Affiliation:
1. Eating Recovery Center and Pathlight Mood and Anxiety Center Bellevue Washington USA
2. Department of Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
3. Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Medical Center Durham North Carolina USA
4. Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
5. Department of Psychology Florida State University Tallahassee Florida USA
6. Eating Recovery Center and Pathlight Mood and Anxiety Center Denver Colorado USA
7. Department of Psychiatry and Behavioral Sciences University of California San Francisco School of Medicine San Francisco California USA
8. Emeritus, Department of Psychiatry and Behavioral Neurosciences The University of Chicago Chicago IL USA
9. ACUTE at Denver Health Denver Colorado USA
10. Department of Internal Medicine University of Colorado School of Medicine Denver Colorado USA
11. Department of Psychiatry and Behavioral Sciences Northwestern University Chicago Illinois USA
Abstract
AbstractObjectiveEating disorder (ED), depression, and anxiety symptoms at admission and discharge were compared, as were admission‐to‐discharge changes, for transgender and gender diverse (TGD), and cisgender adolescents receiving intensive treatment for EDs.MethodParticipants were 44 TGD and 573 cisgender adolescents admitted to a treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE‐Q), Patient Health Questionnaire‐9 (PHQ‐9), and Generalized Anxiety Disorder‐7 (GAD‐7) at admission and discharge.ResultsBoth groups had elevated EDE‐Q scores at admission (TGD: M = 3.78, standard deviation [SD] = 1.70; cisgender: M = 3.33, SD = 1.74) that improved by discharge (TGD: M = 2.27, SD = 1.83, Cohen's d = .98; cisgender: M = 2.10, SD = 1.54, Cohen's d = .79); there were no differences in EDE‐Q between groups at admission (p = .09; odds ratio [OR] = 1.18, 95% confidence interval [CI] [.98, 1.44]) or discharge (p = .48; OR = 1.07, 95% CI [.88, 1.30]). On admission, TGD adolescents had higher suicidality, measured by PHQ‐9, item 9 (p < .001; OR = 1.94, 95% CI [1.51, 2.52]), and depression (p < .001; OR = 1.10, 95% CI [1.05, 1.16]) than cisgender participants. Severity decreased over treatment for all measures. Both groups showed similar improvement on suicidality (p = .93; OR = .98, 95% CI [.70,1.36]), depression (p = .42; OR = 1.02, 95% CI [.97, 1.07]), and anxiety (p = .14; OR = 1.05, 95% CI [.99, 1.12]). However, at discharge, suicidality (p = .02; OR = 1.40, 95% CI [1.04, 1.85]), depression (p < .01; OR = 1.06, 95% CI [1.02, 1.11]), and anxiety (p = .02; OR = 1.06, 95% CI [1.01, 1.12]) were higher for TGD adolescents than their cisgender peers.DiscussionAll participants had similar ED symptom severity and improvement. Depression, anxiety, and suicidality remained elevated for TGD adolescents compared to their cisgender peers at discharge, suggesting the need for targeted treatment.Public SignificanceTransgender and gender diverse (TGD) adolescents have increased risk of eating disorders (EDs); few studies examine how they respond to ED treatment. We examine treatment outcomes of TGD adolescents receiving ED treatment compared to their cisgender peers. We measured ED symptoms along with depression, anxiety, and suicidality at the beginning and end of treatment. While TGD adolescents showed similar improvement in ED symptoms, measures of depression, anxiety, and suicidality remained elevated at the time of discharge.