Disparities in disordered eating between gender minority and cisgender adolescents.

OBJECTIVE: Adolescence is a developmental period of increased risk for disordered eating. Gender minority adolescents (GMAs), or those whose gender identity does not align with their sex assigned at birth, may experience body image concerns related to unique gender-related stressors. GMAs may use disordered eating to affirm a feminine, masculine, or nonbinary gender identity. However, little is known about differences in disordered eating between GMAs and cisgender adolescents. Therefore, this study had two primary goals: (a) to compare disordered eating between GMAs and cisgender adolescents by examining the role of gender identity and sex assigned at birth; and (b) within GMAs, to examine associations between gender identity congruence and disordered eating. METHOD: A large U.S. sample of GMAs and cisgender adolescents (n = 1,191 GMAs; 919 cisgender; Mage = 15.93 years) reported their disordered eating on an anonymous online survey. RESULTS: A MANOVA revealed a significant interaction between gender identity and sex assigned at birth. Follow-up ANOVAs demonstrated that purging, caloric restriction, excessive exercise, and muscle building differed as a function of gender identity and sex assigned at birth. Among GMAs, a multiple multivariate regression model demonstrated that disordered eating was lower among participants who reported greater gender identity congruence. DISCUSSION: GMAs should not be considered a homogenous group, as differences in gender identity may lead to the internalization of different appearance ideals and disparate eating disorder symptomatology. Results suggest that clinicians working with GMAs consider the unique body image concerns that could accompany a specific gender identity.

Depressive Symptoms Assessed Near the End of Pregnancy Predict Differential Response to Postpartum Smoking Relapse Prevention Intervention.

BACKGROUND: Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown. PURPOSE: We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions. METHODS: Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum. RESULTS: End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect. CONCLUSION: Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components. CLINICAL TRIAL REGISTRATION: NCT00757068.

The Gender Minority Youth Study: Overview of Methods and Social Media Recruitment of a Nationwide Sample of U.S. Cisgender and Transgender Adolescents.

Recent research has documented significant mental health disparities for transgender adolescents. However, the extant literature is hindered by vague operationalizations of gender identity and limited measurement of trans-specific stressors. In this article, we (1) introduce and describe the Gender Minority Youth (GMY) Study, a large-scale study of transgender youth disparities; and (2) provide evidence of the feasibility of using social media to recruit a diverse sample of U.S. transgender and cisgender youth. Facebook and Instagram advertisements targeted 14-18-year-old adolescents to complete an online survey. Participants (N = 3318) self-reported gender assigned at birth and current gender identity, mental health symptoms, and transgender-specific stressors and milestones. Adolescents included 1369 cisgender (n = 982 cisgender female; n = 387 cisgender male), 1938 transgender (n = 986 transgender male; n = 132 transgender female; n = 639 nonbinary assigned female at birth; n = 84 nonbinary assigned male at birth; n = 84 questioning gender identity assigned female at birth; n = 13 questioning gender identity assigned male at birth), and 11 intersex youth. The GMY Study is the first nationwide sample of U.S. adolescents recruited specifically for a study of mental health disparities between transgender and cisgender youth. We demonstrate the feasibility of using social media advertisements and a waiver of parental permission to recruit a large sample of adolescents, including subsamples of gender minority youth. We remedied limitations in the existing literature by including appropriate measures of gender assigned at birth, current gender identity, and detailed questions about transgender-specific stressors and transition milestones.

Healthcare provider advice on gestational weight gain: uncovering a need for more effective weight counselling.

Limited research has examined the factors related to knowledge of gestational weight gain (GWG) recommendations and the receipt of advice from healthcare providers regarding GWG recommendations among women with pre-pregnancy overweight/obesity. Women with pre-pregnancy overweight/obesity (N = 191) reported the amount of gestational weight they believed they should gain and that healthcare providers advised them to gain. Only 24% (n = 46) of women had a correct knowledge of GWG recommendations. Women were less likely to have a correct knowledge of GWG recommendations if they had pre-pregnancy obesity, were of a minority race, or were socioeconomically disadvantaged. Meanwhile, only 17% (n = 32) of women reported being correctly advised about GWG recommendations by healthcare providers. There were no differences between women who did and did not report being correctly advised about GWG recommendations from healthcare providers. These findings indicate that women with pre-pregnancy overweight/obesity lack knowledge of GWG recommendations and report being incorrectly advised about GWG recommendations from healthcare providers. Impact statement What is already known on this subject? Extant literature indicates that women's knowledge of gestational weight gain (GWG) recommendations and women's receipt of information from their healthcare providers regarding GWG recommendations are predictive of meeting the Institute of Medicine guidelines for GWG. What do the results of this study add? Findings from the present study indicate that the majority of women with pre-pregnancy overweight/obesity lack knowledge of GWG recommendations and report that education on GWG recommendations from healthcare providers is an aspect of their prenatal care that is largely insufficient. Although there were no differences between women who did and did not report being correctly advised about GWG recommendations by healthcare providers, women were less likely to have a correct knowledge of GWG recommendations if they had pre-pregnancy obesity, were of a minority race, or were socioeconomically disadvantaged. What are the implications of these findings for clinical practise and/or further research? These findings highlight a need for more effective tailoring of prenatal care to ensure that women receive accurate advice from healthcare providers regarding GWG recommendations.

