Depression and Suicide Screening for Gender Diverse Youth: What Pediatric Primary Care Can Learn 

Rates of depression and suicide among young people in the United States have risen sharply over the past decade. For transgender and gender diverse (TGD) youth, the risk is even higher. Research consistently shows that TGD youth experience disproportionately high rates of depression, suicidal ideation, and suicide attempts compared to their cisgender peers. 

A 2025 study by Dover and colleagues examined an important question: Do standard depression and suicide screening tools work effectively for TGD youth in pediatric primary care? And once youth screen positive, do they receive equitable follow-up care? 

Their findings offer both reassurance and a clear call to action. 

The Study at a Glance 

The researchers conducted a retrospective chart review of 782 youth ages 10 to 18 who were screened for depression and suicide risk in two pediatric primary care clinics. Ninety-two of these youth, about 12 percent of the sample, were identified as transgender or gender diverse. 

All youth completed two widely used screening tools: 

• The Ask Suicide-Screening Questions (ASQ) to assess suicide risk 

• The Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms 

The researchers then examined screening results and whether youth accessed follow-up services, including integrated behavioral health (IBH), emergency department visits, and primary care clinician follow-up. 

TGD Youth Screened Positive at Much Higher Rates 

The results were clear. Compared to cisgender youth, TGD youth were significantly more likely to: 

• Screen positive for non-acute suicide risk 

• Screen positive for acute suicide risk 

• Screen positive for moderate depression 

• Report higher average depression scores overall 

For example, 32 percent of TGD youth screened positive for non-acute suicide risk compared to just 10 percent of cisgender peers. Nearly half of TGD youth met the cutoff for moderate depression, compared to 20 percent of cisgender youth. 

These findings align with broader research showing elevated mental health risk among TGD youth. Importantly, the study demonstrates that brief, universal screening tools like the ASQ and PHQ-9 can successfully detect that elevated risk in primary care settings. 

That matters. Many TGD youth do not have consistent access to specialty mental health care. Primary care may be the only point of contact with the healthcare system. 

What Happened After Screening? 

Screening is only the first step. The authors also looked at what happened next. 

Encouragingly, TGD youth were more likely than cisgender youth to receive same-day integrated behavioral health (IBH) consultation, regardless of screening results. This may reflect providers’ awareness of elevated risk or additional behavioral health concerns not captured by screening tools. 

Emergency department visits were rare overall, with only two suicide-related admissions in the entire sample. Both involved TGD youth, although the small numbers make it difficult to draw strong conclusions. 

The most concerning finding involved follow-up with primary care clinicians after a positive depression screen. Among youth who screened positive for depression, TGD youth were significantly less likely to have a primary care follow-up visit within one month compared to cisgender peers. 

However, there was a key nuance. When TGD youth received a same-day IBH consultation, the disparity in follow-up care disappeared. In other words, integrated behavioral health contact appeared to reduce inequities in follow-up. 

Why Integrated Behavioral Health May Matter 

Integrated behavioral health models place mental health professionals directly within primary care clinics. This allows for immediate consultation, assessment, and brief intervention. 

For TGD youth, this model may be especially important. Many report mistrust of healthcare systems, negative prior experiences, or barriers to accessing affirming mental health services. A warm handoff to an on-site behavioral health provider may reduce friction and improve engagement. 

The study suggests that same-day IBH consultation may help ensure that TGD youth receive appropriate follow-up care after positive screening results. Without that support, disparities may emerge. 

Clinical Implications 

Universal depression and suicide screening in pediatric primary care is likely to identify elevated risk disproportionately among TGD youth. That is not a flaw in the system. It reflects real disparities in mental health burden. 

The key question is whether primary care teams are prepared to respond effectively. 

The authors emphasize the importance of affirming care. TGD youth often disclose their gender identity for the first time in medical settings. Invalidating or stigmatizing responses can lead youth to avoid future care altogether. 

Primary care teams should be prepared to: 

• Use affirmed names and pronouns 

• Provide privacy when discussing sensitive topics 

• Explain procedures clearly and respectfully 

• Offer integrated behavioral health services when possible 

Screening without affirming follow-up risks doing more harm than good. 

Limitations and Future Directions 

The study was conducted within a single healthcare system and during the COVID-19 pandemic, which may limit generalizability. The TGD group was also relatively small, and the “other” gender category likely included diverse identities that could not be examined separately. 

Future research should include larger, more diverse samples and prospective data collection. It would also be valuable to examine how access to gender-affirming care and social support influences screening outcomes and follow-up engagement. 

A Clear Takeaway 

This study offers two important conclusions. 

First, common screening tools like the ASQ and PHQ-9 are effective in identifying depression and suicide risk among transgender and gender diverse youth in pediatric primary care. 

Second, integrated behavioral health services may play a critical role in reducing disparities in follow-up care. 

As rates of youth depression and suicide continue to rise, pediatric primary care remains a crucial front line. For TGD youth, who face elevated risk due to minority stress and systemic barriers, thoughtful screening paired with affirming, integrated care may be life-saving. 

Read the full article here. 

For pediatric primary care teams: If your practice is reviewing screening protocols or affirming-care workflows for TGD youth, we have clinicians who are experts to consult on gender-affirming and trauma-informed care.