title: Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study.
abstract: OBJECTIVE
  Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap.
  
  
  METHODS
  A retrospective cohort study of electronic health record data from 180 transgender patients aged 12-29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes.
  
  
  RESULTS
  The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p < .05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.
  
  
  CONCLUSIONS
  Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts. Electronic address: sreisner@fenwayhealth.org.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.affiliation: Sidney Borum Jr. Health Center, Boston, Massachusetts.
authors.forename: Ralph
authors.initials: R
authors.lastname: Vetters
authors.affiliation: Social & Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: M
authors.initials: M
authors.lastname: Leclerc
authors.affiliation: The Fenway Institute, Fenway Health, Boston, Massachusetts.
authors.forename: Shayne
authors.initials: S
authors.lastname: Zaslow
authors.affiliation: The Fenway Institute, Fenway Health, Boston, Massachusetts.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wolfrum
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shumer
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D003153:Community Health Services / Q000379:methods* / Q000639:trends; D003863:Depression / Q000453:epidemiology; D005260:Female; D005783:Gender Identity; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008603:Mental Health; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D059020:Suicidal Ideation; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D014505:Urban Population; D055815:Young Adult
keywords: Adolescent; Gender minority; Health disparity; Mental health; Transgender