3 Self-care and coping behaviours among trans and gender-diverse adolescents in clinical care: A mixed methods study

Abstract

Abstract Background Referrals for transgender and gender-diverse (TGGD) youth to Canadian clinics providing gender-affirming medical care (GAMC) have grown rapidly over time. GAMC includes hormone suppression and/or hormone therapy as safe and effective strategies to modify secondary sexual characteristics and improve psychiatric outcomes in electing TGGD individuals. There are limited data on the types of coping and self-care behaviours TGGD youth in clinical care use to reduce distress and increase wellness. Objectives This research describes the coping and self-care behaviours of TGGD youth in clinical care across Canada and identifies potential self-care and coping behavioural profiles. Design/Methods This mixed methods study uses data from two companion studies. Trans Youth CAN! (TYC!) is a prospective cohort study of pubertal/post-pubertal youth <16 years naïve to gender-affirming hormone therapy (N=174) referred to one of ten clinics across Canada for hormone suppression and/or hormone therapy recruited from 2017-2019. Stories of Gender-Affirming Care administered semi-structured interviews to youth-parent dyads for youth 9 to 17 years (N=36) at three clinics participating in TYC! from November 2017 to August 2018. Quantitative measures included mental health, self-care, and coping behaviours. Qualitative interview guide asked about youths’ adversities and their self-care and coping behaviours. A latent class analysis (LCA) was used to identify latent classes of survey weight-adjusted TGGD youth engaging in self-care and coping behaviours (N=174). Chi-square tests assessed for differences across demographic variables (α=0.05). Qualitative data was previously coded using adapted Grounded Theory methodology and analyzed using integrated Thematic Analysis to expand upon quantitative findings. Results Our analysis suggests the emergence of five classes: Avoidant, self-harming, alcohol use, and legal document changes (Class 1: 21%); Non-avoidant diverse coping and self-harm behaviours (Class 2: 30%); Avoidant, self-harming, and nicotine/substance use behaviours (Class 3: 9%); Atypical and gender-focused coping behaviours (Class 4: 11%); and Gendered-space avoidant and self-harm behaviours (Class 5: 29%). Chi-square tests revealed no significant differences in age (p=0.2510), gender identity (p=0.5646), and income (p=0.9906) between latent classes. There were significant differences between class 2 and each of the other 4 classes for sex assigned at birth (p<0.0001). Pairwise comparisons also revealed a significant difference in immigration background between classes 2 and 5 (p=0.0030). Qualitative data expanded on quantitative findings. Conclusion This study identifies behavioural profiles of TGGD youth in clinical care and demographic variables across which coping and self-care behaviours might vary. This research can inform tailored interventions and supports at the personal/interpersonal, environmental, and structural levels to promote healthy coping strategies.