Psychiatric diagnoses in young transgender women

Transgender youth -- including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female or another diverse gender identity on the transfeminine spectrum -- are a vulnerable population at risk for negative mental health and substance use outcomes.

Sari L. Resiner, Sc.D., of Boston Children's Hospital/Harvard Medical School, Boston, and coauthors used a diagnostic interview in an at-risk sample of young transgender women to assess the prevalence of mental health, substance dependence and coexisting psychiatric disorders.

The study included 298 sexually active transgender women (ages 16 through 29) enrolled in Project LifeSkills in Chicago and Boston. Nearly three-quarters of the study group was unemployed and nearly half had an annual income of less than $10,000.

The authors report prevalence for:

• Lifetime and current major depressive episodes were 35.4 percent and 14.7 percent, respectively
• Past 30-day suicidality was 20.2 percent
• Past 6-month generalized anxiety disorder and posttraumatic stress disorder were 7.9 percent and 9.8 percent, respectively
• Past 12-month alcohol dependence and nonalcohol psychoactive substance use were 11.2 percent and 15.2 percent, respectively

The prevalence of mental health diagnoses by race was significant for lifetime and current major depressive disorder, with Latina young transgender women having the highest prevalence at 48.6 percent and 27 percent, respectively.

The study notes limitations, including that it enrolled participants with sexually risky behavior in an HIV prevention efficacy trial and, as such, the results are not generalizable to the general U.S. population of young transgender women.

"Culturally tailored interventions that work to decrease mental health distress and substance use among young transgender women are needed, as are longitudinal cohort studies that examine the course of mental and physical health of young transgender women over time across adolescence and young adulthood to inform interventions for this at-risk group of youth."

Editorial: Mental Health Disparities Among Transgender Youth

"The entire framework of transgender health care would benefit from a restructuring to meet the needs of patients and clients, as well as acknowledging pragmatic limitations of available professionals," writes Johanna Olson-Kennedy, M.D., of Children's Hospital Los Angeles, in a related editorial.