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Family Discordance in Gender Identification Is Not Associated with Increased Depression and Anxiety Among Trans Youth

Agulleiro, Luis Martinez; Castellanos, F. Xavier; Janssen, Aron; Baroni, Argelinda
Purpose: We examined the relationship between parent- and child-reported gender identity of the youth with internalizing symptoms in transgender and gender-diverse (TGD) youth. In addition, we investigated differences in sex assigned at birth ratios and pubertal development stages in TGD and cisgender youth. Methods: We analyzed longitudinal data from the Adolescent Brain Cognitive Development study (ABCD), corresponding to baseline and 1st-to-3rd-year follow-up interviews (n = 6030 to n = 9743, age range [9"“13]). Sociodemographic variables, self- and parent-reported gender identity, and clinical measures were collected. Results: TGD youth showed higher levels of internalizing symptoms compared with cisgender youth. However, this was not worsened by discordance in gender identification between TGD youth and parents. Over the 3-year follow-up period, the number of TGD participants increased from 0.8% (95% confidence interval (CI) [0.6"“1.0]) at baseline to 1.4% (95% CI [1.1"“1.7]) at the 3rd-year follow-up (v2 = 10.476, df = 1, false discovery rate (FDR)adjusted p = 0.00256), particularly among those assigned female at birth (AFAB) in relation to people assigned male at birth (AMAB) (AMAB:AFAB at baseline: 1:1.9 vs. AMAB:AFAB at 3rd-year follow-up: 1:4.7, v2 = 40.357, df = 1, FDR-adjusted p < 0.0001). Conclusions: TGD youth in ABCD reported higher internalizing symptoms than cisgender youth, although this was not affected by parental discordance in gender identification. A substantial increase over time in TGD children AFAB was documented. More research is needed to understand the clinical implications of these preliminary results, for which the longitudinal design of ABCD will be crucial.
SCOPUS:85176474037
ISSN: 2325-8292
CID: 5615942

A Descriptive Case Study of a Cognitive Behavioral Therapy Group Intervention Adaptation for Transgender Youth With Social Anxiety Disorder

Busa, Samantha; Wernick, Jeremy; Kellerman, John; Glaeser, Elizabeth; McGregor, Kyle; Wu, Julius; Janssen, Aron
PMCID:9236272
PMID: 35765467
ISSN: 0278-8403
CID: 5281132

Comparing Electronic Health Record Domains' Utility to Identify Transgender Patients

Dubin, Samuel; Cook, Tiffany; Liss, Alison; Doty, Glenn; Moore, Kevin; Greene, Richard; Radix, Asa; Janssen, Aron
PURPOSE/UNASSIGNED:Earlier literature has reported on the utility of diagnostic codes and demographic information for identifying transgender patients. We aim to assess which method identifies the most transgender patients utilizing readily available tools from within the electronic health record (EHR). METHODS/UNASSIGNED:(ICD-10) diagnostic codes and demographic data specific to transgender patients from January 2011 to April 2019. RESULTS/UNASSIGNED:Demographic data and ICD-10 codes yielded 1494 individual EHRs with transgender-specific data domains. ICD-10 diagnostic codes alone identified 942 (63.05%) unique EHRs. Demographics alone identified 218 (14.59%) unique EHRs. A total of 334 (22.36%) unique EHRs had both ICD-10 and demographic identifiers. Of those identified by transgender-specific demographic data (552), 294 (53.26%) were trans masculine, 215 (38.95%) were trans feminine, and 43 (7.79%) were nonbinary. Of the 552 demographic-identified transgender patients, 141 (25.86%) were identified by a two-part gender identity demographic question. CONCLUSIONS/UNASSIGNED:ICD-10 diagnostic codes, not demographic data, identified the most transgender patient records, but neither diagnostic codes alone nor demographic data captured the full population. Only 26.36% of the charts identified as transgender patients had both ICD-10 codes and demographic data. We recommend that when identifying transgender populations through EHR domains, a combination of diagnostic codes and demographic data be used. Furthermore, research is needed to optimize disclosure and collection of demographic information for gender minority populations.
PMCID:9829151
PMID: 36644028
ISSN: 2688-4887
CID: 5495082

