(PS6-21) Evaluating Differences in Course of Illness Between Cisgender and Transgender/Gender Diverse Individuals with Treatment Resistant Depression

Abstract Text: Introduction
Major Depressive Disorder (MDD) is a common psychiatric illness, affecting 17.3 million adults in the United States in their lifetime and is strongly linked with suicide, with up to 2/3 of suicide attempts (SAs) occurring among individuals with MDD. Despite the existence of several antidepressant medications, almost 1/3 of patients show partial or no response, and those failing at least two trials may be considered to have treatment-resistant depression. Those with TRD experience higher inpatient psychiatric hospitalizations and SAs rates. Similarly, transgender and gender diverse (TGD) individuals have higher rates of depression than their cisgender counterparts, potentially leading to more referrals to treatment centers for TRD. This study examines differences in depressive illness between TGD and cisgender TRD patients at the MGH Ketamine Clinic.
Methods
Data for the study was extracted by conducting chart review of patients receiving treatment at the MGH Ketamine Clinic. The sample included 314 participants (28 TGD, 286 cisgender). Ages ranged from 17-85 years old (M=46.75, + 16.63). Data collected included age of MDD onset, duration of current depressive episode (in months), past psychiatric hospitalizations, past SAs, past non-suicidal self-injurious behavior (NSSIB), and number of past/current medication trials.
Results
Independent samples t-tests were conducted to compare the mean differences between groups. TGD participants’ age was significantly lower than that of cis patients (M=34.14 + 10.9 vs M=47.38 + 16.6; t(40.44)=5.76, p< 0.001). Given the difference in age between the two groups, analyses were conducted by controlling and not for age.
Relative to cis patients, TGD patients reported shorter depressive episodes (60.09 days, + 89.28 vs. 20.53 days, + 24.73) and fewer past SAs (1.78, + 0.43 vs. 1.46, + 0.51). However, these differences were no longer significant when controlling for age. There were no significant differences in the age of onset of MDD or number of past hospitalizations between cis and TGD patients controlling and not controlling for age.
 
Logistic regression analyses, controlling for age, found that TGD patients had significantly lower odds of past SAs (OR=0.36, 95% CI [0.16, 0.81], p=0.014) and NSSIB (OR=0.35, 95% CI [0.15, 0.83], p=0.018) compared to cis patients. Differences in past hospitalizations were not significant (OR=0.79, 95% CI [0.34, 1.81], p=0.582).
Conclusion
TGD patients at the MGH Ketamine Clinic were significantly younger than cis patients. While cis patients appear to have more severe illnesses, this effect may be due to age. However, prevalence of SAs and NSSIB are higher in cis patients presenting for treatment, indicating a need for more individualized treatments in these areas. Younger mean ages in the TGD population seeking treatment may indicate that TGD patients experience more distress than their cis counterparts at a younger age. Alternatively, these findings may be due to older TGD patients having had more time to seek gender affirming care, allowing for a higher level of gender appearance congruity, and thus decreased symptom severity. Results may also suggest growing comfort of psychiatrists in referring TGD patients for treatments such as ketamine.