In a large cohort study conducted by Kaiser Permanente, higher rates of mental health conditions were found in transgender and gender-nonconforming youth compared to cisgender youth who identified with the gender they were assigned at birth. The findings were published in the journal Pediatrics on April 16.

"We hope this research creates awareness about the pressure young people questioning their gender identity may feel, and how this may affect their mental well-being," said lead author Dr. Tracy A. Becerra-Culqui, a researcher from the Kaiser Permanente Southern California Department of Research and Evaluation. She added that it is crucial for clinicians to have adequate knowledge and resources "to provide social and educational support for their young patients who are figuring out their gender identity."

Previously, such studies have often been limited by self-reporting and small sample sizes. But the new cohort analysis looked at data from electronic medical records on a transgender/gender non-conforming group enrolled in a comprehensive care system between 2006 and 2014. Ranging from 3 to 17 years old, they were all members of Kaiser Permanente in Georgia and California.

44% of the group were transfeminine (youth whose gender assigned at birth was male) and 56% were transmasculine (youth whose gender assigned at birth was female). The researchers measured instances of conditions like anxiety, depression and suicidal thoughts. A high prevalence of mental health diagnoses was found in the transgender/gender non-conforming group. 

"Among these young people, the most prevalent diagnoses were attention deficit disorders (ADD) in children, 3 to 9 years of age, and depressive disorders in adolescents, 10 to 17 years of age," explained Dr. Becerra-Culqui. The results showed the number of cases of ADD was 3 to 7 times higher than the matched cisgender reference group, while the number of cases of depressive disorder was 4 to 7 times higher.

The difference in mental health issues can be attributed to gender dysphoria as well as factors such as discrimination, bullying at school, higher risk of substance abuse etc.  In recent years, the debate on gender pronouns versus freedom of speech has gathered more attention in the west, particularly in Canada. Social attitudes and healthcare challenges have also been seeing significant changes. But since these conversations have not been known or addressed to such a degree in the past, many professionals are still unprepared and inexperienced in helping people who are facing problems related to gender identity.

"What we don't understand is what gender dysphoria looks like over a lifetime in kids who are supported," said Dr. Johanna Olson-Kennedy, medical director of the Center for Transyouth Health and Development at Children's Hospital in Los Angeles.

"With time, as more research attention is focused on transgender individuals, we will start to get a better understanding of the factors that are associated with better versus worse mental health," she added.