OR15-02 Mental Health Implications and Determinants of When Youth Present to a Gender Clinic
Notice bibliographique
Résumé
Abstract Background/Aims: Gender incongruent (GI) youth experience high rates of mental health comorbidities. While gender-affirming medical care (GAMC) provides psychological benefit, GI youth often present to care at older ages. The goals of this study were to 1) assess the relationship between age at presentation to GAMC and rates of mental health comorbidities, 2) identify factors influencing when youth present to GAMC, and 3) determine whether older presenting youth face more barriers to care. Methods: We performed a cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY): <15 years of age at presentation or older presenting youth (OPY): > 15 years of age. Self-reported rates of mental health comorbidities and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health comorbidities. Covariates included pubertal stage at presentation, social transition status, and assigned sex. Next, we performed a sequential exploratory mixed-methods study. Factors influencing age at presentation to GAMC were explored through 24 semi-structured interviews with OPY, YPY, and their caregivers (OPY-C and YPY-C). Thematic analysis identified themes with differential representation between OPY/OPY-C and YPY/YPY-C. From these themes, a questionnaire was designed and distributed to youth and caregivers presenting for follow-up. Responses were compared between OPY and YPY and between OPY-C and YPY-C. Results: Of 300 youth, there were184 OPY and 116 YPY. Upon presentation, more OPY than YPY reported a diagnosis of depression (46% vs. 30%), had self-harmed (40% vs. 28%), had considered suicide (52% vs. 40%), had attempted suicide (17% vs. 9%), and required psychoactive medications (36% vs. 23%), all p < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (OR 5.49 [95% CI: 1.14, 26.32]) and anxiety disorders (OR 4.18 [95% CI: 1.22, 14.49]) while older age remained associated only with psychoactive medication use (OR 1.31 [95% CI: 1.05, 1.63]). Six themes were identified from interviews that influenced age at first clinic visit, including individual, environmental, and healthcare system factors. 101/152 youth and 102/147 caregivers completed questionnaires. While OPY/OPY-C did not endorse more barriers to care than YPY/YPY-C, more OPY than YPY had religious families (54% vs 28%, p=.01) while more YPY than OPY had LGBTQ+ family members (46% vs. 20%, p=.006). Conclusions: Older age and late pubertal stage are associated with worse mental health among GI youth presenting to GAMC. Our findings emphasize the importance of timely access to GAMC for GI youth and highlight familial environment as a factor that influences when youth present to gender-affirmative care.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,013 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».