Suicide and Depression Screening for Gender Diverse Youth in Pediatric Primary Care

Abstract

Objective: We aimed to compare transgender and gender diverse (TGD) youth and cisgender peers regarding universal depression and suicide screening outcomes in primary care and utilization of follow-up healthcare services after screening. Methods: We conducted a retrospective chart review at two pediatric primary care practices including 782 youth aged 10–18 years who were screened using the Ask Suicide Screening Questions (ASQ) and the nine-item Patient Health Questionnaire (PHQ-9). We compared the TGD group to their cisgender peers on demographic factors, screening outcomes, and use of follow-up services, including the emergency department, integrated behavioral health (IBH) contacts, and primary care clinician encounters. Results: Ninety-two (12%) patients were identified as TGD. TGD youth were significantly more likely than their cisgender peers to screen positive for acute and non-acute suicide risk, screen positive for depression, and to receive IBH services regardless of screening outcomes. There were no significant differences in healthcare utilization following positive screens, except TGD youth were less likely to see a primary care clinician within one month of positive depression screening. However, this effect was only significant for youth who did not receive an IBH consult at the time of screening. Conclusions: The results indicate that mental health screenings in pediatric primary care are effective for TGD populations, and that IBH at the time of screening may reduce inequities in follow-up care.

Implications for Impact Statement:

This study indicates that common, brief screening instruments are effective in detecting suicidal risk and depressive symptoms of transgender and gender diverse individuals when employed in pediatric primary care settings. Additionally, the study provides initial evidence that receipt of integrated behavioral health services on the day of screening helps to reduce inequities in follow-up care.