MedicalResearch.com Interview with:
Dr. Sari L. Reisner PhD
Research Fellow in the Department of Epidemiology
Harvard T.H. Chan School of Public Health
Associate Scientific Researcher in the Division of General Pediatrics
Boston Children’s Hospital/ Harvard Medical School
MedicalResearch.com: What are the main findings?
Dr. Reisner: Transgender youth—including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse gender identity on the transfeminine spectrum—represent a vulnerable population at-risk for negative mental health and substance use/abuse outcomes.
Although community surveys of transgender people in the United States have found a high prevalence of depression, anxiety, and substance use relative to the general adult U.S. population, studies typically utilize screening instruments or sub-threshold symptom questions and do not use diagnostic interviews. Diagnostic interview data are scarce among young transgender women; such data are important to establish guidelines for diagnosis and treatment for this youth group given their complex life experiences.
The aim of this study was to report the prevalence of mental health, substance dependence, and co-morbid psychiatric disorders assessed via a diagnostic interview in an at-risk community-recruited sample of young transgender women. This observational study reported baseline finding from a diverse sample of 298 sexually active, young transgender women ages 16-29 years (mean age 23.4; 49.0% Black, 12.4% Latina, 25.5% White, 13.1% other minority race/ethnicity) enrolled in Project LifeSkills, an ongoing randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012-2015 (NIMH-funded, multiple PIs: Rob Garofalo, MD, MPH & Matthew Mimiaga, ScD, MPH).
MedicalResearch.com: What are the main findings?
Dr. Reisner: Overall, 41.5% of young transgender women sampled had one or more mental health and/or substance dependence diagnoses; one in five (20.1%) had two or more co-morbid psychiatric diagnoses.
Prevalence of mental health, substance dependence, and co-morbid psychiatric diagnoses was high in this at-risk community sample of young transgender women. The estimates found here are 1.7-3.6 times that of the general U.S. population. Improving access to routine primary care, diagnostic screening, psychotherapy and pharmacological treatments, and retention in care in clinical community-based, pediatric, and adolescent medicine settings is urgently needed to address mental health and substance dependence disorders in this population.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Reisner: Interventions are urgently needed to address adverse mental health and substance use outcomes for young transgender women, including those delivered by providers and via multidisciplinary teams in clinical community-based, pediatric, adolescent, and young adult medicine settings. Pediatric, adolescent, or young adult primary care providers may be a first resource for families needing education and support and play a critical role in supporting transgender youth, including screening for psychosocial problems and health risks, referring for gender-specific mental health and medical care, and providing advocacy and support. Clinicians should familiarize themselves with current international guidelines for the provision of clinical care to transgender young people in order to best meet both medical and mental health needs of this at-risk population.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Reisner: Further research is needed, particularly longitudinal studies that examine the antecedents and health sequelae of mental health, substance dependence, and psychiatric co-morbidities across adolescent and young adult development. Such research will help to identify optimal timing and targets for psychosocial interventions in relation to transgender-specific developmental stressors (e.g., gender affirmation and gender role transitions) and societal stigma at multiple levels.
MedicalResearch.com: Is there anything else you would like to add?
Response: “The high prevalence of psychiatric diagnoses in this community-recruited sample of young transgender women indicates the urgent need for gender-affirmative mental health and substance use/abuse services for this traditionally underserved youth group.”
“Although the current study did not empirically test social stress pathways that may contribute to the elevated burden of psychiatric comorbidities found among young transgender women, societal stigma is a likely contributor not only to mental health and substance use/abuse risks for this community, but also to lack of gender-affirmative services available to meet the presenting health needs of this highly stigmatized and traditionally underserved youth group.”
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Dr. Sari L. Reisner PhD (2016). Over 40% Transgender Young Women Have Substance Dependence or Mental Health Issues MedicalResearch.com