Anxiety, Depression, And PTSD Among A Cohort Of Middle Aged And Older Transgender Adults

TL;DR

Middle-aged and older transgender adults experience higher rates of anxiety, depression, and PTSD compared to cisgender individuals, with a greater impact on transgender people of color.

Contribution

This study provides the first large-scale analysis of mental health disparities in middle-aged and older transgender adults using real-world health records.

Findings

Transfeminine individuals had significantly higher odds of anxiety, depression, and PTSD compared to cisgender women and men.

Transmasculine individuals showed even higher odds of mental health conditions compared to cisgender men.

The mental health disparities were more pronounced among transgender individuals of color.

Abstract

Systematic studies of mental health status among older transgender adults are largely lacking. Kaiser electronic health records (01/2006–03/2023) were used to identify a cohort of 2,362 transfeminine (TF) and 1,185 transmasculine (TM) individuals aged 45+ years enrolled in three integrated health systems. Each transgender individual was matched to 10 cisgender men (CM) and 10 cisgender women (CW) on birth year, race/ethnicity, study site, and enrollment at index date (first evidence of transgender status in TF/TM cohort members). Enrollment time-adjusted odds ratios (aOR) along with 95% confidence intervals (CI) were calculated to examine prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) among TF and TM adults compared to their respective CM and CW referents. In the analyses comparing TF cohort members to CW referents the aOR (95% CI) estimates were 2.01 (1.84–2.20) for anxiety, 2.66 (2.43–2.90) for depression, and 3.27 (2.80–3.81) for PTSD. When TF individuals were compared to CM referents the aOR was 4.13 (3.77–4.52) for anxiety, 5.46 (4.99–5.97) for depression, and 7.53 (6.33–8.96) for PTSD. The aORs were more pronounced for TM relative to CM and attenuated for TM relative to CW. All associations were stronger in the sub-analyses restricted to persons of color whereas the sub-analyses focusing on gender-affirming hormone therapy recipients showed no discernable difference from the overall results. Older TF and TM adults experience a higher burden of mental health conditions compared to their cisgender counterparts. This burden appears to disproportionally affect transgender persons of color.