Transgender youth face significant health concerns

Transgender and nonbinary children and youth often face significant challenges compared to their cisgender peers. Many experience peer victimization, and trans teens also face verbal harassment in many Canadian schools. These adverse experiences also extend into the home, where trans and nonbinary youth may face emotional neglect or abuse by a parent or other adult.

These experiences cause significant harm, and they also place trans and nonbinary youth at risk for secondary mental health disorders such as depression and anxiety.

Knowing how many transgender and nonbinary youth are dealing with these disorders is critical to inform prevention and treatment efforts. A recent report by the Children’s Health Policy Centre, funded by the BC Ministry of Health, investigated the prevalence of mental health concerns for trans and nonbinary young people.

The report identified:

  • The overall prevalence of mental disorders in transgender and nonbinary youth, which is 56.6% This makes it between 5.9 and 13 times higher than their cisgender counterparts.
  • Significant rates of self harm or suicidal ideation among transgender and nonbinary youth, with prevalence up to five times higher than in their cisgender peers.
  • A need for easily accessible and effective mental health treatments for these children and youth.
  • The importance of addressing the unacceptable and preventable adverse experiences that many transgender and nonbinary young people face and that can contribute to the development of mental health conditions.

These findings can inform efforts to improve mental health service planning, delivery and equity for transgender and nonbinary children and youth in British Columbia.

To learn more, read the report and review the findings.

Mental Health of Transgender and Nonbinary Children and Youth: Informing Service Needs

Schwartz C, Barican J, White O, Tang J, Catherine N, Thomson K, & Waddell C. (2024). Mental Health of Transgender and Nonbinary Children and Youth: Informing Service Needs. Vancouver, BC: Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University.

Executive Summary

Many transgender and nonbinary children and youth face added challenges compared with their cisgender counterparts, including more frequent adverse experiences, peer victimization and harassment. These avoidable hardships cause harm in and of themselves and also raise risks for secondary mental health problems. Knowing the prevalence of mental health concerns for transgender and nonbinary young people is therefore crucial as the numbers of those in need can and should inform service planning to ensure both adequate mental healthcare and greater equity. 

To provide the most accurate estimate, we conducted a systematic review of studies on the prevalence of mental disorders in transgender and nonbinary young people. The two studies that met inclusion criteria, were both conducted in the United States (US). The first study assessed overall prevalence, finding that 56.6% of transgender young people had experienced at least one mental disorder in the previous six months — a proportion between 5.9 and 13.0 times higher than cisgender counterparts. As well, for individual disorders as well as disorder groups, prevalence was higher for transgender children and youth compared with cisgender counterparts. The second study focused exclusively on eating disorders, finding that 4.2% of transgender youth had this diagnosis — a proportion approximately 200% higher than expected according to studies in general populations of young people.

We also identified two studies that assessed suicidal ideation and self-harm including one of the previously cited American studies. This US study found that 3.2% of transgender youth experienced a self-inflicted injury in the previous six months according to health records — a rate at least 17 times higher than cisgender counterparts. As well, health records noted suicidal ideation for 6.3% of transgender youth — a rate approximately 24 times higher than cisgender counterparts. A Canadian study found even higher rates according to an anonymous survey. Researchers found that nearly 80% of transgender and nonbinary youth reported engaging in self-harm in the past year, approximately five times the rate for cisgender peers. As well, 65.2% of transgender and nonbinary youth reported suicidal ideation in the past year, five times the rate for cisgendered peers.

The high prevalence of mental health concerns for transgender and nonbinary young people underscores the need for easily accessible and effective mental health treatments with these populations. It is also imperative that public mental health services be provided with intensity that is proportionate to the needs, and be delivered by practitioners within settings and systems that are sensitive to the experiences of these young people. This approach aligns with the World Health Organization’s recognition of mental health as a basic human right. It is equally crucial to address the unacceptable and preventable adverse experiences that many transgender and nonbinary young people face and that can contribute to the development of mental health conditions.  Ensuring mental wellbeing for these young people also requires adequate monitoring of service use in relation to the needs, as well as monitoring of social determinants including preventable adversities. Such monitoring plays a vital role because “what gets counted counts.” In other words, comprehensive collective efforts encompassing mental healthcare, prevention and monitoring are needed to bring about mental health equity for transgender and nonbinary young people in BC.

Read the full report here

CHPC plays a role in Science Meets Parliament

In the historic halls of the BC provincial legislature, Kimberly Thomson discovered how much government runs on relationships.

