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Comparison of inpatient psychiatric medication management in gender diverse youth with cisgender peers
Carrillo, Nina McGurran, Maren Melton, Brittany L. Moeller, Karen E.
Carrillo, Nina
McGurran, Maren
Melton, Brittany L.
Moeller, Karen E.
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Abstract
Gender diverse (GD) youth, defined as transgender (TG) and nonconforming (NC) adolescents, have a 2- to 3-fold increased risk of having a mental health diagnosis, particularly a depressive or anxiety disorder, compared with cisgender (CG) peers.1,2 Additionally, psychologic distress is commonly reported in GD youths due to harassment, victimization, and bullying by peers.3,4 Approximately 30% to 50% of GD patients report serious psychologic distress leading to attempted suicide, with the highest risk in transmasculine patients.5-7 Mental health evaluations should be routine care for all adolescents.8 However, GD individuals often report stigma and discrimination in health care services secondary to lack of insurance coverage for gender-affirming care, and negative experiences with health care providers.3,9-11
Studies evaluating the treatment of psychiatric disorders in GD youth are limited. Hisle-Gorman et al12 conducted a large retrospective study assessing psychotropic prescribing in GD youth. Researchers identified 3754 military-dependent GD youth (ages <18 years) and matched them to CG siblings (N = 6603) to assess differences in mental health diagnoses, mental health visits, and outpatient psychotropic prescriptions. They found GD youth were approximately 5 times more likely to have a mental health diagnosis and at least 2 times more likely to use mental health services and be prescribed psychotropics.
Literature suggests that gender-affirming care, addressing psychologic, surgical, and hormonal therapies, is medically necessary to alleviate gender dysphoria and reduce psychiatric comorbidities.13-16 In the study by Hisle-Gorman et al,12 researchers additionally assessed the effects of gender-affirming hormone therapy (GAHT) on mental health outcomes in the TG subgroup.12 Among the 963 TG youth receiving GAHT, mental health care use did not significantly change after initiation of GAHT; however, psychotropic medication use increased in all categories except stimulants, migraine agents, and lithium.12
Psychotropic medications are not benign agents and can have short- and long-term effects in children and adolescents. Antidepressants have been associated with reduced growth velocity, reduced bone mineral density, and a potential risk for diabetes mellitus secondary to weight gain in pediatric patients.17 All antidepressants carry a black box warning for increased suicidality in adolescent patients.18 Additionally, antipsychotics have increased risks for metabolic syndromes, specifically hyperlipidemia, diabetes mellitus, and cardiovascular disease.19-22 Our study aims to compare psychotropic prescribing in GD youth to their CG peers with the same primary psychiatric diagnosis during an inpatient psychiatric hospitalization.
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2023-08-07
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AAPP
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Carrillo N, McGurran M, Melton BL, Moeller KE. Comparison of inpatient psychiatric medication management in gender diverse youth with cisgender peers. Ment Health Clin. 2023 Aug 7;13(4):169-175. doi: 10.9740/mhc.2023.08.169. PMID: 37860590; PMCID: PMC10583259