Study: Transgender Children at Higher Risk for Mental Health Problems


Transgender children were more susceptible to depression, anxiety, and other mental health issues than their cisgender counterparts.

Transgender children show an increased susceptibility to mental health problems and suicidality compared to cisgender children, according to research published in JAMA Network Open.

Previous research suggests that transgender children experience concerning levels of depression, anxiety, and other mental health issues. However, much of the research focused on transgender youth include patients attending specialist gender clinics or patients recruited through convenience sampling.

Investigators sought to address the limitations of these studies by conducting research with representative community samples to allow for the generalization of findings. They conducted a cohort study comparing mental health outcomes between transgender and cisgender children 9 to 10 years of age who completed baseline assessment in the Adolescent Brain Cognitive Development study.

The Adolescent Brian Cognitive Development study recruited more than 11,000 children across the United States using multistage probability sampling with the aim of obtaining a representative sample of the US population. Data were collected from the parent-reported Child Behavior Checklist.

T scores for suicidality and 6 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-oriented subscales, including depressive, anxiety, somatic, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant, and conduct problems were used in the statistical analyses.

The analysis included 7169 children who understood and answered the question “Are you transgender?” Of these, 58 participants were transgender and 7111 were cisgender. The mean (SD) age of participants was 10.03 (0.62) years.

Transgender children represented 0.8% (weighted) of respondents. For all 6 subscales, transgender children recorded higher mean T scores, though these were all in the reference range and the standardized mean difference in each case was small.

Researchers also determined the proportion of cisgender and transgender children who scored in the borderline or clinical range (T 65) for each subscale. The odds ratio of transgender children being in this range was increased for all 6 subscales (range, 1.57 [95% CI, 0.50-4.91] to 3.13 [95% CI, 1.46-6.71]) and for suicidality (odds ratio, 5.79 [95% CI, 2.08-16.16]). However, the results for ADHD and oppositional defiant problems were not found to be statistically significant.

These findings suggest that, by 9 to 10 years of age, transgender children show increased susceptibility to mental health problems compared with cisgender peers, which has important public health implications.

“Whether this is due to stigma, minority stress, discrimination, or gender dysphoria is unclear, but providing appropriate mental health supports to this vulnerable group is paramount,” the authors wrote.

This cohort study observed higher rates of depression and anxiety than what was reported by previous research using clinical samples of transgender children aged 5 to 11 years, according to the authors.

They note that a possible reason for this disparity, other than methodological differences in assessing mental health, is that transgender children attending specialist gender clinics are likely to have support from their families. Support from family members is a key protective factor for the mental health of transgender young people, and many transgender children in the general population lack parental support for their gender.

In contrast, the authors noted that previous studies using clinical and convenience samples of transgender adolescents had higher rates of depression and anxiety compared with this sample. However, this is consistent with earlier clinic-based observations that transgender children have lower rates of anxiety and depression compared with transgender adolescents. This may be explained by observations from the general population that depression and anxiety more frequently develop during adolescents, according to the authors.

Though the study had a limitation due to the small number of transgender participants, the authors highlight the fact that this study is the first to their knowledge to report rates of DSM-5-related problems using a representative population sample of transgender children.


Russell D H, Hoq M, Coghill D. Prevalence of mental health problems in transgender children aged 9 to 10 years in the US, 2018. JAMA Netw Open. 2022;5(7):e2223389. Published July 22, 2022. Accessed July 22, 2022.

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