A matched retrospective cohort study of mental health among transgender and cisgender youth patients in care at an urban community health center

Background: Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exists to estimate the prevalence of mental health outcomes among transgender adolescents and emerging adults who access community-based clinical services.

Methods: A retrospective cohort study of electronic medical record (EMR) data from 180 transgender patients age 12-29 years seen between 2001-2010 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM to MTF youth on mental health outcomes.

Results: The sample (n=360) had a mean age of 19.6 (SD=3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared to cisgender matched controls, transgender youth had a two- to three-fold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p<0.05).  No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and

Conclusions: Transgender youth were found to have a disparity in negative mental health outcomes compared to cisgender youth, with equally high burden in FTM and MTF youth. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.