There are multiple factors that influence the mental health outcomes of TGNC-identifying individuals, including stigma and discrimination (Poteat et al., 2013). Students increasingly face anxiety, depression, and other mental health issues (Oswalt et al., 2020). The increase in mental health care utilization may be associated with an increase in the prevalence of poor mental health outcomes and a decrease in stigma surrounding access to mental health care (Lipson et al., 2019) .
Housing disparities are related to discrepancies in income and employment (Felt et al., 2021; Fletcher et al., 2014). Such experiences lead to a much lower quality of life and additional negative health outcomes (White Hughto et al., 2015; Zaliznyak et al., 2021). Examples of proximal stressors include internalized stigma and fear of disclosing a TGNC identity (Wittlin et al., 2023).
A literature review of TGNC youth-related research found that such mental health outcomes also affect TGNC youth (Wittlin et al., 2023). For the TGNC community, structural risk factors include transphobia, stigma, and genderism (Nicolazzo, 2016; White Hughto et al., 2015). Another important factor in mental health outcomes for TGNC individuals is the stage in life in which they begin to transition (Turban et al., 2021).
Such experiences are linked to lower retention rates, higher substance use and lower engagement on campus (Thomas et al., 2021).
RESULTS
Finally, more TGNC respondents reported that they were still on their parent's or guardian's health insurance plan (62.03%) compared to their cisgender peers (49.94%). Additionally, 77.83% of TGNC respondents reported having a diagnosed mental health condition, compared to 44.97% of cisgender respondents (Table 2). Regarding the anxiety and depression scores of the TGNC respondents, more than half reported having a diagnosis of depression and/or anxiety (52.38% and 55.72%) (Table 2).
Overall, more TGNC respondents reported using therapy/counseling services in their lifetime compared to cisgender respondents (83.09% and 53.47%, respectively) (Table 3). In terms of when this service was used, 43.55% of TGNC respondents reported using therapy/counseling both before and during college compared to 19.76% of cisgender respondents (Table 3). Furthermore, over half (52.89%) of TGNC respondents reported using medication in the past 12 months, compared to 27.61% of cisgender respondents (Table 3).
Notably, 37.09% of TGNC respondents reported using an anti-depressant in the past 12 months, compared to 17.51% of cisgender. 72.39% of cisgender respondents said they had not used any of the listed medications in the past 12 months, while only 47.11% of TGNC respondents said they had not taken any medications in 12 months (Table 3). Respondents were also asked to rank the perceived helpfulness of therapy/counseling services on a scale of 1 (very helpful) to 4 (not helpful).
26.59% of TGNC respondents stated that therapy was “very helpful” to them, compared to 16.08% of cisgender respondents (Table 3). 57.08% of TGNC respondents stated that they rely on a non-household friend for emotional and mental support, compared to 39.8% of cisgender respondents (Table 4). During times of severe emotional distress, TGNC respondents reported that they would seek help from a professional physician or a non-household friend (54.74% and 55.87%, respectively) (Table 4).
Regarding the relationship between therapy/counseling utilization timeline and mental health. After controlling for respondents' race, sexuality, sex assigned at birth, and insurance status, TGNC identity remained statistically significant. Although there is a difference between adjusted and unadjusted models, there is still a difference in mental health outcomes between TGNC and cisgender respondents.
DISCUSSION
TGNC individual's life creates the scenarios that lead to worse mental health outcomes (Feldman et al., 2021; White Hughto et al., 2022); thus, necessitating the examination of mental health care utilization among TGNC-identified populations. The TGNC respondents in the HMS reported using mental health services more often compared to their cisgender counterparts. These findings necessitate moving from calling for more therapy/counseling services to working to improve the quality of mental health care, increasing representation among providers, and addressing the structural issues that create worse mental health outcomes for the TGNC community .
The HMS (2022) findings show that the perceived helpfulness of therapy/counseling increases with the duration of care (Table 5), but that disparities in mental health outcomes persist despite the perceived helpfulness of the services. Formal mental health care is thus a stopgap for more structural elements that worsen mental health outcomes. This is consistent with other research looking at mental health outcomes and mental health service utilization among college students; respondents who did not seek care had a higher incidence of poor mental health outcomes (Ebert et al., 2019).
