Psychiatric disorders in the U.S. transgender population

Ann Epidemiol. 2019 Nov:39:1-7.e1. doi: 10.1016/j.annepidem.2019.09.009. Epub 2019 Oct 4.


Purpose: The purpose of the study was to determine the prevalence and odds of mental disorder diagnoses at discharge in U.S. transgender hospital encounters as compared with cisgender hospital encounters using nationally representative data.

Methods: The National Inpatient Sample was used to identify 25,233 transgender and 254,437,363 cisgender inpatient encounters from 2007 to 2014. Univariate analyses were performed to compare the prevalence of mental disorders and comorbid medical diagnoses at the time of discharge. Multivariable analyses controlling for medical comorbid diagnoses were performed to assess the multivariable odds of mental disorder diagnoses in transgender versus cisgender hospital encounters. The prevalence of medical comorbid diagnoses in transgender encounters with and without mental disorder diagnoses was also compared.

Results: The prevalence of mental disorder diagnoses was higher in transgender hospital encounters (77% vs. 37.8%, P < .001). The prevalence of each examined mental disorder diagnosis was significantly higher in transgender hospital encounters. A multivariable analysis demonstrated significantly higher odds of all mental disorder diagnoses (odds ratio [OR] = 7.94; confidence interval [CI], 7.63-8.26; P < .001), anxiety (OR = 3.44; CI, 3.32-3.56; P < .001), depression (OR = 1.63; CI, 1.57-1.70; P < .001), and psychosis (OR = 2.46; CI, 2.36-2.56; P < .001) among transgender versus cisgender inpatient encounters. Transgender encounters with a mental disorder diagnosis had a higher prevalence of chronic medical comorbid diagnoses as compared with transgender encounters without mental disorder diagnoses.

Conclusions: Our findings suggest a high prevalence and significantly higher odds of mental disorder diagnoses in the transgender population as compared with the cisgender population using data that are nationally representative of the U.S.

Keywords: Anxiety; Depression; Hospitalization; Mental illness; Psychiatric disorders; Psychosis; Trans men; Trans women; Transgender.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety / epidemiology
  • Depression / epidemiology
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Mood Disorders / epidemiology
  • Prevalence
  • Psychotic Disorders / epidemiology
  • Transgender Persons / psychology*
  • Transgender Persons / statistics & numerical data
  • United States / epidemiology
  • Young Adult