Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center
Open accessAbstract
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 (χ 2= 51.5, p < .001) and substance use appointments (χ 2= 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.
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Non-binary gender diverse people may experience even greater levels of gender-based discrimination and negative mental health outcomes than binary transgender individuals.
“non-binary gender diverse people may experience even greater levels of gender-based discrimination and negative mental health outcomes than binary transgender individuals”
From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [10]
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Cites
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
Meyer, I. H. (2003) · Psychological Bulletin · doi:10.1037/0033-2909.129.5.674 · Cited by 14,736 · see citing works
The PHQ-9: A New Depression Diagnostic and Severity Measure
Kroenke, K., & Spitzer, R. L. (2002) · Psychiatric Annals · doi:10.3928/0048-5713-20020901-06 · Cited by 5,898 · see citing works
(2001) · Cited by 5,455 · see citing works
Skinner, H. A. (1982) · Addictive Behaviors · doi:10.1016/0306-4603(82)90005-3 · Cited by 3,134 · see citing works
Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Smith, S. M., Huang, B., et al. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.0584 · Cited by 2,556 · see citing works
Hendricks, M. L., & Testa, R. J. (2012) · Professional Psychology: Research and Practice · doi:10.1037/a0029597 · Cited by 2,134 · see citing works
Global health burden and needs of transgender populations: a review
Reisner, S. L., Poteat, T., Keatley, J. G., Cabral, M., Mothopeng, T., Dunham, E., Holland, C. E., Max, R. J., & Baral, S. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00684-x · Cited by 1,489 · see citing works
Development of the Gender Minority Stress and Resilience Measure.
Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000081 · Cited by 1,406 · see citing works
A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health
Conron, K. J., Mimiaga, M. J., & Landers, S. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.174169 · Cited by 860 · see citing works
Non-binary or genderqueer genders
Richards, C., Bouman, W. P., Seal, L., Barker, M. J., Nieder, T. O., & T’Sjoen, G. (2016) · International Review of Psychiatry · doi:10.3109/09540261.2015.1106446 · Cited by 782 · see citing works
Valentine, S. E., & Shipherd, J. C. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.03.003 · Cited by 699 · see citing works
Budge, S. L., Adelson, J. L., & Howard, K. A. S. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0031774 · Cited by 676 · see citing works
Minority stress and physical health among sexual minority individuals
Frost, D. M., Lehavot, K., & Meyer, I. H. (2015) · Journal of Behavioral Medicine · doi:10.1007/s10865-013-9523-8 · Cited by 665 · see citing works
Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2018.02.003 · Cited by 557 · see citing works
Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-analysis
Goldbach, J. T., Tanner‐Smith, E. E., Bagwell, M., & Dunlap, S. L. (2013) · Prevention Science · doi:10.1007/s11121-013-0393-7 · Cited by 513 · see citing works
Nadal, K. L. Y., Whitman, C. N., Davis, L. S., Erazo, T., & Davidoff, K. C. (2016) · The Journal of Sex Research · doi:10.1080/00224499.2016.1142495 · Cited by 484 · see citing works
Hasin, D. S., & Grant, B. F. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1088-0 · Cited by 452 · see citing works
Newcomb, M. E., Hill, R., Buehler, K., Ryan, D. T., Whitton, S. W., & Mustanski, B. S. (2019) · Archives of Sexual Behavior · doi:10.1007/s10508-019-01533-9 · Cited by 424 · see citing works
Lefevor, G. T., Boyd-Rogers, C. C., Sprague, B. M., & Janis, R. A. (2019) · Journal of Counseling Psychology · doi:10.1037/cou0000339 · Cited by 422 · cited 3× · see citing works
“Extending sexual minority stress theory, first proposed by Virginia Brooks [22], to examine mental health disparities among non-binary individuals, Lefevor and colleagues found that non-binary individuals face heightened and unique stressors that differentially impact their psychological well-being [12].”
