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Risk factors for psychological functioning in German adolescents with gender dysphoria: poor peer relations and general family functioning

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Abstract

Adolescents with gender dysphoria (GD) often face various associated social, emotional, and behavioral difficulties. In such a marginalized group, it is crucial to identify factors that may impact psychological functioning to better accommodate their needs. Therefore, the present study investigated the impact of two specific risk factors, poor peer relations and general family functioning, on the development of psychological problems in adolescents with GD, and their possible interaction effect. The Youth Self-Report, a Peer Relations Scale, and a General Family Functioning scale were assessed in a sample ofn = 180 clinically referred adolescents (mean age 15.5; 146 transgender boys with a female birth-assigned sex, and 34 transgender girls with a male birth-assigned sex) with a complete GD diagnosis (fulfillment of the DSM 5 criteria A and B) at their initial admission to the Hamburg Gender Identity Service. Multiple linear regression analysis was conducted to examine the relationship between peer relations, family functioning, and psychological functioning outcomes. Adolescents with GD presented significantly higher Internalizing and Total Problem scores compared to the German reference norm. Externalizing problems were above the norm for transgender boys, but within the normal range for transgender girls. Multiple regression analysis revealed that, overall, adolescents with an advanced age, a female birth-assigned sex, poorer peer relations, and poorer family functioning showed more behavioral and emotional problems. Consequently, incorporating both the family and social environment in transgender care is of high importance to adequately tend to the needs of adolescents with GD.

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Notes

  1. Male birth-assigned sex, identifying as female.

  2. Female birth-assigned sex, identifying as male.

References

  1. Klasen F, Otto C, Kriston L et al (2015) Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 24:695–703.https://doi.org/10.1007/s00787-014-0637-5

    Article PubMed  Google Scholar 

  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub

  3. Becker I, Gjergji-Lama V, Romer G, Möller B (2014) Merkmale von Kindern und Jugendlichen mit Geschlechtsdysphorie in der Hamburger Spezialsprechstunde. [Characteristics of Children and Adolescents with Gender Dysphoria Referred to the Hamburg Gender Identity Clinic.] Prax Kinderpsychol Kinderpsychiatr 63:486–509.https://doi.org/10.13109/prkk.2014.63.6.486

  4. de Graaf NM, Cohen-Kettenis PT, Carmichael P, et al (2017) Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: a clinical comparison study between four clinics. Eur Child Adolesc Psychiatry.https://doi.org/10.1007/s00787-017-1098-4

  5. de Vries ALC, de Steensma TD, de Cohen-Kettenis PT et al (2016) Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis. Eur Child Adolesc Psychiatry 25:579–588.https://doi.org/10.1007/s00787-015-0764-7

    Article PubMed  Google Scholar 

  6. Shiffman M, VanderLaan DP, Wood H et al (2016) Behavioral and emotional problems as a function of peer relationships in adolescents with gender dysphoria: A comparison with clinical and nonclinical controls. Psychol Sex Orientat Gend Divers 3:27–36.https://doi.org/10.1037/sgd0000152

    Article  Google Scholar 

  7. Simons L, Schrager SM, Clark LF et al (2013) Parental support and mental health among transgender adolescents. J Adolesc Health Off Publ Soc Adolesc Med.https://doi.org/10.1016/j.jadohealth.2013.07.019

    Article  Google Scholar 

  8. Olson KR, Durwood L, DeMeules M, McLaughlin KA (2016) Mental health of transgender children who are supported in their identities. PEDIATRICS 137:e20153223–e20153223.https://doi.org/10.1542/peds.2015-3223

    Article PubMed PubMed Central  Google Scholar 

  9. Birkett, McConnell, Mustanski (2016) Families matter: social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. J Adolesc Health 59:674–680.https://doi.org/10.1016/j.jadohealth.2016.07.026

    Article PubMed PubMed Central  Google Scholar 

  10. Arcelus J, Bouman WP, Van Den Noortgate W et al (2015) Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry J Assoc Eur Psychiatr 30:807–815.https://doi.org/10.1016/j.eurpsy.2015.04.005

