Transgender kids: At greater risk of poor mental health?

Despite earlier studies that reveal increased depression an anxiety in transgender children and adolescents, new research published in Pediatrics reveals that children who were supported in their choice of gender identity were no more likely to suffer negative psychosocial effects than other children.

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The study-aligned with the TransYouth Project-followed 73 transgender children aged 3 to 12 years alongside non-transgender children in the same age group. Based on observations and parental reports, researchers found that transgender children raised in an environment that supported their early choices to deviate from their natal sex were no more depressed than other children, and only slightly more anxious.

More than ever in the past, being transgender is becoming more socially acceptable, and some children who have socially transitioned early in their childhood are being raised and presented to others based of their gender identity rather than their natal sex, according to the report.

Despite increased social acceptance of transgender individuals, the research team acknowledges that there is still heated debate on the topic and a lack of research on the mental health implications of social transitioning in transgender children. As a result, physicians have little data to support recommendations to parents of children who question their gender identity.

In adult and adolescent studies of transgender individuals, there have been reports of higher rates of depression, anxiety, and suicide. These findings, however, are likely the result of years of prejudice, discrimination, and social rejection, according to the new report.

“There is now growing evidence that social support is linked to better mental health outcomes among transgender adolescents and adults,” according to the study. “These findings suggest the possibility that social transitions in children, a form of affirmation and support by a prepubescent child’s parents, could be associated with good mental health outcomes in transgender children.”

In previous studies following children who were not supported in their gender identity, researchers found high rates of internalizing disorders such as anxiety and depression. However, the researchers point to 2 newer studies involving children whose gender identifies were affirmed and supported who showed relatively good mental health without the psychopathologies found in the children whose gender identities were unsupported in earlier studies.

NEXT: What were some potential limitations to the study?

“Although no formal quantitative measures were provided, these findings again suggest that socially supported transgender children might have better mental health than children with gender dysphoria or transgender children who are not supported in their identities,” the researchers note. “The current study addresses a critical gap in knowledge by examining parental reports of anxiety and depression among a relatively large cohort of transgender children, all of whom are supported by their families and have socially transitioned (ie, they present to others as the gender consistent with their identity, not their natal sex and use associated gender pronouns consistent with that identity).”

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The study revealed that transgender children whose choices were supported by those close to them were average in term of prevalence of depression, although rates of anxiety were slightly higher but not yet in clinical ranges.

“These findings suggest that familial support in general, or specifically via the decision to allow their children to socially transition, may be associated with better mental health outcomes among transgender children. In particular, allowing children to present in everyday life as their gender identity rather than their natal sex is associated with developmentally normative levels of depression and anxiety.”

The research team cautions that despite its findings, social transitioning is not necessarily advisable for every child whose behavior deviates from his or her natal sex. The children in this study transitioned in a time when it is still controversial, and may have had qualities within their own families that made this transition easier. Additionally, the children involved in this study transitioned earlier than is typical, meaning that they may have been more insistent in their identities and represent an extreme in the spectrum of gender identities.

“There could be some unique third variable that explains the observed occurrence of typical mental health among socially transitioned transgender children. For example, perhaps some attribute unique to the subset of transgender children who are able to convince their parents to allow them to transition (eg, verbal skill, self-confidence) is responsible for these children having particularly good mental health, and it was this unique cognitive ability or aspect of personality that is either correlated with better mental health or leads to better mental health when a child feels he or she achieved his or her goal,” according to the report.

NEXT: What about when the child enters adolescence?

Additionally, the report notes that while social acceptance of transgender individuals is increasing, there are still social distinctions that highlight the differences of transgender children that could increase anxiety. The study results may also change as the children in this cohort age, the authors note.

“Some children in our sample are approaching puberty, and most are aware that puberty will cause physical changes in an unwanted direction (unless puberty blockers are administered), which could generate considerable worry and anxiety,” the study authors note. “Importantly, although these socially transitioned prepubescent children are doing quite well in terms of their mental health at this point, parents and clinicians of such children should still be on the lookout for potential changes in the status of their children’s mental health. In general, the prevalence of depression is relatively low in prepubescent children and rises dramatically during adolescence. It is possible that transgender children will exhibit greater anxiety and depression than their peers during the adolescent transition because of the sources of distress mentioned earlier, which will likely become worse with time.”

Next: Caring for gender atypical children and adolescents

Researchers plan to address with issue in follow-up study with this same cohort.

As far as guidance for pediatricians presented with patients and parents who find themselves addressing questions of gender identity, Kristina Olson, PhD, an associate professor of psychology at the University of Washington in Seattle who leads the TransYouth Project, says more research is needed before clinical recommendations can be made.

“We don’t know yet for whom these social transitions are helpful and whether the transitions themselves, or other features of the families who transition their kids, are leading to their strong mental health outcomes,” Olson says.

Families interested in participating in Olson’s research project can apply online through the TransYouth Project’s website.