Probing The Complexities Of Transgender Mental Health

March 23, 2016


Experiencing the world as a different gender than the one assigned you at birth can take a toll. Nearly all research into transgender individuals’ mental health shows poorer outcomes. A new study looking specifically at transgender women, predominantly women of color, only further confirms that reality.

What’s less clear, however, is whether trans individuals experience more mental distress due to external factors, such as discrimination and lack of support, or internal factors, such as gender dysphoria, the tension resulting from having a gender identity that differs from the sex one was assigned at birth.

Transgender people are often treated extremely poorly by their parents, by their schools, by society at large, and that can leading to problems in school and at work, as well as poverty and increased risk of substance use, according to Ilana Sherer, assistant medical director of the Child and Adolescent Gender Center at the University of California Benioff Children’s Hospital in San Francisco.

“The biggest question we need to answer about transgender mental health is this,” Sherer wrote in an email. “Is there something inherent about being transgender that makes one more at risk for poor mental health, or is it about how society treats transgender people?”

The study published Monday in JAMA Pediatrics reveals the difficulty in picking apart this question. It examined mental health and substance use among nearly 300 young transgender women in Chicago and Boston.

Only a quarter of the women were white, and all were between ages 16 and 29. The researchers, led by Sari Reisner, a research fellow at Harvard Medical School and Boston Children’s Hospital, found that the rate of psychiatric disorders and substance dependence among these women was 1.7 to 3.6 times greater than in the general population.

Four in 10 of the women had a mental health or substance dependence disorder, and 1 in 5 women had at least two diagnosed psychiatric conditions. More than a third of them had experienced depression, and 1in 5 women had contemplated suicide in the past month. Rates of anxiety, post-traumatic stress, alcohol dependence and other substance dependence also remained higher than average.

At the same time, most of these women were unemployed, more than a quarter lacked health insurance, and many lived in extreme poverty — all mental health stressors and potential effects of discrimination, said Joanna Olson-Kennedy, medical director of the Center for Transyouth Health and Development at Children’s Hospital in Los Angeles, the largest transgender youth clinic in the United States.

Those findings contrast significantly from those of another study published this month, which looked at the mental health of 73 transgender children between ages 3 and 12 in Washington state. This younger group did not experience any more depression, and had only slightly more anxiety, than their siblings and non-transgender peers. But the differences between the two studies’ participants are also vast.