Disparities in Childhood Abuse Between Transgender and Cisgender Adolescents Brian C. Thoma, PhD,a Taylor L. Rezeppa, BS,a Sophia Choukas-Bradley, PhD,b Rachel H. Salk, PhD,a Michael P. Marshal, PhDa BACKGROUND AND OBJECTIVES: Transgender adolescents (TGAs) exhibit disproportionate levels of abstract mental health problems compared with cisgender adolescents (CGAs), but psychosocial processes underlying mental health disparities among TGAs remain understudied. We examined self-reported childhood abuse among TGAs compared with CGAs and risk for abuse within subgroups of TGAs in a nationwide sample of US adolescents. METHODS: Adolescents aged 14 to 18 completed a cross-sectional online survey (n 5 1836, including 1055 TGAs, 340 heterosexual CGAs, and 433 sexual minority CGAs). Participants reported gender assigned at birth and current gender identity (categorized as the following: cisgender males, cisgender females, transgender males, transgender females, nonbinary adolescents assigned female at birth, nonbinary adolescents assigned male at birth, and questioning gender identity). Lifetime reports of psychological, physical, and sexual abuse were measured. RESULTS: Seventy-three percent of TGAs reported psychological abuse, 39% reported physical abuse, and 19% reported sexual abuse. Compared with heterosexual CGAs, TGAs had higher odds of psychological abuse (odds ratio [OR] 5 1.84), physical abuse (OR 5 1.61), and sexual abuse (OR 5 2.04). Within separate subgroup analyses, transgender males and nonbinary adolescents assigned female at birth had higher odds of reporting psychological abuse than CGAs. CONCLUSIONS: In a nationwide online sample of US adolescents, TGAs had elevated rates of psychological, physical, and sexual abuse compared with heterosexual CGAs. Risk for psychological abuse was highest among TGAs assigned female at birth. In the future, researchers should examine how more frequent experiences of abuse during childhood could contribute to disproportionate mental health problems observed within this population. WHAT’S KNOWN ON THIS SUBJECT: Limited evidence aDepartment of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and bDepartment of Psychological and Brain Sciences, University of Delaware, Newark, Delaware indicates transgender adolescents (TGAs) are at risk for abuse during childhood. However, in no nationwide study Dr Thoma conceptualized and designed the study, collected data, analyzed the data, drafted the have researchers examined disparities in abuse between initial manuscript, and reviewed and revised the manuscript; Ms Rezeppa drafted the initial TGAs and cisgender adolescents, and risk within manuscript and reviewed and revised the manuscript; Drs Choukas-Bradley and Salk subgroups of TGAs is unknown. conceptualized and designed the study, collected data, and reviewed and revised the manuscript; Dr Marshal contributed to the conceptualization and design of the study and WHAT THIS STUDY ADDS: In a nationwide sample of US critically reviewed the manuscript for important intellectual content; and all authors approved adolescents, TGAs had higher odds of reporting the final manuscript as submitted and agree to be accountable for all aspects of the work. psychological, physical, and sexual abuse than DOI: https://doi.org/10.1542/peds.2020-016907 heterosexual cisgender adolescents. TGAs assigned female at birth had the highest odds of psychological Accepted for publication Jan 27, 2021 abuse. Address correspondence to Brian C. Thoma, PhD, Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213. E-mail: [email protected] To cite: Thoma B C, Rezeppa T L, Choukas-Bradley S, et al. Disparities in Childhood Abuse Between Transgender and PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Cisgender Adolescents. Pediatrics. 2021;148(2):e2020016907 Copyright © 2021 by the American Academy of Pediatrics Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 148, number 2, August 2021:e2020016907 ARTICLE Empirical attention to the during childhood because of this physical abuse, as well as experiences of transgender population’s distinct experiences polyvictimization. However, the adolescents (TGAs) (adolescents with gender identity and gender Minnesota Student Survey only whose gender identity is different expression across development. allowed adolescents to answer “yes” from their sex assigned at birth) has TGAs are less conforming to societal or “no” to the following question: increased in the past decade, and expectations of gender expression “Do you consider yourself mounting evidence indicates TGAs during childhood, even before their transgender, genderqueer, disproportionately experience identification with a gender identity