BACKGROUND AND OBJECTIVES Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations. METHODS This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient's electronic medical record. RESULTS Based on data from 919 898 patients aged 9 to 18 years, adjusted mixed logistic regression indicated significantly greater odds of each MH diagnosis among those with ASD alone, GD alone, and cooccurring ASD/GD diagnoses compared with those with neither diagnosis. Youth with cooccurring ASD/GD were at significantly greater risk of also having anxiety (average predicted probability, 0.75; 95% confidence interval, 0.68-0.81) or depression diagnoses (average predicted probability, 0.33; 95% confidence interval, 0.24-0.43) compared with youth with ASD alone, GD alone, or neither diagnosis. CONCLUSIONS Youth with cooccurring ASD/GD are more likely to also be diagnosed with MH concerns, particularly anxiety and depression. This study highlights the need to implement developmentally appropriate, gender-affirming MH services and interventions for youth with cooccurring ASD/GD.

中文翻译：

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患有自闭症谱系障碍和性别不安的青少年的心理健康。

背景和目标 患有自闭症谱系障碍 (ASD) 或性别不安 (GD) 的青少年也被证明面临更大的心理健康 (MH) 问题风险；然而，很少有研究考虑 ASD 和 GD 同时发生如何可能加剧 MH 的担忧。本研究的目的是调查美国青少年群体中 ASD、GD 和 MH 诊断（焦虑、抑郁、饮食失调、自杀和自残）之间的关联。方法 这是对由 PEDSnet 学习卫生系统网络的 8 名儿科卫生系统成员形成的大型管理数据集的二次分析。分析包括描述性统计数据和调整后的混合逻辑回归模型，测试患者电子病历中记录的 ASD 和 GD 诊断组合与 MH 诊断之间的关联。结果基于 919 898 名 9 至 18 岁患者的数据，调整后的混合逻辑回归表明，与没有诊断的患者相比，仅患有 ASD、仅患有 GD 以及同时患有 ASD/GD 诊断的患者中，每种 MH 诊断的几率显着更高。患有 ASD/GD 的青少年同时患有焦虑症（平均预测概率，0.75；95% 置信区间，0.68-0.81）或抑郁症诊断（平均预测概率，0.33；95% 置信区间，0.24-0.43）的风险显着更高与仅患有 ASD、仅患有 GD 或两者均未诊断的青少年进行比较。结论 同时患有 ASD/GD 的青少年更有可能被诊断出患有 MH 问题，特别是焦虑和抑郁。这项研究强调需要为患有 ASD/GD 的青少年实施适合发育、性别肯定的 MH 服务和干预措施。