Psychiatric Emergency Service Use by Transgender and Gender-Diverse Youth

Objectives: To document the proportion of transgender and gender diverse (TGD) youth presenting to a pediatric psychiatric emergency department (ED) and examine whether their demographic and clinical characteristics differ from cisgender youth. Methods: We analyzed electronic health records of youth ages 5 to 17 years presenting to a specialized pediatric psychiatric ED (N = 2728), including sociodemographic characteristics, gender identity, suicidal risk at admission, and diagnoses at discharge. We examined differences by gender identity using χ2 tests (categorical variables), 2-sample t tests, or Mann-Whitney U tests (continuous variables). Adjusted Poisson regression models estimated the prevalence ratio of the association between gender identity and clinical diagnoses. Results: Of youth, 6% seeking emergency psychiatric care identified as TGD. Compared with cisgender peers, TGD youth exhibited a higher risk for suicide, longer hospital stays, and received more psychiatric diagnoses at discharge, including a higher prevalence of suicidal thoughts and behaviors (prevalence ratio: 1.50, 95% CI: 1.16, 1.90). Conclusions: TGD youth have more severe clinical presentations in the psychiatric ED compared with cisgender youth. Further research is essential to develop targeted interventions to support the mental health of TGD youth.