol ve Önleme Merkezleri (CDC) ve ICF etik kurulları tarafından onaylanmış; orijinal veri toplama sürecinde katılımcılardan ve/veya ebeveynlerinden/velilerinden bilgilendirilmiş onam alınmıştır. Mevcut analiz yalnızca anonim kamu kullanımına açık verileri kullandığından, insan katılımcılarla herhangi bir etkileşim veya kimlik bilgisine erişim içermediğinden, ek etik kurul onayından muaftır ve ayrıca bilgilendirilmiş onam gerektirmemiştir.

Thanks

Yazarlar, ulusal Youth Risk Behavior Survey verilerini kamuya açık hale getiren ABD Hastalık Kontrol ve Önleme Merkezleri'ne (CDC) ve ankete katılan tüm öğrencilere teşekkür eder.

Beyond a Single Risk Category: Within-Group Correlates of Bullying Victimization and Suicidality in Transgender Adolescents

Abstract

Aim: Transgender adolescents experience elevated rates of bullying and adverse mental health outcomes compared with cisgender peers, yet most research has treated this group as homogeneous. We aimed to identify sociodemographic and physical health correlates of bullying victimization and mental health outcomes within the transgender adolescent population. Methods: A secondary analysis of the 2023 national Youth Risk Behavior Survey (YRBS) was conducted with an analytic sample of 612 high school students who self-identified as transgender. Five outcomes were examined: school-based bullying, electronic bullying, persistent sadness or hopelessness, suicidal ideation, and suicide attempt. The complex sampling design was specified using sampling weights, strata, and primary sampling units together, with transgender students defined as a subpopulation (domain) of the full dataset. Survey-weighted multivariable logistic regression models were estimated with sex, grade, race/ethnicity, sexual identity, and body mass index (BMI) entered simultaneously; multivariable models were fitted on complete cases (analytic n = 429–439). Results: The weighted national prevalence of transgender identity was 3.3% (95% CI 2.7–3.9). Prevalence rates were substantially elevated: 42.6% reported school-based bullying, 33.8% electronic bullying, 71.0% persistent sadness or hopelessness, 53.8% suicidal ideation, and 25.7% suicide attempt. Sexual identity was associated with internalizing outcomes, with bisexual (aOR 6.23, p = 0.001), gay/lesbian (aOR 4.94, p = 0.017), and “some other way” (aOR 7.17, p = 0.001) identities showing higher odds of persistent sadness or hopelessness than heterosexual transgender students, corresponding to adjusted predicted probabilities of 75%, 71%, and 77%, respectively, versus 37% in the heterosexual group. Black transgender students had lower odds of reporting school-based bullying (aOR 0.17, p = 0.008); this estimate is based on a small subgroup (n = 31). Compared with 9th grade, only the 11th-grade contrast was significant for school-based bullying, and the 10th- and 11th-grade contrasts for electronic bullying. The a priori BMI hypothesis was not supported at the variable level (joint Wald test non-significant in all models); only the single obesity contrast for school-based bullying reached significance (aOR 2.08, p = 0.035). Conclusion: The transgender adolescent population is heterogeneous; sexual identity, race/ethnicity, and grade are differentially associated with outcomes, supporting individualized risk assessment in clinical and school health settings.

Keywords

• Adolescent
• Bullying
• Sexual and Gender Minorities
• Suicidal Ideation
• Suicide, attempted
• Transgender Persons

Supporting Institution

None. The authors received no financial or institutional support for this study.

Ethical Statement

This study is a secondary analysis of publicly available, fully de-identified data from the 2023 national Youth Risk Behavior Survey (YRBS). The original YRBS protocol was approved by the institutional review boards of the U.S. Centers for Disease Control and Prevention (CDC) and ICF, and informed consent was obtained from participants and/or their parents/guardians during the original data collection. As the present analysis used only anonymized public-use data and did not involve any interaction with human subjects or access to identifiable information, it was exempt from additional institutional review board approval and did not require separate informed consent.

Thanks

The authors thank the U.S. Centers for Disease Control and Prevention (CDC) for making the national Youth Risk Behavior Survey data publicly available, and all students who participated in the survey.

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