Transgender youth more often diagnosed with mental health conditions

Transgender and gender-nonconforming youth are diagnosed with mental health conditions much more frequently than young people who identify with the gender they are assigned at birth, according to new Kaiser Permanente research published today in Pediatrics.

While this subject has been analyzed in small, specialized, clinic-based studies that rely on self-reported behavior problems, this large cohort study is based on electronic medical record information from a transgender/gender non-conforming group enrolled in a comprehensive care system. The investigators examined the prevalence of mental health conditions such as anxiety, depression and suicidal thoughts. In nearly all instances, mental health diagnoses were more common for transgender and gender-nonconforming youth than for youth who identify with the gender assigned at birth, also known as cisgender youth.

"We looked at mental health in transgender and gender-nonconforming youth retrospectively between 2006 and 2014 and found that these youths had three to 13 times the mental health conditions of their cisgender counterparts," said the study's lead author, Tracy A. Becerra-Culqui, PhD, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation. "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."

This study, which was based on information in the electronic health record, included 1,347 transgender and gender-nonconforming youth 3 to 17 years who are members of Kaiser Permanente in Southern California, Northern California and Georgia. The cohort was 44 percent transfeminine (youth whose gender assigned at birth was male) and 56 percent transmasculine (youth whose gender assigned at birth was female).

The most common diagnoses for transgender and gender-nonconforming children and adolescents were:

• Attention deficit disorder (transfeminine: 15 percent, transmasculine: 16 percent). These numbers are 3 to 7 times higher than the matched cisgender reference group.
• Depressive disorder (transfeminine: 49 percent, transmasculine: 62 percent). These numbers are 4 to 7 times higher than the matched cisgender reference group.

"We hope this research creates awareness about the pressure young people questioning their gender identity may feel, and how this may affect their mental well-being," said Becerra-Culqui. "For clinicians, it is important that they are aware of possible mental health conditions that may be more common in transgender and gender-nonconforming youth compared to cisgender youth. It is also crucial they have the knowledge necessary to provide social and educational support for their young patients who are figuring out their gender identity."

The authors noted that the conditions may be related to gender dysphoria, a feeling of distress when one's assigned gender does not match their identity. Also, young people with gender-nonconforming behavior may experience stress from prejudice and discrimination, which can cause or exacerbate emotional or behavioral problems.