Bullied, discriminated transgender college students face significantly higher risk of suicide
Bullied, discriminated, harassed, and even denied access to bathrooms, transgender and other gender minority students are almost four times as likely to have suicidal thoughts, plans, and attempts as compared to their peers, according to a new study.
Gender minority students - whose gender identity differs from the sex assigned them at birth - are also between two and four times more likely to experience mental health problems than the rest of their peers, shows the largest and most comprehensive mental health survey of college students in the US.
“Rates of depression, anxiety, eating disorders, non-suicidal self-injury were approximately twice as high for gender minority students than for cisgender (whose sex assigned at birth aligns with their current gender identity) students, and suicidality indicators such as suicidal ideation, plans, and attempts were three-to-four times higher. Public health efforts are urgently needed to meet the mental health needs of gender minority students,” Sari Reisner, assistant professor at Harvard Medical School, based at Boston Children’s Hospital, and Harvard T.H. Chan School of Public Health, told MEA WorldWide (MEAWW).
The study puts the focus back on one of the decisions taken by the Trump administration, which was to ban transgender individuals from serving in the military.
“We are in a time when transgender people are being denied equal rights - to jobs, to housing, to healthcare, and to participate in the military. These data suggest that new policies eliminating equal rights for transgender people are affecting a population that already experiences a disproportionate burden of disease. As next steps, it will be important to evaluate whether equal rights or the elimination of equal rights for transgender people affects mental health disparities,” Julia Raifman, assistant professor of health law, policy and management at the Boston University School of Public Health, told MEAWW.
Along with a significantly higher prevalence of self-reported mental health issues among the gender-minority community, the researchers also found that transgender men and genderqueer students are particularly vulnerable groups, a statistic that warrants further research. The findings have been published in the American Journal of Preventive Medicine.
“By definition, mental health inequities are differences in mental health status that are avoidable and remediable - they are rooted in injustice experienced by marginalized groups in society. Gender minority students face myriad stressors due to being a member of a stigmatized group. These stressors activate psychological, behavioral, and physiological responses that can result in mental health vulnerabilities in gender minority students. For gender minority students, mental health inequities are driven by stigma at the structural (for example, discriminatory policies, lack of trained medical and mental health providers), interpersonal (for example, family or peer rejection, harassment, and bullying), and individual (for example, internalized transphobia, low self-esteem) levels.” Reisner told MEAWW.
Study lead author Sarah Ketchen Lipson, a Boston University School of Public Health assistant professor of health law, policy, and management, says that there has never been a “more important time” for colleges and universities to take action to protect and support trans, genderqueer, and non-binary students on campus.
“As a cisgender woman working on this topic, I think a lot about allyship and how I can conduct and disseminate research to advance advocacy efforts. First and foremost, allies on campus need to listen to and make space for the voices of trans people. Peers, friends, and colleagues on college campuses should be ‘upstanders,’ speaking up to call out hateful rhetoric, discrimination, microaggressions, and transphobic policies,” says Lipson.
The participants
The research team analyzed data collected between fall 2015 and spring 2017 through the Healthy Minds Study, a national, annual survey about campus mental health. The study sample included 65,213 students (1,237 gender minority students) at 71 colleges and universities across the US. There were 40 public and 31 private institutions.
The term “gender minority” encompasses transgender, genderqueer, and gender non-conforming individuals, as well as those who have another self-identified gender. Overall, 98% identified as cisgender, 2% as a gender minority, 1.3% identified as transmasculine, and 0.8% as transfeminine. The sample was roughly two-thirds white, and most were undergraduate students.
The analysis focused on the following: depression, anxiety, eating disorders, non-suicidal self-injury (NSSI), suicidal ideation, suicide plans, suicide attempts, and any mental health problem.
“Reports that over 40% of transgender people have attempted suicide in their lifetimes suggested to me that there was a large and disproportionate burden of disease among transgender people that public health research can contribute to addressing,” says Raifman.
The Healthy Minds Study, which over 300,000 US college students have voluntarily taken since its launch in 2007, uses clinically validated methods of screening for symptoms of depression, anxiety, eating disorders, and other mental health concerns.
The latest survey included space for participants to fill in their assigned gender at birth as well as their current gender identity, which allowed the researchers to filter their analysis and focus on the collective mental health of gender-minority students.
Analysis shows enormous mental health disparities
The researchers found that the proportion of gender minority students screening positive for depression, anxiety, and eating disorders, and reporting non-suicidal self-injury are more than twice that of cisgender students, The rates of suicidal plans and attempts are three to four more times higher, the findings state.
“Our research demonstrates that trans, genderqueer, and gender non-conforming young people face some of the most significant mental health inequities. Anyone interested in measurably improving adolescent and young adult mental health and reducing inequities should pay attention to gender minority youth.” Sara Abelson, co-Investigator and lead for diversity, equity and inclusion projects with the Healthy Minds Network.
According to the analysis, 78% of the gender-minority students included in the study met the criteria for one or more mental health problems, as compared to 45% cisgender students.
Further, more than half of gender minority students screened positive for depression (58%) and reported non-suicidal self-injury (53%), whereas 28% of cisgender students screened positive for depression and 20% reported non-suicidal self-injury.
More than one-third of gender minority students reported seriously thinking about suicide in the past year, relative to 1 in 10 cisgender students.
“While trans-masculine students had 6.1 times higher odds of screening positive for 1 or more mental health problems, gender minority status was associated with 4.3 -times higher odds of meeting the criteria for 1 or more mental health problems,” says the study.
The Healthy Minds Study has previously shown that college dropout rates are higher among transgender students and that they experience near-constant discrimination, and harassment.
According to the researchers, bathrooms, and housing are some of the most stressful areas on college campuses for transgender students, with research showing that transgender college students are at significantly higher risk for suicide and attempted suicide when denied access to gender-appropriate bathrooms and housing on college campuses.
What can be done?
The findings demonstrate an urgent need to address gender minority student mental health.
“Gender-affirming and transgender-competent systems are needed to screen for and provide mental health services,” says the study.
The researchers recommend policies, programs, and system changes to reduce discrimination and victimization, improve safety, enhance belonging, and create identity-affirming learning environments.
“Mental health outcomes, as well as negative educational outcomes like dropping out, are preventable. The most effective way to prevent them would be, from my perspective, through policy changes. Inclusive policies are necessary to advance equity. And that’s what I really want these data to speak to,” says Lipson.
Slowly, gender-neutral bathrooms and housing options are becoming the norm. The researchers hope that leaders in higher education will use these results as a springboard for much more urgent action, such as addressing gender-minority needs in housing policies, creating or revising policies that allow students to change their name in campus records, improving mental health resources on campuses, and raising awareness of gender-minority issues.
“Just as we have great evidence that national and state policies shape population health, college and university institutional policies can shape the health of student populations. Policies that could support students include those to support the use of students’ preferred names and pronouns, gender-inclusive bathroom, dorm, and student group policies, and health insurance and care programs that support gender transitions,” says Raifman.