The prevalence of mental distress and depression more than doubled among transgender and gender-diverse adults in the U.S. between 2014 and 2022, a research letter in JAMA Internal Medicine has reported.
Michael Liu, M.Phil., of Harvard Medical School and colleagues examined data from the 2014 to 2022 Behavioral Risk Factor Surveillance System (BRFSS), an annual state-based telephone survey of adults run by the CDC in which participants report on their health behaviors and whether health care professionals had ever diagnosed them with a health condition; different participants are surveyed each year. The BRFSS introduced an optional gender identity module in 2014, with more states adopting the module over the study period.
The researchers classified respondents as transgender or gender-diverse if the respondents identified as transgender, male to female; transgender, female to male; or transgender, gender nonconforming. The researchers then assessed three self-reported health outcomes: poor or fair health status, frequent mental distress, and diagnosed depression. Frequent mental distress was defined as reporting 14 or more poor mental health days during the past month.
Overall, 8,884 respondents (out of 1.92 million total across the nine surveys) were transgender or gender-diverse. Between 2014 and 2022, the prevalence of frequent mental distress increased from 18.8% to 38.9% among transgender or gender-diverse adults, while the prevalence of depression rose from 19.7% to 51.3%. Cisgender adults experienced significantly smaller increases in the prevalence of frequent mental distress (11.2% to 15.5%) and depression (18.6% to 21.1%) during this period. The prevalence of poor or fair general health also increased among transgender or gender-diverse adults between 2014 and 2022.
“Further research is required to identify factors contributing to the widening health inequities in this population, especially amid recent proliferation of anti-[transgender or gender-diverse] legislation,” Liu and colleagues wrote. “Our findings highlight the need for the health sector to follow established standards of care and advocate for policies that protect [this population].”
In an accompanying commentary, Carl Streed Jr., M.D., M.P.H., of Boston University and colleagues noted that in 2023, there were 574 bill proposals explicitly targeting transgender and nonbinary populations, of which 83 were signed into law. They added that in 2024 there have been 544 such bills, of which 23 had been passed as of April.
“These efforts to exclude transgender and nonbinary people from civic life threaten the well-being of the more than 1.6 million transgender and nonbinary people in the U.S.,” they wrote. “Given the sociopolitical trajectory of the U.S. regarding increasing discrimination and political attacks on transgender and nonbinary people, we can expect to see worsening mental health in these populations for the foreseeable future.
“To reverse this, we need high-quality health care as well as legal and economic protections for this population,” they concluded.
For related information, see the Psychiatric News Special Report “What You Should Know to Care for LGBTQ Patients.”
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