Tracy a. Becerra-Culqui
Transgender and gender-nonconforming children and adolescents experienced higher levels of mental health conditions when compared with matched reference groups, according to study results published in Pediatrics.
“The study shows that transgender and gender-nonconforming children and adolescents have three to 13 times the mental health conditions compared to youth who identify with the gender assigned at birth,” Tracy A. Becerra-Culqui, PhD, MPH, Kaiser Permanente Southern California Department of Research & Evaluation, told Infectious Diseases in Children.
“Especially worrisome are results for suicidal thoughts and self-inflicted injuries among transgender and gender-nonconforming (TGNC) youth. Among these young people, the most prevalent diagnoses were attention deficit disorders in children, 3 to 9 years of age, and depressive disorders in adolescents, 10 to 17 years of age.”
Becerra-Culqui and colleagues used electronic medical records to identify TGNC youth, including 588 transfeminine and 745 transmasculine children (aged 3 to 9 years) and adolescents (aged 10 to 17 years). The youth were members of three Kaiser Permanente sites in Georgia, Northern California and Southern California, and the study was in partnership with the coordinating center at the Emory University Rollins School of Public Health.
Each TGNC individual in the study was matched with 10 male and 10 female cisgender enrollees based on year of birth, race and/or ethnicity, study site and membership year of index date, which was the first evidence of gender-nonconforming status.
The study found that transgender and gender-nonconforming children and adolescents had three to 13 times the mental health conditions compared to youth who
identify with the gender assigned at birth.
Analysis was conducted on data based on 1,333 TGNC youth, matched with 13,151 reference males and 13,149 reference females who were cisgender, identifying with the sex they were born with.
Children who were aged younger than 10 years included 27% of the transfeminine cohort and 12% of the transmasculine cohort.
Among TGNC children aged 3 to 9 years, the most common diagnostic categories were ADHD (15% transfeminine and 16% transmasculine). Five percent of transfeminine children had a diagnosis of autism spectrum disorder, but no transmasculine children had the diagnosis.
In the adolescent cohorts, the category of depressive disorders had the highest prevalence, including 49% of transfeminine and 62% of transmasculine adolescents.
“For all diagnostic categories, prevalence was several fold higher among TGNC youth than in matched reference groups,” the researchers wrote.
Prevalence ratio (PR) estimates were high among the TGNC adolescents when compared with the reference groups for suicidal ideation, with 45 for transfeminine adolescents (95% CI, 18-218) and 45 for transmasculine adolescents (95% CI, 12-97), as well as self-inflicted injuries, with 70 for transfeminine adolescents (95% CI, 9.0-159) and 144 transmasculine adolescents (95% CI, 14-4,338).
When measured within 6 months of the index date, the PR decreased from 54 (95% CI, 1-218) to 38 (95%, CI 12-159) for transfeminine adolescents when compared with the matched reference males.
“We hope this research creates awareness about the social pressure young people questioning their gender identity may feel, and how this may affect their mental well-being,” Becerra-Culqui said. “We hope our findings raise awareness among health care providers regarding the need for immediate evaluation and urgent implementation of clinical, social and educational gender identity support for transgender and gender-nonconforming children and adolescents.
“Love and support are key — other research has found that transgender and gender-nonconforming children and adolescents who are supported in their identity and receive meaningful gender identity support do not necessarily experience elevated rates of depression and anxiety.”
In an accompanying commentary, Stanley Ray Vance Jr., MD, and Stephen M. Rosenthal, MD, of Benioff Children’s Hospital, San Francisco, and the department of pediatrics, University of California, San Francisco, reflected on the study and one by Laura Baams, PhD, of the University of Groningen, Netherlands, was also published in Pediatrics.
“How can the salient findings in the Baams’ and Becerra-Culqui et al’s studies influence clinical practice for pediatricians? … In these studies, researchers reinforce the need for clinicians to assess for risk factors for poor psychosocial outcomes that disproportionately affect [lesbian, gay, bisexual, transgender and questioning] and gender-nonconverging youth. Even before such risk factors can be assessed, a first crucial step is creating clinical environments that promote these youth feeling comfortable with disclosing their sexuality and gender identity. In addition, from residency through continuing medical education, providers themselves need the tools, skills and guidance to feel comfortable and confident in their ability to assess for risk factors for poor psychosocial outcomes that disproportionately affect these youth.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.