How is everyone doing? Baseline psychological distress and adaptive functioning among transgender, nonbinary, and cis youth presenting for intensive outpatient psychiatric services.

Abstract

Psychological and psychosocial functioning of binary transgender and nonbinary youth has been understudied in settings treating individuals at risk for psychiatric hospitalization. Further, little is currently known about potential differences in baseline levels of psychiatric distress and adaptive functioning across gender-diverse youth and their psychiatrically distressed cisgender counterparts. Key differences may elucidate avenues for adapted treatment and protocols among youth presenting for psychiatric care. Archival data of 426 youth (M age = 14.94, SD = 1.5 years) referred to a psychiatric Intensive Outpatient Program (IOP) were used to examine differences in self-reported domains of psychological (e.g., depression, anxiety, Posttraumatic Stress Disorder [PTSD], emotion dysregulation) and psychosocial (e.g., parental and interpersonal relations) functioning across gender. The group included N = 272 cisfemale (64.1%), N = 137 cismale (32.2%), N = 10 transgender (2.3%) and N = 7 nonbinary (1.6%) self-identified youth. Cismales reported the lowest levels of distress and highest levels of adaptive functioning as compared to the other groups, whereas binary transgender and cisfemale youth did not significantly differ across any measured domain. Nonbinary youth reported higher levels of anxiety, hyperactivity, psychological inflexibility, and inadequacy than cisfemales, but largely did not differ from binary transgender youth. Beyond statistical comparisons, nonbinary youth demonstrated globally elevated levels of psychiatric distress and compromised adaptive functioning, with most ratings falling in the clinically significant and/or at-risk ranges. Results highlight the need for clinicians to carefully attend to unique needs of nonbinary youth and for future research to expand upon our preliminary findings. Clinical implications are discussed. Impact StatementNonbinary and binary transgender youth are overrepresented in intensive outpatient psychiatric settings. They report elevated levels of psychiatric distress and lower levels of adaptive functioning when compared with clinic-referred cisgender counterparts, with special concerns for nonbinary youth. Education on the Minority Stress Model as well as special considerations for intervention and psychosocial assessment are warranted in intensive outpatient treatment settings.

Demystifying treatment disposition patterns for psychiatrically high-risk youth referred for intensive outpatient psychiatric services: The role of demographics and telehealth

“…), and previous treatment history (e.g., number of previous hospitalizations) may further inform treatment disposition. Future work should also examine nuances related to gender, as only documented sex was available, limiting our ability to clarify potential discrepancies among gender diverse and expansive youth treated in IOP settings (Childs et al, 2022). Finally, the race/ethnicity variable was collapsed for analytic purposes.…”

“…This study examined archival records of 744 youth (M age = 14.91, SD = 1.60) who were admitted to [INSTITUTION A] adolescent psychiatric IOP between January 25 th , 2016, and June 4 th , 2021. As documented elsewhere (Childs et al, 2020(Childs et al, , 2022, the program provides comprehensive psychiatric services for a transdiagnostic population of youth aged 12 to 18 presenting with moderate to high levels of psychiatric distress in a predominately group-based format. Youth enrolled receive 4 days per week of IOP services, with at least 3.5 hours of clinical treatment per service day.…”

“…Additionally, all caregivers have at least two focused sessions during the IOP admission with their youth and primary treater for family psychotherapy, psychoeducation, and treatment planning. Treatment duration is approximately 6 weeks, though may periodically be lengthened (e.g., 8 weeks) or shortened (e.g., 4 weeks) according to patient needs (Childs et al, 2022).…”

Cognitive Disengagement Syndrome–Clinical Interview (CDS-CI): Psychometric support for caregiver and youth versions.

“…The BASC-3 is a reliable and well-validated multidimensional measure to evaluate emotional and behavioral functioning in children. As in other studies examining ADHD symptom dimensions (Barden et al, 2023; Childs et al, 2022), the BASC-3 Self-Report of Personality Attention Problems and Hyperactivity clinical scales were used to have self-report measures of ADHD-IN and ADHD-HI. The BASC-3 parent and adolescent self-report scales of global functional impairment were used as our measures of impairment.…”

“…The second objective used a multitrait (CDS, ADHD-IN, and ADHD-HI) by multimethod (clinical interview and rating scale) by multisource (parents and adolescents) matrix with Pearson correlations to evaluate the convergent and discriminant validity of the CDS-CI scores (Campbell & Fiske, 1959;Eid et al, 2023). Figure 1 shows this matrix.…”