Bayesian Ising model network analysis of adversity exposure, health-risk behaviors, and psychological distress among US transgender and gender diverse adolescents

Background Transgender and gender diverse (TGD) adolescents experience disproportionate rates of adversity, risk behaviors, and suicidality. However, the complex, interdependent pathways linking these domains remain poorly understood, largely due to the limitations of traditional unidirectional modeling. This study applies Bayesian Ising model analysis to map the symptom topology of TGD Adolescents and identify specific psychopathological mechanisms driven by compounding minority stress.Methods Using data from the 2023 Youth Risk Behavior Survey, I estimated a 23-node Bayesian Ising model on a propensity-score-matched sample of 401 TGD and 401 cisgender adolescents. Nodes were grouped into adversity/trauma, health-risk behaviors, and psychological distress. I computed expected influence and bridge expected influence with 95% highest density intervals to identify network hubs and cross-cluster bridges.Results Interpersonal abuse and household dysfunction emerged as primary structural hubs. A dual-pathway structure mediated the adversity-to-suicidality trajectory: an affective conduit via sadness/hopelessness and a behavioral conduit via substance use (notably early alcohol initiation). The TGD network exhibited denser intra-cluster connectivity than the matched cisgender network. Furthermore, structural topology varied significantly by sex assigned at birth: substance use functioned as the dominant bridge for Adolescents assigned female at birth, whereas emotional abuse and household violence anchored the network for Adolescents assigned male at birth.Conclusions The psychopathological network of TGD Adolescents is driven by interpersonal abuse and bridged to suicidality through distinct affective and behavioral mechanisms. Findings highlight the necessity of replacing one-size-fits-all approaches with targeted public health interventions sensitive to specific bridging pathways and intra-group structural heterogeneities.