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Transgender, non-binary, and gender-diverse people had a disproportionately high rate of self-reported mental health conditions, a British study suggested.

Among over 1.5 million survey respondents, non-binary patients who were transgender reported a long-term mental health condition most often out of 15 gender groups, with a rate of 47.21% after age adjustment (95% CI 42.86-51.60), Ruth Elizabeth Watkinson, PhD, of the University of Manchester in England, and colleagues found.

Coming in second most common in reporting a mental health condition were the 35.03% of transgender patients who self-described their gender (e.g., respondents who did not identify with the predefined choices), followed by the 32.90% of non-binary patients who preferred not to say their cisgender or transgender identity.

This was juxtaposed by only 8.80% and 11.97% of cisgender male and females reporting a mental health condition, respectively, the researchers reported in .

"Trans, non-binary and gender diverse people across England face widespread discrimination, leading to stressful social interactions and feelings of unacceptance, increasing the risk of poor mental health," co-author Luke Munford, PhD, also of the University of Manchester, explained in a statement.

"Additionally, gender dysphoria -- a sense of unease due to a mismatch between a person's biological sex and their gender identity -- may increase the risk of poor mental health amongst some trans, non-binary, and gender diverse people, especially when combined with very long waiting times for [National Health Service] gender identity clinics," Munford added.

Beyond a greater likelihood of listing a mental health condition, transgender, non-binary, and gender diverse people were also more likely to self-report having unmet mental health needs at their last general practitioner (GP) visit. Cisgender males (15.55%) and females (15.93%) had the lowest probabilities of reporting unmet mental health needs. All other gender groups had higher rates, ranging from 19.95% for transgender males up to 28.64% of patients who preferred not to say their gender identity.

"Poor communication from health-care 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," Watkinson suggested in a statement. "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 health-care records systems and staff training to ensure health-care professionals meet the mental health needs of all patients, whatever their gender."

Survey responses for the analysis came from the 2021 and 2022 English General Practitioner Patient Surveys, which included 1,520,457 patients ages 16 and older who are registered at GPs in England. Patients were allowed to respond to the survey more than once. Within the questionnaire, respondents were asked two questions on gender and identity:

• "Which of the following best describes you?" with the answer options "female," "male," "non-binary," "prefer to self-describe," and "I would prefer not to say"
• "Is your gender identity the same as the sex you were registered at birth?" with the answer options "yes" (coded as cisgender), "no" (coded as transgender), and "I would prefer not to say" (coded as preferring not to say)

From there, respondents were categorized into the following 15 exposure groups: five gender groups -- female, male, non-binary, prefer to self-describe, and prefer not to say -- within three cisgender or transgender identity groups of cisgender, transgender, or prefer not to say.

Most were female (51.4%), while 47.4% were male, 0.3% were non-binary, 0.2% self-described their gender, and 0.7% preferred not to state their gender. The vast majority were cisgender (98.3%), while 0.7% were transgender (7,994 individuals) and 1% preferred not to say their cisgender or transgender identity.

When stratified by age, differences in self-reported mental health conditions tend to be smaller among older age groups. The reverse was noted for unmet mental health needs though, as gender-related disparities tended to increase with age.

Despite the large sample size, the small group sizes of transgender, non-binary, and gender diverse people limited further investigation into other factors that might have played a role, like ethnicity, socioeconomic status, or disability, the researchers pointed out.

As for steps toward tackling these apparent disparities, co-author Jack Tielemans, of the Proud Trust, called for a broad set of solutions.

"Empowering young LGBT+ people to be proud of who they are through youth groups, mentoring programs and societal support, alongside inclusive healthcare, are important in tackling the higher risk of mental health conditions amongst trans, non-binary, and gender diverse young people," he said in a .

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