PASADENA, Calif. — Transgender and gender-nonconforming youth are diagnosed with mental health conditions much more frequently than young people who identify with the gender they are assigned at birth, according to new Kaiser Permanente research published today in Pediatrics.

While this subject has been analyzed in small, specialized, clinic-based studies that rely on self-reported behavior problems, this large cohort study is based on electronic medical record information from a transgender/gender non-conforming group enrolled in a comprehensive care system. The investigators examined the prevalence of mental health conditions such as anxiety, depression and suicidal thoughts. In nearly all instances, mental health diagnoses were more common for transgender and gender-nonconforming youth than for youth who identify with the gender assigned at birth, also known as cisgender youth.

“We looked at mental health in transgender and gender-nonconforming youth retrospectively between 2006 and 2014 and found that these youths had three to 13 times the mental health conditions of their cisgender counterparts,” said the study’s lead author, Tracy A. Becerra-Culqui, PhD, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation. “Among these young people, the most prevalent diagnoses were attention deficit disorders in children, 3 to 9 years of age and depressive disorders in adolescents, 10 to 17 years of age.”

This study, which was based on information in the electronic health record, included 1,347 transgender and gender-nonconforming youth 3 to 17 years who are members of Kaiser Permanente in Southern California, Northern California and Georgia. The cohort was 44 percent transfeminine (youth whose gender assigned at birth was male) and 56 percent transmasculine (youth whose gender assigned at birth was female).

The most common diagnoses for transgender and gender-nonconforming children and adolescents were:

Attention deficit disorder (transfeminine: 15 percent, transmasculine: 16 percent). These numbers are 3 to 7 times higher than the matched cisgender reference group.

Depressive disorder (transfeminine: 49 percent, transmasculine: 62 percent). These numbers are 4 to 7 times higher than the matched cisgender reference group.

“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 Becerra-Culqui. “For clinicians, it is important that they are aware of possible mental health conditions that may be more common in transgender and gender-nonconforming youth compared to cisgender youth. It is also crucial they have the knowledge necessary to provide social and educational support for their young patients who are figuring out their gender identity.”

The authors noted that the conditions may be related to gender dysphoria, a feeling of distress when one’s assigned gender does not match their identity. Also, young people with gender-nonconforming behavior may experience stress from prejudice and discrimination, which can cause or exacerbate emotional or behavioral problems.

The research was funded through a contract with the Patient-Centered Outcomes Research Institute and a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

In addition to Becerra-Culqui, study authors include senior author and principal investigator Michael Goodman, MD, MPH, Yuan Liu, PhD, Department of Biostatistics and Bioinformatics, Rebecca Nash, MPH, Department of Epidemiology, Timothy L. Lash, DSc — all from the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta; Lee Cromwell, MS, and Brandi Robinson, MPH, Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta; W. Dana Flanders, MD, DSc, and Shawn V. Giammattei, PhD, the Rockway Institute, Alliant International University, San Francisco; Darios Getahun, MD, PhD, MPH, and Virginia P. Quinn, PhD, MPH, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.; Enid M. Hunkeler, MA, Emeritus, Andrea Millman, MA, and Michael J. Silverberg, PhD, Division of Research, Kaiser Permanente Northern California, Oakland, Calif.; Douglas Roblin, PhD, Mid-Atlantic Permanente Research Institute, Kaiser Permanente of the Mid-Atlantic States, Rockville, Md.; David E. Sandberg, PhD, Department of Pediatrics, University of Michigan, School of Medicine, Ann Arbor; and Vin Tangpricha, MD, PhD, Emory University, School of Medicine and the Atlanta VA Medical Center.

About the Kaiser Permanente Southern California Department of Research & Evaluation

The Department of Research & Evaluation conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiologic research, health services research, biostatistics research and behavioral research as well as clinical trials. Major areas of study include chronic disease, infectious disease, cancer, drug safety and effectiveness and maternal and child health. Headquartered in Pasadena, California, the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general public. Visit kp.org/research.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.