Study: Transgender youth have more negative outcomes

Transgender youth have a higher rate of negative mental health outcomes than non-transgender youth, according to a new study.

Study results showed transgender youth had a higher probability of being diagnosed with depression when compared to non-transgender youth (50.6 percent vs. 20.6 percent); and higher probabilities of 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).

The study was based on data from the Sidney Borum Jr. Health Center in Boston, and compared the electronic health records of 180 transgender patients (ages 12 to 29) to non-transgender patients.

The findings were published in the Journal of Adolescent Health in January.

Sari Reisner, ScD, MA, research scientist at The Fenway Institute and postdoctoral research fellow at Harvard School of Public Health was the lead author of the report. He said this study is unique in that until now, limited data existed comparing the mental health of transgender adolescents and young adults to cisgender patients.

The research points to the need for gender-affirming mental health services and for the appropriate screenings, interventions, and supports for transgender young people, Reisner said.

Earlier interventions may improve outcomes. Reisner noted a recent U.S. National Transgender Discrimination Survey in which 41 percent of transgender adult respondents reported having attempted suicide in their lifetimes. “You can see there’s still some opportunity for early intervention here,” he said.

“To be clear it’s not that transgender youth are mentally ill,” Reisner said. “These youth experience a lot of social stressors in their life, rejection from parents and peers, bullying in school, and the need to have supports to handle the social structures around them. This suggests that in the process of clinical care, we can really provide some interventions.”

Routine mental health screening for transgender youth in clinical settings is important. “Routinely screening for not only mental health, but for sources of stress” that might increase the likelihood of a negative outcome, Reisner said. “A lot of transgender youth experience a high amount of bullying from peers.” Additionally, coming out to family and friends, and even just visiting the doctor can be an additional source of stress.

According to the study, expanded care for transgender youth can be provided in the context of overall pediatric care and integration of behavioral health and pediatric primary care – a medical home approach – can help support the needs of transgender youth and improve outcomes.

The capture of transgender identity data in medical records is important, Reisner said. Providers can do routine captures of both gender and gender identity for electronic health records, by doing something as simple as including those questions on patient registration forms, just as you would the question of age, for example. “That signals to a patient, ‘We are welcoming you in a friendly environment,’” he said. “So just incorporate that into the routine.”

“If you are a psychologist and have a registration form, ask them for a preferred pronoun, which can really go a long way,” he said. “Misgendering people can really be a source of stress. Asking these questions helps to sensitize care.”

“If you are not being affirmed in the way you see yourself to be, that can be very depressing,” he said.

Also, in the context of clinical care, making sure the space is friendly for transgender youth in other ways, such as by posting policies around non-discrimination, is important, he said, as is the need for increased training for pediatric and mental health providers in gender awareness issues.