This study examines the relationship between substance use (identified as maladaptive coping response to chronic stress) to associated outcomes—such as suicidality and homelessness. The cohort included 2,824,289 adolescents, of whom 12,230 were identified as TGD. TGD adolescents had significantly higher risk of anxiety (83.8% vs. 33.3%, RR 2.52) and depression (79.7% vs. 24.5%, RR 3.26). These findings emphasize the need for integrated screening and targeted interventions addressing substance use, mental health, and housing instability in this high-risk population.
