Study Shows Mental Health Disparities Among Transgender, Nonbinary Communities

A recent analysis, the first of its kind to be nationally representative, indicates that in England, the likelihood of experiencing a long-term mental health condition is approximately 1 in 6 for transgender individuals, both men (16.4%) and women (15.9%). In contrast, the risk for cisgender men and women stands at 1 in 10, with rates of 8.8% and 12.0%, respectively.

The research, published in The Lancet Public Health journal, further reveals a notably elevated risk for certain gender minority groups, particularly non-binary transgender individuals, where almost 1 in 2 (47.2%) reported having a mental health condition.

Transgender, non-binary, and gender-diverse individuals continue to face pervasive discrimination and barriers when accessing health care, contributing to higher rates of mental health conditions compared with cisgender individuals, according to the study. Despite the existing evidence, gender recording in health records and surveys has been limited, hindering a comprehensive understanding of the mental health landscape. The researchers aimed to bridge this gap by providing the first national estimates of gender-related inequalities in self-reported mental health conditions and mental health support across 15 gender groups in England.

The study utilized changes to the 2021 and 2022 nationally representative cross-sectional English General Practitioner (GP) Patient Surveys. Age-adjusted logistic regression was employed to predict the probabilities of 2 outcomes: self-reporting a mental health condition and self-reporting unmet mental health needs. The 15 exposure groups included 5 gender groups (female, male, non-binary, prefer to self-describe, and prefer not to say) within 3 cisgender or transgender identity groups (cisgender, transgender, or prefer not to say). Potential mediation effects were explored through the inclusion of covariates.

The estimation sample comprised 1,520,457 respondents, with females (n = 861,017) accounting for 51.4%, males (n = 645,300) for 47.4%, non-binary individuals (n = 2600) for 0.3%, self-described gender (n = 2277) for 0.2%, and those who preferred not to state their gender (n = 9263) for 0.7%. Regarding cisgender or transgender identity, 98.3% (n = 1,499,852) identified as cisgender, 0.7% (n = 7,994) as transgender, and 1.0% (n = 12,611) preferred not to disclose their cisgender or transgender identity.

Findings demonstrated wide gender-related differences in the probability of self-reporting a mental health condition. Non-binary patients who were transgender exhibited the highest probabilities at 47.21%. This group was followed by transgender patients who self-described their gender (35.03%) and those who preferred not to disclose their cisgender or transgender identity (32.90%). Conversely, cisgender patient groups had the lowest probabilities, ranging from 8.80% (male) to 11.97% (female).

Probabilities of self-reported unmet mental health needs were lowest among cisgender males (15.55%) and females (15.93%). Increased probabilities were observed across other groups, ranging from 19.95% in transgender males to 28.64% in individuals who preferred not to disclose their gender or cisgender/transgender identity.

The findings underscore significant gender-related inequalities in self-reported mental health outcomes in England. The existence of self-reported unmet mental health needs suggests a pressing need for enhanced inclusivity within the health care system and increased training for health care professionals, the study noted. Researchers advocate for broader improvements in the social and legal environment to support transgender, non-binary, and gender-diverse individuals.

“There is also an emerging literature exploring the power of gender euphoria, gender affirmation, resistance, and community building as protective factors for mental health among transgender, non-binary, and gender diverse groups,” the researchers wrote. “Further research could provide valuable insights into strategies to promote wellbeing.”

References

Watkinson RE, Linfield A, Tielemans J, et al. Gender-related self-reported mental health inequalities in primary care in England: A cross-sectional analysis using the GP patient survey. The Lancet Public Health Journal. Published online January 31, 2024. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00301-8/fulltext