The Assistant Professor in the Faculty of Health Sciences at Simon Fraser University and member of the Children’s Health Policy Centre was attending a two-day session at the legislature as part of a Science Meets Parliament event in April.

With the goal of improving conversation between policymakers and scientists, the Science Meets Parliament organizers had arranged for Thomson and the other delegates, including several members of SFU’s Faculty of Health Sciences, to meet with MLAs and government staff.

As part of the experience, all delegates met with Raj Chouhan, the Speaker of the Legislative Assembly, and with Lieutenant Governor Janet Austin. Thomson also met with BC Green Party representatives, including Party Leader Sonia Furstenau, and with NDP MLA Dan Coulter, the Minister of State for Infrastructure and Transit. Despite working in different fields, Thomson and the MLAs she met with discovered several points of connection, including shared interests in child rights, diversity and inclusion, and youth justice. These conversations helped Thomson better understand how policymakers set their agendas.

“It was really beneficial to spend the day immersed in their world and understand what their priorities are, the considerations that they are juggling when making different policies,” Thomson said.

“Research is important for policy making, but it’s only one part. Your researcher brain says that if you just construct the best possible evidence and present it to them, they’ll make the decision based on that. But that’s not entirely how it works. At the end of the day, policymakers want to make the best decisions for people living in BC and there are a number of factors to consider.”

For Thomson, this experience also highlighted the importance of the work the Children’s Health Policy Centre does to share its research with policymakers.

“Building connections with policymakers allows you to be part of their process so they might call on you for advice,” she said. “This experience made me respect and appreciate the time and effort that goes into building these relationships and how special it is that the Centre has these relationships.”

Thomson spent the rest of the program attending Question Period, listening to panel discussions with legislators, and networking with the 30 other Science Meets Parliament delegates from universities across BC. She left the legislature with several new connections and a stronger sense of how she could support policy decisions through her work.

“I would absolutely recommend it [Science Meets Parliament] to other researchers,” Thomson said. “This was an invaluable experience to better understand the roles and responsibilities of policy makers, their priorities, and how science can best support decision-making.”

Science Meets Parliament is hosted by the Canadian Science Policy Centre, a non-profit organization dedicated to building a strong and inclusive science policy community in Canada. Since 2018, the annual event has brought emerging science leaders to Parliament Hill in an effort to strengthen the connection between Canada’s scientific and political communities. The Science Meets Parliament BC program was the event’s first expansion into a provincial legislature.

Showcasing Indigenous-led-research

Centre Director Charlotte Waddell gave a virtual talk about a Nuu-chah-nulth-led study on healthy child development to the child health advisory board at the Canadian Institutes of Health Research on April 10.

The talk was titled, “Everything is One, Everything is Connected.”

Waddell presented together with SFU scholar Pablo Nepomnaschy, on behalf of Lynnette Lucas and the Nuu-chah-nulth Tribal Council team, the study leads.

The presentation described a multi-generational study being conducted by and within the 14 Nuu-chah-nulth Nations, whose ancestral lands are located on the west coast of Vancouver Island.

“As non-Indigenous research allies,” Waddell said, “team members from SFU are helping to merge the best of Indigenous and ‘Western’ science while upholding high ethical standards including ensuring Indigenous data sovereignty.”

“This study will be ‘the Framingham’ of Indigenous Peoples,” Waddell added, quoting Indigenous scholar Jeff Reading, who is co-leading the Nuu-chah-nulth project. Framingham refers to a famous long-term cardiovascular health study that began in 1948 and is now on its third generation of participants, helping to improve population wellbeing.

Funding and community consultations for the Nuu-chah-nulth project began in 2017 and continued in 2022 with a grant of $15 million over six years from the Canadian Institutes of Health Research, in partnership with Alberta First Nations.

“Everything we do,” Waddell said, “involves constant reciprocity and respect for Indigenous Knowledge and wishes.

“We are working to overcome some of the harmful legacies of colonialism by supporting Indigenous leadership of research that is by and about them, as one step towards truth and reconciliation.”

Preventing and Treating Childhood Eating Disorders

  • How can we prevent and treat childhood eating disorders? This presentation from February 2024 looks at the prevalence of eating disorders in young people and identifies what puts youth at risk. It also discusses effective interventions for the prevention and treatment of these disorders.

Why we need to do a better job of serving children who are neurodiverse

Centre Director Charlotte Waddell gave a Zoom talk to close to 300 parents, practitioners and policy makers on Dec. 2. The talk was titled, “Neurodiversity and mental health: Serving children better.”

