{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:02:06Z","timestamp":1792886526288,"version":"4.5.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"\n Importance<\/jats:title>\n Transgender youth are at an elevated risk for adverse mental health outcomes compared with their cisgender peers. Identifying opportunities for intervention is a priority.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate differences in the association between gender identity milestones and mental health outcomes among transgender youth, stratified by level of family support.<\/jats:p>\n <\/jats:sec>\n \n Design, Settings, and Participants<\/jats:title>\n This retrospective cohort study compares changes in mental health outcomes among transgender youth who initiate gender identity milestones compared with those who initiate the same milestones 1 year later, stratified by level of family support, using the 2015 US Transgender Survey. The analytic samples included 18\u202f303 transgender adults aged 18 and older who had initiated at least 1 gender identity milestone between ages 4 and 18 years.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Four gender identity milestones: feeling one\u2019s gender was different, thinking of oneself as transgender, telling another that one is transgender, and living full-time in one\u2019s gender identity, stratified by 3 levels of family support: supportive, neutral, and adverse.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes<\/jats:title>\n Age at first suicide attempt and at running away.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Study participants included 18\u202f303 transgender adults (10\u202f288 [56.2%] assigned female at birth; 14\u202f777 [80.7%] White). Initiating a gender identity milestone was associated with a higher risk of suicide attempt and running away from home among transgender youth. This finding was driven by children who live in unsupportive families. For example, thinking of oneself as transgender was associated with a meaningful increase in the overall probability of attempting suicide among those in either adverse families (estimate\u2009=\u20091.75 percentage points; 95% CI, 0.47-3.03) or neutral families (estimate\u2009=\u20091.39 percentage points; 95% CI, 0.72-2.05). Among youth living with supportive families, there were no statistically significant associations between gender identity milestones and adverse mental health outcomes and 95% CIs generally ruled out any meaningful associations.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n These results demonstrate that without a supportive family environment, gender identity development increases the risk of transgender youth attempting suicide or running away from home. Social services and community resources to establish supportive relationships between transgender children and their parents are essential.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.2035","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T11:33:18Z","timestamp":1721043198000},"page":"870","source":"Crossref","is-referenced-by-count":26,"title":["Mental Health of Transgender Youth Following Gender Identity Milestones by Level of Family Support"],"prefix":"10.1001","volume":"178","author":[{"given":"Travis","family":"Campbell","sequence":"first","affiliation":[{"name":"Department of Economics, Southern Oregon University, Ashland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Mann","sequence":"additional","affiliation":[{"name":"RAND Corporation, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana van der Meulen","family":"Rodgers","sequence":"additional","affiliation":[{"name":"Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel M.","family":"Tran","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Administration, University of Illinois at Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"3-4","key":"poi240035r1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1080\/09540261.2022.2093629","article-title":"Mental health in transgender individuals: a systematic review.","volume":"34","author":"Pinna","year":"2022","journal-title":"Int Rev Psychiatry"},{"issue":"12","key":"poi240035r2","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1111\/jcpp.12833","article-title":"Research review: gender identity in youth: treatment paradigms and 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Tracking the rise of anti-trans bills in the US. Accessed June 7, 2024. https:\/\/translegislation.com\/learn."},{"key":"poi240035r13","unstructured":"Oklahoma State Legislature. SB 129 by Bullard and West (Kevin). Accessed June 10, 2024. http:\/\/www.oklegislature.gov\/BillInfo.aspx?Bill=sb129"},{"key":"poi240035r14","unstructured":"State of Wyoming Legislature. SF0111\u2014Child abuse-change of sex. Accessed June 10, 2024. https:\/\/wyoleg.gov\/Legislation\/2023\/SF0111"},{"key":"poi240035r21","unstructured":"Kosciw? JG, Clark? CM, Truong? NL, Zongrone? AD. The 2019 National School Climate Survey: the experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation\u2019s schools. Accessed June 10, 2024. https:\/\/www.glsen.org\/sites\/default\/files\/2020-10\/NSCS-2019-Full-Report_0.pdf"},{"key":"poi240035r36","unstructured":"Substance Abuse and Mental Health Services Administration. 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