Differences in Patient and Parent Informant Reports of Depression and Anxiety Symptoms in a Clinical Sample of Transgender and Gender Diverse Youth F. Hunter McGuire, MPH, 1, * ,i Alexandra Carl, MPH, 1 Lindsay Woodcock, MPH, 1 Lauren Frey, MPH, 1 Emily Dake, MPH, 1 Derrick D. Matthews, PhD, MPH, 1 Kristen J. Russell, MSW, 2 and Deanna Adkins, MD 3 Abstract Purpose: We assessed characteristics of patients at a pediatric gender clinic and investigated if reports of mental health concerns provided by transgender and gender diverse (TGD) youth patients differed from reports provided by a parent informant on their behalf. Methods: This cross-sectional study included 259 TGD patients 8 to 22 years of age attending a pediatric gender clinic in the southeast United States from 2015 to 2020. Pearson correlations and paired sample t-tests compared patient-reported mental health concerns at patient intake with those provided by a parent informant. Clinical symptom severity was assessed with standardized T-scores. Level 2 Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression Scale and Level 2 PROMIS Emotional Distress- Anxiety Scale assessed depression and anxiety symptoms of patients. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure was used with parents. Results: Patients had a mean age of 14.9 at first visit, with most identifying as White (85.5%), non-Hispanic (91.1%), and as a boy or man (63.6%). Half had moderate-to-severe depression (51.2%) or anxiety (47.9%) symptoms. There was a moderate, positive correlation between patient-reported and parent-reported depression symptoms, with no correlation for anxiety symptoms. Informant type differences were statistically significant (patients reporting greater depression and anxiety symptoms). Conclusions: TGD youth patients reported more severe depression and anxiety symptoms compared with parent informants. Despite moderate agreement on depression symptoms, parents did not accurately detect their child’s anxiety symptoms. These discrepancies highlight a need for interventions which increase parental recognition of child mental health status. Keywords: adolescent, anxiety, depression, health services for transgender persons, parents, transgender Introduction T ransgender and gender diverse (TGD) youth are at increased risk of depression and anxiety disorders com- pared with cisgender youth. 1,2 Prevalence estimates among TGD youth range from 47% to 79% for depression symptoms and from 12% to 63% for anxiety symptoms. 3–6 Based on the minority stress model, 7 the gender minority stress model pos- its that observed disparities result from adverse experiences which disproportionately impact TGD individuals, includ- ing stigma, violence, discrimination, and internalized trans- phobia. 8,9 Resilience factors, including pride in one’s identity and community connectedness, may buffer impacts of gender minority stressors. 8,10 Reductions in symptoms and distress may be associated with social transition, social and paren- tal support for one’s gender, and receiving gender-affirming care. 11–14 Gender-affirming medical clinics exist nationwide to help increasing numbers of TGD youth fulfill gender expressions reflective of their identities. 15 Although medical services have expanded for TGD youth, knowledge gaps remain about pedi- atric gender-affirming care and case management. 16 Recent 1 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA. 2 Clinical Social Work Division, Department of Case Management, Duke University Medical Center, Durham, North Carolina, USA. 3 Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA. *Current affiliation: The Brown School, Washington University in St. Louis, St. Louis, Missouri, USA. i ORCID ID (https://orcid.org/0000-0003-0522-2748). LGBT Health Volume 8, Number 6, 2021 ª Mary Ann Liebert, Inc. DOI: 10.1089/lgbt.2020.0478 404 Downloaded by 54.144.218.150 from www.liebertpub.com at 08/31/21. For personal use only.