Higher likelihood of mental health conditions among trans people
Transgender people had a higher risk of having a long-term mental health condition than their cisgender counterparts, according to analysis described as being the first of its kind in England.
Researchers from the University of Manchester said the study of 1.5 million people aged 16 and over, including almost 8,000 transgender people, is the first which can be said to be nationally representative.
The research, published in the Lancet Public Health journal, looked at self-reported mental health conditions.
Its findings suggested the risk of having a long-term mental health condition in England is around one in six for transgender men and women, compared with one in 10 for cisgender men and women.
Cisgender is when a person’s gender identity matches their biological sex at birth.
The researchers used data from the 2021 and 2022 waves of the English GP Patient Survey, where patients were asked if they had a mental health condition – although did not ask for details of which condition – and about whether they had any unmet mental needs in their care.
People were asked how they identified their gender – female, male, non-binary, prefer to self-describe, prefer not to say; and how their gender identity compared with their sex registered at birth, whether cis, trans, or prefer not to say.
The paper said: “Prevalence of long-term mental health conditions tended to be higher among transgender patients compared to patients who were cisgender or who did not state their cisgender or transgender identity, and there were substantial additional health disadvantages among non-binary patients and those who self-described their gender relative to patients with binary gender identities.”
While around one in six cisgender males and cisgender females reported their mental health needs were unmet, the proportion was higher among other gender identity groups, ranging from between one in five (20.0%) for transgender males and one in four (28.6%) among patients who preferred not to say their gender identity.
Dr Luke Munford, senior lecturer in health economics, at the University of Manchester, noted that gender dysphoria – described by the NHS as a sense of unease a person might have because of a mismatch between their biological sex and their gender identity – can increase the risk of poor mental health “especially when combined with very long waiting times for NHS gender identity clinics”.
The research paper noted waiting times for gender identity healthcare in England, “with patients routinely waiting five years from referral to first appointment, potentially exacerbating mental health risks for some patients”.
The Gender Identity Development Service (Gids) for children and young people at the Tavistock NHS Trust is due to close by the end of March to be replaced by new regional gender identity clinics in England, which have been beset by delays in opening.
The new NHS service for children and young people will be made up of the southern hub – a partnership between Great Ormond Street Hospital, Evelina London Children’s Hospital and South London and Maudsley NHS Foundation Trust – and the northern hub – a partnership between Alder Hey Children’s NHS Foundation Trust and the Royal Manchester Children’s Hospital.
The adult gender clinic at the Tavistock will remain open.
Dr Ruth Watkinson, also from the University of Manchester, said: “Poor communication from healthcare professionals and inadequate staff-patient relationships may explain why trans, non-binary, and gender diverse patients were more likely to report their mental health needs were not met at recent general practice appointments.”
Dr Watkinson added: “Changes are urgently needed for the NHS to become a more supportive service to transgender, non-binary, and gender diverse patients, including improved recording of gender across healthcare records systems and staff training to ensure healthcare professionals meet the mental health needs of all patients, whatever their gender.”
The researchers noted limitations to their study including that pooling data from two survey years could mean some participants were re-sampled “leading to biased estimates”, and that the clinical language in the survey and a reliance on self-reporting might have influenced which patients reported a mental health condition.
The peer-reviewed observational study was funded by the Department of Health and Social Care (DHSC) and the National institute for Health and Care Research (NIHR) and was carried out by researchers from the University of Manchester in collaboration with staff from The Proud Trust and LGBT Foundation.
An NHS spokesperson said: “Mental health is one of five key priority areas for the NHS in its efforts to reduce healthcare inequalities, while the health service has opened five new adult Gender Dysphoria Clinics in England since 2020 to reduce waiting times.”
A Department of Health and Social Care spokesperson said: “We are determined to support people with their mental health, regardless of their sex, which is why we are investing an additional £2.3 billion a year into NHS mental health services.”
Published: by Radio NewsHub