We tracked the mental health of trans and gender-diverse Australians for over 20 years. And we’re worried

The mental health of trans, nonbinary and gender-diverse Australians is worse than the general population and the gulf is getting wider.

Our new study, published recently in BMJ Mental Health, shows the gap has grown considerably since 2010, particularly for young people.

This is the first time the mental health of trans, nonbinary and gender-diverse Australians has been tracked over time for so long using data that represents the whole population.

Here’s why we’re so concerned, and what we can do to help alleviate the distress.

What we did

We sourced information from Australia’s longest-running population survey of households – the Household, Income and Labour Dynamics in Australia (HILDA) Survey. This survey includes questions about mental health, which we tracked from 2001 to 2022.

Since 2022, the HILDA survey has included questions on gender identity. This allowed us to identify people who were trans (whose gender identity is not typically associated with their assigned sex at birth), nonbinary (who describe their gender outside of the female/male binary), gender-diverse (whose gender identity differs from the sex they were assigned at birth, including people who don’t identify as male or female), or cisgender (whose gender identity and expression matches the biological sex they were assigned at birth).

So we were able to compare the mental health of Australians who identified as trans, nonbinary or gender-diverse to that of Australians who identified as cisgender.

What we found

Across the 22-year period, trans, nonbinary and gender-diverse Australians consistently reported worse mental health than cisgender Australians.

Between 2001 and 2010, they scored five to seven points lower on mental health, which is a clinically relevant difference.

Between 2011 and 2022, the difference was even greater. Trans, nonbinary and gender-diverse Australians scored eight to 13 points lower than cisgender Australians. We found these increasing disparities over time were even greater for young people (under 30 years old).

These trends remained even after controlling for other characteristics such as household income, education level and living in rural areas.

What’s behind this?

Several studies and reports indicate what could be behind these differences in mental health.

Trans, nonbinary and gender-diverse populations are more likely to face stigma, discrimination, violence and other human rights challenges, such as refusal of health care, compared with the general population.

These experiences have profound and lasting impacts on mental health and health behaviours, such as seeking help for physical and mental health issues.

Exposure to anti-trans rhetoric and discrimination against trans, nonbinary and gender-diverse Australians has been increasing in recent years.

Trans, nonbinary and gender-diverse populations are more likely to experience gender dysphoria – the psychological distress that can arise when a person’s gender identity does not align with their sex assigned at birth.

Gender-affirming medical care (for instance, with puberty blockers, hormonal therapy or surgery) can help combat gender dysphoria. However many aspects of this care, particularly surgeries, are not currently funded in the public system in Australia. And not everyone has access to gender-affirming care, including young people who wish to start puberty blockers in Queensland’s public health system.

What can we do?

Improving trans, nonbinary and gender-diverse mental health requires urgent action at multiple levels if we are to avoid the devastating consequences for these Australians and their families.

1. Reduce stigma and discrimination

We need to reduce stigma and discrimination against trans, nonbinary and gender-diverse Australians. We know discrimination or stigma directed at an individual (including harassment or abuse) and broader structural discrimination (for instance, through laws and policies or broader community attitudes) impacts the mental health of minority groups.

Governments must implement policies that protect against discrimination, including banning harmful conversion practices in all states and territories. These practices, which attempt to change or suppress a person’s gender identity, have been shown to cause lasting psychological harm.

Trans, nonbinary and gender-diverse Australians also need legal protections in education, employment, and health care to help lessen and prevent the negative mental health impacts of discrimination and social exclusion.

2. Make services inclusive

Trans, nonbinary and gender-diverse community-controlled organisations should be adequately funded to provide peer support, mental health services and training for other health workers.

Ensuring health-care providers are trained in how to deliver safe and welcoming services for trans, nonbinary and gender-diverse people is essential in addressing health-care barriers and improving health outcomes.

3. More gender-affirming care

Expanding access to gender-affirming care is also crucial to improve mental health. This includes reducing psychological distress, self-harm and suicide attempts.

There must be a concerted effort to depoliticise this area of health care and acknowledge that gender-affirming care is essential, evidence-based medical treatment.

We hope the National Health and Medical Research Council
review of clinical guidelines for gender-affirming care in young people will help consolidate the evidence and counter misinformation to ensure that trans, nonbinary and gender-diverse Australians receive the care they need.

Trans, nonbinary and gender-diverse people, and organisations that represent them, coauthored the paper mentioned in this article. We also value the contributions of Ricki Spencer and Ian Down (from LGBTIQ+ Health Australia).

If this article has raised issues for you, or if you’re concerned about someone you know, contact QLife (call 1800 184 527 or chat online, 3pm–midnight, every day) or call Lifeline on 13 11 14 (24 hours a day).