Bailey Sasha, Lin Ashleigh, Cook Angus, Winter Sam, Watson Vanessa, Toussaint Dani Wright, Barrett Emma L, Newton Nicola C, Perry Yael, Grummitt Lucinda, Strauss Penelope
Faculty of Medicine and Health, The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6 G05 Jane Foss Russell Building, Camperdown, NSW, 2050, Australia.
School of Population and Global Health, University of Western Australia, Perth, Australia.
Community Ment Health J. 2025 Jan;61(1):181-192. doi: 10.1007/s10597-024-01342-y. Epub 2024 Sep 2.
Though significant research highlights higher rates of mental ill-health and substance use among trans, non-binary and gender diverse (henceforth 'trans') young people, little research has considered patterns, contextual characteristics, and correlates of co-occurring experiences of mental ill-health and substance use among trans young people. Using data from the Trans Pathways study, we used prevalence ratios and age- and gender-adjusted logistic regression models to examine prevalence and differences of co-occurring substance use (past six-month cigarette use, alcohol use, and other drug use) and contextual characteristics of substance use (past six-month solitary alcohol and/or drug use, substance use for coping) by mental ill-health (depression disorder, anxiety disorder, past 12-month self-harm thoughts and behaviours, suicidal thoughts, planning, and attempt/s). Age- and gender-adjusted models assessed associations between co-occurring depressive and anxiety disorders and recent cigarette, alcohol, and other drug use (six co-occurring items total) and 18 interpersonal stressors. Significantly increased odds of smoking or recent use of cannabis or sedatives was observed among trans young people reporting depressive disorder, anxiety disorder (aORs ranging 1.8-3.1). Trans young people who reported recent smoking or use of cannabis, inhalants, or sedatives, had 40% to 80% reduced odds of past 12-month self-harm thoughts, self-harm behaviours, suicidal thoughts, and suicide attempt/s (aORs ranging 0.2-0.6). On the other hand, solitary alcohol and/or other drug use and substance use for coping was significantly associated with increased odds of all mental ill-health outcomes. Issues with school, secure housing, and intimate partner abuse were the most robust correlates of co-occurring mental ill-health and substance use. Trans young people using substances, especially cigarettes, cannabis, and sedatives, often so do with co-occurring experiences of depression and anxiety though limited substance use in more 'social' contexts may confer benefits for preventing self-harm and suicide thoughts and behaviours. Continued research in partnership with trans young people is warranted to conceptualise more nuanced and precise conceptual parameters of trans-affirming substance use harm reduction approaches.
尽管大量研究凸显了跨性别、非二元性别及性别多样化（以下简称“跨性别”）的年轻人中精神健康问题和物质使用问题更为高发，但很少有研究探讨跨性别年轻人中精神健康问题和物质使用问题同时出现的模式、背景特征及相关因素。利用“跨性别途径”研究的数据，我们采用患病率比以及年龄和性别调整后的逻辑回归模型，来检验同时出现的物质使用情况（过去六个月内吸烟、饮酒及使用其他药物）的患病率及差异，以及按精神健康问题（抑郁症、焦虑症、过去12个月内的自我伤害想法及行为、自杀想法、计划及企图）划分的物质使用背景特征（过去六个月内独自饮酒和/或使用药物、为应对而使用物质）。年龄和性别调整后的模型评估了同时出现的抑郁和焦虑症与近期吸烟、饮酒及使用其他药物（总共六个同时出现的项目）以及18种人际压力源之间的关联。在报告患有抑郁症、焦虑症的跨性别年轻人中，观察到吸烟或近期使用大麻或镇静剂的几率显著增加（调整后的比值比范围为1.8至3.1）。报告近期吸烟或使用大麻、吸入剂或镇静剂的跨性别年轻人，过去12个月内出现自我伤害想法、自我伤害行为、自杀想法及自杀企图的几率降低了40%至80%（调整后的比值比范围为0.2至0.6）。另一方面，独自饮酒和/或使用其他药物以及为应对而使用物质与所有精神健康问题结果几率的增加显著相关。学校问题、安全住房问题及亲密伴侣虐待是精神健康问题和物质使用问题同时出现的最有力相关因素。跨性别年轻人使用物质，尤其是香烟、大麻和镇静剂时，往往伴随着抑郁和焦虑的同时出现，不过在更多“社交”背景下有限地使用物质可能对预防自我伤害及自杀想法和行为有益。有必要继续与跨性别年轻人合作开展研究，以概念化更细致、精确的跨性别肯定性物质使用减少伤害方法的概念参数。
