Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers

Abstract

BACKGROUND Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3–9 years old) and adolescents (10–17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. RESULTS Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4–82) to 144 (95% CI 36–1248). The corresponding range for suicidal ideation was 25 (95% CI 14–45) to 54 (95% CI 18–218). CONCLUSIONS TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.

Suicidality Disparities Between Transgender and Cisgender Adolescents

“…In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among TGAs and CGAs. As in previous research, 3,[5][6][7][8]13 TGAs had higher odds of experiencing suicidality compared with CGAs. This pattern of results was observed in both adjusted and unadjusted models for most outcomes.…”

“…2 It is indicated in emerging evidence that transgender adolescents (TGAs; adolescents whose true gender identity diverges from their gender assigned at birth) are at higher risk for suicidality when compared with cisgender adolescents (CGAs; adolescents whose gender identity is the same as their gender assigned at birth). [3][4][5][6][7][8] In initial studies, 34% of TGAs report experiencing suicidal ideation during the past year, 6 61% report experiencing suicidal ideation during their lifetime, 5 and 30% to 51% of TGAs report at least 1 lifetime suicide attempt. 5,7 Furthermore, over half of TGAs report engaging in nonsuicidal self-injury (NSSI) during the past year.…”

The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

“…On a population basis, trans youth experience significantly poorer health outcomes than the general population, including increased risk of depression, anxiety, suicidality, and self-harm (Becerra-Culqui et al, 2018;Eisenberg et al, 2017;Rider, McMorris, Gower, Coleman, & Eisenberg, 2018;Veale, Watson, Peter, & Saewyc, 2017). This increased risk of poor mental health has also been documented in trans youth seeking medical care, with Reisner et al (2015) noting that, compared to their cisgender peers, trans youth experience "a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment" (p. 274).…”

Transgender pediatric surgical patients—Important perioperative considerations

“…While the US Transgender Survey included only adults, studies in youth have demonstrated similar vulnerabilities. Transgender youth, when compared to their cisgender peers, are more likely to experience bullying, 6,19 to have comorbid psychiatric illness like anxiety or depression, 6,15,20‐22 to have issues with substance abuse, 6 to have inflicted self‐harm, 20‐22 and to have thought about or attempted suicide 6,19‐22 . As in adults, the numbers regarding suicidality are striking.…”