Gender minority college students at increased mental health risk

(Reuters Health) - Gender minority students in U.S. colleges and universities are four times as likely as other students to experience mental health problems, researchers say.

Students who identify as transgender, gender nonconforming, genderqueer and nonbinary need gender-affirming services on campus, as well as screening for mental health concerns, the authors of a new study conclude in the American Journal of Preventive Medicine.

“The traditional college years coincide with the onset of about 75% of mental illnesses, and students are experiencing newfound autonomy living on their own with new social environments, new health behaviors and different forms of stress,” said Sarah Ketchen Lipson of the Boston University School of Public Health, who led the study.

“This is a key time for students to address their mental health, and we often see students experience symptoms for the first time,” she told Reuters Health in a phone interview. “That’s particularly relevant for the students who identify as nonbinary, transgender or genderqueer.”

Lipson and colleagues analyzed data from the 2015-2017 Healthy Minds Study, an annual survey of randomly selected students at U.S. campuses who are 18 years or older and answer the questions online. Among more than 65,000 participants from 71 campuses across four semesters whose responses were included in the new analysis, about 1,200 students identified as gender minorities.

The research team analyzed survey responses for symptoms of common mental health problems, including depression, anxiety, eating disorders, self-injury, suicidal ideation, suicide plans and suicide attempts.

Overall, about 78% of gender minority students met the criteria for one or more mental health disorders, as compared with 45% of cisgender students.

In particular, nearly 60% of gender minority students screened positive for depression, and more than one third reported seriously thinking about suicide in the past year.

Genderqueer students had a higher prevalence of seven out of the eight mental health measures examined, and transgender students had the highest rate of suicide attempts.

“Working with this dataset for 10 years now, I’m used to the numbers, and I talk about how the prevalence of mental health problems is increasing,” she said. “What’s surprising is the magnitude of disparities, and the consistency across all the indicators makes you step back and take pause,” Lipson said.

After adjusting for race, age, socioeconomic status and other factors, the researchers calculated that gender minority status carried a greater than four-fold risk for mental health symptoms compared with cisgender students.

In future research, Lipson said more surveys need to measure gender identity and gender expression. Beyond that, researchers need to understand how college campus environments are affecting students with regard to student housing policies, student health insurance coverage for hormone replacement therapies and gender-neutral bathrooms. Counseling centers also need staff who are trained and knowledgeable about unique issues related to gender minority students, she said.

“It’s important for health centers and academic presidents to look at the culture being created on campus and what they can do to make an environment that supports healthy mental health,” said Sara Oswalt of the University of Texas at San Antonio, who wasn’t involved in the study.

This could include policies such as not allowing assignments to be due at midnight, incorporating more green space and pedestrian-friendly areas, creating private spaces for napping, and offering services that help students to learn resiliency and coping skills, Oswalt said in a phone interview.

The Human Rights Campaign’s Healthcare Equality Index and Campus Pride’s Best of the Best lists can be helpful rankings for students, parents and administrators to see which campuses offer support, she noted.

“If you’re a student already at college, tap into the resources that are available on campus, which may be a student group that gives you support,” Oswalt advised. “Look at your own work-life balance and coping strategies and see what’s available around you for help.”

SOURCE: American Journal of Preventive Medicine, online August 16, 2019.