Gender minority students experience mental health inequities compared with cisgender students, with an associated 2- to 4-fold higher prevalence of depression, anxiety, eating disorders, self-injury, and suicidality, according to the results of a large campus-based study published in the American Journal of Preventive Medicine.

Sarah Ketchen Lipson, PhD, from the Department of Health Law Policy and Management at Boston University School of Public Health, Massachusetts, and colleagues analyzed data from the 2015 to 2017 Healthy Minds Study, a survey of 65,213 randomly selected students from 71 US campuses that included 1237 gender minority students. Outcomes were symptoms of depression, anxiety, eating disorders, self-injury, and suicidality. The investigators used bivariable and multivariable analyses to explore differences between gender minority and cisgender students.

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“Compared with 45% of cisgender students, 78% of [gender minority] students met the criteria for 1 or more mental health problems,” the authors wrote. Gender minority students more often screened positive for depression (58%) and reported nonsuicidal self-injury (53%) compared with cisgender students (58% and 53% vs 28% and 20%, respectively).

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“[T]rans masculine students had 3.9 times higher odds (95% CI=2.90, 5.10) and trans feminine students 1.9-times higher odds (95% CI=1.44, 2.56) of meeting the criteria for 1 or more mental health problems” compared with cisgender males, the authors noted.

Among gender minority students, “nearly 90% of both genderqueer [female at birth] and other self-identified gender [female at birth] students met criteria for 1 or more mental health problems,” the authors wrote. “Genderqueer students had a higher prevalence of 7 of 8 mental health outcomes than transgender students and students of other self-identified gender,” with the exception of suicide attempts.

Although validated screens were used to identify mental health outcomes, these do not constitute clinical diagnoses. The researchers also noted that the binary (male/female) data collected by campus registrars may not have accurately reflected minority genders.

“Findings from this largest campus-based study of its kind…underscore the importance of recognizing and addressing [gender minority] mental health burdens, such as by screening for mental health and providing gender-affirming services,” the researchers concluded.


Ketchen Lipson S, Raifman J, Abelson S, Reisner SL. Gender minority mental health in the US: result of a national survey on college campuses. Am J Prev Med. 2019;57:293-301. 

This article originally appeared on Psychiatry Advisor