The presentation covered the following themes:

  • The need to create communities where all children are welcomed and celebrated, and where services are delivered according to needs so that all children can flourish and meet their potential.
  • The prevalence of anxiety, ADHD, behaviour disorders and depression, which are higher for children experiencing three particular forms of neurodiversity (autism spectrum disorder, fetal alcohol syndrome disorder and intellectual disability).
  • The research evidence for effective treatments for these four conditions for children with the three forms of neurodiversity.
  • The effective treatments for other common childhood mental disorders that can also be offered, with adaptations when needed

“We need to ensure that timely and effective treatments are offered to all children, particularly if they are neurodiverse, given higher prevalence rates,” Waddell told the group.

The talk ended with celebrating people who are neurodiverse, and the communities that support them over the lifespan.

Waddell then stayed on the Zoom call to respond to questions and comments. She also joined a small breakout group discussion to learn more about parent’s perspectives.

A recording of the talk can be seen here.

 

Nurse-Family Partnership findings featured in podcast

Findings from the Children’s Health Policy Centre’s scientific evaluation of the Nurse-Family Partnership program are the subject of a recent podcast recorded with SFU assistant professor Nicole Catherine, co-principal investigator for the randomized-controlled trial.

The podcast was recorded by the Association for Child and Adolescent Mental Health (ACAMH), the organization for the journal that published the main child findings in July 2023.

“I relished the chance to be able to speak about these important findings,” Catherine said. “I’m committed to ensuring that the voices of these young families, as told through their research data, are heard and amplified,” she added.

The podcast recording can be found here.

Two new studies on Covid-19 published by CHPC scholar

A new study on the Covid-19 pandemic by SFU Assistant Professor and CHPC team member Kim Thomson, has just been published in Plos One.

The study found that parents with children at home reported nearly double pre-pandemic population estimates of moderate to severe psychological distress.

Psychological distress was more frequently reported among parents with pre-existing mental health conditions, disabilities and financial stressors. As well, parents with greater psychological distress reported an increase in negative interactions with their children as a result of the pandemic, and perceived higher anxiety in their children.

“These results highlight that meaningful responses to promote mental health among parents and families must address social and structural inequalities,” the report concluded.

In the same timeframe, Thomson was also co-author of another paper on the Covid-19 pandemic, this one published in the Journal of Adolescence. It profiled the social connectedness among early adolescents in Grade 7 before the pandemic was declared (Winter 2020) and in Grade 8 during the second wave of the pandemic (Winter 2021).

The paper concluded that connectedness with peers and adults in Grade 7 was significantly related to higher levels of mental wellbeing in Grade 8 even during the Covid-19 pandemic, highlighting the protective role of social connection.

 

 

 

NFP put on the agenda for Interior Health nurses

Charlotte Waddell, Centre Director, joined BC Ministry of Health lead partners for the Sept. 26 Annual Education Meeting held online for approximately 10 public health nurses with BC’s Interior Health Authority.

The focus was Nurse-Family Partnership (NFP) and a review of the main findings from the 10-year randomized controlled trial that the Centre has led. This trial has evaluated NFP in Canada for the first time. Nicole Catherine and Harriet MacMillan are co-leads with Waddell.

The study has shown that NFP reduces prenatal substance exposure and improves child language and mental health by age two years. All three outcomes are crucial for early healthy development.

Waddell also spoke about the high number of Indigenous participants and about ongoing work with Indigenous collaborators to tell the stories of these participants. As well, she noted long-term follow-up plans: “In the US and England, NFP led to enduring benefits in middle school and beyond, so we are also committed to learning how well NFP works to help children longer-term in BC.”

Child and youth mental health practitioners and policymakers urged to address service gaps

Charlotte Waddell, Centre Director, gave a Sept. 14 talk with the Doctors of BC, Community of Practice on Child and Youth Mental Health. The talk was titled, “Children’s mental health: Research for informing practice and policy.”

Waddell covered crucial messages including the high prevalence of childhood mental disorders and the severe service shortages — with fewer than half of children with these disorders getting any kind of help.

For this talk, which took place in Vancouver with an audience of approximately 100 family physicians, child and youth psychiatrists and policymakers, among others, she urged strong advocacy — to not only address the service gaps, but also ensure that BC invests in effective prevention programs to reduce needs in the population. Waddell noted: “Your advocacy can and will be very powerful in making a difference for children.”