1. Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Psychiatric Diagnoses and Comorbidities in Young Transgender Women Reisner SL, Biello KB, White Hughto JM, et al. Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: baseline findings from Project LifeSkills. JAMA Pediatr. Published online March 21, 2016. doi:10.1001/jamapediatrics.2016.0067.

2. Copyright restrictions may apply Background –Adolescent and young adult transgender women—individuals assigned a male sex at birth who identify as girls, women, female, transgender women, transfemale, male-to-female, or another diverse transfeminine gender identity—represent a vulnerable population at risk for negative mental health and substance use outcomes. –Diagnostic clinical interviews to assess prevalence of mental health, substance dependence, and comorbid psychiatric disorders in young transgender women remain scarce. Study Objective –To report the prevalence of mental health, substance dependence, and comorbid psychiatric disorders assessed via clinical diagnostic interview in a high-risk community-recruited sample of young transgender women. Introduction

3. Copyright restrictions may apply Study Design –Observational study reporting baseline finding from an ongoing randomized controlled human immunodeficiency virus (HIV) prevention intervention efficacy trial. Setting –Chicago, Illinois, and Boston, Massachusetts, between 2012 and 2015. Patients –298 sexually active, young transgender women aged 16 through 29 years (mean age, 23.4 years; 49.0% black, 12.4% Latina, 25.5% white, and 13.1% other minority race/ethnicity). Methods

4. Copyright restrictions may apply Methods Outcomes –Prevalence of mental health and substance dependence disorders assessed via the Mini-International Neuropsychiatric Interview (MINI) version 6: Major depressive episode (current and lifetime). Past 30-day suicidality risk (no/low risk vs moderate/high risk). Past 6-month generalized anxiety disorder. Past 6-month posttraumatic stress disorder. Past 12-month alcohol dependence. Past 12-month nonalcohol psychoactive substance use dependence. Limitations –Generalizability: Urban convenience sample that enrolled participants with sexual risk behavior in an HIV prevention efficacy trial; results are not generalizable to the US general population of transgender women. –Social desirability: Interviewers were also transgender women; social desirability bias may have underestimated the reported prevalence estimates.

5. Copyright restrictions may apply Results 41.5% had 1 or more mental health or substance dependence diagnoses. –21.4% had 1 diagnosis. –20.1% had 2 or more diagnoses. Prevalence of mental health conditions (adjusted for age and study site): –35.4% lifetime major depressive episode. –14.7% current major depressive episode. –20.2% past 30-day suicidality. –15.2% past 12-month nonalcohol psychoactive substance use dependence. –11.2% past 12-month alcohol dependence. –9.8% past 6-month posttraumatic stress disorder. –7.9% past 6-month generalized anxiety disorder.

6. Copyright restrictions may apply Results Number of diagnoses significantly increased with age (Table 1). Prevalence of depression and suicidality increased with age (Table 1). Diagnosis of lifetime and current major depressive episode significantly differed by race: –Lifetime: 48.6% Latina; 46.1% white; 42.1% other race/ethnicity; 24.5% black (χ 2 = 9.17; P =.03). –Current: 27.0% Latina; 17.9% other race/ethnicity; 15.8% white; 8.9% black (χ 2 = 7.9; P =.048). Differences in past-30 day suicidality by race approached significance (χ 2 =7.71; P =.05) (Table 2) –Highest prevalence was among white participants (30.3%). –Lowest prevalence was among black participants (13.5%).

7. Copyright restrictions may apply Results Table 1. Prevalence of Mental Health and Substance Dependence Diagnoses, Overall and by Age (N=298)

8. Copyright restrictions may apply Results Table 2. Distribution of Mental Health and Substance Dependence Diagnoses by Race and Ethnicity

9. Copyright restrictions may apply Comment In this community-recruited sample of young transgender women, the estimates of prevalence of psychiatric diagnoses were 1.7 to 3.6 times that of the US general population. Differences in mental health disorders were found by race, with Latina transgender women having the highest and black women the lowest prevalence of major depressive episode. Prevalence of depression and suicidality increased with age, and comorbidities were least prevalent in the youngest group and highest in the oldest group. These data suggest an important opportunity for early prevention efforts. Young transgender women experience unique stressors, both positive and negative, such as gender transition and gender affirmation, that may affect psychiatric health and well-being across adolescence and young adulthood.

10. Copyright restrictions may apply Comment Clinicians should familiarize themselves with current international guidelines for the provision of clinical care to transgender young people to best meet the medical and mental health needs of this at-risk population. Improving access to routine primary care, diagnostic screening, psychotherapy, and pharmacological treatments, and retention in care in clinical community-based, pediatric, and adolescent medicine settings are urgently needed to address mental health and substance dependence disorders in this population. Pediatric, adolescent, or young adult primary care providers may be a first resource for families needing education and support and play a critical role in supporting transgender youth, including screening for psychosocial problems and health risks, referring for gender-specific mental health and medical care, and providing advocacy and support. Further research will be critical, particularly longitudinal studies across development, to understand risk factors and identify optimal timing and targets for psychosocial interventions among this population.

11. Copyright restrictions may apply If you have questions, please contact the corresponding author: –Sari L. Reisner, ScD, Division of General Pediatrics, Boston Children’s Hospital/Harvard Medical School, 300 Longwood Ave, Mailstop BCH 3201, Office #223, Boston, MA 02115 (sari.reisner@childrens.harvard.edu). Funding/Support Research reported in this publication was supported by the National Institute of Mental Health (NIMH) of the National Institutes of Health under award R01MH094323 (Drs Garofalo and Mimiaga). Ms White Hughto is supported by awards T32MH020031 and P30MH062294 from NIMH. Conflict of Interest Disclosures None reported. Contact Information