Gender Divide: Trans Youth Face Higher Mental Health Risk, Study Says

With the tragic death by suicide of transgender teenager Leelah Alcorn still in the news, Boston researchers are reporting that many transgender youth may be particularly vulnerable to a variety of mental health-related problems.

The new study published in the Journal of Adolescent Health found that transgender youth faced a higher risk of being diagnosed with a mental illness or related problem, compared to non-transgender teens.

Specifically, the study says:

Compared with non-transgender youth, transgender youth had an elevated probability of being diagnosed with depression (50.6% vs. 20.6%); suffering from anxiety (26.7% vs. 10%); attempting suicide (17.2% vs. 6.1%); and engaging in self-harming activities without lethal intent (16.7% vs. 4.4%).

Researchers suggest that primary care doctors should address gender identity more directly and routinely screen transgender adolescents for mental health concerns.

Sari Reisner, a research scientist at the Fenway Institute who was the lead author on the survey, says gender affirming care by pediatricians can have a positive impact on a child’s future mental health outcomes:

“Gender affirmation is a very important part of a person’s identity. If a person is not being seen for who they are it can be very distressing. So pediatricians present a very important entry point into care and can get youth who need services to the right place.”

According to the study:

…it is recommended that primary care providers include gender identity as part of a basic patient history. Training programs and continuing education programs for primary care providers and mental health providers should include gender identity education.

Providers should familiarize themselves with community resources for transgender youth.

Patients with a transgender identity or history should be recognized as having higher risk for mental health concerns and should be carefully screened and evaluated.

Patients identified with co-occurring transgender identity and mental health concerns should be seen by a mental health provider who is qualified to provide evidence-based care with sensitivity to the diversity of gender identity and expression.

Here’s the full news release:

Transgender youth have disparately negative mental health outcomes related to depression, anxiety, suicide ideation, suicide attempt, and self-harm without lethal intent compared to their non-transgender youth counterparts. The finding is detailed in a new study entitled Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study

“To date, there are limited comparative mental health data available in transgender adolescents and young adults to document health inequities by gender minority status. This research points to the need for gender-affirming mental health services and interventions to support transgender youth,” said Sari Reisner, ScD, Research Scientist at The Fenway Institute and Postdoctoral Research Fellow in the Department of Epidemiology at Harvard School of Public Health, and the lead author of the report. “It is clear that clinicians serving transgender youth should routinely screen for mental health concerns.”

The study examined data from the electronic health records of 180 transgender patients age 12-29 years matched with non-transgender patients who were seen for healthcare at the Sidney Borum Jr. Health Center, a Boston-based community health center serving youth. There were 106 female-to-male patients and 74 male-to-female patients. Key findings from the study show that transgender patients have disparately negative mental health outcomes compared to their non-transgender youth counterparts (depression, anxiety, suicide ideation, suicide attempt, and self-harm without lethal intent). There were no statistically significant differences in negative mental health outcomes between female-to-male and male-to-female youth.

The findings show that clinicians serving transgender youth should screen for mental health concerns. It is also recommended that gender-inclusive measures be integrated into electronic health records, including assigned sex at birth and current gender identity at patient registration. Including these questions facilitates clinic-based epidemiologic research as well as quality improvement efforts to ensure high-quality, gender-affirming care.

The Sidney Borum, Jr. Health Center, the clinic site where this study took place, while devoting a good part of its resources to the care of transgender youth, is still a primary care clinic for adolescents and emerging adults. Therefore, this study shows that expanded care for transgender youth can be provided in the context of overall pediatric care: integration of behavioral health, psychiatry, and pediatric primary care – a medical home approach – can more than adequately support the medical and behavioral health needs of transgender youth and provide a locus of care for reduction of psychiatric outcomes described by the study.

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