The first nationally representative analysis published in The Lancet Public Health journal suggests that the risk of having a long-term mental health condition in England is approximately one in six for transgender men and women (16.4% and 15.9%, respectively) and one in ten for cisgender men and women (8.8% and 12.0%). For other gender minority groups, the likelihood of reporting a mental health issue was much greater; for non-binary transgender people, it was nearly one in two (47.2%).
Research from the past indicates that patients who identify as transgender, non-binary, or gender nonconforming are more likely to have mental health issues like anxiety and depression than patients who identify as male or female cisgender. These results, however, are not applicable to the entire community because they are based on small studies that were restricted to populations, such as students or patients seeking gender-affirming medical care.
“Trans, non-binary, and gender-diverse people across England face widespread discrimination, which leads to stressful social interactions and feelings of unacceptance, increasing the risk of poor mental health,” says Dr. Luke Munford, Senior Lecturer in Health Economics, University of Manchester.
Furthermore, among some transgender, non-binary, and gender diverse people, gender dysphoria—a feeling of uneasiness stemming from a mismatch between one’s biological sex and gender identity—may raise the risk of poor mental health, particularly when combined with extremely long wait times for NHS gender identity clinics.”
The English GP Patient Survey had more answer options for questions about gender identification in 2021 than it did in 2022; therefore, data from both waves were merged for this study. All survey participants over 16 were asked to rate their gender identity compared to the sex they were registered with at birth, with three coded responses (cis, trans, prefer not to say).
Respondents could select one of five options for their gender (female, male, non-binary, prefer to self-describe, prefer not to say). The researchers examined the responses to the following two survey questions.
One response to the question “Which, if any, of the following kinds of long-term conditions do you have?” is “A mental health condition.”
“During your last routine medical appointment, did you feel that your health care professional recognized and/or acknowledged any mental health needs that you might have had?”
Among the 1,520,457 respondents to the study, 7,994 (0.7%) identified as transgender, 1,499,852 (98.3%) as cisgender, and 12,611 (1.0%) said they would prefer not to answer.
The survey was completed by 2,600 (0.3%) non-binary people and 2,277 (0.2%) people who self-described as gender positive. This is significant because it allows the researchers to examine the results for these populations, who are underrepresented in health statistics.
Once age was considered, the researchers discovered that, compared to cisgender men and women, all transgender patients and cisgender non-binary patients had a higher chance of reporting a long-term mental health issue.
Patients who identify as transgender but are non-binary are most at risk; of them, half (47.2%) reported having a long-term mental health issue.
The risk was approximately one in six for cisgender non-binary patients and transgender men and women (16.4%, 15.9%, and 15.8%, respectively).
At one in ten (8.8% and 12.0%), the risk was lowest for cisgender males and women.
The survey omitted questions about specific mental health conditions, but prior studies have shown that transgender, non-binary, and gender-diverse groups are more likely to experience common mental health conditions like eating disorders, anxiety, and depression, as well as eating disorders, self-harm, and suicidality, while severe mental illnesses like bipolar disorder or schizophrenia are thought to occur at rates comparable to those in the binary cisgender population.
Journal Reference
Gender-related self-reported mental health inequalities in primary care in England: a cross-sectional analysis using the GP Patient Survey, The Lancet Public Health (2024). DOI: 10.1016/S2468-2667(23)00301-8.
