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Journal article
Gender-concordant identity documents and mental health among transgender adults in the USA: a cross-sectional study
The Lancet. Public health, v 5(4), pp E196-E203
01 Apr 2020
PMID: 32192577
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Transgender (trans) people experience profound mental health disparities compared with the general population, attributable in part to the psychological effects of gender non-affirmation. Despite the barriers to legal gender affirmation for trans people, little is known about its association with mental health. We therefore sought to determine whether having gender-concordant identity documents (IDs) is associated with mental health among trans adults in the USA. We hypothesised that having an ID that reflects one's preferred name and gender marker would be associated with reduced psychological distress and suicide risk.
Methods In this cross-sectional observational study, we obtained data from the 2015 US Transgender Survey, the largest cross-sectional survey of trans adults in the USA, with 27715 participants. Eligible participants were adults (>= 18 years), residing in a US state, territory, or overseas US military base; and considered themselves transgender, trans, genderqueer, non-binary, or similar. We excluded participants not living day-to-day in a different gender to the sex they were assigned at birth, participants who identified as crossdressers, and those missing data. The primary exposure of interest was whether all or some (vs none) of a respondent's IDs reflected their preferred name and gender market We examined associations with psychological distress (measured with the Kessler 6 scale) and suicide ideation, planning, and attempts in the past year, which we analysed using linear and modified Poisson regression models to examine associations with respondents' IDs.
Findings Of 22286 respondents included in our analytic sample, 10 288 (weighted percentage 45.1%) had their preferred name and gender marker on none, 9666 (44.2%) on some, and 2332 (10.7%) on all of their IDs. Compared with those with no gender-concordant ID, respondents for whom all IDs were concordant had lower prevalence of serious psychological distress (adjusted prevalence ratio 0-68,95% CI 0.61-0.76), suicidal ideation (0-78,0.72-0.85), and suicide planning (0.75, 0.64-0. 87), adjusting for potential confounders. Having some versus no concordant ID was generally associated with smaller reductions in distress and suicidality. Gender-concordant ID was not associated with suicide attempts (eg, adjusted prevalence ratio for all vs no IDs was 0.92, 95% CI 0.68-1.24).
Interpretation Possession of gender-concordant IDs might improve mental health among trans persons. Gender recognition policies should be considered structural determinants of transgender health. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
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Details
- Title
- Gender-concordant identity documents and mental health among transgender adults in the USA: a cross-sectional study
- Creators
- Ayden I. Scheim - Drexel UniversityAmaya G. Perez-Brumer - Division of Social and Behavioural Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.Greta R. Bauer - Western University
- Publication Details
- The Lancet. Public health, v 5(4), pp E196-E203
- Publisher
- Elsevier
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000522787400013
- Scopus ID
- 2-s2.0-85082449535
- Other Identifier
- 991019168210604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health