genderfluid, or unsure about your mental health problems when that differs from their sex assigned gender identity?” This approach to compared with cisgender at birth.16,17 Children who are measurement ignores heterogeneity adolescents (CGAs) (adolescents gender nonconforming are more among TGAs and implicitly assumes whose gender identity is the same likely to experience abuse when the psychosocial experiences and 1–5 as their sex assigned at birth). compared with gender-conforming mental health sequelae of TGAs do TGAs report high rates of suicidality, peers.18–20 Thus, TGAs could be not differ across subgroups. Recent depressive symptoms, and more likely to experience abuse evidence indicates TGAs with binary 3,4,6,7 anxiety. In particular, TGAs during childhood, and it is identities (eg, transgender males experience very high rates of particularly important to document and transgender females) have suicidality, and as many as one-half this population’s level of risk for elevated rates of suicidal ideation of TGAs report making a suicide abuse compared with their peers and behavior compared with CGAs, 3 attempt in their lifetime. Despite given their elevated rates of mental but these same elevations are not emerging evidence of stark mental health problems during adolescence. uniformly observed among health disparities between TGAs and nonbinary TGAs (TGAs who identify CGAs, little work has examined However, little research has as nonbinary, genderqueer, agender, psychosocial factors that could examined rates of childhood abuse etc).3 In addition, sex assigned at underlie mental health problems among TGAs compared with CGAs, birth likely contributes to among TGAs. and relative risk of abuse among differences in psychosocial subgroups of TGAs (eg, transgender experiences among TGAs because Experiences of abuse during males, transgender females, TGAs assigned female at birth have childhood contribute to the onset of nonbinary adolescents) compared mental health problems during reported higher levels of peer with CGAs has never been examined. adolescence and adulthood, victimization than TGAs assigned Most research examining childhood 7 including suicidality and male. Furthermore, sex assigned at – abuse among transgender depression.8 11 Individuals who birth predicts experiences of individuals has been conducted with experience abuse during childhood childhood abuse in the general adults, and few studies have 9,26,27 are 3 to 5 times more likely to population. However, no investigated abuse among TGAs 18 develop suicidality later in previous research has documented and younger.21 One study found development.12 Experiencing sexual relative risk of childhood abuse TGAs reported higher levels of or physical abuse during childhood among TGA subgroups subdivided abuse than sexual minority CGAs is related to chronic and repeated by sex assigned at birth or binary (CGAs who identify as lesbian, gay, versus nonbinary identities suicidal behavior into 22 adulthood.13,14 Initial reports have or bisexual), a population with compared with CGAs. elevated risk for experiencing revealed higher risk for suicidal 23 behavior among TGAs who report childhood abuse. Similar findings In the current study, we investigate childhood abuse.15 Given the were reported in a sample of disparities in childhood abuse extremely high rates of suicidal lesbian, gay, bisexual, and between TGAs and CGAs within a ideation and behavior observed transgender youth and young large nationwide sample of 24 within samples of TGAs, greater adults. In only one previous study adolescents in the United States. attention to this population’s has childhood abuse among TGAs Because sexual minority CGAs are psychosocial experiences, which been compared with a subsample of known to have an elevated risk of could underlie their CGAs that was not limited to sexual childhood abuse compared with 25 disproportionate rates of mental minority CGAs. Using a statewide heterosexual CGAs, we compare TGAs health problems, is needed. survey of adolescents, the Minnesota and sexual minority CGAs separately Student Survey, Baams25 reported with heterosexual CGAs. Additionally, Furthermore, TGAs could be at TGAs were more likely than non- we used the recommended two-item elevated risk for enduring abuse TGAs to report psychological or approach to measure gender identity 2 THOMA et al Downloaded from www.aappublications.org/news by guest on September 27, 2021 by assessing both the sex assigned at Advertisements were served gender identities they currently birth and current gender identity 377 469 times, and 8747 clicks were identify with from the following with a number of different identity recorded (2.48% click-through