Nav: Home

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health

March 16, 2020

  • Drawing on the largest sample of transgender people ever surveyed, a new study is the first to assess the relationship between gender-concordant IDs and mental health among transgender people in the USA.
  • The study finds that possessing gender-concordant IDs is associated with reduced psychological distress, and a lower prevalence of suicidal thoughts and suicide planning.
  • The authors suggest policy changes to increase access to gender-concordant IDs. For example, by reducing fees, administrative hurdles and eligibility requirements, and also by either expanding gender options beyond male or female, or by removing gender markers entirely.
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The authors note that the survey only questioned respondents at one time point, making it difficult to confirm whether lack of gender-affirming IDs caused psychological distress or the other way around. It is possible that trans people suffering from psychological distress might find it harder to obtain IDs. However, a previous Canadian study [1] found that having at least one document showing a trans person's preferred gender marker was associated with fewer suicidal thoughts and suicide attempts, and previous research has found that mental health risks in transgender adolescents are reduced when their preferred name is used socially [2].

"Our results suggest that governments and administrative bodies can play an important role in helping to reduce psychological distress for trans people, simply by making it easier to access identity documents that reflect their identity," says Dr Ayden Scheim from Drexel University, USA. [3]

Of the 1.4 million Americans who identify as transgender, over half are estimated to have clinical depression, compared to around 30% over a lifetime in the general US population, while 31% to 41% attempt suicide at some point during their lives, compared to less than 9% generally in the US. These mental health disparities can be attributed in part to a lack of recognition and acceptance of trans people's identified gender. Lack of gender-concordant official documents can prevent access to services such as healthcare, education, and employment, and increase exposure to verbal harassment and violence.

The authors suggest that at the moment, the ID change process in the USA, which varies across states, can be difficult to impossible. For example, in most US states updating a name on government-issued ID first requires a court-ordered name change, which can cost several hundred dollars. Most states require medical letters or affidavits to validate reclassification requests, and some may require gender transition surgery. In most jurisdictions, gender markers reflecting non-binary gender identity (such as an 'X' marker) are not yet available.

To explore the impact of access to IDs on psychological distress, suicidal thoughts and suicide attempts, researchers analysed data from 22,286 trans people, who were surveyed in 2015. Respondents were asked whether all, some or none of their IDs - including birth certificates, passports and driving licences - listed their preferred name and gender marker. Psychological distress was measured using a validated scale with a score between 0 and 24, with 13 or greater indicating serious psychological distress. To assess respondents' suicide risk, they were asked whether they had seriously considered suicide in the previous 12 months, whether they had made any plans to kill themselves and whether they had attempted suicide.

To ensure that the analysis was able to pick up any association between mental health and access to updated IDs, the authors of the current study adjusted the results to account for other variables that could contribute to psychological distress and suicidal thoughts - such as age, ethnicity, medical transition status and years living full-time in the identified gender.

The results found that 45.1% of respondents (10,288 out of 22,286) had no IDs with their preferred name and gender marker, 44.2% (9,666/22,286) had some ID that matched their name and/or gender, and only 10.7% (2,332/22,286) had their preferred name and gender on all their documents. The authors weighted the sample to reflect the age and ethnicity of the US population, although they note that trans demographics may not mirror broader US population demographics.

The reasons for not changing gender markers included a lack of suitable gender options (in the group with no concordant ID, people with non-binary identities were over-represented), cost, and perceived ineligibility (for example, believing that additional medical treatment was required). The authors also identified geographic variation in the results, with participants in western states more likely to have gender-concordant ID, while those in the Midwest were less likely.

Those with all gender-concordant IDs had a 32% lower prevalence of serious psychological distress than those with no updated documents. They were also 22% less likely to have had suicidal thoughts in the past year and 25% less likely to have made plans to kill themselves. Those with some updated IDs had smaller reductions in distress and suicidal thoughts (e.g., 12% reduction in distress). The results did not indicate an association between access to IDs and suicide attempts, once the authors had adjusted for other influences on mental health.

"When a trans person changes their gender on their official documents, it can be a critical step towards gaining social acceptance and legal recognition, and our findings suggest that policy changes to support trans people with taking this step should be considered, in order to help improve their wellbeing, reduce their exposure to discrimination and reduce suicidal thoughts," says Professor Greta Bauer from Western University, Canada. [3]

The authors note that other variables not covered in the study may mediate psychological distress, for example access to social support.

Writing in a linked Comment, lead author Dr Monica Malta (who was not involved in the study) from the University of Toronto says: "The cross-sectional study design prohibits causal interpretation of the identified relationships, and reverse causation is plausible--those with better mental health might be better able to navigate the difficult bureaucratic requirements to obtain gender congruent IDs. Even with those limitations, the large dataset and careful inclusion of potential confounders strengthen the study design. Thus, the authors' findings support the need to increase the availability of and streamline the processes to obtain gender congruent IDs. Gaining gender-congruent IDs should be easy, affordable, and quickly completed by adequately trained officials at TGD-friendly environments."
-end-
NOTES TO EDITORS

No funding was received for this analysis. It was conducted by researchers from the University of California San Diego, Drexel University, the University of Toronto and Western University.

If you are reporting on this study, please consider including a link to information and support for your readers. In the USA, the National Suicide Prevention Lifeline can be contacted on 1-800-273-TALK (8255) or visit https://suicidepreventionlifeline.org/. In the UK, the number is 116 123, or email: jo@samaritans.org or visit http://www.samaritans.org For those outside the USA and UK, Befrienders Worldwide also provide support: http://www.befrienders.org/

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com

[1] https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2

[2] https://www.jahonline.org/article/S1054-139X(18)30085-5/fulltext

[3] Quote direct from author and cannot be found in the text of the Article. Peer-reviewed / Survey / People

The Lancet

Related Mental Health Articles:

Mental illness, mental health care use among police officers
A survey study of Texas police officers examines how common mental illness and mental health care use are in a large urban department.
COVID-19 outbreak and mental health
The use of online platforms to guide effective consumption of information, facilitate social support and continue mental health care delivery during the COVID-19 pandemic is discussed in this Viewpoint.
COVID-19 may have consequences for mental health
The COVID-19 pandemic appears to be adversely affecting mental health among hospitalised patients, the healthcare professionals treating them and the general population.
Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.
Mental ill health 'substantial health concern' among police, finds international study
Mental health issues among police officers are a 'substantial health concern,' with around 1 in 4 potentially drinking at hazardous levels and around 1 in 7 meeting the criteria for post traumatic stress disorder and depression, finds a pooled data analysis of the available international evidence, published online in Occupational & Environmental Medicine.
Examining health insurance nondiscrimination policies with mental health among gender minority individuals
A large private health insurance database was used to examine the association between between health insurance nondiscrimination policies and mental health outcomes for gender minority individuals.
Mental health care for adolescents
Researchers examined changes over time in the kinds of mental health problems for which adolescents in the United States received care and where they got that care in this survey study with findings that should be interpreted within the context of several limitations including self-reported information.
Heat takes its toll on mental health
Hot days increase the probability that an average adult in the US will report bad mental health, according to a study published March 25, 2020 in the open-access journal PLOS ONE by Mengyao Li of the University of Georgia, and colleagues.
Mental health of health care workers in china in hospitals with patients with COVID-19
This survey study of almost 1,300 health care workers in China at 34 hospitals equipped with fever clinics or wards for patients with COVID-19 reports on their mental health outcomes, including symptoms of depression, anxiety, insomnia and distress.
The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.
More Mental Health News and Mental Health Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.