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Child Psychiatry Hum Dev. 2021 Dec 03; doi: 10.1007/s10578-021-01289-1. Epub 2021 Dec 03.

Examining the Mental Health Presentations of Treatment-Seeking Transgender and Gender Nonconforming (TGNC) Youth.

Child psychiatry and human development

Shannon L Stewart, Jocelyn N Van Dyke, Jeffrey W Poss

Affiliations

  1. Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada.
  2. Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada. [email protected].
  3. School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada.

PMID: 34860314 DOI: 10.1007/s10578-021-01289-1

Abstract

Recent research suggests that transgender and/or gender nonconforming (TGNC) youth present with heightened levels of mental health problems compared to peers. This study seeks to examine the mental health needs of a large sample of treatment-seeking TGNC youth by comparing them to cisgender males and females. Participants were 94,804 children and youth ages 4-18 years (M = 12.1, SD = 3.72) who completed the interRAI Child and Youth Mental Health Instrument (ChYMH) or Screener (ChYMH-S) at participating mental health agencies in the Ontario, Canada. Overall, the mental health presentations of TGNC youth were similar to cisgender females but at higher acuity levels. TGNC youth showed significantly higher levels of anxiety, depression, social disengagement, positive symptoms, risk of suicide/self-harm, and were more likely to report experiencing emotional abuse, past suicide attempts, and a less strong, supportive family relationship than cisgender females and males. Clinical implications of these findings are discussed.

© 2021. The Author(s).

Keywords: Adolescent mental health; Gender nonconforming; TGNC; Transgender; interRAI