    Article CAS  Google Scholar 

  11. Zucker KJ, Bradley SJ, Owen-Anderson A et al (2008) Is gender identity disorder in adolescents coming out of the closet? J Sex Marital Ther 34:287–290.https://doi.org/10.1080/00926230802096192

    Article PubMed  Google Scholar 

  12. Aitken M, Steensma TD, Blanchard R et al (2015) Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med 12:756–763.https://doi.org/10.1111/jsm.12817

    Article PubMed  Google Scholar 

  13. de Graaf NM, de Giovanardi G, Zitz C, Carmichael P (2018) Sex ratio in children and adolescents referred to the gender identity development service in the UK (2009–2016). Arch Sex Behav 47:1301–1304.https://doi.org/10.1007/s10508-018-1204-9

    Article PubMed  Google Scholar 

  14. Steensma TD, Cohen-Kettenis PT, Zucker KJ (2018) Evidence for a change in the sex ratio of children referred for gender dysphoria: data from the center of expertise on gender dysphoria in amsterdam (1988–2016). J Sex Marital Ther.https://doi.org/10.1080/0092623X.2018.1437580

    Article PubMed  Google Scholar 

  15. Cohen-Kettenis PT, Owen A, Kaijser VG et al (2003) Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. J Abnorm Child Psychol 31:41–53

    Article  Google Scholar 

  16. Skagerberg E, Davidson S, Carmichael P (2013) Internalizing and externalizing behaviors in a group of young people with gender dysphoria. Int J Transgenderism 14:105–112.https://doi.org/10.1080/15532739.2013.822340

    Article  Google Scholar 

  17. Steensma TD, Zucker KJ, Kreukels BPC et al (2014) Behavioral and emotional problems on the teacher’s report form: A cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. J Abnorm Child Psychol 42:635–647.https://doi.org/10.1007/s10802-013-9804-2

    Article PubMed  Google Scholar 

  18. Aitken M, VanderLaan DP, Wasserman L et al (2016) Self-harm and suicidality in children referred for gender dysphoria. J Am Acad Child Adolesc Psychiatry 55:513–520

    Article  Google Scholar 

  19. Grossman AH, D’Augelli AR (2007) Transgender youth and life-threatening behaviors. Suicide Life Threat Behav 37:527–537

    Article  Google Scholar 

  20. Taliaferro LA, McMorris BJ, Rider GN, Eisenberg ME (2018) Risk and protective factors for self-harm in a population-based sample of transgender youth. Arch Suicide Res Off J Int Acad Suicide Res.https://doi.org/10.1080/13811118.2018.1430639

    Article  Google Scholar 

  21. Coleman E, Bockting W, Botzer M et al (2012) Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgenderism 13:165–232.https://doi.org/10.1080/15532739.2011.700873

    Article  Google Scholar 

  22. Costa R, Dunsford M, Skagerberg E et al (2015) Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. J Sex Med 12:2206–2214.https://doi.org/10.1111/jsm.13034

    Article CAS PubMed  Google Scholar 

  23. de Vries ALC, de McGuire JK, Steensma TD et al (2014) Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 134:696–704.https://doi.org/10.1542/peds.2013-2958

    Article PubMed  Google Scholar 

  24. Hembree WC, Cohen-Kettenis PT, Gooren L et al (2017) Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 102:3869–3903.https://doi.org/10.1210/jc.2017-01658

    Article PubMed  Google Scholar 

  25. Clark BA, Veale JF, Townsend M, et al (2018) Non-binary youth: Access to gender-affirming primary health care. Int J Transgenderism 0:1–12.https://doi.org/10.1080/15532739.2017.1394954

  26. Frohard-Dourlent H, Dobson S, Clark BA et al (2017) “I would have preferred more options”: accounting for non-binary youth in health research. Nurs Inq 24:e12150.https://doi.org/10.1111/nin.12150

    Article  Google Scholar 

  27. Masten AS, Cutuli JJ, Herbers JE, Gabrielle-Reed MJ (2009) Resilience in development. Handb Posit Psychol 117–131

  28. Rutter M (2000) Psychosocial influences: critiques, findings, and research needs. Dev Psychopathol 12:375–405

    Article CAS  Google Scholar 

  29. Schwarzer R, Knoll N (2007) Functional roles of social support within the stress and coping process: A theoretical and empirical overview. Int J Psychol 42:243–252.https://doi.org/10.1080/00207590701396641

