Looking at mental health disparities in gender diverse and transgender teens

Being a gender diverse and transgender adolescent can mean an increased risk of mental health concerns. When those concerns lead to treatment programs, are they more likely to have worse outcomes than their cisgender peers?

When compared to cisgender peers, teenagers who are gender diverse and transgender are at an increased risk of mental health concerns such as depression, anxiety, and suicidality. Sometimes those concerns are severe enough to require acute residential treatment. An investigation in JAMA Network Open looks into whether transgender and gender diverse adolescents enter such treatment programs with worse symptoms and have worse outcomes when discharged than their cisgender peers.1

The investigators looked at adolescents who had participated in a 2-week acute residential treatment program for psychiatric disorders. They compared groups at treatment entry, treatment discharge, and 1-month postdischarge follow-up. Each participant was assessed for age of depression onset, self-injury, suicidality, and childhood trauma at the start of treatment. Depressive and anxiety symptoms as well as emotional dysregulation were assessed at entry, discharge, and postdischarge.

There were 200 participants who completed entry and discharge assessments, of which 35 were transgender and gender diverse. The investigators found that the transgender and gender diverse participants had an earlier average age of age of depression onset (transgender and gender diverse: 10.8 [2.4] years vs cisgender: 11.9 [2.3] years; difference: 1.07 years; 95% CI, 0.14-2.01 years; P = .02), higher average suicidality scores (transgender and gender diverse: 44.4 [23.1] vs cisgender: 28.5 [25.4]; difference: 16.0; 95% CI, 6.4-25.5; P = .001), more self-injurious behavior (average RBQ-A score for transgender and gender diverse: 3.1 [2.5] vs cisgender: 1.7 [1.9]; difference: 1.42; 95% CI, 0.69-2.21; P = .001) and more childhood trauma (eg, average CTQ-SF score for emotional abuse in transgender and gender diverse: 12.7 [5.4] vs cisgender: 9.8 [4.7]; difference: 2.85; 95% CI, 1.06-4.64; P = .002). Transgender and gender diverse teenagers were also found to have higher symptom scores.

The investigators concluded there were disparities in care for mental health among transgender and gender diverse teenagers, who had worse scores at all 3 time periods included in the study. This difference in outcomes should lead to greater focus on improving outcomes in patients who are a gender minority.


1. Silveri M, Schuttenberg E, Schmandt K, et al. Clinical outcomes following acute residential psychiatric treatment in transgender and gender diverse adolescents. JAMA Netw Open. 2021;4(6):e2113637. doi:10.1001/jamanetworkopen.2021.13637