Mental Health Comorbidity Examined in Transgender and Gender-Nonconforming Youth

gender symbols
gender symbols
These findings suggest an urgent need for improved measures of social and clinical support in transgender and/or gender-nonconforming youth.

Research published in Pediatrics indicated a higher prevalence ratio of certain mental health disorders in transgender and/or gender-nonconforming (TGNC) youth compared with cisgender controls, suggesting an urgent need for improved measures of social and clinical support.

Using electronic medical records, researchers identified a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old). Each TGNC participant was matched with 10 male and 10 female cisgender referent enrollees by birth year, race and/or ethnicity, study site, and membership year of the index date, defined as date of the first evidence of gender-nonconforming status. Prevalence ratios were calculated for diagnostic categories and for specific mental health diagnoses in the TGNC cohort by dividing the proportion of affected TGNC individuals by the corresponding proportion in each reference group.

Prevalence ratios for all diagnostic categories were significantly higher among TGNC youth compared with the reference population. Prevalence ratios (95% CIs) for suicidal ideation and self-inflicted injuries, respectively, were 54 (18-218) and 70 (9.0-159) for transfeminine participants and 45 (23-97) and 144 (14-4338) for transmasculine participants compared with reference males. Compared with reference female enrollees, transfeminine and transmasculine adolescents also experienced a significantly higher rate of psychosis, at prevalence ratios (95% CI) of 101 (14-4375) and 30 (12-94), respectively. The most common diagnoses for children age 3 to 9 years were attention-deficit disorders, found in 15% of transfeminine participants and in 16% of transmasculine participants. Among TGNC adolescents, depressive disorders were most common (transfeminine 49%; transmasculine 62%) compared with other diagnostic categories.

Related Articles

These results underscore the necessity of clinical, educational, and social measures of gender identity support for TGNC individuals, and may be helpful in developing proper mental health intervention strategies for this specific population. As follow-up on this study cohort continues, researchers hope to examine temporal changes in mental health diagnoses and explore the efficacy of different treatment strategies for gender dysphoria.  


Becerra-Culqui TA, Liu Y, Nash R, et al. Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics. 2018;141(5):e20173845.