38.7 Retrospective Study of Characteristics of Transgender and Gender-Nonconforming Adolescents Admitted to an Inpatient Psychiatric Unit Compared to Cis-Gender Adolescent Inpatients

Abstract

The number of transgender and gender-nonconforming (TGNC) youth presenting to outpatient medical services has increased. Alarmingly, TGNC youth are at greater risk for depression, suicide attempts, completed suicide, self-injurious behaviors, and substance abuse compared to cisgender adolescents. This research suggests that understanding factors that influence the development of TGNC adolescents is important. Few studies have targeted TGNC youth admitted to a psychiatric unit. This can be a critical experience in the youth's treatment trajectory. The purpose of this study is to examine characteristics, treatment histories, and trauma histories of adolescent inpatient TGNC psychiatric patients compared with cisgender inpatients. A retrospective chart review was done on all adolescent admissions to a university inpatient psychiatric unit in 2012 and 2017 (n = 432; mean age 15 years old). Data abstracted from the medical record included age, ethnicity, sex assigned at birth, gender identity, sexual preference, trauma history, bullying experiences, psychiatric diagnoses, psychiatric treatment, family psychiatric history, rural vs urban home environment, and religious preference. χ2 and Fischer’s exact tests were used to examine associations between these data points. For both years, 53.8% of nonbinary adolescents reported psychiatric comorbidity, 30.8% experiencing bullying, 30.8% history of suicide attempts, and 61.5% histories of self-harm behavior. There was a positive association between nonbinary and comorbidity (p = 0.019), being bullied (p = 0.006), suicide attempt (p = 0.009), self-harm (p = 0.000), aggression (p = 0.004), and legal issues (p = 0.011). The results were consistent between the 2 years and significantly greater than the cisgender inpatients. Many adolescents who identify as transgender or who are questioning their identity exhibit concerning mental health consequences. Understanding characteristics of adolescents who enter psychiatric inpatient facilities may help educate community-based providers to better understand the unique needs of this group. The inpatient unit experience could potentially impact these youth moving forward in their treatment, and it is important for the treatment team to be aware of their vulnerabilities.