6 - (IOP 32) Longitudinal Trajectories of Family Support and Their Impact on the Mental Health of Transgender Youth: A Mixed Methods Analysis

Transgender (trans) youth experience adverse mental health outcomes, with family support established as a protective factor. This study aims to identify patterns of change in general family support and gender-specific parent support for trans youth over the span of adolescence into emerging adulthood and youth perspectives of the impact and mechanisms of those changes. Trans youth, 12 - 18 years, who initiated care at a multidisciplinary gender-affirming clinic in Dallas, Texas before the age of 18 (n=617) completed self-report measures for annual follow-up and included the Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Parental Attitudes of Gender Expansiveness (PAGES), Quick Inventory of Depressive Symptomology, Screen for Child Anxiety Related Disorders, Generalized Anxiety Disorder-7 and the Pediatric Quality of Life Inventory. Using growth mixture models and four waves of data, trajectories were anchored on ages 12 to 21 years. A 3-class solution was retained for MSPSS, and a 2-class solution was retained for PAGES. For MSPSS, two classes emerged showing stable support, both above median, with one class demonstrating relatively higher support than the other, and the third class demonstrated a curvilinear trajectory with an initial decrease in middle adolescence then an increase entering adulthood. PAGES classes showed relatively stable support with some curvilinearity in middle adolescence such that the class with relatively lower gender-specific support experienced a decline in middle adolescence, and the higher PAGES class demonstrated an increase in support during middle adolescence. ANOVAs and T-tests for the MSPSS and PAGES respectively were run to compare differences in age and mental health outcomes among classes. Demographic differences were compared with χ² analyses. Among MSPSS classes, there were significant differences in age at baseline with the curvilinear support class having an older average baseline age compared to the higher stable support class. There was a significant difference in age between PAGES classes such that the higher support class had a lower mean age at baseline compared to the moderately high support group. Results indicated significant differences in QOL and anxiety change scores among the MSPSS classes. Those in the curvilinear class had significantly less change in QOL compared to the higher stable class. Those in the curvilinear class had significantly less change in anxiety in comparison to both stable classes. Virtual interviews of 13 trans youth aged 19 to 23 were conducted discussing family support and significant developmental experiences from ages 12 to 21 years. Qualitative data was coded by two individuals and examined using Thematic Analysis. Four themes emerged from 36 codes. Themes emerged representing identity-related experiences, developmental experiences, mental health experiences, and parent-level factors impacting support. Parent-level factors impacting support included two subthemes describing factors improving support and factors hindering support. All participants described some form of general parent support and gender-specific support as well as mental health difficulties altering their perceived support levels.