Jarrett Brooke A, Peitzmeier Sarah M, Restar Arjee, Adamson Tyler, Howell Sean, Baral Stefan, Beckham S Wilson
Department of Epidemiology; Bloomberg School of Public Health, Johns Hopkins University.
Department of Health Behavior and Biological Sciences; School of Nursing; University of Michigan.
medRxiv. 2020 Nov 4:2020.11.02.20224709. doi: 10.1101/2020.11.02.20224709.
Transgender and non-binary people are disproportionately burdened by barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) pandemic and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and non-binary people globally.
We collected global cross-sectional data from 964 transgender and non-binary 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 the COVID-19 pandemic. 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.
Individuals resided in 76 countries, including Turkey (27.4%,n=264/964) and Thailand (20.6%,n=205). A majority were non-binary (66.8%,n=644) or transfeminine (29.4%,n=283). Due to the COVID-19 pandemic, 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.
The COVID-19 pandemic has reduced access to gender-affirming resources and the ability of transgender and non-binary 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 transgender and non-binary health globally, increased access to gender-affirming resources should be achieved through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.
跨性别者和非二元性别者在获得优质医疗保健、应对心理健康挑战和经济困难方面负担过重。本研究调查了新型冠状病毒病（COVID-19）疫情及后续防控措施对全球跨性别者和非二元性别者的性别肯定医疗、心理健康和经济稳定性的影响。
我们于2020年4月至8月从Hornet和Her应用程序的964名跨性别和非二元性别成年用户中收集了全球横断面数据，以描述因COVID-19疫情导致的性别肯定医疗、心理健康和经济稳定性的变化。我们进行了泊松回归模型分析，以评估获得性别肯定医疗的机会以及按照自身性别生活的能力是否与抑郁症状、焦虑和自杀意念的变化有关。
参与者来自76个国家，包括土耳其（27.4%，n = 264/964）和泰国（20.6%，n = 205）。大多数为非二元性别（66.8%，n = 644）或跨性别女性（29.4%，n = 283）。由于COVID-19疫情，55.0%（n = 320/582）的人报告获得性别肯定资源的机会减少，38.0%（n = 327/860）的人报告按照自身性别生活的时间减少。约一半的人抑郁筛查呈阳性（50.4%，442/877），焦虑筛查呈阳性（45.8%，n = 392/856）。六分之一（17.0%，n = 112/659）的人预计会失去医疗保险，77.0%（n = 724/940）的人预计收入会减少。获得性别肯定资源机会减少的个体出现抑郁症状、焦虑和自杀意念增加的患病率分别比未减少的个体高1.63倍（95%CI：1.36 - 1.97）、1.61倍（95%CI：1.31 - 1.97）和1.74倍（95%CI：1.07 - 2.82）。
COVID-19疫情减少了全球跨性别者和非二元性别者获得性别肯定资源的机会以及按照自身性别生活的能力。这些减少可能导致本样本中报告的抑郁症状、焦虑和自杀意念增加。为改善全球跨性别者和非二元性别者的健康状况，应通过政策（如数字处方）、灵活干预措施（如远程医疗）以及对现有跨性别健康倡议的支持，增加获得性别肯定资源的机会。
