@article{824d6f895c06445bb965aea36a3cc68f,
title = "Behavioral Health Diagnoses in Youth with Gender Dysphoria Compared with Controls: A PEDSnet Study",
abstract = "Objective: To assess the odds of a psychiatric or neurodevelopmental diagnosis among youth with a diagnosis of gender dysphoria compared with matched controls in a large electronic health record dataset from 6 pediatric health systems, PEDSnet. We hypothesized that youth with gender dysphoria would have higher odds of having psychiatric and neurodevelopmental diagnoses than controls. Study design: All youth with a diagnosis of gender dysphoria (n = 4173 age at last visit 16.2 ± 3.4) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables to controls without gender dysphoria (n = 16 648, age at last visit 16.2 ± 4.8) using multivariable logistic regression. The odds of having psychiatric and neurodevelopmental diagnoses were examined using generalized estimating equations. Results: Youth with gender dysphoria had higher odds of psychiatric (OR 4.0 [95% CI 3.8, 4.3] P < .0001) and neurodevelopmental diagnoses (1.9 [1.7, 2.0], P < .0001). Youth with gender dysphoria were more likely to have a diagnosis across all psychiatric disorder subcategories, with particularly high odds of mood disorder (7.3 [6.8, 7.9], P < .0001) and anxiety (5.5 [5.1, 5.9], P < .0001). Youth with gender dysphoria had a greater odds of autism spectrum disorder (2.6, [2.2, 3.0], P < .0001). Conclusions: Youth with gender dysphoria at large pediatric health systems have greater odds of psychiatric and several neurodevelopmental diagnoses compared with youth without gender dysphoria. Further studies are needed to evaluate changes in mental health over time with access to gender affirming care.",
keywords = "ADHD, anxiety, autism, depression, eating disorder, gender dysphoria, mood disorder, neurodevelopment, psychiatric, transgender",
author = "Marissa Nunes-Moreno and Cindy Buchanan and Cole, {F. Sessions} and Shanlee Davis and Amanda Dempsey and Nadia Dowshen and Anna Furniss and Kazak, {Anne E.} and Kerlek, {Anna J.} and Peter Margolis and Laura Pyle and Hanieh Razzaghi and Reirden, {Daniel H.} and Beth Schwartz and Sequeira, {Gina M.} and Nokoff, {Natalie J.}",
note = "Funding Information: This work was supported in part by NIH / Eunice Kennedy Shriver National Institute of Child Health and Human Development K23HD092588 and R03HD102773 (to S.D.), NIH / Eunice Kennedy Shriver National Institute of Child Health and Human Development K12HD057022 (to N.N.), Doris Duke Foundation (to S.D., and N.N.), the Patient-Centered Outcomes Research Institute ( RI-CRN-2020-007 ) ([to F.C.]), and the Seattle Children{\textquoteright}s Institute Career Development Award (to G.S.). Contents are the authors' sole responsibility and do not necessarily represent views of the funders. The funders had no role in the design and conduct of the study. N.N. has consulted for Antares Pharma, Inc and Neurocrine Biosciences. N.D. is supported by the Stoneleigh Foundation . The other authors declare no conflicts of interest. Funding Information: This work was supported in part by NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development K23HD092588 and R03HD102773 (to S.D.), NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development K12HD057022 (to N.N.), Doris Duke Foundation (to S.D., and N.N.), the Patient-Centered Outcomes Research Institute (RI-CRN-2020-007) ([to F.C.]), and the Seattle Children's Institute Career Development Award (to G.S.). Contents are the authors' sole responsibility and do not necessarily represent views of the funders. The funders had no role in the design and conduct of the study. N.N. has consulted for Antares Pharma, Inc and Neurocrine Biosciences. N.D. is supported by the Stoneleigh Foundation. The other authors declare no conflicts of interest.Data for this analysis were obtained from PEDSnet (https://pedsnet.org/), a pediatric Learning Health System and a clinical research network in PCORnet, the National Patient Centered Clinical Research Network, an initiative funded by the Patient-Centered Outcomes Research Institute, with a Common Data Model. Six pediatric health systems participated in this PEDSnet dataset, collectively including over 6 million children: Children's Hospital Colorado, Children's Hospital of Philadelphia, Nemours Children's Health System, Nationwide Children's Hospital, St. Louis Children's Hospital, and Seattle Children's Hospital. Clinical data are available from the electronic health record (EHR) of these health systems from 2009 onward for patients with an in-person encounter with a provider. All youth (age range 3.4-28.5 years at last visit) with a diagnosis of gender dysphoria (by PEDSnet concept ID, Table I (available at www.jpeds.com) includes codes extracted from the EHR problem list or diagnosis code from any encounter) and at least 1 outpatient visit from 2009-2019 were extracted from the PEDSnet database in November 2019. Gender dysphoria is a diagnosis in the DSM-5, which was released in 2013,4 and Gender Identity Disorder was the prior related diagnosis in the 4th edition of the DSM.19 In hospital systems, other diagnosis codes are often used based on the International Classification of Diseases or ICD system. Cases with a diagnosis of gender dysphoria were selected based on one of 32 PEDSnet Concept IDs (Table I). A random sample of 197 042 patients with at least 1 outpatient visit in the same time period who did not have a diagnosis of gender dysphoria were used as a pool of controls. To ensure these controls were representative of the general PEDSnet population, we evaluated the prevalence of well characterized pediatric diagnoses (asthma, type 1 diabetes, and acute lymphoid leukemia) to ensure the prevalence in the controls was similar to PEDSnet as a whole. We chose 1 outpatient visit as a criterion for cases and controls to not oversample from those who were only seen in the health systems for urgent/emergent care.We thank the PEDSnet Data Coordinating Center for their support in the data acquisition and all PEDSnet site contributors. We also thank the team at the Adult and Child Consortium for Health Outcomes Research and Delivery Science including prior analysts Jacob Thomas, Bridget Mosley, and Angela Moss, who worked on data cleaning and the early analyses, and Elizabeth Juarez-Colunga who helped develop the initial analysis plan. Ben Bear, MSW at Nemours read and commented on this report. Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",
year = "2022",
month = feb,
doi = "10.1016/j.jpeds.2021.09.032",
language = "English",
volume = "241",
pages = "147--153.e1",
journal = "Journal of Pediatrics",
issn = "0022-3476",
}