BackgroundMethodUnderstanding the Well-Being of LGBTQI+ Populations
Committee on Understanding the Well-Being of Sexual and Gender Diverse Populations, Committee on Population, Education, D. O. B. A. S. S. A., & National Academies of Sciences, E. (2020) · doi:10.17226/25877 · Cited by 399 · see citing works
Semlyen, J. K., King, M., Varney, J., & Hagger‐Johnson, G. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0767-z · Cited by 386 · see citing works
Non-binary/Genderqueer Identities: a Critical Review of the Literature
Matsuno, E. G., & Budge, S. L. (2017) · Current Sexual Health Reports · doi:10.1007/s11930-017-0111-8 · Cited by 341 · see citing works
Chodzen, G., Hidalgo, M. A., Chen, D., & Garofalo, R. (2018) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2018.07.006 · Cited by 316 · see citing works
Rimes, K. A., Goodship, N., Ussher, G., Baker, D., & West, E. (2017) · International Journal of Transgenderism · doi:10.1080/15532739.2017.1370627 · Cited by 236 · see citing works
Non-binary youth: Access to gender-affirming primary health care
Clark, D. B. A., Veale, J. F., Townsend, M., Frohard‐Dourlent, H., & Saewyc, E. (2018) · International Journal of Transgenderism · doi:10.1080/15532739.2017.1394954 · Cited by 198 · see citing works
Substance use and treatment of substance use disorders in a community sample of transgender adults
Keuroghlian, A. S., Reisner, S. L., Hughto, J. M. W., & Weiss, R. D. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.04.008 · Cited by 193 · see citing works
Witcomb, G. L., Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., & Arcelus, J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.051 · Cited by 186 · see citing works
Mizock, L. M., & Lundquist, C. M. (2016) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000177 · Cited by 182 · see citing works
Healthcare Experiences Among Young Adults Who Identify as Genderqueer or Nonbinary
Lykens, J., LeBlanc, A. J., & Bockting, W. O. (2018) · LGBT Health · doi:10.1089/lgbt.2017.0215 · Cited by 182 · see citing works
Hughto, J. M. W., Murchison, G. R., Clark, K. A., Pachankis, J. E., & Reisner, S. L. (2016) · LGBT Health · doi:10.1089/lgbt.2016.0044 · Cited by 179 · see citing works
Reisner, S. L., & Hughto, J. M. W. (2019) · PLOS ONE · doi:10.1371/journal.pone.0221583 · Cited by 177 · see citing works
Thorne, N., Witcomb, G. L., Nieder, T. O., Nixon, E., Yip, A. K.-T., & Arcelus, J. (2018) · International Journal of Transgenderism · doi:10.1080/15532739.2018.1452660 · Cited by 165 · see citing works
Kattari, S. K., Walls, N. E., Whitfield, D. L., & Langenderfer‐Magruder, L. (2015) · International Journal of Transgenderism · doi:10.1080/15532739.2015.1064336 · Cited by 162 · see citing works
Routine Collection of Patient-Reported Outcomes in an HIV Clinic Setting:The First 100 Patients
Crane, H. M., Lober, W. B., Webster, E., Harrington, R. D., Crane, P. K., Davis, T., & Kitahata, M. M. (2006) · Current HIV Research · doi:10.2174/157016207779316369 · Cited by 155 · see citing works
Social Epidemiology of Depression and Anxiety by Gender Identity
Reisner, S. L., Katz‐Wise, S. L., Gordon, A. R., Corliss, H. L., & Austin, S. B. (2016) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2016.04.006 · Cited by 146 · see citing works
Claes, L., Bouman, W., Witcomb, G., Thurston, M., Fernández-Aranda, F., & Arcelus, J. (2015) · Journal of Sexual Medicine · doi:10.1111/jsm.12711 · Cited by 145 · see citing works
Sexual Minority Stress Theory: Remembering and Honoring the Work of Virginia Brooks
Rich, A. J., Salway, T. J., Scheim, A. I., & Poteat, T. (2020) · LGBT Health · doi:10.1089/lgbt.2019.0223 · Cited by 144 · see citing works
Invalidation experiences among non-binary adolescents
Johnson, K. C., LeBlanc, A. J., Deardorff, J., & Bockting, W. O. (2020) · The Journal of Sex Research · doi:10.1080/00224499.2019.1608422 · Cited by 142 · see citing works
Budge, S. L., Rossman, H. K., & Howard, K. A. S. (2014) · Journal of LGBT Issues in Counseling · doi:10.1080/15538605.2014.853641 · Cited by 135 · see citing works
Lowry, R., Johns, M. M., Gordon, A. R., Austin, S. B., Robin, L. E., & Kann, L. K. (2018) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2018.2140 · Cited by 133 · see citing works
Khan, S., Okuda, M., Hasin, D. S., Secades‐Villa, R., Keyes, K., Lin, K., Grant, B., & Blanco, C. (2013) · Alcoholism: Clinical and Experimental Research · doi:10.1111/acer.12158 · Cited by 121 · see citing works
Health Care Experiences of Transgender Binary and Nonbinary University Students
Goldberg, A. E., Kuvalanka, K. A., Budge, S. L., Benz, M. B., & Smith, J. Z. (2019) · The Counseling Psychologist · doi:10.1177/0011000019827568 · Cited by 117 · see citing works
Valentine, S. E., Peitzmeier, S. M., King, D. S., O’Cleirigh, C. M., McKetchnie, S. M., Presley, C., & Potter, J. E. (2017) · LGBT Health · doi:10.1089/lgbt.2016.0113 · Cited by 116 · see citing works
Self-citationAdherence to Mammography Screening Guidelines Among Transgender Persons and Sexual Minority Women
Bazzi, A. R., Whorms, D. S., King, D. S., & Potter, J. E. (2015) · American Journal of Public Health · doi:10.2105/ajph.2015.302851 · Cited by 110 · see citing works
Self-citationToward defining, measuring, and evaluating LGBT cultural competence for psychologists.
