February 20, 2024
Stark mental health disparities negatively impact transgender, non-binary, and gender-diverse individuals, according to a recent study of 1.5 million people, including nearly 8,000 transgender people aged 16 or older in England. 1
According to the study, published in the Lancet Public Health journal, gender-diverse adult populations experience a much higher prevalence of mental health conditions compared to cisgender adults, with inequalities concentrated in patients younger than 35 years. Long-term mental health conditions impact approximately one in two non-binary transgender adults, and one in six transgender men, women, and cisgender non-binary adults; in contrast, just one in ten cisgender men and women is diagnosed with a mental health condition.
The study did not cite the types or severity of conditions. However, previous research has indicated that mental health conditions, such as anxiety, depression, eating disorders, self-harm, and suicidality are more common among transgender, non-binary, and gender-diverse groups.1, 2,3
Unmet Medical Needs Among Transgender and Non-Binary Patients
The study found that almost one in two transgender, non-binary, and gender-diverse patients (47%) said that their last general practice appointment did not meet their mental health needs. Those patients also reported having their identities invalidated, feeling misunderstood, and experiencing inadequate communication with healthcare providers during their last healthcare provider appointment. Past negative healthcare experiences also led them to fear being stereotyped, pathologized, or discriminated against by medical professionals.
“Cisgender people have a gender identity that matches their sex assigned at birth. In contrast, trans people have a gender identity that is different from the sex assigned at birth,” Sharon Saline, Psy.D., and Julie Julie Mencher, MSW, explained during the ADDitude webinar “Gender Diversity and Neurodiversity: How to Support a Child, Teen, or Young Adult with ADHD Exploring Gender.” “Experiencing this disconnect, many trans people feel significant distress — called gender dysphoria — with their physical sex characteristics or how their gender is misread by others.”
The researchers suggest that mental health outcomes for this patient population could benefit from practitioners who are better training medical staff, adopting inclusive language, and standardizing electronic healthcare record systems to include transgender, non-binary, and gender-diverse identities.
“Such mechanisms would also affirm and validate patients’ gender identities and reduce the psychological burden associated with repeated explaining or being misgendered, again reducing minority stress and potentially improving mental health,” the study’s authors wrote.
Data for the study came from the 2021 and 2022 English General Practitioner Patient Surveys across five gender groups (female, male, non-binary, prefer to self-describe, prefer not to say), within three cisgender and transgender identity groups (cisgender, transgender, prefer not to say).
Health Disparities Among Transgender and Gender-Diverse Medicare Beneficiaries
Findings from the English study are mirrored in research recently published in JAMA Internal Medicine by a research team from the Brown University School of Public Health that found transgender and gender-diverse (TGD) Medicare beneficiaries aged 65 or older were significantly more likely to use the emergency department and be admitted to the hospital from the emergency room than were cisgender beneficiaries the same age. 5
“TGD individuals often postpone routine medical care due to various reasons, including anticipated discrimination, lack of knowledgeable clinicians, and costs,” the study’s authors wrote. The study examined data from 3,693 TGD and 6,151,389 cisgender Medicare beneficiaries spanning 2011 to 2020.
Both studies emphasized a call to action for improved mental healthcare and routine medical services for this marginalized community.
“Clinicians and frontline staff should be trained in TGD-inclusive care and cultural humility to reduce enacted discrimination in primary care settings and reduce ED utilization for TGD Medicare beneficiaries,” the Brown University researchers wrote.
“The mental health disparities experienced by transgender, non-binary, and gender-diverse individuals are alarming and call for immediate attention,” the authors of the English study wrote. “The healthcare sector, along with policymakers, must work together to address these unique needs and ensure that these individuals’ mental health of these individuals is not neglected by providing adequate training to healthcare providers, implementing inclusive policies, and promoting understanding and acceptance at all levels of society.”
View Article Sources
1Watkinson, R. E., Linfield, A., Tielemans, J., Francetic, I., & Munford, L. (2024). Gender-Related Self-Reported Mental Health Inequalities in Primary Care in England: Cross-Sectional Analysis Using the GP Patient Survey. The Lancet Public Health. 9(2), E100-E108. DOI: 10.1016/S2468-2667(23)00301-8
2Coleman, E., Radix, A.E., Bouman, W.P., et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.Int J Transgender Health. DOI: 10.1093/eurpub/cky226
3Zeeman, L., Sherriff, N., Browne, K., et al. (2019). A Review of Lesbian, Gay, Bisexual, Trans, and Intersex (LGBTI) Health and Healthcare Inequalities. Eur J Public Health. DOI: 10.1080/26895269.2022.2100644
4Dhejne, C., Van Vlerken, R., Heylens, G., and Arcelus, J. (2016). Mental Health and Gender Dysphoria: A Review of the Literature.Int Rev Psychiatry. doi: 10.3109/09540261.2015.1115753
5Gray Babb, et al. (2024). Emergency Department Use Disparities Among Transgender and Cisgender Medicare Beneficiaries, 2011-2020. JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2023.8209
