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Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system

Abstract

Purpose

Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination.

Methods

We used data on substance use, depressive symptoms, suicidality, and social–structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social–structural factors, and suicidality.

Results

A three-class LCA solution identified a subset of student respondents in a “high use” latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28–1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35–17.71) were associated with increased odds of “high use” class membership relative to the “no use” class membership. “High use” class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75–2.94), plans (aOR: 2.59; 95% CI: 2.01–3.36), and attempts (aOR: 6.85; 95% CI: 3.17–15.68).

Conclusion

The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.

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Acknowledgements

EL would like to thank the Black Health Scholars Network and the E2 Social Epidemiology Lab for their support of this work. The authors would like to thank Adam Mally with his assistance with figure preparation.

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The authors did not receive support from any organization for the submitted work.

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Lett, E., Abrams, M.P., Moberg, E. et al. Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system. Soc Psychiatry Psychiatr Epidemiol (2022). https://doi.org/10.1007/s00127-022-02348-1

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Keywords

  • Suicide
  • Syndemic
  • Transgender and gender diverse youth
  • Depression
  • Substance use
  • Health inequities