Studies: LGBTQ youths have higher rates of mental health issues, abuse

Transgender youths experience anxiety, depression and attention-deficit disorders at higher rates than their peers, according to a new study.

The study is one of three released today in Pediatrics that explore the types of adversity that lesbian, gay, bisexual, transgender and questioning (LGBTQ) adolescents face.

Previous studies have found high prevalence of mental health issues in transgender youths, but many of those studies were small. Therefore, researchers conducted a large cohort study detailed in “Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers” (Becerra-Culqui TA, et al. Pediatrics. April 16, 2018, https://doi.org/10.1542/peds.2017-3845).

The team looked at electronic medical records of 588 transfeminine and 745 transmasculine children (3-9 years) and adolescents (10-17 years). Each was compared to 10 male and 10 female demographically matched cisgender children.

Among children, the most common issues were attention-deficit disorders (15% in transfeminine and 16% in transmasculine) and anxiety disorders (12% in transfeminine and 16% in transmasculine).

Mental health problems were most prevalent six months before first presenting as transgender or gender nonconforming (TGNC). During that time, transfeminine children had especially high rates of conduct/disruptive disorders, while transmasculine children had especially high rates of depressive disorders.

In the older cohort, depressive disorders were most prevalent, occurring in 49% of transfeminine and 62% of transmasculine adolescents. Like the younger group, attention-deficit and anxiety disorders also were common.

Similarly, rates of mental health concerns were greatest within six months before presenting as TGNC. During that time, transgender adolescents had high rates of psychoses, suicidal ideation and self-inflicted injuries. Transfeminine adolescents also had elevated levels of autism spectrum disorders, while transmasculine adolescents were diagnosed with schizophrenia spectrum disorder at higher rates.

"Overall, these data reveal that children and adolescents presenting as TGNC to health care providers may require not only thorough and immediate evaluation of mental health needs but also urgent implementation of social and educational measures of gender identity support," authors wrote.

Teens who are lesbian, gay, bisexual or questioning also face mental health challenges, according to another study published today, “Sexual Orientation and Depressive Symptoms in Adolescents” (Luk JW, et al. Pediatrics. April 16, 2018, https://doi.org/10.1542/peds.2017-3309).

The study found these sexual minority adolescents reported higher rates of depressive symptoms in their late teens and early 20s compared to heterosexual peers. Nearly half of the disparity was linked to low family satisfaction, cyberbullying victimization or unmet medical needs.

In a third study, a researcher found LGBTQ teens were more likely to experience multiple adverse childhood experiences and psychological/physical abuse than their heterosexual or cisgender peers.

Higher levels of gender nonconformity were linked to greater likelihood of adversity, according to the study “Disparities for LGBTQ and Gender Nonconforming Adolescents” (Baams L. Pediatrics. April 16, 2018, https://doi.org/10.1542/peds.2017-3004).

Authors of a related commentary wrote about the need for pediatric practices be a safe, comfortable place for sexual minority patients and for providers to have the skills to assess and help them.

“Only by identifying LGBTQ and gender nonconforming youth and appropriately screening them can they be provided with specific potentially lifesaving supports that may be needed, including gender-affirming treatments for transgender youth, referral to a mental health provider, family engagement, and referrals to community programs for peer engagement,” they wrote.