Self-perceived gender expression, discrimination, and mental health disparities in adulthood

Abstract Applying a symbolic interactionist and minority stress framework, we examine how self-perceived gender expression and everyday discrimination contributes to gender disparities in mental health using a sample of 5896 cisgender women and 4433 cisgender men from Wave 1 (ages 11–18) and Wave 5 (ages 33–43) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We estimate Poisson regression to assess counts of depressive symptoms, and logistic regression to assess odds of suicidality, as a function of self-perceived gender expression, experiences of discrimination, and other established correlates of poor mental health outcomes. We then utilize generalized structural equation models to test whether self-perceived gender expression mediates the relationship between discrimination and mental health. Results suggest women report more variation in their perceived gender expression than men. Higher levels of perceived gender expression nonconformity are associated with depressive symptoms for men and women, even when accounting for experiences of discrimination. In addition, elevated discrimination is associated with increased depressive symptoms and higher odds of suicidality. Mediation analyses suggest that discrimination works directly and indirectly through self-perceived gender expression to shape mental health outcomes. This study contributes to a more nuanced understanding of the association between gender and mental health.