The rate of self-reported mental distress and depression among American adults who identify as transgender or gender-diverse (TGD) has more than doubled between 2014 and 2022, an analysis of federal health data reveals.

During that time, “a record number of enacted laws has threatened the rights and protections of TGD people, including restricting access to gender-affirming care and permitting discrimination in public accommodations,” noted a team of researchers led by health care policy investigator Michael Liu, of Harvard Medical School.

The findings are published June 24 in the journal JAMA Internal Medicine.

Liu’s team tracked survey data from the federal government’s ongoing Behavioral Risk Factor Surveillance System, which follows the self-reported physical and mental health of U.S. adults over time.

The analysis started in 2014, the first year in which gender identity was added to the survey, and tracked data through 2022.

Liu’s team found that the “prevalence of frequent mental distress increased from 18.8% in 2014 to 38.9% in 2022” among transgender or gender-diverse people.

In contrast, the rise in mental distress was less steep among cisgender people — from 11.2% to 15.5%.

Depression rates among transgender and gender-diverse adults also rose sharply between 2014 and 2022 — more than doubling from 19.7% to 51.3%, Liu’s group found. Over the same time period, depression rates among cisgender adults rose only slightly, from 18.6% to 21.1%.

Even physical health was affected: During the study period, the percentage of transgender/gender-diverse adults who rated their health as just “fair” or “poor” went from 26.6% to 35.1%, while that number remained stable at just over 17% among cisgender people.

In a linked journal editorial, three experts in health policy say the Harvard findings are not unexpected.

Dr. Carl Streed of Boston University, Kellan Baker of the Johns Hopkins School of Public Health in Baltimore and Arjee Javellana Restar of the University of Washington School of Public Health in Seattle, point to hundreds of state bills “explicitly targeting transgender and nonbinary populations” proposed in 2023 and 2024.

“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.,” the experts said.

Increasing stigma means transgender and gender-diverse Americans are dealing with daily assaults to mental health, including deliberate misuse of pronouns, issues around restroom access, discrimination on the job and even acts of violence, the editorialists said.

It’s probably not going to get better anytime soon.

“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,” the experts said.

More information

Find out more about the impact of discrimination on health at the Mental Health Foundation.

SOURCE: JAMA Internal Medicine, June 24, 2024