Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Jan 25;16(1):e0245872.
doi: 10.1371/journal.pone.0245872. eCollection 2021.

Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center

Amelia M Stanton  1   2   3 , Abigail W Batchelder  1   2   3 , Norik Kirakosian  1 , James Scholl  3   4 , Dana King  3 , Chris Grasso  3 , Jennifer Potter  3   5 , Kenneth H Mayer  2   3   5 , Conall O'Cleirigh  1   2   3
Affiliations
Comparative Study

Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center

Amelia M Stanton et al. PLoS One. .

Abstract

Mental health disparities among transgender and gender diverse (TGD) populations have been documented. However, few studies have assessed differences in mental health symptom severity, substance use behavior severity, and engagement in care across TGD subgroups. Using data from the electronic health record of a community health center specializing in sexual and gender minority health, we compared the (1) severity of self-reported depression, anxiety, alcohol use, and other substance use symptoms; (2) likelihood of meeting clinical thresholds for these disorders; and (3) number of behavioral health and substance use appointments attended among cisgender, transgender, and non-binary patients. Participants were 29,988 patients aged ≥18 who attended a medical appointment between 2015 and 2018. Depression symptom severity (F = 200.6, p < .001), anxiety symptom severity (F = 102.8, p < .001), alcohol use (F = 58.8, p < .001), and substance use (F = 49.6, p < .001) differed significantly by gender. Relative to cisgender and transgender individuals, non-binary individuals are at elevated risk for depression, anxiety, and substance use disorders. Gender was also associated with differences in the number of behavioral health (χ2 = 51.5, p < .001) and substance use appointments (χ2 = 39.3, p < .001) attended. Engagement in treatment among certain gender groups is poor; cisgender women and non-binary patients assigned male at birth were the least likely to have attended a behavioral health appointment, whereas transgender men and cisgender women had attended the lowest number of substance use appointments. These data demonstrate the importance of (1) assessing gender diversity and (2) addressing the barriers that prevent TGD patients from receiving affirming care.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Mental health and substance use behavior severity among the gender categories.
AMAB = Assigned Male at Birth; AFAB = Assigned Female at Birth. Letters embedded in each bar denote homogeneous groups (i.e. means of subgroups that have the same superscript do not significantly differ from each other) based on Tukey’s Honestly Significant Difference test significance at the p < .05 level.
See this image and copyright information in PMC

References

    1. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: a review. Lancet. 2016;388: 412–436. 10.1016/S0140-6736(16)00684-X - DOI - PMC - PubMed
    1. Lowry R, Johns MM, Gordon AR, Austin SB, Robin LE, Kann LK. Nonconforming gender expression and associated mental distress and substance use among high school students. JAMA Pediatr. 2018;172: 1020–1028. 10.1001/jamapediatrics.2018.2140 - DOI - PMC - PubMed
    1. Valentine SE, Shipherd JC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev. 2018;66: 24–38. 10.1016/j.cpr.2018.03.003 - DOI - PMC - PubMed
    1. Reisner SL, Katz-Wise SL, Gordon AR, Corliss HL, Austin SB. Social epidemiology of depression and anxiety by gender identity. J Adolesc Health. 2016;59: 203–208. 10.1016/j.jadohealth.2016.04.006 - DOI - PMC - PubMed
    1. Chodzen G, Hidalgo MA, Chen D, Garofalo R. Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. J Adolesc Health. 2019;64: 467–471. 10.1016/j.jadohealth.2018.07.006 - DOI - PMC - PubMed

Publication types

MeSH terms