References

  1. Eisenberg ME, Gower AL, McMorris BJ, Rider GN, Shea G, Coleman E (2017) Risk and protective factors in the lives of transgender/gender nonconforming adolescents. J Adolesc Health 61:521–526 - PubMed
  2. Goodman M, Adams N, Corneil T, Kreukels B, Motmans J, Coleman E (2019) Size and distribution of transgender and gender nonconforming populations: a narrative review. Endocrinol Metab Clin North Am 48:303–321 - PubMed
  3. Newcomb ME, Hill R, Buehler K, Ryan DT, Whitton SW, Mustanski B (2020) High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults. Arch Sex Behav 49:645–659 - PubMed
  4. Roberts AL, Rosario M, Corliss HL, Koenen KC, Austin SB (2012) Childhood gender nonconformity: a risk indicator for childhood abuse and posttraumatic stress in youth. Pediatrics 129:410–417 - PubMed
  5. Roberts AL, Rosario M, Slopen N, Calzo JP, Austin SB (2013) Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: an 11-year longitudinal study. J Am Acad Child Adolesc Psychiatry 52:143–152 - PubMed
  6. Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM et al (2014) The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). J Adolesc Health 55:93–99 - PubMed
  7. Reisner SL, Greytak EA, Parsons JT, Ybarra ML (2015) Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. J Sex Res 52:243–256 - PubMed
  8. Toomey RB, Ryan C, Diaz RM, Card NA, Russell ST (2010) Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment. Dev Psychol 46:1580–1589 - PubMed
  9. Wilson EC, Garofalo R, Harris DR, Belzer M (2010) Sexual risk taking among transgender male-to-female youths with different partner types. Am J Public Health 100:1500–1505 - PubMed
  10. Veale JF, Watson RJ, Peter T, Saewyc EM (2017) Mental health disparities among Canadian transgender youth. J Adolesc Health 60:44–49 - PubMed
  11. Becerra-Culqui TA, Liu Y, Nash R, Cromwell L, Flanders WD, Getahun D et al (2018) Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics 141:e20173845 - PubMed
  12. Davey A, Arcelus J, Meyer C, Bouman WP (2016) Self-injury among trans individuals and matched controls: prevalence and associated factors. Health Soc Care Community 24:485–494 - PubMed
  13. Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, Shumer D et al (2015) Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health 56:274–279 - PubMed
  14. Borgogna NC, McDermott RC, Aita SL, Kridel MM (2019) Anxiety and depression across gender and sexual minorities: Implications for transgender, gender nonconforming, pansexual, demisexual, asexual, queer, and questioning individuals. Psychol Sex Orientat Gend Divers 6:54–63 - PubMed
  15. Bouman WP, Claes L, Brewin N, Crawford JR, Millet N, Fernandez-Aranda F et al (2017) Transgender and anxiety: a comparative study between transgender people and the general population. Int J Transgend 18:16–26 - PubMed
  16. Perez-Brumer A, Day JK, Russell ST, Hatzenbuehler ML (2017) Prevalence and correlates of suicidal ideation among transgender youth in California: findings from a representative, population-based sample of high school students. J Am Acad Child Adolesc Psychiatry 56:739–746 - PubMed
  17. Grossman AH, D’Augelli AR (2007) Transgender youth and life-threatening behaviors. Suicide Life Threat Behav 37:527–537 - PubMed
  18. Stewart SL, Hirdes JP, Curtin-Telegdi, N, Perlman C, MacLeod K, Ninan A et al (2015) interRAI child and youth mental health (ChYMH) assessment form and user’s manual. Version 9.3. interRAI, Washington, DC - PubMed
  19. Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J et al (2020) The interRAI suite of mental health assessment instruments: an integrated system for the continuum of care. Front Psychiatry 10:926 - PubMed
  20. Lau C, Stewart SL, Saklofske DH, Tremblay PF, Hirdes J (2018) Psychometric evaluation of the interRAI child and youth mental health disruptive/aggression behaviour scale (DABS) and hyperactive/distraction scale (HDS). Child Psychiatry Hum Dev 49:279–289 - PubMed
  21. Stewart SL, Babcock SE (2020) interRAI child and youth mental health-screener (ChYMH-S): a psychometric evaluation and validation study. Child Psychiatry Hum Dev 51:769–780 - PubMed
  22. Stewart SL, Babcock SE, Li Y, Dave HP (2020) A psychometric evaluation of the interRAI Child and Youth Mental Health instruments (ChYMH) anxiety scale in children with and without developmental disabilities. BMC Psychiatry 20:1–14 - PubMed
  23. Stewart SL, Celebre A, Hirdes JP, Poss JW (2020) Risk of suicide and self-harm in kids: the development of an algorithm to identify high-risk individuals within the children’s mental health system. Child Psychiatry Hum Dev 51:913–924 - PubMed
