Highlights
- •Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality.
- •Limited mental health data are available in this patient population from community-based clinic settings, including comparative data that examine disparities in mental health outcomes.
- •Transgender patients have disparately negative mental health outcomes compared with their nontransgender counterparts, with equally high burden for female-to-male and male-to-female youth.
- •Clinicians serving transgender youth should screen for mental health concerns.
- •Collecting gender-inclusive measures in electronic health records is recommended, including assigned sex at birth and current gender identity at patient registration.
Abstract
Purpose
Transgender youth represent a vulnerable population at risk for negative mental health
outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist
to compare the mental health of transgender adolescents and emerging adults to cisgender
youth accessing community-based clinical services; the present study aimed to fill
this gap.
Methods
A retrospective cohort study of electronic health record data from 180 transgender
patients aged 12–29 years seen between 2002 and 2011 at a Boston-based community health
center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients
were matched on gender identity, age, visit date, and race/ethnicity to cisgender
controls. Mental health outcomes were extracted and analyzed using conditional logistic
regression models. Logistic regression models compared FTM with MTF youth on mental
health outcomes.
Results
The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white,
33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender
matched controls, transgender youth had 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 (all p < .05). No statistically significant differences in mental health outcomes were observed
comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.
Conclusions
Transgender youth were found to have a disparity in negative mental health outcomes
compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying
gender identity differences in clinical settings and providing appropriate services
and supports are important steps in addressing this disparity.
Keywords
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Article info
Publication history
Published online: January 07, 2015
Accepted:
October 10,
2014
Received:
July 21,
2014
Footnotes
Conflicts of Interest: S.L.R. and M.J.M. are partly supported by NIMH R01 MH094323-01A1. D.S. is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, 1T32HD075727-01. The authors have no conflicts of interest or financial relationships to disclose.
Identification
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© 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
