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High Rate of Mental Health Problems in Transgender Children

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New research shows that transgender children, even as young as 9 or 10, are already showing increased susceptibility to mental health issues compared to their cisgender peers.

The researchers assessed a sample of more than 7,000 children aged 9-10 in the general population and found that those who reported being transgender scored significantly higher on all six subscales of the DSM-focused Child Behavior Checklist (CBCL). 5.

Transgender children were almost six times more likely to have suicidal tendencies and more than twice as likely to have depressive and anxiety problems compared to cisgender children. Moreover, transgender children showed higher levels of mental health problems compared to previous studies of transgender children recruited from specialized gender clinics.

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“Our results highlight the vulnerability of transgender children, including those who may not yet have access to specialized support,” Senior Author Kenneth S. Pang, MBBS, BMedSc, PhD, Associate Professor, Murdoch Children’s Research Institute, University of Melbourne , Royal Children’s Hospital. , Australia, Medscape Medical News reported.

“Physicians providing general medical care to transgender children should be mindful of this vulnerability and actively address any existing mental health issues,” he said.

The results were published online on July 22 as a research letter in the JAMA Network Open.

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Higher level of support?

“We think this study is important to do because previous research on the mental health of transgender children has been done on children receiving gender-specific care,” Pang said.

“Transgender children who receive such assistance are likely to receive a higher level of support than those who do not have access to such services, and this can lead to mental health disparities,” he added.

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To investigate this issue, the researchers turned to participants (n = 7169, mean age 10.3 years) from the Adolescent Brain Cognitive Development (ABCD) study.

“The ABCD study is a longitudinal study of more than 11,000 children who were recruited to reflect the socio-demographic differences of the US population,” lead author Douglas H. Russell, M.Sc., Ph.D. at the University of Melbourne, Victoria, Australia, told Medscape. Medical news.

To be included in the current study, children had to understand and answer the question “Are you transgender?”

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The researchers compared the mental health outcomes of transgender and cisgender children (n = 58 and n = 7111, respectively) using the CBCL, which study participants completed at baseline.

Key protective factor

Transgender children recorded higher mean T scores on all six CBCL subscales, although all children scored within the reference range; and the standardized mean difference was “small”.

Subscale Mean subscale T-score Mean Difference (95% CI)
depressive problems Cisgender: 53.7
Transgender: 57.3
-3.61 (from -3.89 to -3.33)
Anxiety problems Cisgender: 53.4
Transgender: 57.0
-3.58 (from -3.86 to -3.30)
Somatic problems Cisgender: 55.2
Transgender: 57.0
-1.79 (from -2.05 to -1.53)
ADHD Cisgender: 53.2
Transgender: 55.6
-2.36 (from -2.65 to -2.07)
Opposition issues Cisgender: 53.6
Transgender: 55.8
-2.21 (from -2.51 to -1.90)
Recalcitrant Problems Cisgender: 53.2
Transgender: 56.4
-3.20 (from -3.52 to -2.88)
suicide Cisgender: N/A
Transgender: N/A
N/A
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Suicidality was measured by summing the two suicide-related items on the CBCL Parental Report assessing suicidal thoughts and attempts.

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“For CBCL, T scores are calculated for indicators that are evaluated on a continuous scale,” Pang noted. “Responses to questions about suicide in the CBCL were rated categorically (at risk of suicide or not), as described previously by others. Thus, T-scores could not be calculated.”

When the researchers determined the proportion of cisgender and transgender children who scored in the “borderline” or “clinical” range (T score of 65), they found an increased chance of transgender children scoring in this range on all six subscales, as well as suicidality. .

Subscale Proportion of scores above the clinical threshold (%) Odds ratio (95% CI)
depressive problems Cisgender: 7.8
Transgender: 18.1
2.53 (2.53 – 2.53)
Anxiety problems Cisgender: 8.0
Transgender: 18.7
2.70 (1.43 – 5.11)
Somatic problems Cisgender: 13.4
Transgender: 20.3
1.62 (1.62 – 1.62)
ADHD Cisgender: 6.4
Transgender: 10.2
1.57 (0.50 – 4.91)
Opposition issues Cisgender: 6.1
Transgender: 13.6
2.39 (0.85 – 6.77)
Recalcitrant Problems Cisgender: 7.1
Transgender: 18.4
3.13 (1.46 – 6.71)
suicide Cisgender: 2.9
Transgender: 14.8
5.79 (2.08 – 16.16)

The researchers note that the results for ADHD and oppositional defiant behavior were not statistically significant.

Previous studies using clinical samples of young transgender children (ages 5 to 11) have reported lower rates of depression and anxiety than those found in the current study.

“Transgender children in the general population showed higher rates of mental health problems compared to previous studies of transgender children recruited in gender specific clinics,” Russell said.

One reason for this may be that children in specialized clinics are “likely to receive support from their families (a key protective factor for the mental health of transgender young people); by comparison, many transgender children in the general population lack parental support because of their gender. ‘, the investigators wrote.

“Our results show that by 9–10 years of age, transgender children already show increased susceptibility to mental health issues compared to their cisgender peers, with important public health implications,” they add.

The researchers note that it is not clear whether this susceptibility is due to “stigma, minority stress, discrimination, or gender dysphoria, but providing appropriate mental health support to this vulnerable group is paramount.”

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“Pathology and Damage”

Commenting for Medscape Medical News, Jack Turban, MD, new assistant professor of child and adolescent psychiatry at the University of California, San Francisco, said “unfortunately” the results are “largely in line with past studies that have shown major differences in mental health.” . for transgender and gender diverse youth.

“The dramatically increased chances of suicide are of particular public health concern,” said Turban, who was not involved in the study.

He noted that these results “come at a time when transgender youth are under attack from lawmakers in many states across the country, and the national rhetoric around them is pathological and destructive.”

Turban added that he worries “if our national discourse around trans youth doesn’t change soon, these inequalities will get worse.”

Funding has been provided to individual investigators by the Hugh Williamson Foundation, the Royal Children’s Hospital Foundation, the National Health and Medical Research Council, and the Australian Government Research Training Program Fellowship. Russell and Pang reported being members of the Australian Professional Association for Transgender Health. Pang is also a member of the World Professional Association for Transgender Health and a member of the editorial board of Transgender Health. Disclosures to other authors are listed in the original article. Turban reported textbook royalties from Springer Nature, membership on Panorama Global’s (UpSwing Fund) scientific advisory board, and payments as an expert witness to the American Civil Liberties Union, Lambda Lega and Cooley LLP. He has also received a pilot study award from AACAP and pharmaceutical partners (Arbor and Pfizer), a research fellowship from the Sorensen Foundation, and freelance grants from the New York Times, Washington Post, and Los Angeles Times.

JAMA The network is open. 2022;5:e2223389. Full article

Batya Swift Yasgur, Massachusetts, LSW, is a freelance writer with a consulting practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-focused health books, as well as Behind the Burqa: Our Life in Afghanistan and How We Fled to Freedom (a memoir of two brave Afghan sisters who told her their story).

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