Transgender youth and young adults suffer a significantly greater burden of mental health conditions and poor mental health outcomes than do nontransgender individuals, known as cisgender individuals, according to a recent study.

“Findings point to the need for gender-affirming mental health services and interventions to support transgender youth,” reported Sari L. Reisner, Sc.D., of Harvard T.H. Chan School of Public Health, Boston ( J. Adolesc. Health 2015;56:274-9 ). “Community-based clinics should be prepared to provide mental health services or referrals for transgender patients.”

Dr. Reisner and his colleagues retrospectively analyzed medical records to compare the mental health outcomes of 106 female-to-male and 74 male-to-female transgender patients, aged 12-29 years, to 180 cisgender controls matched by gender identity, age, race/ethnicity, and visit date at a community health center in Boston between 2002 and 2011.

Cisgender refers to an individual whose self-identified gender identity matches his or her biological sex assigned at birth.

The transgender patients had four times the risk for depression, compared with the matched control patients (50.6% vs. 20.6%; relative risk = 3.95) and more than three times the risk for anxiety (26.7% vs. 10.0%; RR = 3.27), suicide ideation (31.1% vs. 11.1%; RR = 3.61) and suicide attempts (17.2% vs. 6.1%; RR = 3.20). Transgender individuals were more than four times more likely than were cisgender patients to self-harm without suicidal intent (16.7% vs. 4.4%; RR = 4.30).

Overall, 22.8% of transgender patients, compared with 11.1% of cisgender patients, used inpatient mental health care services (RR = 2.36), and 45.6% of transgender patients, compared with 16.1% of cisgender ones, accessed outpatient mental health services (RR = 4.36).

“The elevated mental health burden among transgender youth is hypothesized to result from experiences of social stress such as family rejection, bullying, violence, victimization, and discrimination, which occur due to disadvantaged social status,” all confounders not accounted for if present for these patients, the authors noted. On the other hand, the study’s lack of reliance on a gender identity disorder diagnosis “offers unique comparative data that directly compare the health and well-being of transgender and cisgender youth using a nonpathological perspective of gender variation,” they added.

Other potential limitations of the study were that transgender patients’ greater use of mental health services could have inflated prevalence estimates and that the findings, for an urban population, may not generalize to other geographic or clinical settings.

“Future research is needed to contextualize the mental health concerns of transgender adolescent and emerging adult patients in community-based clinic settings, including prospective assessment of social stressors and mental health symptoms and diagnoses over time,” the authors wrote.

The research was supported by the National Institute of Mental Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors reported no relevant financial disclosures.


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