Poster #57 - Parent-Adolescent Concordance of Mental Health Concerns in Transgender Adolescents

• In Event: Poster Session 11

Abstract

Background: Transgender and non-binary (TNB) adolescents experience disproportionately high rates of mental health concerns (Becerra-Culqui et al., 2018). Parents need to recognize these mental health concerns to facilitate care for their children. Research comparing parent and cisgender adolescent reports of adolescent mental health has yielded mixed findings, with poor concordance being associated with increased family stress and worse treatment outcomes (Goolsby et al., 2017). A recent study reported poor parent-child concordance on mental health measures among TNB adolescents, with TNB youth endorsing more concerns than their parents (McGuire et al., 2021), though associations between symptom severity and concordance were not examined. Within a sample of TNB adolescents, we examined: 1) the prevalence of depression and anxiety disorders; 2) parent-adolescent concordance on adolescent mental health; and 3) the impact of severity of mental health concerns and age on concordance.
Methods: Participants were adolescents aged 11-19 (Mage=16.29, SD=1.71) at a Midwestern U.S. pediatric gender clinic, identifying as transmasculine (n=46, 59.7%), transfeminine (n=24, 31.2%), or non-binary (n=7, 9.1%). Parents were mothers (n=51, 68.00%), fathers (n=16, 21.33%), or step-parents (n=5, 6.67%). The prevalence of each mental health concern was determined by examining the number of adolescents that reported a symptom count exceeding the established clinical cutoff (Table 1 footnote). Concordance of parent and adolescent reports (i.e., whether they agreed if the adolescent had clinically concerning symptoms) was calculated with McNemar tests using the established clinical cutoffs to determine the frequency of concordance in parent/adolescent reports. Additionally, a continuous variable was created for each parent and adolescent report by taking the distance from the clinical cutoff divided by the highest possible score for each scale, creating a variable between -1 and 1. Paired sample t-tests were used to test the magnitude of discordance. Lastly, logistic regressions were used to analyze the relationship between adolescent age and severity of mental health concerns on parent-adolescent concordance.
Results: There was high prevalence of clinically concerning mental health symptoms among TNB adolescents: 58.67% reported depression, 70.67% reported panic disorder, 73.33% reported generalized anxiety disorder (GAD), 52.06% reported separation anxiety, and 76.71% reported social anxiety. Parent-adolescent concordance was low (Table 1); adolescents reported significantly more concerns than parents (all McNemar p<.001-.002; all paired samples t-test p<.001). Logistic regression models analyzing predictors (age and adolescent self-reported mental health) of parent-adolescent concordance were significant for: depression (p<.001), GAD (p=.026), separation anxiety (p<.001), and social anxiety (p=.001). Adolescent age did not significantly predict concordance in any of the models, but higher adolescent self-report scores of depression (p=.009), GAD (p=.011), separation anxiety (p<.001), and social anxiety (p=.001) all significantly predicted worse concordance (Table 2).
Conclusions: Parent-adolescent concordance was poor across all five mental health constructs, with parents of TNB adolescents consistently underreporting the frequency and magnitude of depression and anxiety in their children. This is a major health concern in a population with high rates of anxiety, depression, and suicidality, as parents may be the primary point of contact for providers and thus many health concerns could be missed.

Authors

• Sophia Liles, Nationwide Children's Hospital
  Presenting Author

• Anna Lorraine Olsavsky, Nationwide Children's Hospital

• Connor Grannis, Nationwide Children's Hospital

• Eric Nelson, Nationwide Children's Hospital

• Kristen Hoskinson, Nationwide Children's Hospital

• Leena Nahata, The Research Institute at Nationwide Children's Hospital