In a recent study published in The Lancet Public Healthresearchers assessed gender differences in self-reported mental health disorders and support in England.
Background
Non-binary, gender diverse and transgender individuals face prejudice and health difficulties that contribute to increased rates of mental disorders such as depression and anxiety. Minority stress is a major cause of poor mental health outcomes, and gender dysphoria, or distress caused by gender nonconformity at birth, may increase risk.
Access to early treatment can benefit mental health, but long waiting times at NHS gender identity clinics can increase the dangers. Existing evidence for gender-based differences in mental health is scarce.
About the research
In the current study, researchers assessed disparities in self-reported mental health and unmet needs across 15 different categories, including five genders and three cisgender and transgender identity groupings. They also assessed potential mediators such as socioeconomic status, long-term health problems, general practitioner (GP) appointments and contact with health professionals.
The team used individual-level data from the English General Practice Patient Survey (GPPS) conducted in 2021 and the following year. They performed logistic regression modeling to estimate the probabilities of the study outcomes, ie. self-report of mental disorders and unmet mental health needs. The two exposure variables were gender and cisgender and transgender identity.
The team presented findings for five gender-based groups (nonbinary, male, female, choose to self-report and choose not to disclose) and three transgender or cisgender identity groups. They investigated possible mediation by introducing variables. They recruited GPPS participants through multiple stratified random sampling of patients aged 16 or over registered with general practitioners in England.
The team sent participants self-administered surveys available in 17 languages, including British Sign Language, which they could complete on paper, over the phone or online. They aimed to engage the public and community members through online discussion groups with the Greater Manchester Applied Research Collaborative Panel (ARC-GM) and the ARC-GM/Health Innovation Manchester Forum. They included people with life and professional experience and representatives from relevant charities and learned about gender, cisgender and transgender identities. The team considered study year, regimen 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 gender, and 9 263 (0.7%) chose not to state 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 indicate their gender.
The team found significant gender differences in the likelihood of self-reporting a mental disorder, with non-binary individuals most likely to be either transgender (47%), or those who choose to hide their transgender or cisgender identity (33% ), and self-reported transgender individuals (35%).
Excluding non-binary individuals, cisgender patients had the lowest probability (ranging from 8.8% to 12%), followed by patients who chose not to disclose their gender identity (ranging from female at 7.2 % to self-documentation at 10%). The odds of self-reporting unmet mental health requirements were lowest among cisgender men (16%) and women (16%), with higher odds among other groups of individuals, ranging between 20% among transgender men and 29% among individuals, who have chosen to hide their gender and transgender or cisgender identity.
Differences in health care contacts may account for gender differences, with hypothesized mediators such as long-term health problems, socioeconomic indicators, and treatment enrollment and continuity characteristics having minimal impact. Gender differences in unmet mental health needs appear to increase with age. At their last session, 40% of respondents reported that they met the mental health requirements, while 16% reported that they did not. Patients who chose not to declare their gender, cisgender, or transgender identification represent the most gender diverse population.
Conclusions
Overall, the study results revealed significant gender-based disparities in mental health outcomes, particularly among non-binary, gender diverse and transgender individuals. Transgender patients have more long-term mental health problems than cisgender patients or those who do not disclose their gender. Non-binary patients and those who self-identify as gender also face significant health risks. The findings highlight the need for improved inclusion in the health system, professional training, and social and legal context.
Socio-economic disadvantage can contribute to poor psychological outcomes and poverty. The study suggests improvements in the recording of gender in NHS health record systems, primary surveys and gender inclusion. It also calls for wider social and legal reform to reduce minority stress on these groups.