Online interventions for the mental health needs of trans and gender diverse young people

Transgender (trans) young people experience many additional pressures compared to their non-trans (ie, cisgender) peers, including discrimination, harassment, victimisation, and marginalisation.1Grossman AH D'Augelli AR Transgender youth: invisible and vulnerable.J Homosex. 2006; 51: 111-128Crossref PubMed Scopus (437) Google Scholar Members of our research team have done an online survey (Trans Pathways) exploring the mental health and care pathways of trans and gender diverse youth in Australia. Results from the 859 participants and 194 parents and guardians of trans youth indicate that nearly three quarters of trans young people have been diagnosed with depression or anxiety, and nearly half have attempted suicide.2Strauss P Cook A Winter S Watson V Wright Toussaint D Lin A Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Telethon Kids Institute, Perth, Australia2017Google Scholar These figures highlight the importance of young trans people accessing support and early intervention services; however, trans young people are confronted with many barriers to uptake of services, including accessibility, cost, perceived stigma, potential refusal of care, transphobia, discrimination, and insufficient provider knowledge, experience, or sensitivity.2Strauss P Cook A Winter S Watson V Wright Toussaint D Lin A Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Telethon Kids Institute, Perth, Australia2017Google Scholar From the perspective of trans youth, this restricted access to competent health service providers only reinforces their relative marginality in society.1Grossman AH D'Augelli AR Transgender youth: invisible and vulnerable.J Homosex. 2006; 51: 111-128Crossref PubMed Scopus (437) Google Scholar An alternative or complement to face-to-face health services for trans young people is the use of web-based (eHealth) or mobile (mHealth) mental health interventions. Online interventions might be particularly suited to this population given that trans youth commonly experience isolation and stigma,1Grossman AH D'Augelli AR Transgender youth: invisible and vulnerable.J Homosex. 2006; 51: 111-128Crossref PubMed Scopus (437) Google Scholar which might interfere with seeking out traditional forms of support. Moreover, for some trans youth living in rural and remote communities (where there are often no gender clinics), or for those who are not "out" or lacking parental support, technology might enable access to appropriate and culturally sensitive services for the first time. Emerging evidence indicates the broad acceptability of online interventions for trans young people. Most trans young people are skilful users of the internet and report using online activities to make themselves feel better.2Strauss P Cook A Winter S Watson V Wright Toussaint D Lin A Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Telethon Kids Institute, Perth, Australia2017Google Scholar The anonymity of the internet affords trans young people the opportunity to safely explore their gender identity, share likeness with others, and even potentially expand identities formed online into offline life.3Craig SL McInroy L You can form a part of yourself online: the influence of new media on identity development and coming out for LGBTQ youth.J Gay Lesbian Ment Health. 2014; 18: 95-109Crossref Scopus (169) Google Scholar Although it is encouraging that the effectiveness of online interventions is well established in cisgender young people,4Calear AL Christensen H Review of internet-based prevention and treatment programs for anxiety and depression in children and adolescents.Med J Aust. 2010; 192: S12-S14PubMed Google Scholar and is emerging for sexual minority youth,5Lucassen MF Merry SN Hatcher S Frampton CM Rainbow SPARX: a novel approach to addressing depression in sexual minority youth.Cogn Behav Pract. 2015; 22: 203-216Crossref Scopus (71) Google Scholar there are still no evidence-based interventions of this nature aimed specifically at gender diverse young people. Whether trans young people derive equal or less benefit—or potential harms—from these programmes compared with their cisgender peers is unknown. The Trans Pathways survey showed that almost half of trans young people describe their gender in non-binary terms.2Strauss P Cook A Winter S Watson V Wright Toussaint D Lin A Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Telethon Kids Institute, Perth, Australia2017Google Scholar Thus, whether the gender-binary nature of existing interventions affects their uptake, acceptability, or feasibility in trans young people is also unclear. Pending outcomes of empirical investigation, we must establish whether current interventions should be used or adapted, or if novel programmes are necessary to achieve meaningful outcomes in this population. In the future, developers of mental health interventions for young people might also wish to consider using gender non-binary characters and content to enhance generalisability and acceptability. To ensure that not only the literature informs these interventions, but also the lived experience of those individuals who will use them, the inclusion of trans young people in the design, development (or adaptation), and implementation of online mental health resources will be crucial. For more on the Trans Pathways survey see https://www.telethon kids.org.au/transpathways For more on the Trans Pathways survey see https://www.telethon kids.org.au/transpathways We declare no competing interests.