Although therapy/counseling is not the ultimate solution to closing the gap in mental health outcomes, the use of such services works to close the gap. There are many barriers to bridging mental health outcomes in TGNC individuals. Addressing the quality of care that TGNC people receive will help close the gap in mental health outcomes.
In context of my findings, while TGNC university-enrolled individuals access formal mental health care services at a significantly higher rate than their cisgender peers, they still report significantly worse mental health outcomes. According to the frameworks of social determinants of health and BMHSU, the differences in mental health make sense in context to the political condition of TGNC in the United States (Casey et al., 2019; Gonzales et al., 2022). This means that the results of this study using both of those scales of mental health outcomes are less reliable and may have invariance for LGBTQ+ identifying respondents.
Therefore, it may be useful to look not only at the respondent's country of residence at the time they are enrolled in college or university, but also at their country of origin prior to enrolling in school in relation to mental health outcomes and utilization. Another point of further investigation could be to examine perceived usefulness and differences in mental health outcomes. Finally, another point of further investigation would be to conduct interviews with university enrolled students about their perceived usefulness of therapy/counseling services and relate this to existing quantitative data I have collected on perceived usefulness and mental health outcomes.
CONCLUSION
APPENDIX Tables
Created at baseline as a sum of scores recorded during the administration of the Patient Health Questionnaire 9 (PHQ-9). Created at baseline as a sum of scores recorded during the administration of the Generalized Anxiety Disorder 7 (GAD-7) questionnaire. Created during the cleanup as a sum of the scores recorded during the administration of the Diener test as a way to measure positive mental health.
Created during cleaning to specify whether a respondent checked that they had any mental health diagnoses detailed in the next variable about what the diagnosis is. This question was only shown to people who did not select "no, never" when asked if they had ever used therapy or counseling services. Associations between gender identity and mental health in college-enrolled students in US colleges and universities.
Have you ever been diagnosed with any of the following conditions by a health care professional (eg, primary care physician, psychiatrist, psychologist, etc.)? Eating disorders (e.g. anorexia nervosa, bulimia nervosa); Psychosis (eg schizophrenia, schizoaffective disorder); Personality disorder (eg antisocial personality disorder, paranoid personality disorder, schizoid personality disorder); Substance use disorder (eg alcohol abuse, other drug abuse); No, none of these [mutually exclusive]; I do not know.". Informal help-seeking' 'Have you received support for your mental or emotional health from any of the following sources in the last 12 months.
Significant others; Relative; Religious counselor or other religious contact; Support Group; Other non-clinical source (please specify);. No never; Yes, before you start college; Yes, since you started studying; Yes, both of the above (before university and since starting college). Helpfulness of services "How helpful, in general, do you think therapy or counseling has been or has been for your mental or emotional health?".
Use of medication” “In the past 12 months, have you taken any of the following types of prescription medication. Psychostimulants (methylphenidate (Ritalin or Concerta), amphetamine salts (Adderall), dextroamphetamine (Dexerdine), etc.);. taken a few times a week, or take. I have no health insurance coverage (discovered) [mutually exclusive]; I have health insurance through my parent/guardian(s) or their employer; I have health insurance through my employer; I have health insurance through my spouse's employer; I have a student health insurance plan; I have health insurance through an embassy or sponsoring agency for international students; I have individual health insurance purchased directly from an insurance company; I have Medicaid or other government insurance; I am not sure if I have health.
WORKS CITED
Health insurance and mental health care utilization among adults who identify as transgender and gender diverse. Barriers to mental health treatment utilization among first-year college students: First international results from WHO World Mental. State policies and health disparities among transgender and cisgender adults: Considerations and challenges using population-based survey data.
Parental responses to transgender and gender nonconforming youth: Associations with parental support, parental abuse, and adolescent psychological adjustment. Closing the Generation Gap: Health Equity by Acting on the Social Determinants of Health. Just go in and look good': Resiliency, resistance, and the forging of kinship ties of trans* students.
Does the Andersen Behavioral Model of Health Services Use predict university students' use of mental health services on campus. A qualitative systematic review of service user and service provider perspectives on acceptance, relative benefits and potential harms of art therapy for people with non-psychotic mental disorders. Being Trans Crosses My Cultural Identity”: Social Determinants of Mental Health Among Asian Transgender People.
Timing of social transition for transgender and gender diverse youth, elementary school bullying, and 12-year-old and adult mental health.
