O4313: Suicidal Ideation in Transgender and Gender Diverse Youth in the Emergency Department

Background:

Background: Suicide among transgender and gender diverse (TGD) youth represents a national crisis. One in four high school youth who identify as a sexual or gender minority attempts suicide during a 6-month period, and nearly half of these youth seriously consider attempting suicide. In healthcare settings, research involving TGD individuals has historically been limited to specialized clinic populations or youth with gender-specific diagnostic codes documented in the electronic medical record (EMR). However, this approach likely significantly underestimates the prevalence of TGD youth in healthcare settings. To bridge this gap, one study utilized an EMR keyword search strategy to identify transgender youth, but this study did not identify other youth on the gender diversity spectrum. Our objective was to develop a novel keyword-based method for identifying TGD youth in the EMR and to employ this method to identify rates of suicidal ideation among TGD youth in the emergency department (ED).

Methods:

Methods: We conducted a retrospective cross-sectional study of ED encounters by TGD youth who received suicide screening at an urban tertiary children’s hospital from September 2019-August 2022. Suicide screening was conducted using Ask Suicide-Screening Questions (ASQ). TGD youth were identified using keyword searching. If any of 9 keywords (they/them, preferred name, pronouns, male-to-female, female-to-male, nonbinary, agender, transgender, gender dysphoria) were present in the ED note, the surrounding text was extracted and manually reviewed to determine whether the text conveyed TGD status.

Results:

Results: We identified 459 ED encounters by 342 unique TGD youth. Thirty-one percent of ED encounters by TGD youth contained just one keyword. TGD youth ranged from 8 to 23 years old and were 43% White, 33% Latinx, 11% Black, 5% Asian, and 7% other/two or more races. Of TGD youth, 39% were publicly insured and 50% resided in a neighborhood with a “low” or “very low” Child Opportunity Index category. Most identified ED encounters (77.5%) were for a mental health chief complaint. In 81% of encounters, TGD youth screened positive on the ASQ with 10% endorsing active suicidal ideation at the time of ED presentation.

Conclusion:

Conclusion: Use of a keyword-based method to identify TGD youth in the EMR revealed high rates of suicidal ideation, which may inform suicide prevention efforts. Future analyses will further characterize ED encounters by TGD youth, including characteristics associated with suicidal ideation and trends in rates of suicidal ideation over time.

This work was supported by Stanley Manne Children’s Research Institute at Ann and Robert H. Lurie Children’s Hospital of Chicago through the Mental Health Springboard Award (2022).