https://aub.ie/MilitaryREACH-Hisle-Gorman2021

Hisle-Gorman, E., Schvey, N. A., Adirim, T. A., Rayne, A. K., Susi, A., Roberts, T. A., & Klein, D. A. (2021). Mental healthcare utilization of transgender youth before and after affirming treatment. The Journal of Sexual Medicine, 18(8), 1444-1454. https://doi.org/10.1016/j.jsxm.2021.05.014

Using 8 years of retrospective medical records, this study compared the utilization of mental healthcare (e.g., mental health diagnosis, number of visits) and psychotropic medications (e.g., depression medications) across transgender and gender-diverse (TGD) military youth (i.e., whose gender identity and expression do not align with the sex assigned at birth; n = 3,754) and their cisgender siblings (i.e., whose gender aligns with the sex assigned at birth; n = 6,603). Overall, TGD youth attended more mental health visits and obtained more psychotropic medications per year than their cisgender siblings. TGD youth who initiated gender-affirming pharmaceutical treatment (e.g., hormones) during the study period also attended mental healthcare visits and used psychotropic medications at similar rates before and after treatment.

https://doi.org/10.1016/j.jsxm.2021.05.014

Children
Youth
Mental health
Physical health

Multiple branches

Active Duty

Child of a service member or veteran

Childhood (birth - 12 yrs)
School age (6 - 12 yrs)
Adolescence (13 - 17 yrs)
Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)

Quantitative Study

Hisle-Gorman, Elizabeth, Schvey, Natasha A., Adirim, Terry A., Rayne, Anna K., Susi, Apryl, Roberts, Timothy A., Klein, David A.

Objective Transgender and gender-diverse (TGD) adolescents experience increased mental health risk compared to cisgender peers. Limited research suggests improved outcomes following gender-affirmation. This study examined mental healthcare and psychotropic medication utilization among TGD youth compared to their siblings without gender-related diagnoses and explored utilization patterns following gender-affirming care. Method This retrospective cohort study used military healthcare data from 2010–2018 to identify mental healthcare diagnoses and visits, and psychotropic medication prescriptions among TGD youth who received care for gender dysphoria before age 18, and their siblings. Logistic and Poisson regression analyses compared mental health diagnosis, visits, and psychotropic prescriptions of TGD youth to their siblings, and compared healthcare utilization pre- and post-initiation of gender-affirming pharmaceuticals among TGD adolescents. Results 3,754 TGD adolescents and 6,603 cisgender siblings were included. TGD adolescents were more likely to have a mental health diagnosis (OR 5.45, 95% CI [4.77–6.24]), use more mental healthcare services (IRR 2.22; 95% CI [2.00–2.46]), and be prescribed more psychotropic medications (IRR = 2.57; 95% CI [2.36–2.80]) compared to siblings. The most pronounced increases in mental healthcare were for adjustment, anxiety, mood, personality, psychotic disorders, and suicidal ideation/attempted suicide. The most pronounced increased in psychotropic medication were in SNRIs, sleep medications, anti-psychotics and lithium. Among 963 TGD youth (Mage: 18.2) using gender-affirming pharmaceuticals, mental healthcare did not significantly change (IRR = 1.09, 95% CI [0.95–1.25]) and psychotropic medications increased (IRR = 1.67, 95% CI [1.46–1.91]) following gender-affirming pharmaceutical initiation; older age was associated with decreased care and prescriptions. Conclusion Results support clinical mental health screening recommendations for TGD youth. Further research is needed to elucidate the longer-term impact of medical affirmation on mental health, including family and social factors associated with the persistence and discontinuation of mental healthcare needs among TGD youth.

Elsevier

Article
REACH Publication

Department of Pediatrics, Uniformed Services University, EHG
Department of Preventive Medicine and Biostatistics, Uniformed Services University, EHG
Department of Medical and Clinical Psychology, Uniformed Services University, NAS
Department of Preventive Medicine and Biostatistics, Uniformed Services University, TAA
Department of Defense, TAA
Department of Family Medicine, Fort Belvoir Community Hospital, AKR
Department of Pediatrics, Uniformed Services University, AS
Department of Preventive Medicine and Biostatistics, Uniformed Services University, AS
Division of Adolescent Medicine, Children's Mercy Kansas City, TAR
Department of Pediatrics, University of Missouri-Kansas City School of Medicine, TAR
Department of Pediatrics, Uniformed Services University, DAK
Department of Family Medicine, Uniformed Services University, DAK