Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      COVID-19*/economics ; COVID-19*/epidemiology ; COVID-19*/psychology ; SARS-CoV-2*; Mental Health/*economics ; Sex Reassignment Procedures/*economics ; Transgender Persons/*psychology; Adolescent ; Adult ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged
    • Abstract:
      Background: Transgender and nonbinary people are disproportionately affected by structural barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) crisis and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and nonbinary people in multiple countries.
      Methods: We collected multi-national, cross-sectional data from 964 transgender and nonbinary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of COVID-19. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one's gender were related to depressive symptoms, anxiety, and changes in suicidal ideation.
      Results: Individuals resided in 76 countries, including Turkey (27.4%, n = 264) and Thailand (20.6%, n = 205). A majority were nonbinary (66.8%, n = 644) or transfeminine (29.4%, n = 283). Due to COVID-19, 55.0% (n = 320/582) reported reduced access to gender-affirming resources, and 38.0% (n = 327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%, n = 392/856). One in six (17.0%, n = 112/659) expected losses of health insurance, and 77.0% (n = 724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36-1.97), 1.61 (95% CI: 1.31-1.97), and 1.74 (95% CI: 1.07-2.82) times higher for individuals whose access to gender-affirming resources was reduced versus not.
      Discussion: The COVID-19 crisis is associated with reduced access to gender-affirming resources and the ability of transgender and nonbinary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve health of transgender and nonbinary communities, increased access to gender-affirming resources should be prioritized through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.
      Competing Interests: SWB has received funding from Viiv Healthcare as a consultant. SH is the co-founder, chairman, and president of Hornet. Participant recruitment was conducted via the Hornet app. No other authors had competing interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
    • Comments:
      Update of: medRxiv. 2020 Nov 04;:. (PMID: 33173876)
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    • Grant Information:
      F31 MH121128 United States MH NIMH NIH HHS; K01 MH114715 United States MH NIMH NIH HHS; R01 MH110358 United States MH NIMH NIH HHS; T32 AI102623 United States AI NIAID NIH HHS
    • Publication Date:
      Date Created: 20210709 Date Completed: 20210719 Latest Revision: 20240402
    • Publication Date:
      20240402
    • Accession Number:
      PMC8270151
    • Accession Number:
      10.1371/journal.pone.0254215
    • Accession Number:
      34242317