Transgender people in England are much more likely to have a long-term mental health condition, the first study of its kind shows, with some facing a risk five times higher than cisgender people.

Research previously suggested a higher risk of conditions such as depression and anxiety among transgender, non-binary and gender-diverse people. However, this was based on small studies that cannot be generalised to the full population.

Now the first nationally representative study of its kind has calculated the burden of mental ill health among the transgender population, and the extent to which they report that their needs are not being met.

The risk of a long-term mental health condition in England is about one in six for transgender men and women (16.4% and 15.9% respectively) and one in 10 for cisgender men and women (8.8% and 12%), according to the study.

The risk of reporting a mental health condition was even higher for some gender minority groups, at almost one in two (47.2%) for non-binary transgender people.

The research, led by the University of Manchester in collaboration with the Proud Trust and LGBT Foundation, was published in the Lancet Public Health journal.

“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,” said Dr Luke Munford, a senior lecturer in health economics at Manchester and co-author of the paper.

“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 NHS gender identity clinics.”

The study of 1.5 million people aged 16 and over in England, including 8,000 transgender people, 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.

The researchers noted limitations to their study. They included the fact that pooling data from two 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 survey questions did not record when their mental health condition developed. Munford said the researchers could therefore not rule out the possibility that the mental health condition predated the change of their gender identity.

Alongside investigating the frequency of mental health conditions, the researchers looked at how well people’s mental health needs were met at GP appointments. Those with a gender identity other than cisgender male or cisgender female were more likely to report unmet needs at their last consultation.

One in six cisgender men and cisgender women reported their mental health needs were unmet (15.6% and 15.9% respectively). This was lower than all other gender identity groups, which ranged between one in five (20%) for transgender men and one in four (28.6%) among patients who preferred not to say their gender identity.

“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,” said the study’s co-author, Dr Ruth Watkinson, a research fellow at the University of Manchester.

“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.”

Meanwhile, a coalition of charities and human rights groups said on Wednesday that they “strongly oppose” the government’s draft guidance on how schools in England should treat transgender students.

The alliance, including Stonewall, Liberty and Mermaids, said the guidance “seeks to deny the existence of transgender pupils” and could lead to them being forcibly outed. “It hampers teachers’ ability to tackle bullying and ultimately risks causing more harm and exclusion of trans young people,” the group stated, calling for the guidance to be withdrawn.

The draft guidance, published late last year, advised schools that they had no “general duty” to let students change their preferred names or uniforms – known as social transitioning – and emphasised that parents should be involved where possible.

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