Study reveals extent of mental health challenges for transgender and non-binary patients in England

In a recent study published in The Lancet Public Health, researchers assessed gender-related disparities in self-documented mental health disorders and support in England.

Background

Non-binary, gender-diverse, and transgender individuals encounter prejudice and healthcare difficulties, which contribute to an increased incidence of mental disorders such as depression and anxiety. Minority stress is the primary cause of poor mental health outcomes, and gender dysphoria, or distress produced by a mismatch between gender and sex at birth, may heighten the risk.

Access to early treatment can benefit mental health, but high wait times at National Health Service (NHS) gender identity clinics might increase dangers. Existing evidence of gender-based disparities in mental health is scarce.

About the study

In the present study, researchers evaluated discrepancies in self-documented mental health and unmet needs across 15 distinct categories, including five genders and three cisgender and transgender identity groupings. They also assessed potential mediators such as socioeconomic status, long-term health issues, general practitioner (GP) appointments, and contact with healthcare professionals.

The team used individual-level data from the English General Practice (GP) Patient Survey (GPPS) conducted in 2021 and the following year. They performed logistic regression modeling to estimate probabilities of the study outcomes, i.e., self-reporting mental disorders and unfulfilled mental healthcare needs. The two exposure variables were gender and cisgender and transgender identity.

The team presented findings for five gender-based groups (non-binary, male, female, choose to self-report, and not to disclose) and three transgender or cisgender identity groups. They investigated possible mediation by introducing variables. They included GPPS participants by repeated stratified random sampling of patients aged 16 years or older registered with general practitioners in England.

The team sent self-completion surveys to the participants, accessible in 17 languages, including British Sign Language, which they could complete on paper, by phone, or online. They aimed to involve the public and community members through online discussion groups with the Applied Research Collaboration Greater Manchester (ARC-GM) Panel and the ARC-GM/Health Innovation Manchester Forum. They included individuals with lived and professional experience and representatives from relevant charitable organizations, and they learned about gender, cisgender, and transgender identities. The team considered the survey year, mode, and age group as variables.

Results

Among 1,520,457 respondents, 2,600 (0.30%) were non-binary, 861,017 (51%) were female, 645,300 (47%) were male, 2,277 (0.20%) self-reported their sex, and 9,263 (0.7%) chose not to specify their gender. There were 1,499,852 (98%) respondents who identified as cisgender, 7,994 (0.7%) as transgender, and 12,611 (1.0%) who did not specify their gender identification.

The team found significant gender-related disparities in the likelihood of self-reporting a mental disorder, with the most likelihood in non-binary individuals, either transgender (47%) or those choosing to conceal their transgender or cisgender identity (33%), and transgender individuals who self-reported their sex (35%).

Except for non-binary individuals, cisgender patients had the lowest probability (ranging from 8.8% to 12%), followed by patients who opted not to disclose their gender identification (ranging from females at 7.2% to self-documentation at 10%). The likelihood of self-reporting unfulfilled mental health requirements was the least among cisgender males (16%) and female patients (16%), with higher likelihoods in other groups of individuals, ranging between 20% in transgender males and 29% among individuals who chose to conceal their gender and transgender or cisgender identity.

Disparities in healthcare encounters may cause gender disparities, with putative mediators such as long-term health problems, socioeconomic indicators, and appointment and continuity of treatment characteristics having minimal impact. Gender-related disparities in unmet mental health needs appeared to widen with age. At their most recent session, 40% of respondents reported fulfilling mental health requirements, whereas 16% reported that they were not. Patients who decided not to declare their gender, cisgender, or transgender identification denoted the most diverse gender population.

Conclusions

Overall, the study findings revealed significant gender-based disparities in mental health outcomes, especially among non-binary, gender-diverse, and transgender individuals. Transgender patients have more long-term mental health issues than cisgender patients or those who don’t disclose their gender identification. Non-binary patients and those who self-identify as gender also face significant health risks. The findings emphasize the need for improved healthcare system inclusion, professional training, and the social and legal context.

Socioeconomic disadvantage may contribute to poor psychological outcomes and poverty. The study suggests improvements in recording gender across healthcare record systems, primary surveys, and the gender-inclusivity of the English National Health Service. It also calls for broader social and legal reform to reduce minority stress for these groups.