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman, E; Radix, A E; Bouman, W P; Brown, G R; de Vries, A L C; Deutsch, M B; Ettner, R; Fraser, L; Goodman, M; Green, J; Hancock, A B; Johnson, T W; Karasic, D H; Knudson, G A; Leibowitz, S F; Meyer-Bahlburg, H F L; Monstrey, S J; Motmans, J; Nahata, L; Nieder, T O; Reisner, S L; Richards, C; Schechter, L S; Tangpricha, V; Tishelman, A C; Van Trotsenburg, M A A; Winter, S; Ducheny, K; Adams, N J; Adrián, T M; Allen, L R; Azul, D; Bagga, H; Başar, K; Bathory, D S; Belinky, J J; Berg, D R; Berli, J U; Bluebond-Langner, R O; Bouman, M-B; Bowers, M L; Brassard, P J; Byrne, J; Capitán, L; Cargill, C J; Carswell, J M; Chang, S C; Chelvakumar, G; Corneil, T; Dalke, K B; De Cuypere, G; de Vries, E; Den Heijer, M; Devor, A H; Dhejne, C; D'Marco, A; Edmiston, E K; Edwards-Leeper, L; Ehrbar, R; Ehrensaft, D; Eisfeld, J; Elaut, E; Erickson-Schroth, L; Feldman, J L; Fisher, A D; Garcia, M M; Gijs, L; Green, S E; Hall, B P; Hardy, T L D; Irwig, M S; Jacobs, L A; Janssen, A C; Johnson, K; Klink, D T; Kreukels, B P C; Kuper, L E; Kvach, E J; Malouf, M A; Massey, R; Mazur, T; McLachlan, C; Morrison, S D; Mosser, S W; Neira, P M; Nygren, U; Oates, J M; Obedin-Maliver, J; Pagkalos, G; Patton, J; Phanuphak, N; Rachlin, K; Reed, T; Rider, G N; Ristori, J; Robbins-Cherry, S; Roberts, S A; Rodriguez-Wallberg, K A; Rosenthal, S M; Sabir, K; Safer, J D; Scheim, A I; Seal, L J; Sehoole, T J; Spencer, K; St Amand, C; Steensma, T D; Strang, J F; Taylor, G B; Tilleman, K; T'Sjoen, G G; Vala, L N; Van Mello, N M; Veale, J F; Vencill, J A; Vincent, B; Wesp, L M; West, M A; Arcelus, J
PMCID:9553112
PMID: 36238954
ISSN: 2689-5277
CID: 5361212

A Clinical Program for Transgender and Gender-Diverse Neurodiverse/Autistic Adolescents Developed through Community-Based Participatory Design

Strang, John F; Knauss, Megan; van der Miesen, Anna; McGuire, Jenifer K; Kenworthy, Lauren; Caplan, Reid; Freeman, Andrew; Sadikova, Eleonora; Zaks, Zosia; Pervez, Noor; Balleur, Anouk; Rowlands, D W; Sibarium, Ely; Willing, Laura; McCool, Marissa A; Ehrbar, Randall D; Wyss, Shannon E; Wimms, Harriette; Tobing, Joshua; Thomas, John; Austen, Julie; Pine, Elyse; Griffin, April D; Janssen, Aron; Gomez-Lobo, Veronica; Brandt, Abigail; Morgan, Colleen; Meagher, Haley; Gohari, Dena; Kirby, Laura; Russell, Laura; Powers, Meredith D; Anthony, Laura G
Objective: A series of studies report elevated rates of autism and autistic characteristics among gender-diverse youth seeking gender services. Although youth with the co-occurrence present with complex care needs, existing studies have focused on co-occurrence rates. Further, clinical commentaries have emphasized provider-centered interpretations of clinical needs rather than key stakeholder-driven clinical approaches. This study aimed to employ community-based participatory research methodologies to develop a key stakeholder-driven clinical group program.Method: Autistic/neurodiverse gender-diverse (A/ND-GD) youth (N = 31), parents of A/ND-GD youth (N = 46), A/ND-GD self-advocates (N = 10), and expert clinical providers (N = 10) participated in a multi-stage community-based participatory procedure. Needs assessment data were collected repeatedly over time from A/ND-GD youth and their parents as the youth interacted with one another through ongoing clinical groups, the curriculum of which was developed progressively through the iterative needs assessments.Results: Separate adolescent and parent needs assessments revealed key priorities for youth (e.g., the importance of connecting with other A/ND-GD youth and the benefit of experiencing a range of gender-diverse role models to make gender exploration and/or gender affirmation more concrete) and parents (e.g., the need for A/ND-related supports for their children as well as provision of an A/ND-friendly environment that fosters exploration of a range of gender expressions/options). Integration and translation of youth and parent priorities resulted in 11 novel clinical techniques for this population.Conclusions: With generally high acceptability ratings for each component of the group program, this study presents a community-driven clinical model to support broad care needs and preferences of A/ND-GD adolescents.
PMID: 32375521
ISSN: 1537-4424
CID: 4437202

