Antitrans Policy Environment and Depression and Anxiety Symptoms in Transgender and Nonbinary Adults
Date
2024-08-22
Journal Title
Journal ISSN
Volume Title
Publisher
Jama Network Open
Abstract
Key Points
Question: Is awareness of current policies addressing access to health care for transgender and nonbinary (trans) populations associated with depression and anxiety?
Findings: In this cross-sectional study of 797 trans individuals living in Washington State, concerns about trans rights being taken away were associated with significantly higher odds of depression and anxiety symptoms. Individuals with accurate knowledge of state-level protective legislation had lower odds of depression and anxiety.
Meaning: In a policy environment with increasing legislation aimed at eroding trans rights and access to care, interventions that increase awareness and accurate knowledge of policies that protect access to trans health care could help address distress around losing trans rights and may mitigate the negative impact of nationwide antitrans policies on mental health outcomes in trans adults.
Abstract
Importance: With the increasing legislation restricting health care access for transgender and nonbinary (trans) populations in recent years, there has been limited research on how awareness of and concerns about legislative restrictions and protections influence mental health outcomes.
Objective: To examine whether awareness of and concerns about the current policy environment regarding trans individuals are associated with depression and anxiety symptoms among trans adults.
Design, Setting, and Participants: This study uses cross-sectional data collected between March and April 2023 from the Washington Priority Assessment in Trans Health (PATH) Project, an online study designed by, with, and for trans communities. All participants were trans adults, aged 18 years or older, living in Washington state.
Exposure: Awareness and concerns about the antitrans policy environment.
Main Outcomes and Measures: The primary outcomes were depression and anxiety symptoms, assessed via the Patient Health Questionnaire–4. A series of multivariable regression models was used to assess the association between awareness and concerns about the antitrans policy environment and depression and anxiety symptoms. Models were adjusted for covariates, including demographics, social marginalization, and health care experiences.
Results: A total of 797 participants (653 women [81.93%]; 455 aged 18-29 years [57.09%]) were included. The majority screened positive for current depression (689 individuals [86.45%]) and anxiety (686 individuals [86.07%]) symptoms. Trans individuals who were concerned or worried about their rights being taken away (vs not) had significantly higher odds of current depression symptoms (adjusted odds ratio [aOR], 1.66; 95% CI, 1.08-2.54), as well as current anxiety symptoms (aOR, 2.67; 95% CI, 1.63-4.36). Those who knew (vs did not know) about state-level protective legislation had significantly lower odds of current depression symptoms (aOR, 0.44; 95% CI, 0.28-0.67), as well as current anxiety symptoms (aOR, 0.11; 95% CI, 0.04-0.25). When examining interaction effect estimates, trans individuals who correctly knew about the protective policies and were not worried about having their rights taken away reported the lowest odds of depression and anxiety.
Conclusions and Relevance: The findings of this cross-sectional study are consistent with research elucidating the negative mental health consequences of policies limiting health care access and provide insights into informing policies and interventions that target trans populations’ worsened mental health outcomes as a result of antitrans legislation.
Description
This article was originally published in Jama Network Open. The version of record is available at: https://doi.org/10.1001/jamanetworkopen.2024.31306.
This is an open access article distributed under the terms of the CC-BY License (https://jamanetwork.com/pages/cc-by-license-permissions). © 2024 Restar A et al. JAMA Network Open.
Keywords
Citation
Restar A, Layland EK, Hughes L, et al. Antitrans Policy Environment and Depression and Anxiety Symptoms in Transgender and Nonbinary Adults. JAMA Netw Open. 2024;7(8):e2431306. doi:10.1001/jamanetworkopen.2024.31306