MONDAY, March 21, 2016 -- More than 40 percent of young, low-income transgender women with a history of unsafe sexual behavior struggle with at least one serious mental health issue and/or substance abuse problem, a small study suggests.
Nearly 20 percent have two or more serious mental health diagnoses, the investigators said.
The findings concern both teens and young adults who identify as women but were born male. The study also found that mental health and substance abuse issues are roughly two to four times greater among these transgender women than among the U.S. population at large.
The findings show that "interventions are urgently needed to address adverse mental health and substance use outcomes for young transgender women," said study author Sari Reisner, an assistant professor of pediatrics at Harvard Medical School.
However, the researchers stressed that because the findings specifically concerned a relatively poor group of transgender women with a history of risky sexual behavior, the findings may not reflect mental health and substance use risk among all young transgender women.
And, other recent research suggests that when transgender children feel supported in their transition, their mental health doesn't suffer. That study, published last month in the journal Pediatrics, found that depression and anxiety rates were the same in transgender children between the ages of 3 and 12 as in non-transgender children of the same ages.
The researchers behind the Pediatrics study said they weren't sure what was behind the good mental health findings in these children. But, they added, the positive news from their study was that transgender people don't necessarily face a lifetime of mental health problems.
Approximately 0.5 percent of the American population is transgender. Someone who is transgender identifies with the gender they weren't assigned at birth.
The new study looked at the mental health of almost 300 young transgender women. Between 2012 and 2015, the study volunteers were between the ages of 16 and 29. Their average age was 23. They lived in either Chicago or Boston, and had been previously enrolled in an HIV prevention study called "Project LifeSkills."
That effort had reached out to the transgender communities of both cities (via notices in bars, on websites, and through ads and local health centers) to enlist individuals who were assigned a male identity at birth, but currently identified as women, female, transgender women, transfemale, and/or male-to-female, the study authors said.
Nearly half the participants were black, a quarter were white, and about 12 percent were Latino. The vast majority were poor. Nearly three-quarters were unemployed and almost half earned less than $10,000 per year. All had a history of "risky" sexual behavior, according to the study.
Participants completed both written and in-person interviews designed to screen for a number of past or present psychiatric diagnoses, including depression, anxiety, post-traumatic stress disorder (PTSD), suicide risk, and both alcohol and drug abuse and/or use.
An analysis of their responses revealed that more than a third had a history of major depression in their lifetime. Fifteen percent currently struggled with depression. Risk was particularly high among Latina women, among whom nearly half had a lifetime history of depression, while more than a quarter were currently depressed, the study showed.
More than one in five of the transgender women said they had contemplated suicide in the prior month, with the highest risk seen among older women (between 25 and 29), according to the study.
Nearly 10 percent suffered from PTSD in the prior year. And almost 8 percent had experienced a form of anxiety disorder in the past six months, the study said.
In addition, in the year leading up to the study more than 1 in 10 of the women had abused alcohol. More than 15 percent said they used some type of psychoactive drug, researchers said.
Although the study wasn't designed to look into what caused the increased mental health problems in this specific group of transgender women, Reisner said the stigma that transgender people face in society likely plays a significant role.
The study was published March 21 in the journal JAMA Pediatrics.
Reisner said the findings highlighted "the urgent need for gender-affirmative mental health and substance use/abuse services for this traditionally underserved youth group."
That notion was seconded by Johanna Olson-Kennedy, medical director of the Center for Transyouth Health and Development Children's Hospital in Los Angeles, and author of an accompanying editorial in the journal.
"To me, this [study] demonstrates the impact that lack of access to medical and mental health services can have on this population of young people," she said.
Olson-Kennedy added that this can be changed by providing access to affordable and timely mental health care that's tailored for transgender people.More information
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