    Article  Google Scholar 

  30. Wille N, Bettge S, Ravens-Sieberer U, BELLA study group (2008) Risk and protective factors for children’s and adolescents’ mental health: results of the BELLA study. Eur Child Adolesc Psychiatry 17 Suppl 1:133–147.https://doi.org/10.1007/s00787-008-1015-y

  31. Rubin KH, Bukowski WM, Laursen B (2009) Handbook of peer interactions, relationships, and groups. Guilford Press, New York, NY, US

    Google Scholar 

  32. Bowes L, Maughan B, Caspi A et al (2010) Families promote emotional and behavioural resilience to bullying: evidence of an environmental effect. J Child Psychol Psychiatry 51:809–817.https://doi.org/10.1111/j.1469-7610.2010.02216.x

    Article PubMed  Google Scholar 

  33. Phillips T (2012) The influence of family structure vs. family climate on adolescent well-being. Child Adolesc Soc Work J.https://doi.org/10.1007/s10560-012-0254-4

    Article  Google Scholar 

  34. Youngblade LM, Theokas C, Schulenberg J et al (2007) Risk and promotive factors in families, schools, and communities: a contextual model of positive youth development in adolescence. Pediatrics 119(Suppl 1):S47–53.https://doi.org/10.1542/peds.2006-2089H

    Article PubMed  Google Scholar 

  35. Byles J, Byrne C, Boyle MH, Offord DR (1988) Ontario Child Health Study: reliability and validity of the general functioning subscale of the McMaster Family Assessment Device. Fam Process 27:97–104

    Article CAS  Google Scholar 

  36. Epstein NB, Baldwin LM, Bishop DS (1983) The McMaster family assessment device. J Marital Fam Ther 9:171–180.https://doi.org/10.1111/j.1752-0606.1983.tb01497.x

    Article  Google Scholar 

  37. Meyer IH (2015) Resilience in the study of minority stress and health of sexual and gender minorities. Psychol Sex Orientat Gend Divers 2:209–213.https://doi.org/10.1037/sgd0000132

    Article  Google Scholar 

  38. Testa RJ, Habarth J, Peta J et al (2015) Development of the gender minority stress and resilience measure. Psychol Sex Orientat Gend Divers 2:65–77.https://doi.org/10.1037/sgd0000081

    Article  Google Scholar 

  39. Toomey RB, Ryan C, Diaz RM et al (2010) Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Dev Psychol 46:1580–1589.https://doi.org/10.1037/a0020705

    Article PubMed  Google Scholar 

  40. Baams L, Beek T, Hille H et al (2013) Gender nonconformity, perceived stigmatization, and psychological well-being in Dutch sexual minority youth and young adults: A mediation analysis. Arch Sex Behav 42:765–773.https://doi.org/10.1007/s10508-012-0055-z

    Article PubMed  Google Scholar 

  41. Bockting WO (2016) Vulnerability and resilience among gender-nonconforming children and adolescents: mental health professionals have a key role to play. J Am Acad Child Adolesc Psychiatry 55:441–443.https://doi.org/10.1016/j.jaac.2016.04.008

    Article PubMed  Google Scholar 

  42. Winkler J, Stolzenberg H (1999) Der sozialschichtindex im bundes-gesundheits survey [Social class index in the Federal health survey]. Gesundheitswesen 61:178–183

    Google Scholar 

  43. Achenbach TM (1991) Manual for the youth self-report and 1991 profile. University of Vermont, Burlington, VT, Dept. of Psychiatry

    Google Scholar 

  44. Döpfner, M., Plück, J., Bölte, S., et al (1998) Fragebogen für Jugendliche; deutsche Bearbeitung der Youth Self-Report Form der Child Behavior Checklist (YSR). Einführung und Anleitung zur Handauswertung mit deutschen Normen: Arbeitsgruppe Deutsche Child Behavior Checklist. [Questionnaire for Adolescents; German Version of the Youth Self Report Form of the Child Behavior Checklist (YSR). Introduction and Manual for the Evaluation using German norm data: Work Group of the German Child Bheavior Checklist.] Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik (KJFD), Köln