  24. Stewart SL, Celebre A, Hirdes JP, Poss JW (under review) Risk of injury to others: the development of an algorithm to identify youth at high-risk of violence perpetration within the mental health system. Child Psychiatry Hum Dev - PubMed
  25. Stewart SL, Hamza CA (2017) The child and youth mental health assessment (ChYMH): an examination of the psychometric properties of an integrated assessment developed for clinically referred children and youth. BMC Health Serv Res 17:1–10 - PubMed
  26. Stewart SL, Morris JN, Asare-Bediako YA, Toohey A (2020) Examining the structure of a new pediatric measure of functional independence using the interRAI Child and Youth Mental Health assessment system. Dev Neurorehabil 23:526–533 - PubMed
  27. Stewart SL, Poss JW, Thornley E, Hirdes JP (2019) Resource intensity for children and youth: the development of an algorithm to identify high service users in children’s mental health. Health Serv Insights 12:1178632919827930 - PubMed
  28. Stewart SL, Hirdes JP, McKnight M, Curtin-Telegdi N, Perlman CM, MacLeod K et al (2017) interRAI child and youth mental health screener (ChYMH-S) assessment form and user’s manual. Version 9.3. interRAI, Washington, DC - PubMed
  29. Perlman CM, Hirdes JP, Barbaree H, Fries BE, McKillop I, Morris JN et al (2013) Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment. BMC Health Serv Res 13:1–12 - PubMed
  30. Li, Y, Babcock SE, Stewart SL, Hirdes JP, Schwean VL (2021) Psychometric Evaluation of the depressive severity index (DSI) Among children and youth using the interRAI child and youth mental health (ChYMH) assessment tool. Child & Youth Care Forum. Springer, pp 1–20 - PubMed
  31. Blakesley RE, Mazumdar S, Dew MA, Houck PR, Tang G, Reynolds C 3rd et al (2009) Comparisons of methods for multiple hypothesis testing in neuropsychological research. Neuropsychology 23:255–264 - PubMed
  32. Berkout OV, Young JN, Gross AM (2011) Mean girls and bad boys: recent research on gender differences in conduct disorder. Aggress Violent Behav 16:503–511 - PubMed
  33. Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS et al (2009) Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 66:785–795 - PubMed
  34. Gershon J (2002) A meta-analytic review of gender differences in ADHD. J Atten Disord 5:143–154 - PubMed
  35. Mowlem FD, Rosenqvist MA, Martin J, Lichtenstein P, Asherson P, Larsson H (2019) Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry 28:481–489 - PubMed
  36. Fergusson DM, Horwood LJ, Lynskey MT (1993) Prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds. J Am Acad Child Adolscent Psychiatry 32:1127–1134 - PubMed
  37. Barrocas AL, Hankin BL, Young JF, Abela JR (2012) Rates of nonsuicidal self-injury in youth: age, sex, and behavioral methods in a community sample. Pediatrics 130:39–45 - PubMed
  38. Bresin K, Schoenleber M (2015) Gender differences in the prevalence of nonsuicidal self-injury: a meta-analysis. Clin Psychol Rev 38:55–64 - PubMed
  39. Sornberger MJ, Heath NL, Toste JR, McLouth R (2012) Nonsuicidal self-injury and gender: patterns of prevalence, methods, and locations among adolescents. Suicide Life Threat Behav 42:266–278 - PubMed
  40. Gorey KM, Leslie DR (1997) The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse Negl 21:391–398 - PubMed
  41. Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I et al (2019) Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health 64:265–283 - PubMed
  42. Bentall RP, de Sousa P, Varese F, Wickham S, Sitko K, Haarmans M et al (2014) From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Soc Psychiatry Psychiatr Epidemiol 49:1011–1022 - PubMed
  43. Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W et al (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophr Bull 38:661–671 - PubMed
  44. Dhillon R, Bastiampillai T, Krishnan S, Opray N, Tibrewal P (2011) Transgender late onset psychosis: the role of sex hormones. Aust N Z J Psychiatry 45:595–595 - PubMed
  45. Summers SM, Onate J (2014) New onset psychosis following abrupt discontinuation of hormone replacement therapy in trans women. J Gay Lesbian Ment Health 18:312–319 - PubMed
  46. McConnell EA, Birkett MA, Mustanski B (2015) Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT Health 2:55–61 - PubMed
  47. Newcomb ME, Heinz AJ, Mustanski B (2012) Examining risk and protective factors for alcohol use in lesbian, gay, bisexual, and transgender youth: a longitudinal multilevel analysis. J Stud Alcohol Drugs 73:783–793 - PubMed
