State of play: mental health, gender minority stress and affirmative experiences among trans and gender diverse young people in the United Kingdom

Abstract Background Trans and gender diverse (TGD) young people experience substantially poorer mental health than their cisgender peers, yet large-scale UK evidence integrating mental health outcomes with gender minority stressors and affirmative experiences remains limited. Method We analysed cross-sectional survey data collected across the UK in 2023 from 5856 TGD young people aged 13–24. Five binary outcomes were examined: probable depression, probable anxiety, and past-year suicidal ideation, suicide attempts, and self-harm. Gender minority stressors comprised past-year discrimination, victimisation, and exposure to conversion practices. Affirmative experiences included perceived community acceptance, access to LGBTQ+ affirming spaces, knowing other LGBTQ+ people, gender identity disclosure, pronoun respect, and family and friend support. Probit structural equation models were estimated adjusting for gender identity, ethnicity, disability or autism diagnosis, socioeconomic indicators and age. Results Mental health difficulties were highly prevalent (depression: 67.6%; anxiety: 73.8%; suicidal ideation: 66.5%; self-harm: 68.6%; suicide attempts: 23.7%). Gender minority stress was common (discrimination: 69.6%; victimisation: 38.1%; conversion practice exposure: 13.1%) and varied across identities. Discrimination, victimisation, and conversion practice exposure were each independently associated with higher probabilities of all five outcomes, with conversion practice exposure showing the strongest association with suicide attempts. Community acceptance and LGBTQ+ affirming spaces were consistently protective; interpersonal supports were weaker and less consistent. Conclusions TGD young people in the UK face a substantial and preventable mental health crisis associated with identifiable, modifiable social conditions. Reducing harm and building credible affirmation across schools, services, and communities must be priorities for UK policy and practice.