Elle Lett1,2, Matthew P Abrams3,4, Emery Moberg5, G Perusi Benson6, Jacob E Perlson7. 1. Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, 19146, USA. ellel@upenn.edu. 2. Center for Applied Transgender Studies, Chicago, IL, USA. ellel@upenn.edu. 3. Center for Emergency Care Policy and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Penn Medicine Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Unaffiliated Recent College Graduate, Los Angeles, CA, USA. 6. Department of Psychology, North Carolina State University, Raleigh, NC, USA. 7. Department of Psychiatry, Columbia University, New York, NY, USA.
Abstract
PURPOSE: Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination. METHODS: We used data on substance use, depressive symptoms, suicidality, and social-structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social-structural factors, and suicidality. RESULTS: A three-class LCA solution identified a subset of student respondents in a "high use" latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28-1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35-17.71) were associated with increased odds of "high use" class membership relative to the "no use" class membership. "High use" class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75-2.94), plans (aOR: 2.59; 95% CI: 2.01-3.36), and attempts (aOR: 6.85; 95% CI: 3.17-15.68). CONCLUSION: The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.
PURPOSE: Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination. METHODS: We used data on substance use, depressive symptoms, suicidality, and social-structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social-structural factors, and suicidality. RESULTS: A three-class LCA solution identified a subset of student respondents in a "high use" latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28-1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35-17.71) were associated with increased odds of "high use" class membership relative to the "no use" class membership. "High use" class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75-2.94), plans (aOR: 2.59; 95% CI: 2.01-3.36), and attempts (aOR: 6.85; 95% CI: 3.17-15.68). CONCLUSION: The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.
Authors: Matthew J Mimiaga; Jaclyn M W Hughto; Katie B Biello; Christopher M Santostefano; Lisa M Kuhns; Sari L Reisner; Robert Garofalo Journal: J Acquir Immune Defic Syndr Date: 2019-06-01 Impact factor: 3.731
Authors: John P Shields; Rebekah Cohen; Jill R Glassman; Kelly Whitaker; Heather Franks; Ilsa Bertolini Journal: J Adolesc Health Date: 2012-08-15 Impact factor: 5.012
Authors: Amaya Perez-Brumer; Jack K Day; Stephen T Russell; Mark L Hatzenbuehler Journal: J Am Acad Child Adolesc Psychiatry Date: 2017-07-05 Impact factor: 8.829
Authors: Sari L Reisner; Ralph Vetters; M Leclerc; Shayne Zaslow; Sarah Wolfrum; Daniel Shumer; Matthew J Mimiaga Journal: J Adolesc Health Date: 2015-01-07 Impact factor: 5.012
Authors: Norman P Spack; Laura Edwards-Leeper; Henry A Feldman; Scott Leibowitz; Francie Mandel; David A Diamond; Stanley R Vance Journal: Pediatrics Date: 2012-02-20 Impact factor: 7.124