(PS1-B41) Examining Differences in Clinical Presentation in Individuals Presenting for Treatment Resistant Depression Based on Sexual Orientation and Gender Identity

Background: Sexual and gender minority (SGM) individuals are at heightened risk for psychopathology, including depressive disorders, and for greater psychiatric severity (Lefevor & Yanis, 2019; Rodriguez-Seijas et al., 2019). While nascent research has investigated how best to serve SGM individuals presenting at higher levels of care, no prior research has examined whether SGM individuals present with differing concerns than their cisgender heterosexual counterparts, or whether treatment recommendations for treatment resistant depression (TRD) differ as a function of SGM status. To address these gaps, the goals of the current study were to examine whether SGM and non-SGM individuals with TRD differed in clinical presentation and history, and whether there were differences in the primary treatment recommendation they received.

Methods: We used data from 254 individuals (202 cisgender heterosexual, 52 SGM) who presented for treatment consultation at a TRD program and consented to using their clinical data for research purposes. Patients completed a battery of clinician-administered and self-report measures, which were used to inform primary treatment recommendations (e.g., transcranial magnetic stimulation, electroconvulsive therapy, ketamine). We used chi-squared tests, t-tests and ANOVAs to compare SGM and cisgender heterosexual patients on demographics, clinical presentation, and treatment recommendations.

Results: Of the 254 patients, 20% identified as SGM. SGM patients presented to the TRD program at significantly younger ages than their cisgender heterosexual counterparts. Additionally, they were less likely to complete higher education, although they were more likely to be employed. Moreover, they presented with higher levels of suicidal ideation than cisgender heterosexual patients. In contrast, there were no significant differences in clinician-rated and self-reported depression severity between SGM and cisgender heterosexual patients. Additionally, primary treatment recommendations did not differ as a function of SGM status.

Conclusions: Our results highlight that SGM individuals are seeking care for TRD at a disproportionate rate, and they are requiring more intensive treatment at a younger age than cisgender heterosexual individuals. Although SGM patients presented with greater suicidal ideation than cisgender heterosexual patients, their clinical presentations were otherwise similar, and they did not differ in the primary psychiatric treatment strategy for which they were recommended. Future research into whether treatment outcomes differ for SGM and cisgender heterosexual patients seeking treatment for TRD is encouraged.