535 - Depression and Suicidality in Sexual and Gender Minority Youth in a Healthcare System

Poster Number: 535
Publication Number: 535.423

Sarah Grycza, Children's Hospital at Dartmouth-Hitchcock, lebanon, NH, United States; Catherine Shubkin, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Susanne E Tanski, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States

Background:
In the US, suicide is the 2nd highest cause of death among youth < 18. Data suggest that sexual and gender minority youth (SGMY) experience higher rates of depression and attempted suicide than their heterosexual/cisgender (H/C) peers. Much of this research is based on urban healthcare systems which fails to capture potential disparities for youth living in rural settings who may face different barriers to care, social stress, and exclusion.

Objective: To determine whether positive screening rates for depression, anxiety and suicidality differ between SGMY as compared to
H/C peers in the outpatient pediatrics setting in a diverse healthcare system, and whether rates differ by rurality.

Design/Methods:

Standardized screening for psychosocial and health risk behaviors, including mental health concerns (PHQ-9a and GAD-7), was completed for all 12-22y well visits via tablet-based patient report. Patients self-identify as SGMY with a single item “Do you think you may be gay, lesbian, bisexual or transgender”. Summary scores for health risks, including anxiety/depression, suicidality/self-harm alert providers to topics for additional discussion. Moderate or greater anxiety (GAD-7) or depression (PHQ-9a) was dichotomized. Rurality was based on Rural Urban Commuting Area defined by home zipcode. IRB at Dartmouth-Hitchcock Medical Center approved this study. Data were deidentified; repeat annual cross sections (2019-2021) were used to assess for change pre-pandemic to present. Chi square analyses were used.

Results: From 2019-2021, ~6000 annual screeners were completed. Some 13% identified as SGMY, with increasing prevalence from 2019 (10.4%) to 2021 (16.3%) (p < 0.001) (Table). Prevalence of mental health concerns have increased pre-pandemic to present, with moderate/severe depression or anxiety increasing from 2019 (11.1%) to 2021 (16.3%) (p trend < 0.001). SGMY consistently had higher prevalence of mental health issues, suicidality and suicide attempts as compared to H/C peers: e.g. in 2021, 29.9% of SGMY screened for moderate/severe anxiety compared to 7.1% of H/C peers (p < 0.001). Suicidality/suicide attempt rates did not vary over time but diverged by SGMY (12.9% and 17.7% in 2021 respectively) compared to H/C youth (2.0% and 2.8%) (p < 0.001). SGM did not vary by rural residence, nor did mental health concerns.
 Conclusion(s): The pandemic has affected youth mental health. SGMY have marked increased rates of depression, anxiety, suicidal ideation, and previous suicide attempts than H/C peers. As a uniquely vulnerable population, it is imperative that SGMY be identified and screened for mental health concerns.
Table. Prevalence of mental health concerns among SGMY and H/C youth, pre-pandemic to present in a population of adolescents in a health care system.H/C: Heterosexual/Cisgender
SGMY: Sexual and Gender Minority Youth
Depression: Moderate to Severe based on PHQ-9a≧10
Anxiety: Moderate to Severe based on GAD-7≧10
Suicidality: Yes, Has there been a time in the past month when you gave had serious thoughts about ending your life?
Suicide attempt: Yes, Have you ever, in your whole life, tried to kill yourself or made a suicide attempt?
Bullying: Yes, Are you worried about bullying, your safety or violence?
Abuse: Yes, Have you ever been physically, emotionally, or sexually abused?