Boroughs, M. S., Bedoya, C. A., O'Cleirigh, C., & Safren, S. A. (2015) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12098 · Cited by 104 · see citing works
Self-citationO׳Cleirigh, C., Magidson, J. F., Skeer, M. R., Mayer, K. H., & Safren, S. A. (2015) · Psychosomatics · doi:10.1016/j.psym.2014.08.004 · Cited by 101 · see citing works
Self-citationSelf-injury among trans individuals and matched controls: prevalence and associated factors
Davey, A., Arcelus, J., Meyer, C., & Bouman, W. P. (2015) · Health & Social Care in the Community · doi:10.1111/hsc.12239 · Cited by 96 · see citing works
The evolution of the Fenway Community Health model
Mayer, K. H., Appelbaum, J., Rogers, T., Lo, W., Bradford, J., & Boswell, S. (2001) · American Journal of Public Health · doi:10.2105/ajph.91.6.892 · Cited by 89 · see citing works
Self-citationStreed, C. G., McCarthy, E. P., & Haas, J. S. (2018) · LGBT Health · doi:10.1089/lgbt.2017.0275 · Cited by 75 · see citing works
Flentje, A., Bacca, C. L., & Cochran, B. N. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.11.012 · Cited by 69 · see citing works
Attitudes Toward Bisexuality According to Sexual Orientation and Gender
Hertlein, K. M., Hartwell, E. E., & Munns, M. E. (2016) · Journal of Bisexuality · doi:10.1080/15299716.2016.1200510 · Cited by 59 · see citing works
Flanders, C. E., Dobinson, C., & Logie, C. H. (2016) · Critical Public Health · doi:10.1080/09581596.2016.1158786 · Cited by 57 · see citing works
Coyne, C. A., Poquiz, J. L., Janssen, A. C., & Chen, D. (2020) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2020.1765433 · Cited by 57 · see citing works
Batchelder, A., Stanton, A. M., Kirakosian, N., King, D. S., Grasso, C., Potter, J. E., Mayer, K. H., & O’Cleirigh, C. M. (2021) · LGBT Health · doi:10.1089/lgbt.2020.0293 · Cited by 39 · see citing works
Self-citationChaudhry, A. B., & Reisner, S. L. (2019) · LGBT Health · doi:10.1089/lgbt.2018.0207 · Cited by 37 · see citing works
Valentine, S. E., Elsesser, S. A., Grasso, C., Safren, S. A., Bradford, J., Mereish, E. H., & O’Cleirigh, C. M. (2015) · Journal of Urban Health · doi:10.1007/s11524-015-9989-5 · Cited by 22 · see citing works
Self-citationGuy, A. A., Yoder, W., Manser, K., Ramos, S. D., & Bois, S. N. D. (2020) · Annals of LGBTQ Public and Population Health · doi:10.1891/lgbtq.2019-0002 · Cited by 13 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [11]Green ER, Maurer L. The gender issue: A portrait of gender today. Journal of National Geographic Society. 2017; 321: 12– 17.
Cited by
Sorted by citations
Evelyn, S., Clancy, E. M., Klettke, B., & Tatnell, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116560 · Cited by 38 · see citing works
“Though often included with binary transgender individuals for research and sampling purposes, non-binary gender diverse people may experience even greater levels of gender-based discrimination and negative mental health outcomes than binary transgender individuals, as their gender identity further defies cultural gend…”
Background
- Authors
- Stanton, A. M., Batchelder, A. W., Kirakosian, N., Scholl, J., King, D., Grasso, C., Potter, J., Mayer, K. H., & O’Cleirigh, C.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- VA Boston Healthcare System (US)
- Fenway Health (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Stanton, Amelia M.
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-01-25
- Volume
- 16
- Issue
- 1
- Pages
- e0245872
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7833136
- OpenAlex
- W3124332842
- Cited by
- 71
- References
- 59
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 13 · 2023: 18 · 2022: 8 · 2021: 8
- FWCI
- 11.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Mental Health (T32MH116140)
- National Institute on Drug Abuse (K23DA043418)
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Gender Studies › Gender Roles and Identity Studies
- Keywords
- transgender and gender-diverse individuals, mental health disparities, depression severity, anxiety symptom severity, alcohol consumption, substance use disorders, engagement in care, nonbinary patients, affirming care, sexual and gender minority health, community health centers
- MeSH terms
- Adult, Community Health Centers, Delivery of Health Care, Female, Humans, Male, Mental Health, Patient Acceptance of Health Care, Substance-Related Disorders, Transgender Persons
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