Using global positioning system methods to explore mobility patterns and exposure to high HIV prevalence neighbourhoods among transgender women in New York

Goedel, William C; Regan, Seann D; Chaix, Basile; Radix, Asa; Reisner, Sari L; Janssen, Aron C; Duncan, Dustin T
The aim of this study was to assess mobility patterns among a sample of transgender women (n=14) in New York City via survey and Global Positioning System (GPS) monitoring. We found varying levels of concordance between the residential neighbourhood and each of the non-residential contexts: 64.3% considered the neighbourhood that they socialised in most often to be different from their residential neighbourhood. While participants' residences represented 10 zone improvement plan code tabulation areas (ZCTAs), GPS data were recorded in 124 of 263 ZCTAs (47.1%). Overall, 58.2% (n=373,262) were recorded in ZCTAs in the highest quartile of human immunodeficiency virus (HIV) prevalence. The association between place, community HIV prevalence, mobility, and factors that increase the vulnerability of transgender women to HIV infection are worthy of future investigation in reducing the burden of the HIV epidemic in these communities.
PMID: 31724385
ISSN: 1970-7096
CID: 4185632

A Systematic Review of the Psychological Benefits of Gender-Affirming Surgery

Wernick, Jeremy A; Busa, Samantha; Matouk, Kareen; Nicholson, Joey; Janssen, Aron
For individuals with gender dysphoria, gender-affirming surgeries (GAS) are one means of reducing the significant distress associated with primary and secondary sex characteristics misaligned with their gender identity. This article uses a systematic review to examine the existing literature on the psychological benefits of GAS. Findings from this review indicate that GAS can lead to multiple, significant improvements in psychological functioning. Methodological differences in the literature demonstrate the need for additional research to draw more definitive conclusions about the psychological benefits of GAS.
PMID: 31582022
ISSN: 1558-318x
CID: 4116432

The Complexities of Treatment Planning for Transgender Youth with Co-Occurring Severe Mental Illness: A Literature Review and Case Study

Janssen, Aron; Busa, Samantha; Wernick, Jeremy
Gender variance and dysphoria are present across all classes, ethnicities, and experiences, including among those with severe and chronic mental illness. In these, our most vulnerable populations, adequate assessment and treatment of gender dysphoria often is overlooked despite evidence that appropriate treatment of gender dysphoria leads to improvement in psychological functioning (Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005). The World Professional Association for Transgender Health recommend in their Standards of Care that somatic and surgical treatments for gender dysphoria should be made available to those with medical or mental illness with the caveat that "[the illness] must be reasonably well-controlled (2011)." In this article, we will utilize case-based material to elucidate the challenges of treating gender dysphoria in the context of complex mental illness such as bipolar disorder, schizophrenia, and sexual trauma, and the pitfalls of defining "well-controlled" for the sake of treatment.
PMID: 30607715
ISSN: 1573-2800
CID: 3563492

Not by convention: Working with people on the sexual and gender continuum

Chapter by: Wernick, Jeremy; Liaw, K; Janssen, A; Busa, S
in: The Massachusetts General Hospital textbook on diversity and cultural sensitivity in mental health by Parekh, Ranna (Ed)
New York : Humana Press, 2019
pp. 229-252
ISBN:
CID: 4044492

The implications of trauma for sexual and reproductive health in adolescents

Chapter by: Weis, Rebecca; Janssen, Aron; Wernick, Jeremy
in: Beyond PTSD : helping and healing teens exposed to trauma by Gerson, Ruth; Heppell, Patrick (Eds)
Washington, DC : American Psychiatric Association Publishing, [2019]
pp. ?-?
ISBN: 1615371109
CID: 3305732