Mental Health Comorbidities and Outcomes in Transgender and Gender Nonconforming Patients With Inflammatory Bowel Disease

Background:
Prior studies have demonstrated high rates of mental health comorbidities in transgender and gender nonconforming (TGNC) individuals as well as patients with inflammatory bowel disease (IBD). The prevalence and characteristics of mental health comorbidities in TGNC patients who also have IBD is unknown.
Methods:
This was an IRB-approved, retrospective, multicenter study across 5 tertiary care IBD centers. Adult TGNC IBD patients were identified through the electronic medical record (EMR) by use of demographic data (including self-reported gender identity, where available) and ICD-10 diagnoses. Records were reviewed for clinical characteristics and outcomes. Mental health diagnoses were identified by ICD-10 codes, psychiatric medication use was determined by electronic medication list, and involvement in mental health therapy was determined by review of clinical notes. Use of gender-affirming hormone (GAH) therapy was determined by review of medication list and clinical notes. Depression screening was performed in the year prior to GAH start and the year after GAH start with the Patient Health Questionnaire (PHQ-2, PHQ-8, and PHQ-9), a validated tool with cutoff values of PHQ-2 ≥3, PHQ-8 ≥10, and PHQ-9 ≥10 to identify at least moderate depressive symptoms. Statistical analysis was performed using 2 sample t-test with unequal variances.
Results:
115 TGNC IBD patients were included in this study. The median age was 29 years (range 18-69). 48 patients (42%) were transgender women, 36 (31%) were transgender men, and 31 (27%) were gender nonconforming. Most patients (93%) were white, and the majority had commercial insurance (68%). 98/115 patients (85%) had a diagnosed mental health comorbidity—82 (71%) had anxiety, 74 (64%) had depression, 9 (8%) had bipolar disorder, 11 (10%) had PTSD and 17 (15%) had other mental health conditions. Most patients (99/115, 86%) received GAH therapy and 85/99 (86%) of patients had an IBD diagnosis prior to starting GAH therapy. Median age at GAH start was 23.5 years (range16-60). Of the 98 total patients with a mental health diagnosis, 66 (67%) were prescribed a psychiatric medication and 58 (59%) had seen a mental health provider. PHQ scores in the year after GAH start (n=16, mean 6.2 ± 6.3) were significantly lower than PHQ scores in the year prior to GAH start (n=8, mean 12.4 ± 6. 5, p=0.04).
Conclusions:
This multicenter study found the prevalence of mental health comorbidities in TGNC IBD patients far exceeds the prevalence of mental health conditions in the general US population and the US IBD population. This study also found that depressive symptoms, as measured by PHQ, improved after GAH start. Screening TGNC patients for mental health comorbidities in the IBD clinic is crucial to properly identify individuals who may benefit from additional mental health resources and support.