  45. Döpfner M, Berner W, Lehmkuhl G (1995) Reliabilität und faktorielle Validität des Youth Self-Report der Child Behavior Checklist bei einer klinischen Stichprobe. [Reliability and factorial validity of the Youth Self-Report of the Child Behavior Checklist in a clinical sample.] Diagnostica 41:221–244

  46. Zucker KJ, Bradley SJ, Owen-Anderson A et al (2012) Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. J Sex Marital Ther 38:151–189.https://doi.org/10.1080/0092623X.2011.611219

    Article PubMed  Google Scholar 

  47. Little RJA, Rubin DB (2014) Statistical analysis with missing data. John Wiley & Sons

  48. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Routledge, New York, NY

    Google Scholar 

  49. Cumming G, Finch S (2005) Inference by eye: confidence intervals and how to read pictures of data. Am Psychol 60:170–180.https://doi.org/10.1037/0003-066X.60.2.170

    Article PubMed  Google Scholar 

  50. Röder M, Barkmann C, Richter-Appelt H, et al (2018) Health-related quality of life in transgender adolescents: Associations with body image and emotional and behavioral problems. Int J Transgenderism 0:1–14.https://doi.org/10.1080/15532739.2018.1425649

  51. Holt V, Skagerberg E, Dunsford M (2016) Young people with features of gender dysphoria: Demographics and associated difficulties. Clin Child Psychol Psychiatry 21:108–118.https://doi.org/10.1177/1359104514558431

    Article PubMed  Google Scholar 

  52. Veale JF, Peter T, Travers R, Saewyc EM (2017) Enacted stigma, mental health, and protective factors among transgender youth in Canada. Transgender Health 2:207–216.https://doi.org/10.1089/trgh.2017.0031

    Article PubMed PubMed Central  Google Scholar 

  53. Breslow AS, Brewster ME, Velez BL et al (2015) Resilience and collective action: exploring buffers against minority stress for transgender individuals. Psychol Sex Orientat Gend Divers 2:253–265.https://doi.org/10.1037/sgd0000117

    Article  Google Scholar 

  54. Pullen Sansfaçon A, Robichaud M-J, Dumais-Michaud A-A (2015) The experience of parents who support their children’s gender variance. J LGBT Youth 12:39–63.https://doi.org/10.1080/19361653.2014.935555

    Article  Google Scholar 

  55. Becker I, Ravens-Sieberer U, Ottová-Jordan V, Schulte-Markwort M (2017) Prevalence of adolescent gender experiences and gender expression in Germany. J Adolesc Health 61:83–90.https://doi.org/10.1016/j.jadohealth.2017.02.001

    Article PubMed  Google Scholar 

  56. Schneider C, Cerwenka S, Nieder TO et al (2016) Measuring gender dysphoria: A multicenter examination and comparison of the utrecht gender dysphoria scale and the gender identity/gender dysphoria questionnaire for adolescents and adults. Arch Sex Behav 45:551–558.https://doi.org/10.1007/s10508-016-0702-x

    Article PubMed  Google Scholar 

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Acknowledgements

We thank all the participants who contributed to this study by providing important personal data on many levels, and the clinicians for their contribution to the data collection in the care unit, especially Saskia Fahrenkrug.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany

    Naina Levitan, Claus Barkmann, Michael Schulte-Markwort & Inga Becker-Hebly

  2. Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Hertha Richter-Appelt & Inga Becker-Hebly

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  1. Naina Levitan

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  2. Claus Barkmann

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  3. Hertha Richter-Appelt

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  4. Michael Schulte-Markwort

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  5. Inga Becker-Hebly

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Correspondence toInga Becker-Hebly.

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All human and animal studies have been approved by the appropriate local ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Levitan, N., Barkmann, C., Richter-Appelt, H.et al. Risk factors for psychological functioning in German adolescents with gender dysphoria: poor peer relations and general family functioning.Eur Child Adolesc Psychiatry28, 1487–1498 (2019). https://doi.org/10.1007/s00787-019-01308-6

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