Mind-body interactions in the regulation of airway inflammation in asthma: A PET study of acute and chronic stress.

BACKGROUND: Psychological stress has long been recognized as a contributing factor to asthma symptom expression and disease progression. Yet, the neural mechanisms that underlie this relationship have been largely unexplored in research addressing the pathophysiology and management of asthma. Studies that have examined the mechanisms of this relationship in the periphery suggest that it is the superimposition of acute stress on top of chronic stress that is of greatest concern for airway inflammation. METHODS: We compared asthmatic individuals with high and low levels of chronic life stress in their neural and peripheral physiological responses to the Trier Social Stress Test and a matched control task. We used FDG-PET to measure neural activity during performance of the two tasks. We used both circulating and airway-specific markers of asthma-related inflammation to assess the impact of acute stress in these two groups. RESULTS: Asthmatics under chronic stress had a larger HPA-axis response to an acute stressor, which failed to show the suppressive effects on inflammatory markers observed in those with low chronic stress. Moreover, our PET data suggest that greater activity in the anterior insula during acute stress may reflect regulation of the effect of stress on inflammation. In contrast, greater activity in the mid-insula and perigenual anterior cingulate seems to reflect greater reactivity and was associated with greater airway inflammation, a more robust alpha amylase response, and a greater stress-induced increase in proinflammatory cytokine mRNA expression in airway cells. CONCLUSIONS: Acute stress is associated with increases in markers of airway inflammation in asthmatics under chronic stress. This relationship may be mediated by interactions between the insula and anterior cingulate cortex, that determine the salience of environmental cues, as well as descending regulatory influence of inflammatory pathways in the periphery.

Perceived Gender Transition Progress, Gender Congruence, and Mental Health Symptoms Among Transgender Adolescents.

PURPOSE: Transgender adolescents (TGAs) have high risk for experiencing mental health problems, but little is known about how aspects of gender identity relate to their mental health symptoms. Evidence from child and adult samples of transgender individuals indicates making progress in gender transition milestones and higher levels of congruence between gender identity and gender expression are related to fewer mental health problems. We examined associations between perceived transition progress, gender congruence, and mental health symptoms in a diverse, nationwide sample of TGAs. METHODS: TGAs (n = 1,943) participated in a cross-sectional online survey. Perceived gender transition progress, gender congruence, and depressive and anxiety symptoms were assessed. Path analysis was conducted to examine whether transition progress was related to mental health symptoms via higher levels of gender congruence. RESULTS: Most TGAs had undertaken at least one social transition step (98%), but only 11% had taken medical transition steps. Higher gender congruence was associated with lower mental health symptoms. Greater transition progress was associated with higher gender congruence, and perceived transition progress evidenced negative indirect associations with mental health symptoms. TGAs identifying with binary identities (transmasculine and transfeminine youth) reported lower levels of transition progress and gender congruence compared to other subgroups of TGAs. DISCUSSION: Higher levels of perceived transition progress and gender congruence are related to lower mental health symptoms among TGAs. Mental health interventions tailored to the unique developmental needs of TGAs are needed given high risk for mental health problems within this population, and interventions addressing transition progress and gender congruence should be examined.

Measurement-based care for suicidal youth: Outcomes and recommendations from the Services for Teens At Risk (STAR) Center.

Measurement-based care has demonstrable benefits, but significant implementation barriers slow dissemination in real-world clinical settings, especially youth behavioral health care. Here, we describe use of measurement-based care in a specialty clinic offering a continuum of outpatient care for suicidal youth. We characterize strategies used to facilitate measurement-based care in this population and ways in which challenges to implementation have been addressed. We examined adherence to measurement-based care procedures relative to treatment engagement data from electronic medical records, as well as data from clinicians regarding acceptability and utility of measurement-based care. Results suggest that measurement-based care is both feasible and acceptable for use with suicidal youth. Here we provide future directions in measurement-based care in this, and other, behavioral health settings.

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents.

Gender minority (GM) youth are at heightened risk for psychopathology, purportedly due to their experiences of GM stressors. However, few studies have examined how GM stressors are associated with depression and anxiety among GM youth. Furthermore, no prior studies have investigated how experiences of GM stressors differ across gender identity and race/ethnicity within a diverse sample of GM youth. A nationwide online cross-sectional survey of 1,943 fourteen- to 18-year-old GM adolescents (66.91% White, 11.73% multiracial, 8.49% Latinx, 7.10% Black, 3.09% Asian, 1.49% American Indian/Alaskan Native) in the United States assessed GM stressors (prejudice events, expectations of rejection, internalized transnegativity, and concealment) and mental health. Structural equation modeling was used to examine how GM stressors and depressive and anxiety symptoms differ across gender identity and race/ethnicity. Higher levels of each GM stressor were related to higher depressive symptoms. Prejudice events, expectations of rejection, and concealment were related to higher anxiety symptoms. Transmasculine and transfeminine youth reported higher levels of GM prejudice events and expectations of rejection, and higher mental health symptoms, than nonbinary youth. Findings were relatively consistent across racial/ethnic identities, with the exception that Black GM adolescents reported fewer GM prejudice events and expectations of rejection and indirectly exhibited lower mental health symptoms as compared to White GM youth. Researchers and clinicians should be attuned to how intersectional identities are related to stress and mental health among diverse GM youth. Recommendations for individual and structural-level interventions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An intensive outpatient program for suicidal college students.

Objective: College counseling centers (CCCs) have limited capacity to accommodate high-risk students who need more intensive care than traditional outpatient treatment. We describe an Intensive Outpatient Program (IOP) to meet the specialized needs of suicidal undergraduates. Participants: Suicidal undergraduates aged 18-24. Methods: Fact-gathering meetings with local universities confirmed high need for prompt access to IOP care for students presenting in crisis at CCCs and emergency rooms, and post-inpatient discharge. We thus iteratively designed and implemented the College Option Services for Teens at Risk (COSTAR) IOP. Results: The 6-week program includes initial diagnostic evaluation and risk assessment followed by weekly skills groups, individual therapy, and medication management. Between September 2017 and January 2020, 148 students (M age = 19.7) attended an average of 5.7 COSTAR group sessions (SD = 4.7). Conclusions: A specialty IOP for suicidal college students holds promise in a stepped care approach for at-risk college students.

Examining Sexual Behavior Among U.S. Transgender Adolescents.

The health of transgender adolescents (i.e., those identifying with a gender other than their sex assigned at birth) is gaining attention from researchers, yet little work has examined normative sexual behaviors among this population. Self-identified gender minority adolescents, including those identifying as trans boys, trans girls, nonbinary, and questioning their gender identity (age range 14-18, Mage = 16, n = 1,223) from all 50 U.S. states responded to anonymous online surveys. Participants reported on their age of initiation and number of sexual partners for four sexual behaviors ranging in intimacy (i.e., sexual touching, oral sex, vaginal sex, and anal sex). Participants also indicated the gender of their sexual partners and experiences with sexually transmitted infections (STIs), STI tests, and pregnancy. Overall, transgender adolescents' age of initiating sexual behaviors and number of sexual partners are similar to those observed in prior studies of cisgender adolescents. No differences were found between gender identity subgroups on ever engaging, age of initiation, number of partners, and gender of partners across the four sexual behaviors, with some exceptions for anal sex. Participants reported low rates of STIs and pregnancy, but also low rates of STI testing. Implications for sex education and health care are discussed.

Disparities in Childhood Abuse Between Transgender and Cisgender Adolescents.

BACKGROUND AND OBJECTIVES: Transgender adolescents (TGAs) exhibit disproportionate levels of 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 = 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] = 1.84), physical abuse (OR = 1.61), and sexual abuse (OR = 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.

Sleep among gender minority adolescents.

STUDY OBJECTIVES: Stigmatized youth experience poorer sleep than those who have not experienced stigma. However, no studies have examined the sleep of gender minority adolescents (GMAs). Examining sleep disparities between GMAs and non-GMAs is critical because poor sleep is associated with mental health outcomes experienced disproportionately by GMAs. We examined sleep duration, sleep problems, and sleep quality among our sample and compared these parameters between GMAs and non-GMAs. METHODS: Adolescents aged 14-18 years (n = 1,027 GMA, n = 329 heterosexual non-GMA, n = 415 sexual minority non-GMA; mean age = 16 years; 83% female sex at birth) completed a cross-sectional online survey, reporting sex assigned at birth and current gender identity, sleep duration, sleep problems (too much/too little sleep and inadequate sleep), sleep quality, and depressive symptoms. RESULTS: Accounting for demographic covariates, GMAs were more likely to report inadequate sleep and shorter sleep duration and had higher odds of reporting poor sleep quality and getting too little/too much sleep than heterosexual non-GMAs. After also adjusting for depressive symptoms, the finding that GMAs more often reported poor sleep quality remained significant. CONCLUSIONS: This first large, nationwide survey of sleep among GMAs suggests that GMAs may be more likely to have poor sleep than non-GMAs. The significance of our results was reduced when adjusting for depressive symptoms, suggesting that poorer sleep may occur in the context of depression for GMAs. Future work should include objective measures of sleep, examine the emergence of sleep disparities among GMAs and non-GMAs, and explore pathways that increase risk for poor sleep among GMAs.

Psychosocial correlates of body esteem and disordered eating among sexual minority adolescent girls.

The present study examined whether body esteem mediates the associations between psychosocial factors, including peer victimization and parent-adolescent relationship quality, and multiple categories of disordered eating (DE) within a diverse sample of adolescent sexual minority (SM) girls. Participants were 528 girls, aged 14-18 years, recruited as part of a larger online study on LGBTQ + adolescent health. Participants anonymously completed self-report measures of parent-adolescent relationship quality, sexual orientation-based victimization, body esteem, and DE behaviors, including binge eating, purging, and caloric restriction. Parent-adolescent relationship quality was positively associated with SM adolescent girls' body esteem, and some aspects of body esteem subsequently mediated the associations between parent-adolescent relationship quality and DE behaviors. Experiences of sexual orientation-related victimization were also positively related to endorsement of caloric restriction. However, no significant indirect effects were observed between sexual orientation-related victimization and DE via body esteem. These results suggest parents could influence their SM daughters' DE behaviors via body esteem, and SM girls may be engaging in caloric restriction if they experience victimization, regardless of their body esteem.

Exploring transgender adolescents' body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth.

Transgender adolescents (TGAs) face many of the same sociocultural and biological influences on body dissatisfaction and disordered eating as cisgender peers. Additionally, TGAs experience unique body- and gender-related concerns. The purpose of this study is to explore the nuances of gender identity, gender transitioning, body image, and disordered eating among TGAs. Case summaries and a synthesis of key themes are presented from interviews with nine TGAs aged 16-20 (Mage = 17). All participants reported engaging in at least one behavior to change their weight or shape. Consistent with a theoretical biopsychosociocultural model we proposed, TGAs described body dissatisfaction and disordered eating related to transgender-specific factors (e.g., behaviors aimed at minimizing secondary sex characteristics) and broader developmental and sociocultural factors. Some participants reported improvements in body image and disordered eating following gender transition. The interviews highlight complex associations among gender identity, gender transitioning, body image, and disordered eating during adolescence, suggesting that disentangling transgender-specific factors from other individual factors is difficult. These findings may guide future research on the prevalence and functions of disordered eating among TGAs and point to a unique set of needs for effective detection and treatment of concurrent gender incongruence, body dissatisfaction, and disordered eating.

Group Intervention for Young Adults With Mood and Anxiety Disorders Transitioning to College.

Young adults with chronic mood and anxiety disorders may receive a range of services in pediatric care (eg, psychiatry, therapy) and within the school system (eg, individualized education plans). Such services rely on the involvement of parents or guardians to support youth (eg, attending appointments, administering medications). However, in college, young adults are often on their own and need to assume responsibility for scheduling appointments, obtaining and taking medications, and seeking out additional services (eg, accommodations). Unfortunately, many young adults may not have developed the skills needed to navigate campus and health care systems effectively, which can often lead to dire consequences. Adding to these difficulties are the high rates of depression and suicidal ideation observed in today's college students. Many students need intermediate levels of care to stay in school successfully, although not all have the maturity and skills to navigate health care without a transition plan. To address the needs of young adults transitioning out of pediatric mental health care, we developed a brief group intervention delivered to young adults and their parents during the 6 months before college or transition to living independently in the community. The transition group program structured sessions focused on scaffolding knowledge about one's own skills (and deficits) related to independent living, successful transition to college or community, and ability to independently manage a chronic mental health disorder. All young adults and parents reported that they would recommend or strongly recommend the group to a friend, and the majority found the group to be acceptable with regard to length and frequency. For both young adults and parents, the future outlook also improved from pregroup to postgroup.

Mental health among sexual and gender minority adolescents: Examining interactions with race and ethnicity.

OBJECTIVE: Sexual and gender minority (SGM) adolescents report elevated risk for psychopathology. Identifying as a racial/ethnic minority and sexual minority (SM) or gender minority (GM) may lead to greater stress/discrimination and psychopathology. We examined nonsuicidal self-injury, suicide ideation, and suicide attempts (i.e., self-injurious thoughts and behaviors [SITBs]) and depressive symptoms across intersections of sexual orientation, gender, and race/ethnicity. METHOD: Study participants consisted of a large (n = 2,948; 59% GM) sample of adolescents aged 14-18 who were recruited online to complete a cross-sectional survey. SGM status, race/ethnicity, and their interactions were used to predict depressive symptoms and SITBs. Associations among race/ethnicity and GM-specific psychosocial factors were assessed. RESULTS: SM (B = 3.75) and GM (B = 8.81) participants reported higher depressive symptoms and SITB histories (odds ratios [ORs] from 1.92 to 2.43 and 2.87 to 5.44, respectively). Asian participants were less likely to report nonsuicidal self-injury (OR = 0.45), and Latinx participants were more likely to report suicide attempts (OR = 1.50). Although omnibus tests of interactions were largely insignificant, exploratory analyses revealed fewer depressive symptoms (B = -8.40) and SITBs (ORs from -0.95 to -2.05) among Black SM participants and, at times, Black GM participants. This protective effect may relate to lower self-reported expectations of rejection due to gender. CONCLUSIONS: GM participants reported the highest risk for depressive symptoms and SITBs. Contrary to hypotheses, multiple minority identification was not associated with greater psychopathology. Future research, assessing specific sexual and gender identities across diverse samples, is needed to highlight how race affects psychopathology risk across these identities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Interpersonal Relationships and Suicidal Ideation in Youth with Bipolar Disorder.

This study examines how relationship quality in family and peer domains are associated with suicidal ideation (SI) in youth with bipolar disorder (BP). We assessed 404 Course and Outcome of Bipolar Youth study participants for psychiatric disorders and SI at intake and for family/peer relationships the month after intake. Multivariate logistic regression examined associations between relationships and SI, controlling for significant covariates. There were 144 youth (36%) who reported SI at intake; bivariate analyses indicated they had significantly worse family/peer relationships. Multivariate analyses showed that family/peer relationships were associated with current SI, controlling for significant covariates. Results support associations between poor relationships and SI in BP youth, regardless of current mood symptom severity. Clinicians should assess relationships when completing risk assessments with BP youth.

Suicidality Disparities Between Transgender and Cisgender Adolescents.

BACKGROUND AND OBJECTIVES: Emerging evidence indicates transgender adolescents (TGAs) exhibit elevated rates of suicidal ideation and attempt compared with cisgender adolescents (CGAs). Less is known about risk among subgroups of TGAs because of limited measures of gender identity in previous studies. We examined disparities in suicidality across the full spectrum of suicidality between TGAs and CGAs and examined risk for suicidality within TGA subgroups. METHODS: Adolescents aged 14 to 18 completed a cross-sectional online survey (N = 2020, including 1148 TGAs). Participants reported gender assigned at birth and current gender identity (categorized as 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 suicidality (passive death wish, suicidal ideation, suicide plan, suicide attempt, and attempt requiring medical care) and nonsuicidal self-injury were assessed. RESULTS: Aggregated into 1 group, TGAs had higher odds of all outcomes as compared with CGAs. Within TGA subgroups, transgender males and transgender females had higher odds of suicidal ideation and attempt than CGA groups. CONCLUSIONS: In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among TGAs and CGAs. TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt. Authors of future adolescent suicidality research must assess both gender assigned at birth and current gender identity to accurately identify and categorize TGAs.