Gender Minority Behavioral Health Disparities

Results of two studies have been recently published on behavioral health disparities in transgender youth. The studies show, respectively, that transgender youth are at an increased risk for negative mental health outcomes including anxiety, depression, self-harm and suicidality, and that gender minority youth have an increased odds of substance use behaviors alcohol use, marijuana use, and non-marijuana illicit drug use compared to cisgender (i.e., those with a gender identity or expression that matches assigned at birth) youth.

Though transgender youth are a vulnerable population to negative mental health outcomes, there’s little available data to date to compare the mental health of transgender youth to cisgender youth. The retrospective cohort study of electronic health record data at a Boston community health center was performed matching 106 transgender youth to cisgender controls. Researchers found that transgender youth had to have a disparity in negative mental health outcomes compared with cisgender youth, with no difference in female-to-male and male-to-female patients. The authors concluded that:

“Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.”

Further, it is recommended that providers collect gender-inclusive measures in electronic health records, including assigned sex at birth and current gender identity at patient registration.

Likewise, though bullying and substance use are serious public health issues for adolescents, there have been very limited studies looking at indicators by gender identity. The Teen Health and Technology Study sampled youth (13-18 years of age) online. Self-identified gender minority youth represented 11.5 percent of youth overall. Looking at their experiences over the past 12 months, gender minority youth disproportionately experienced bullying, and increased odds of alcohol use, marijuana use, and other illicit drug use. Reisner et al. demonstrated that stress in the form of bullying experiences mediates the association between gender minority identity and substance use behaviors. Researchers hypothesize that these associations are related to the social stress perspective that postulates one’s disadvantage in the social hierarchy leads to more stressful conditions and fewer resources, thereby resulting in greater rates of behavioral health disorders.

Several resources are available to both providers and patients, including: