transgender 青年在接受肯定治疗前后的精神保健利用情况。
Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment.
机构信息
Department of Pediatrics, Uniformed Services University, Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA.
Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.
出版信息
J Sex Med. 2021 Aug;18(8):1444-1454. doi: 10.1016/j.jsxm.2021.05.014. Epub 2021 Jul 8.
OBJECTIVE
Transgender and gender-diverse (TGD) adolescents experience increased mental health risk compared to cisgender peers. Limited research suggests improved outcomes following gender-affirmation. This study examined mental healthcare and psychotropic medication utilization among TGD youth compared to their siblings without gender-related diagnoses and explored utilization patterns following gender-affirming care.
METHOD
This retrospective cohort study used military healthcare data from 2010-2018 to identify mental healthcare diagnoses and visits, and psychotropic medication prescriptions among TGD youth who received care for gender dysphoria before age 18, and their siblings. Logistic and Poisson regression analyses compared mental health diagnosis, visits, and psychotropic prescriptions of TGD youth to their siblings, and compared healthcare utilization pre- and post-initiation of gender-affirming pharmaceuticals among TGD adolescents.
RESULTS
3,754 TGD adolescents and 6,603 cisgender siblings were included. TGD adolescents were more likely to have a mental health diagnosis (OR 5.45, 95% CI [4.77-6.24]), use more mental healthcare services (IRR 2.22; 95% CI [2.00-2.46]), and be prescribed more psychotropic medications (IRR = 2.57; 95% CI [2.36-2.80]) compared to siblings. The most pronounced increases in mental healthcare were for adjustment, anxiety, mood, personality, psychotic disorders, and suicidal ideation/attempted suicide. The most pronounced increased in psychotropic medication were in SNRIs, sleep medications, anti-psychotics and lithium. Among 963 TGD youth (M: 18.2) using gender-affirming pharmaceuticals, mental healthcare did not significantly change (IRR = 1.09, 95% CI [0.95-1.25]) and psychotropic medications increased (IRR = 1.67, 95% CI [1.46-1.91]) following gender-affirming pharmaceutical initiation; older age was associated with decreased care and prescriptions.
CONCLUSION
Results support clinical mental health screening recommendations for TGD youth. Further research is needed to elucidate the longer-term impact of medical affirmation on mental health, including family and social factors associated with the persistence and discontinuation of mental healthcare needs among TGD youth. Hisle-Gorman E, Schvey NA, Adirim TA, et al. Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment. J Sex Med 2021;18:1444-1454.
目的
与顺性别同龄人相比，跨性别和性别多样化（TGD）青少年的心理健康风险增加。有限的研究表明，性别肯定后会有更好的结果。本研究调查了 TGD 青少年与没有性别相关诊断的兄弟姐妹相比，在接受性别认同治疗前的心理健康护理和精神药物使用情况，并探讨了性别认同治疗后的使用模式。
方法
本回顾性队列研究使用 2010 年至 2018 年的军事医疗保健数据，确定了接受性别认同治疗前年龄在 18 岁以下的 TGD 青年及其兄弟姐妹的心理健康诊断、就诊和精神药物处方。逻辑回归和泊松回归分析比较了 TGD 青少年与兄弟姐妹的心理健康诊断、就诊和精神药物处方，并比较了 TGD 青少年在开始性别肯定药物治疗前后的医疗保健使用情况。
结果
纳入 3754 名 TGD 青少年和 6603 名顺性别兄弟姐妹。TGD 青少年更有可能被诊断出心理健康问题（OR 5.45，95%CI[4.77-6.24]），使用更多的心理健康护理服务（IRR 2.22；95%CI[2.00-2.46]），并且开的精神药物处方更多（IRR=2.57；95%CI[2.36-2.80]）与兄弟姐妹相比。心理健康护理最明显增加的是调整、焦虑、情绪、人格、精神病和自杀意念/自杀企图。精神药物最明显增加的是 SNRIs、睡眠药物、抗精神病药和锂。在 963 名（M：18.2）使用性别肯定药物的 TGD 青少年中，心理健康护理没有显著变化（IRR=1.09，95%CI[0.95-1.25]），而精神药物的使用增加（IRR=1.67，95%CI[1.46-1.91]），这是在开始性别肯定药物治疗后；年龄较大与护理和处方减少有关。
结论
研究结果支持对 TGD 青少年进行临床心理健康筛查的建议。需要进一步研究阐明医疗确认对心理健康的长期影响，包括与 TGD 青少年的心理健康护理需求持续和停止相关的家庭和社会因素。
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