Temporal trends in psychiatric admissions for cisgender, transgender, and gender-nonconforming youth

Studies have suggested that transgender/gender nonconforming (TGNC) youth were particularly vulnerable to poor mental health outcomes during the COVID-19 pandemic due to greater disruptions in mental health services, less social support, and greater unmet mental health needs compared to cisgender youth. This study aimed to identify differences in clinical characteristics of psychiatric admissions between cisgender and TGNC youth and to evaluate the psychosocial impact of the COVID-19 pandemic on TGNC youth. Because TGNC youth face additional vulnerabilities to mental health disorders in the setting of stressors, we hypothesized that a higher proportion of TGNC youth would be psychiatrically hospitalized compared to cisgender youth after the start of the pandemic. Sociodemographic and clinical characteristics were extracted from charts of a diverse population of youth admitted to an urban 17-bed psychiatric unit from June 2018 to November 2021 (n = 1101). Comparisons between cisgender and TGNC youth from specified time frames of pre–COVID-19, quarantine, and postquarantine were obtained through analyses, including χ2 tests, t tests, ANCOVA, and descriptive statistics. The proportion of admitted TGNC patients was 20/572 (3.5%) pre–COVID-19, 33/327 (10.1%) during quarantine, and 27/232 (11.6%) postquarantine. Thus, the proportion of TGNC youth admissions increased relative to cisgender counterparts when comparing admissions in pre–COVID-19 to quarantine and postquarantine (p < .001). TGNC patients were more likely to have a history of mood disorders (p < .001), self-injurious behavior (nonsuicidal self-injurious behavior [NSSIB]) (p < .001), and suicide attempts (SAs) (p = .007), whereas cisgender patients more often had histories of ADHD (p = .011) and violence (p < .001). TGNC patients were more likely to be admitted for suicidal ideation (SI) (p = .003), whereas cisgender patients were more likely to be admitted for aggression (p < .001). This study found that the proportion of youth who identify as TGNC increased during the COVID-19 pandemic, with higher rates of mood disorders, history of NSSIB and SAs, and admission for SI. TGNC youth may be more vulnerable to mental health crises and require additional targeted support in the face of multifaceted stressors and life disruptions.