Transgender children, even those young as 9 or 10 years old, already show increased susceptibility to mental health problems compared with their cisgender peers, new research suggests.
Investigators assessed a sample of more than 7000 children aged 9-10 years in the general population and found those who reported being transgender scored considerably higher on all six subscales of the DSM-5-oriented Child Behavior Checklist (CBCL).
Transgender children had almost sixfold higher odds of suicidality and over twice the odds of depressive and anxiety problems, compared with cisgender children. Moreover, transgender children displayed higher levels of mental health problems compared with previous studies of transgender children recruited from specialist gender clinics.
“Our findings emphasize the vulnerability of transgender children, including those who may not yet have accessed specialist support,” senior author Kenneth C. Pang, MBBS, BMedSc, PhD, associate professor, Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Australia, told Medscape Medical News.
“Clinicians providing general healthcare to transgender children should keep this vulnerability in mind and proactively address any mental health problems that exist,” he said.
The findings were published online July 22 as a research letter in JAMA Network Open.
Higher Levels of Support?
“We felt this study was important to conduct because previous studies regarding the mental health of transgender children have been drawn from children receiving specialist gender-related care,” Pang said.
“Transgender children receiving such care are likely to enjoy higher levels of support than those unable to access such services, and this might create differences in mental health,” he added.
To investigate this issue, the researchers turned to participants (n = 7169; mean age, 10.3 years) in the Adolescent Brain Cognitive Development (ABCD) study.
“The ABCD study is a longitudinal study of over 11,000 children who were recruited to reflect the sociodemographic variation of the US population,” lead author Douglas H. Russell, MSc, a PhD candidate at the University of Melbourne, Victoria, Australia, told Medscape Medical News.
To be included in the current study, children had to understand and respond to the question “Are you transgender?”
The researchers compared mental health outcomes between transgender and cisgender children (n = 58 and n = 7111, respectively) using the CBCL, which study participants had completed at baseline.
Key Protective Factor
The transgender children recorded higher mean T scores for all six subscales of the CBCL, although all children scored in the references range; and the standardized mean difference was “small.”
| Subscale | Mean T Score on Subscale | Difference in Mean (95% CI) |
|---|---|---|
| Depressive problems | Cisgender: 53.7 Transgender: 57.3 |
−3.61 (−3.89 to −3.33) |
| Anxiety problems | Cisgender: 53.4 Transgender: 57.0 |
−3.58 (−3.86 to −3.30) |
| Somatic problems | Cisgender: 55.2 Transgender: 57.0 |
−1.79 (−2.05 to −1.53) |
| ADHD | Cisgender: 53.2 Transgender: 55.6 |
−2.36 (−2.65 to −2.07) |
| Oppositional problems | Cisgender: 53.6 Transgender: 55.8 |
−2.21 (−2.51 to −1.90) |
| Defiant problems | Cisgender: 53.2 Transgender: 56.4 |
−3.20 (−3.52 to −2.88) |
| Suicidality | Cisgender: N/A Transgender: N/A |
N/A |
Suicidality was measured by summing the two suicide-related items in the parent-report CBCL assessing suicidal ideation and attempts.
“For the CBCL, T scores are calculated for measures that are scored on a continuous scale,” Pang noted. “Responses to the suicidality questions on the CBCL were assessed in a categorical manner (at risk of suicide vs not), as previously described by others. So T scores were therefore not able to be calculated.”
When the investigators determined the proportion of cisgender and transgender children who scored in the “borderline” or “clinical” range (T score, 65), they found increased odds of transgender children scoring in that range in all six subscales, as well as suicidality.
| Subscale | Proportion Scoring Above Clinical Cutoff (%) | Odds Ratio (95% CI) |
|---|---|---|
| Depressive problems | Cisgender: 7.8 Transgender: 18.1 |
2.53 (2.53 – 2.53) |
| Anxiety problems | Cisgender: 8.0 Transgender: 18.7 |
2.70 (1.43 – 5.11) |
| Somatic problems | Cisgender: 13.4 Transgender: 20.3 |
1.62 (1.62 – 1.62) |
| ADHD | Cisgender: 6.4 Transgender: 10.2 |
1.57 (0.50 – 4.91) |
| Oppositional problems | Cisgender: 6.1 Transgender: 13.6 |
2.39 (0.85 – 6.77) |
| Defiant problems | Cisgender: 7.1 Transgender: 18.4 |
3.13 (1.46 – 6.71) |
| Suicidality | Cisgender: 2.9 Transgender: 14.8 |
5.79 (2.08 – 16.16) |
The researchers note the results for ADHD and oppositional defiant problems were not statistically significant.
Previous studies that used clinical samples of young transgender children (aged 5 – 11 years) reported lower rates of depression and anxiety than what was found in the current study.
“Transgender children in the general population displayed higher levels of mental health problems compared to previous studies of transgender children recruited from specialist gender clinics,” Russell said.
One reason for that may be children in specialist clinics “are likely to have support from their families (a key protective factor for the mental health of transgender young people); in comparison, many transgender children in the general population lack parental support for their gender,” the investigators write.
“Our findings suggest that by 9 to 10 years of age transgender children already show increased susceptibility to mental health problems compared with their cisgender peers, which has important public health implications,” they add.
The researchers note that whether this susceptibility “is due to stigma, minority stress, discrimination, or gender dysphoria is unclear, but providing appropriate mental health supports to this vulnerable group is paramount.”
“Pathologizing and Damaging”
Commenting for Medscape Medical News, Jack Turban, MD, incoming assistant professor of child and adolescent psychiatry, University of California, San Francisco, said that “sadly” the findings are “largely in line with past studies that have shown dramatic mental health disparities” for transgender and gender diverse youth.
“The dramatically elevated odds of suicidality warrants particular public health concern,” said Turban, who was not involved with the study.
He noted these results “come at a time when transgender youth are under legislative attack in many states throughout the country, and the national rhetoric around them has been pathologizing and damaging.”
Turban added he worries “if our national discourse around trans youth doesn’t change soon, that these disparities will worsen.”
Funding was provided to individual investigators by the Hugh Williamson Foundation, the Royal Children’s Hospital foundation, the National Health and Medical Research Council, and the Australian Government Research Training Program Scholarship. Russell and Pang reported being members of the Australian Professional Association for Trans Health. Pang is also a member of the World Professional Association for Transgender Health and a member of the editorial board of the journal Transgender Health. Disclosures for the other authors are listed in the original paper. Turban reported textbook royalties from Springer Nature, being on the scientific advisory board of Panorama Global (UpSwing Fund), and payments as an expert witness for the American Civil Liberties Union, Lambda Lega, and Cooley LLP. He has also received a pilot research award from AACAP and pharmaceutical partners (Arbor and Pfizer), a research fellowship from the Sorensen Foundation, and freelance payments from the New York Times, the Washington Post, and the Los Angeles Times.
JAMA Netw Open. 2022;5:e2223389. Full article
Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as “Behind the Burqa: Our Lives in Afghanistan” and “How We Escaped to Freedom” (the memoir of two brave Afghan sisters who told her their story).
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