Psychiatric disorders prevalent in young transgender women

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Extraordinarily high rate of diagnoses

Dr. Reisner and his associates confirm what has already been consistently reported in the research literature: The prevalence of mental health diagnoses among transgender adolescents and women is extraordinarily high, and timely, appropriate care is imperative to help them achieve health and wellness. What is different with this cohort is that the young transgender women were recruited from the community, rather than from a population of those with the resources to access transgender-specific health care.

It is clear that mental health services are lacking and inaccessible to much of the transgender population. This is due in part to the limited number of professionals who are experienced in working with transgender youth. But it can also be attributed to the lack of clarity, among both mental health professionals and the scientific and medical community in general, regarding the complex nature of the transgender experience.

Dr. Johanna Olson-Kennedy is with Children’s Hospital Los Angeles. She reported having no relevant financial disclosures. Dr. Olson-Kennedy made these remarks in an editorial accompanying Dr. Reisner’s report (JAMA Pediatr. 2016 Mar 21 doi: 10.1001/jamapediatrics.2016.0155).




Young transgender women have a high prevalence of psychiatric disorders that is two to four times higher than that in the general population, according to a report published online March 21 in JAMA Pediatrics.

“Improving access to culturally competent primary care, diagnostic screening, psychotherapy, and pharmacologic treatments, and retention in care in clinical community-based pediatric and young-adult medicine settings, are urgently needed to address the adverse mental health and substance dependence disorders in this population,” said Sari L. Reisner, Sc.D., of Boston Children’s Hospital and Harvard Medical School, and his associates.

They assessed mental health using brief structured diagnostic interviews with 298 young transgender women participating in an HIV-prevention study in Boston and Chicago during a 3-year period. The study participants, all aged 16-29 years (mean age, 23 years), had been assigned male sex at birth but self-identified as woman, female, transgender woman, transfemale, male-to-female, or other identity on the transfeminine spectrum. All reported participating in high-risk sexual activity. The study population was urban and ethnically diverse: 49.0% black, 12.4% Latina, 25.5% white, and 13.1% other race/ethnicity. Seventy-two percent reported ever using cross-sex hormones and 21% had undergone gender-reassignment surgery.

A total of 42% of these study participants had at least one psychiatric disorder, and 20% had two or more mental health diagnoses. The prevalence of lifetime major depressive disorder was 35%, suicidality within the preceding month was 20.2%, generalized anxiety disorder during the preceding 6 months was 8%, PTSD during the preceding 6 months was 10%, alcohol dependence during the preceding year was 11%, and substance dependence during the preceding year was 15%.

These findings suggest that stressors that are unique to gender transition, such as adverse processes in identity development, “may affect psychiatric health and well-being across adolescence and young adulthood,” the investigators said (JAMA Pediatr. 2016 March 21 doi: 10.1001/jamapediatrics.2016.0067).

“Pediatric, adolescent, or young-adult primary-care providers may be a first resource for families needing education and support and play a critical role in supporting transgender youth, including screening for psychosocial problems and health risks, referring for gender-specific mental health and medical care, and providing advocacy and support,” Dr. Reisner and his associates said.

They added that clinicians “should familiarize themselves with current international guidelines for the provision of clinical care to transgender young people, to best meet both medical and mental health needs of this at-risk population.”

This study was supported by the National Institute of Mental Health. Dr. Reisner and his associates reported having no relevant financial disclosures.

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