Study reveals extent of mental health challenges for transgender and non-binary patients in England

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In a recently published study, Dr Lancet Public HealthResearchers assessed gender-related disparities in self-reported mental health disorders and support in England.

Study: Gender-related self-reported mental health inequalities in primary care in England: a cross-sectional analysis using the GP patient survey.  Image Credit: Chinnapong/
Study: Gender-related self-reported mental health inequalities in primary care in England: a cross-sectional analysis using the GP Patient Survey.. Image Credit: Chinnapong/


Non-binary, gender-diverse and transgender people face prejudice and healthcare difficulties, which contribute to an increase in mental disorders such as depression and anxiety. Minority stress is a primary cause of poor mental health outcomes, and gender dysphoria, or distress caused by a mismatch between sex and gender at birth, may increase risk.

Access to early treatment can benefit mental health, but high waiting times at National Health Service (NHS) gender identity clinics can increase the risk. Existing evidence of gender-based disparities in mental health is scarce.

About the study

In the current study, researchers assessed self-reported mental health and disparity needs across 15 distinct categories, including 5 gender and three cisgender and transgender identity groups. They assessed potential mediators such as socioeconomic status, long-term health problems, general practitioner (GP) appointments and contact with healthcare professionals.

The team used individual-level data from the English General Practice (GP) Patient Survey (GPPS) conducted in 2021 and subsequent years. They performed logistic regression modeling to estimate the probabilities of study outcomes, such as self-reported mental disorders and unmet mental health care needs. The two exposure variables were gender, cisgender, and transgender identity.

The team presented findings for five gender-based groups (non-binary, male, female, self-reported choosing and non-disclosure) and three transgender or cisgender identity groups. They investigate potential mediation by introducing variables. They included GPPS participants by repeated stratified random sampling of patients aged 16 years and over registered with general practitioners in England.

The team sent participants self-completed surveys, accessible in 17 languages ​​including British Sign Language, which they could complete on paper, over the phone or online. They aim to engage members of the public and community through online discussion groups with the Applied Research Collaboration Greater Manchester (ARC-GM) Panel and the ARC-GM/Health Innovation Manchester Forum. They included people with lived and professional experience and representatives from relevant charities and learned about gender, cisgender and transgender identities. The team considered the year, mode and age group of the survey as variables.


Of the 1,520,457 respondents, 2,600 (0.30%) were non-binary, 861,017 (51%) were female, 645,300 (47%) were male, 2,277 (0.20%) self-reported their gender, and 9,263 (0.2%) did not choose. Specify their gender. There were 1,499,852 (98%) respondents who identified as cisgender, 7,994 (0.7%) as transgender, and 12,611 (1.0%) who did not specify their gender identification.

The team found significant gender-related disparities in the likelihood of self-reporting a mental disorder, with the highest likelihood among non-binary individuals, either transgender (47%) or those who choose to conceal their transgender or cisgender identity (33%), and Transgender individuals who self-reported their gender (35%).

Excluding non-binary individuals, cisgender patients had the lowest likelihood (ranging from 8.8% to 12%), followed by patients who chose not to disclose their gender identification (ranging from 7.2% female to 10% self-documented). The odds of self-reporting unmet mental health needs were lowest among cisgender male (16%) and female patients (16%), with higher odds among individuals of other groups, 20% among transgender males and 29% among transgender individuals. Choose to hide their gender and transgender or cisgender identity.

Disparities in health care encounters may account for gender disparities with positive mediators such as long-term health problems, socioeconomic indicators, and recruitment and continuation of treatment characteristics having minimal effects. Gender-related disparities in unmet mental health needs have been shown to widen with age. At their most recent session, 40% of respondents reported meeting mental health requirements, while 16% reported they did not. Patients who chose not to declare their gender, cisgender, or transgender identification represent the most diverse gender population.


Overall, study results revealed significant gender-based disparities in mental health outcomes, particularly among non-binary, gender-diverse and transgender individuals. Transgender patients have more long-term mental health problems than cisgender patients or those who do not disclose their gender identification. Non-binary patients and those who self-identify as genderqueer also face significant health risks. The findings emphasize the need for improved healthcare system inclusion, professional training, and social and legal context.

Socioeconomic disadvantage may contribute to poorer psychological outcomes and poverty. The research suggests improvements in recording gender across healthcare record systems, primary surveys and gender-inclusion in the English National Health Service. It also called for greater social and legal reforms to reduce minority pressures on these groups.

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