The Role of Parental Rejection in Mental Health Outcomes of Transgender and Gender‐Diverse Youth

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INTRODUCTION: Early identification of mental health risks in transgender and gender-diverse youth is crucial for preventing severe psychiatric outcomes. This study examined the association between parental rejection and depression, suicidality and non-suicidal self-injury (NSSI) in a non-Western clinical setting, highlighting the implications for early intervention within this population experiencing marginalization. METHODS: A retrospective chart review was conducted for youth presenting with gender dysphoria. Initial assessment data included gender identity, social transition status (chosen name, gender-affirming clothing at home), indicators of parental rejection (non-acknowledgment of identity, refusal to use chosen name, restriction of expression), psychiatric diagnoses, suicidal ideation, lifetime NSSI and suicide attempts. RESULTS: Of 81 adolescents (aged 12-18), 92.6% had disclosed their identity to at least one parent; 73.3% were sex-assigned female at birth. Social transition was evident in 61.3% (chosen name use) and 81.3% (gender-affirming clothing). At least one form of parental rejection was reported by 80%, including rejection of identity (76%), refusal of chosen name (79%) and clothing restriction (62.3%). Depression (40%) and anxiety (13.3%) were the most common diagnoses. Suicidal ideation occurred in 38.7%, NSSI in 36% and suicide attempts in 21.3%. Parental rejection was significantly associated with NSSI (p = 0.021) and depression (p = 0.010), but not with suicidal ideation or attempts. DISCUSSION: These findings underscore the need for early intervention strategies that actively engage families, as enhancing parental support may play a pivotal role in reducing depression and self-harm among transgender and gender-diverse youth.