Mental Health Issues and Complex Experiences of Abuse Among Trans and Gender Diverse Young People: Findings from Trans Pathways

Abstract

Purpose: Trans and gender diverse (TGD) young people have reported high levels of mental distress in research studies, specifically depression, anxiety, self-harming, and suicidal behaviors. Rates of abuse are also high in TGD populations, but little is known about how this relates to mental health in populations of TGD young people. This study sought to examine associations between experiences of abuse and mental health outcomes. Methods: A cross-sectional study design was used. An anonymous online questionnaire was conducted to determine rates of abuse among Australian TGD young people (N = 859) and the potential association with poor mental health. Primary outcomes of interest were self-reported psychiatric diagnoses, self-harm and suicidal behaviors, and current anxiety and depressive symptoms. Results: Exposures to six forms of abuse are reported in this article: extrafamilial physical abuse, familial physical abuse, extrafamilial sexual abuse, familial sexual abuse, abuse within an intimate relationship, and other familial abuse (including emotional or verbal abuse and neglect). All six forms of abuse measured were associated with poor mental health overall; risk estimates for some forms of abuse were much stronger than others. Conclusion:The current findings have wide-ranging implications for clinical practice. Those working in TGD health care need to be aware of the high prevalence of violence and abuse among TGD young people and the association with poor mental health outcomes. The findings also have implications for broader societal change and interventions targeting increasing parental support to reduce familial violence against TGD young people.

A Survey of Specialist Youth Gender Diversity Services in Australia: A Whole‐of‐Family Approach

“…All participants reported an increase in referrals for gender diverse young people over the past five years, supported by the research literature (Strauss et al., ; Telfer et al., ). For the three publicly funded gender diversity services, two‐fold, four‐fold, and seven‐fold increases in referrals were reported.…”

“…Some gender diverse children and adolescents can experience a discrepancy between their gender assigned at birth and their experienced or true gender self (Ehrensaft, , ; Hidalgo et al, ; Keo‐Meier & Ehrensaft, ). Unfortunately, family members and gender diverse youth are frequently subjected to discrimination, ostracisation, and inequitable healthcare (Riggs & Due, ), with the rate of significant mental health difficulties greatly increased compared with the general population (Strauss et al, ).…”

Cross‐sex hormone therapy in Australia: the prescription patterns of clinicians experienced in adult transgender healthcare

“…Questions were designed to gauge perspectives on the requirement for a formal mental health assessment prior to the commencement of hormonal therapy – at times described as a potential barrier to healthcare . Current standards of care place a strong emphasis on involving a mental health professional to diagnose gender dysphoria and assess criteria for hormone therapy .…”

“…The consequences of delaying access to hormone therapies are significant. Australian studies demonstrate that over 70% of transgender people have medically diagnosed depression, and 48% have attempted suicide, numbers far higher than population prevalence rates, noting the potential for responder bias . Despite consensus between clinicians and individuals whose lived experience confirms the critical and often life‐saving role of hormone treatment, research in the transgender field is in its infancy.…”

Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia

“…Research suggests an overrepresentation of ASD diagnoses or autistic traits in gender diverse samples, particularly in children and adolescents [4,5,6,7,8], compared to the general population [9,10]. For example, data from Trans Pathways, the largest study conducted in Australian trans and gender-diverse young people ( n = 859; mean age = 19.4), found that 22.5% of the sample reported having received a formal ASD diagnosis, while more than one third (35.2%) warranted further diagnostic assessments to clarify whether ASD was present [11]. Causal underpinnings of this co-occurrence remain poorly understood, and while theories have been postulated (see Van Der Miesen & Colleagues for a review of underlying hypotheses [12]), a robust evidence base is lacking.…”