Transgender, Gender-Nonconforming Youth Suffer More Mental Health Conditions Than Cisgender Counterparts

Tracy Becerra-Culqui, PhD, MPH, Kaiser Permanente Southern California Department of Research and Evaluation

Tracy Becerra-Culqui, PhD, MPH

According to new study results published in Pediatrics, transgender and gender-nonconforming youth are diagnosed with mental health conditions more frequently than young individuals identifying with the gender assigned at birth.

While previous studies have often been limited by self-reporting and small sample sizes, in this large cohort analysis, researchers utilized electronic medical records on a transgender/gender-nonconforming group enrolled in a comprehensive care system between 2006—2014.

Researchers assessed a cohort of 588 transfeminine (44%) and 745 transmasculine (56%) children (3—9 years old) and adolescents (10–17 years old) enrolled in Kaiser Permanente integrated health care systems in California and Georgia to examine the prevalence of mental health conditions like anxiety, depression and suicidal thoughts.

Children younger than 10 years old consisted of 27% of the transfeminine cohort and 12% of the transmasculine cohort.

In almost every instance, mental health diagnoses were more common for transgender and gender-nonconforming youth than cisgender youth.

“We looked at mental health in transgender and gender-nonconforming youth retrospectively between 2006—2014 and found that these youths had 3 to 13 times the mental health conditions of their cisgender counterparts,” lead author, Tracy Becerra-Culqui, PhD, MPH, Kaiser Permanente Southern California Department of Research and Evaluation, said in a statement. “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.”

Each transgender/gender-nonconforming individual 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 the index date — first evidence of gender-nonconforming status.

The most common mental health diagnoses for transgender/gender-nonconforming youth were attention deficit disorder in children 3—9 years of age (transfeminine 15%; transmasculine 16%) and depressive disorder in adolescents 10–17 years of age (transfeminine 49%; transmasculine 62%).

For all diagnostic categories, prevalence was significantly higher among transgender/gender-nonconforming youth than in match cisgender reference groups, as results showed that the number of cases of attention deficit disorder was 3 to 7 times higher and depressive disorder cases 4 to 7 times higher.

Prevalence ratios (95% confidence intervals [CIs]) of adolescents with a history of self-inflicted injury 6 months before the index date ranged from 18 (95% CI 4.4—82) to 144 (95% CI 36–1248), while the corresponding range for suicidal ideation was 25 (95% CI 14–45) to 54 (95% CI 18–218).

“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,” Becerra-Culqui concluded. “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 study concluded that transgender/gender-nonconforming youth may present with mental health conditions that require immediate evaluation and implementation of clinical, social and educational gender identity support measures.

The study, “Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers” was published in Pediatrics.