LGBTQ+ Health Updates

LGBTQ+ Health Updates

Disclosures: One study author reports receiving a grant from the National Key Research & Development Program of China. The other study authors report no relevant financial disclosures. Thoma reports receiving grants from the NIH during the conduct of the study. Choukas-Bradley reports no relevant financial disclosures.
October 28, 2020
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Transgender adolescents at increased risk for numerous mental health challenges

Disclosures: One study author reports receiving a grant from the National Key Research & Development Program of China. The other study authors report no relevant financial disclosures. Thoma reports receiving grants from the NIH during the conduct of the study. Choukas-Bradley reports no relevant financial disclosures.
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Transgender or gender-nonconforming adolescents may have increased risk for various mental health challenges, according to results of a cross-sectional survey study published in JAMA Network Open.

“Research has shown that a significant proportion of adolescents with gender dysphoria have a history of other psychiatric diagnoses,” Yuanyuan Wang, PhD, of the department of psychiatry at the Second Xiangya Hospital of Central South University in China, and colleagues wrote. “There are also a number of studies reporting a high percentage of suicidal ideation, self-harm and suicide attempts in adolescents with gender dysphoria. Compared with their cisgender peers, [transgender or nonconforming youth] (TGNC) youth are more likely to report mental health problems such as anxiety, depression and suicidal ideation.

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“Moreover, within the school environment, transgender adolescents are vulnerable to harassment and bullying,” they added.

To the researchers’ knowledge, no school-based surveys have examined the prevalence and mental health status of TGNC adolescents in mainland China. In the current study, Wang and colleagues sought to compare the mental health status of TGNC adolescents in China with that of their cisgender peers. They analyzed questionnaire data of 12,108 adolescents from 18 secondary schools in one city in China. Participants completed the Patient Health Questionnaire to measure depressive symptoms, a generalized anxiety disorder screening, the Pittsburgh Sleep Quality Index and a risk checklist for self-harm and suicide. The researchers also measured the frequency of being bullied at school. They classified participants who reported their perceived gender as the opposite of their assigned sex at birth as transgender, those who identified as neither male nor female as nonbinary and those who were unsure of their perceived gender as questioning. All participants were considered TGNC adolescents.

A total of 6,518 participants were assigned male at birth, of whom 3.2% were classified as transgender girls, 2.1% as nonbinary youth assigned male at birth and 4.9% as questioning youth assigned male at birth. A total of 5,590 participants were assigned female at birth, of whom 15.4% were classified as transgender boys, 2% as nonbinary youth assigned female at birth and 8.5% as questioning youth assigned female at birth. Wang and colleagues observed significantly higher health concerns among TGNC adolescents vs. cisgender adolescents. These included lower overall health, poorer sleep, higher depression and anxiety symptoms and higher rate of self-harm and suicide ideation. TGNC youth who were assigned male at birth had an increased risk for experiencing bullying vs. cisgender boys. Further, TGNC groups also had significantly greater amounts of thoughts of self-harm, thoughts of suicide, suicide plan formation, deliberate self-harm during the last month and attempts of suicide compared with cisgender boys.

“The findings indicate the need for researchers, practitioners and policy makers to address these mental health risks,” Wang and colleagues wrote. “School-level intervention is recommended to support the well-being and equity of gender minority youth.”

In a related editorial, Brian C. Thoma, PhD, of the department of psychiatry at the University of Pittsburgh School of Medicine, and Sophia Choukas-Bradley, PhD, of the department of psychological and brain sciences at the University of Delaware, provided a path forward for obtaining needed data on this global health issue.

“Our knowledge about the scope of this public health problem, including the potential psychosocial antecedents of impoverished mental health outcomes among transgender youth, continues to be inhibited by inadequate measures of gender identity in our highest-quality surveys of adolescent health,” they wrote. “It is imperative that representative surveys of adolescents around the world implement comprehensive measures of sex assigned at birth and gender identity. This would provide robust data on the mental health and psychosocial experiences of transgender youth at the population level, affording researchers more of the tools they need to begin to develop and implement effective treatments to reduce the burden of mental health problems within this vulnerable population around the globe.”