To Örebro University

Introduction: Teenagers who identify as other genders than their biological sex (transgender and gender diverse: TGD) are at a higher risk of health problems compared to gender conforming peers (cisgender youth). One aim of the current study was to investigate the prevalence of TGD youth in a general population sample. A second aim was to investigate differences in insomnia and stress between TGD youth ,cisgender girls, and cisgender boys as well as the influence of stressors and demographic factors on insomnia for the different groups.

Method: Cross-sectional survey data from a Swedish school-based study collected in 2018 were used. Those who had reported their gender identity as “other” were compared to cisgendered girls and boys. ANOVAs were used to compare group means. Regression models (hierarchical linear regressions) were tested in the whole group to explore if demographics and stressors as measured by the Adoles-cent Stress Questionnaire (ASQ) statistically predicted outcomes on the Insomnia Severity Index (ISI).

Results: The sample consisted of 3067 students (M = 17.8 years) who were categorized as cisgendered girls (n = 1544), cisgendered boys (n = 1482) or TGD youth (n = 41, 1.3% of the whole sample). ANOVAs demonstrated that TGD youth (ISI = 9.28) and cisgender girls (8.84) reported more insomnia symptoms in comparison to boys (6.78). Also, TGD youth (ASQ = 65.66) and cisgender girls (60.32) reported higher degrees of stress compared to cisgender boys (45.37). Further, the regressions demonstrated that cisgender girls were more likely to report insomnia symptoms than cisgender boys, when only demographic variables were entered into regression models. (TGD youth showed a similar result, albeit not significant). Models with stressors magnified the odds of reporting insomnia for the whole group, and erased gender differences.

Conclusion: Stress increased the odds of reporting insomnia. The higher degrees of insomnia symptoms in cisgender girls and TGD youth might be explained by more exposure to stressors. Thus, this study highlights health disadvantages of not belonging to the gender norm. As both stress and insomnia are possible to affect through prevention and promotion, targeted interventions for vulnerable groups might decrease the gender differences.