  48. Pflum SR, Testa RJ, Balsam KF, Goldblum PB, Bongar B (2015) Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychol Sex Orientat Gend Divers 2:281–286 - PubMed
  49. Ryan C, Huebner D, Diaz RM, Sanchez J (2009) Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 123:346–352 - PubMed
  50. Tankersley AP, Grafsky EL, Dike J, Jones RT (2021) Risk and resilience factors for mental health among transgender and gender nonconforming (TGNC) youth: a systematic review. Clin Child Fam Psychol Rev 24:183–206 - PubMed
  51. Carmel TC, Erickson-Schroth L (2016) Mental health and the transgender population. Psychiatr Ann 46:346–349 - PubMed
  52. Wilson EC, Chen YH, Arayasirikul S, Raymond HF, McFarland W (2016) The impact of discrimination on the mental health of trans* female youth and the protective effect of parental support. AIDS Behav 20:2203–2211 - PubMed
  53. Valentine SE, Shipherd JC (2018) A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev 66:24–38 - PubMed
  54. Gower AL, Rider GN, Brown C, McMorris BJ, Coleman E, Taliaferro LA et al (2018) Supporting transgender and gender diverse youth: Protection against emotional distress and substance use. Am J Prev Med 55:787–794 - PubMed
  55. Grossman AH, D’Augelli AR, Frank JA (2011) Aspects of psychological resilience among transgender youth. J LGBT Youth 8:103–115 - PubMed
  56. Katz-Wise SL, Ehrensaft D, Vetters R, Forcier M, Austin SB (2018) Family functioning and mental health of transgender and gender-nonconforming youth in the trans teen and family narratives project. J Sex Res 55:582–590 - PubMed
  57. Simons L, Schrager SM, Clark LF, Belzer M, Olson J (2013) Parental support and mental health among transgender adolescents. J Adolesc Health 53:791–793 - PubMed
  58. Taliaferro LA, McMorris BJ, Rider GN, Eisenberg ME (2019) Risk and protective factors for self-harm in a population-based sample of transgender youth. Arch Suicide Res 23:203–221 - PubMed
  59. Matsuno E, Budge SL (2017) Non-binary/genderqueer identities: a critical review of the literature. Curr Sex Health Rep 9:116–120 - PubMed
  60. Thorne N, Witcomb GL, Nieder T, Nixon E, Yip A, Arcelus J (2019) A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary. Int J Transgend 20:241–250 - PubMed
  61. Sani G, Simonetti A, Janiri D, Banaj N, Ambrosi E, De Rossi P et al (2018) Association between duration of lithium exposure and hippocampus/amygdala volumes in type 1 bipolar disorder. J Affect Disord 232:341–348 - PubMed
  62. Wang Y, Dix T (2015) Mothers’ early depressive symptoms predict children’s low social competence in first grade: mediation by children’s social cognition. J Child Psychol Psychiat 56:183–192 - PubMed
  63. Zhang X, Gatzke-Kopp (2020) Exposure to parental aggression and the development of psychopathology in young children: the mediating role of early dissociative symptoms. J Interpers Violence 1–26 - PubMed
  64. Sani G, Kotzalidis GD, Vöhringer P, Pucci D, Simonetti A, Manfredi G (2013) Effectiveness of short-term olanzapine in patients with bipolar 1 disorder, with or without comorbidity with substance use disorder. J Clin Psychopharmacol 33:231–235 - PubMed
  65. Holler K, Kavanaugh B (2013) Physical aggression, diagnostic presentation, and executive functioning in inpatient adolescents diagnosed with mood disorders. Child Psychiatry Hum Dev 44:573–581 - PubMed
  66. Benson KE (2013) Seeking support: transgender client experiences with mental health services. J Fem Fam Ther 25:17–40 - PubMed
  67. Hendricks ML, Testa RJ (2012) A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pr 43:460–467 - PubMed
  68. Mizock L, Lundquist C (2016) Missteps in psychotherapy with transgender clients: promoting gender sensitivity in counseling and psychological practice. Psychol Sex Orientat Gend Divers 3:148–155 - PubMed
  69. Bauer GR, Zong X, Scheim AI, Hammond R, Thind A (2015) Factors impacting transgender patients’ discomfort with their family physicians: a respondent-driven sampling survey. PloS One 10:e0145046 - PubMed
  70. Grossman AH, D’augelli AR (2006) Transgender youth: invisible and vulnerable. J Homosex 51:111–128 - PubMed
  71. Oransky M, Burke EZ, Steever J (2019) An interdisciplinary model for meeting the mental health needs of transgender adolescents and young adults: the mount sinai adolescent health center approach. Cogn Behav Pract 26:603–616 - PubMed

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