Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people

• Published in: PloS one 2021-07, Vol.16 (7), p.e0254215-e0254215
• Main Authors: Jarrett, Brooke A, Peitzmeier, Sarah M, Restar, Arjee, Adamson, Tyler, Howell, Sean, Baral, Stefan, Beckham, S Wilson
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anxiety; Care and treatment; Control stability; Coronaviruses; COVID-19; COVID-19 - economics; COVID-19 - epidemiology; COVID-19 - psychology; Cross-Sectional Studies; Depression, Mental; Diagnosis; Disease transmission; Economic aspects; Economic models; Epidemics; Epidemiology; Female; Gender; Gender-affirming care; Health aspects; Health promotion; HIV; Human immunodeficiency virus; Humans; Impact analysis; Male; Medicine and Health Sciences; Men; Mental depression; Mental health; Mental Health - economics; Middle Aged; Minority & ethnic groups; Non-binary gender; Pandemics; Psychological aspects; Public health; Regression analysis; Regression models; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Sex Reassignment Procedures - economics; Signs and symptoms; Social aspects; Social research; Social Sciences; Suicidal behavior; Supervision; Transgender people; Transgender persons; Transgender Persons - psychology; United States; Viral diseases; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0254215

Transgender and nonbinary people are disproportionately affected by structural barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) crisis and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and nonbinary people in multiple countries. We collected multi-national, cross-sectional data from 964 transgender and nonbinary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of COVID-19. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one's gender were related to depressive symptoms, anxiety, and changes in suicidal ideation. Individuals resided in 76 countries, including Turkey (27.4%, n = 264) and Thailand (20.6%, n = 205). A majority were nonbinary (66.8%, n = 644) or transfeminine (29.4%, n = 283). Due to COVID-19, 55.0% (n = 320/582) reported reduced access to gender-affirming resources, and 38.0% (n = 327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%, n = 392/856). One in six (17.0%, n = 112/659) expected losses of health insurance, and 77.0% (n = 724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36-1.97), 1.61 (95% CI: 1.31-1.97), and 1.74 (95% CI: 1.07-2.82) times higher for individuals whose access to gender-affirming resources was reduced versus not. The COVID-19 crisis is associated with reduced access to gender-affirming resources and the ability of transgender and nonbinary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve health of transgender and nonbinary communities, increased access to gender-affirming resources should be prioritized through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.