{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:45:19Z","timestamp":1777452319799,"version":"3.51.4"},"reference-count":59,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["2T32MH016434-41"],"award-info":[{"award-number":["2T32MH016434-41"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Autism"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>\n                    Autistic people are more likely to be transgender and gender diverse than the general population. Furthermore, co-occurring trait-level autism and transgender and gender-diverse identity are associated with symptoms of depression and anxiety, and autistic adolescents who identify as transgender and gender diverse have more internalizing behaviors than both non-transgender and gender-diverse autistic adolescents and non-autistic transgender and gender-diverse adolescents. However, no study has yet examined the extent to which transgender and gender-diverse identity predicts specific co-occurring mental health diagnoses in autistic adolescents. In a sample of 9027 autistic adolescents aged 13 to 17 drawn from the Simons Powering Autism Research for Knowledge cohort, 36 of whom we identified as transgender and gender diverse, we estimated univariate models of transgender and gender-diverse identity as a predictor of individual diagnoses. Depression, but no other diagnosis, remained statistically significant after adjustment for multiple comparisons. In a multiple regression model that incorporated known risk factors for adolescent depression (e.g. language impairment and disturbed sleep), transgender and gender-diverse identity remained a significant predictor (odds ratio: 4.01, 95% confidence interval: 1.87\u20138.67,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20095.94\u2009\u00d7\u200910\n                    <jats:sup>\u22124<\/jats:sup>\n                    ) with an effect size at least as strong as that of a depression family history. This suggests transgender and gender-diverse autistic adolescents, who often face stigma and discrimination, are particularly vulnerable to depression.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Lay abstract<\/jats:title>\n                    <jats:p>\u201cTransgender and gender diverse\u201d (TGD) people have gender identities that differ from the sex they were assigned at birth. Many autistic people have a TGD identity. Autistic adolescents who are TGD have more \u201cinternalizing symptoms,\u201d which include symptoms of depression and anxiety, than autistic adolescents who are not TGD. In this study, we examined a group of 9027 autistic adolescents, 36 of whom had a TGD identity, to determine which, if any, mental health diagnoses would be associated with TGD identity, and whether those associations would remain even after accounting for known risk factors for a diagnosis. We found that depression, but no other diagnosis, was associated with TGD identity. This association remained even when accounting for known risk factors for depression, and in fact, TGD identity was associated with depression at least as strongly as a family history of that diagnosis. This strong association is perhaps not surprising. TGD adolescents often face stigma, social rejection, and discrimination, which can lead to depression. Autistic adolescents can face similar difficulties. Autistic youth who also have a TGD identity may therefore be at particular risk of developing depression. Our study highlights that providers who work with autistic youth in the community should be aware of this risk so they can identify and treat depression when it is present. Future studies should investigate the relationship between depression and TGD identity in autism further, to determine how providers and caregivers can support these youth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13623613251396712","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T11:38:50Z","timestamp":1765021130000},"page":"316-328","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transgender and gender-diverse autistic adolescents are at elevated risk of depression"],"prefix":"10.1177","volume":"30","author":[{"given":"Joseph","family":"Pereira","sequence":"first","affiliation":[{"name":"Columbia University, USA"},{"name":"New York State Psychiatric Institute, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8688-9426","authenticated-orcid":false,"given":"Natalia","family":"Ramos","sequence":"additional","affiliation":[{"name":"University of California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LeeAnne Green","family":"Snyder","sequence":"additional","affiliation":[{"name":"Simons Foundation, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Veenstra-VanderWeele","sequence":"additional","affiliation":[{"name":"Columbia University, USA"},{"name":"New York State Psychiatric Institute, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5973-9940","authenticated-orcid":false,"given":"Amandeep","family":"Jutla","sequence":"additional","affiliation":[{"name":"Columbia University, USA"},{"name":"New York State Psychiatric Institute, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Avenevoli S. 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