Association of Nondiscrimination Policies With Mental Health Among Gender Minority Individuals

Abstract

In the past decade, many states have implemented policies prohibiting private health insurers from discriminating based on gender identity. Policies banning discrimination have the potential to improve access to care and health outcomes among gender minority (ie, transgender and gender diverse) populations.OBJECTIVE To evaluate whether state-level nondiscrimination policies are associated with suicidality and inpatient mental health hospitalizations among privately insured gender minority individuals. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, difference-in-differences analysis comparing changes in mental health outcomes among gender minority enrollees before and after states implemented nondiscrimination policies in 2009-2017 was conducted. A sample of gender minority children and adults was identified using gender minority-related diagnosis codes obtained from private health insurance claims. The present study was conducted from August 1, 2018, to September 1, 2019.EXPOSURE Living in states that implemented policies banning discrimination based on gender identity in 2013, 2014, 2015, and 2016. MAIN OUTCOMES AND MEASURESThe primary outcome was suicidality. The secondary outcome was inpatient mental health hospitalization. RESULTSThe study population included 28 980 unique gender minority enrollees (mean [SD] age, 26.5 [15] years) from 2009 to 2017. Relative to comparison states, suicidality decreased in the first year after policy implementation in the 2014 policy cohort (odds ratio [OR], 0.72; 95% CI, 0.58-0.90; P = .005), the 2015 policy cohort (OR, 0.50; 95% CI, 0.39-0.64; P < .001), and the 2016 policy cohort (OR, 0.61; 95% CI, 0.44-0.85; P = .004). This decrease persisted to the second postimplementation year for the 2014 policy cohort (OR, 0.48; 95% CI, 0.41-0.57; P < .001) but not for the 2015 policy cohort (OR, 0.81; 95% CI, 0.47-1.38; P = .43). The 2013 policy cohort experienced no significant change in suicidality after policy implementation in all 4 postimplementation years (2014:

State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People

“…While previous studies found positive outcomes where state-level policies were protective, such as reduced suicidal ideation or attempts [ 10 , 41 , 42 ] or greater utilization of healthcare services [ 43 ], we found either null results or greater odds of discrimination and victimization. The social context in the USA, as viewed through the social ecological model, is an important consideration to interpret these unexpected findings.…”

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…However, transgender identity is not a mental illness, and these elevated rates have been linked to complex trauma, societal stigma, violence, and discrimination (Nuttbrock et al., 2014 ; Peterson et al., 2021 ). In addition, psychiatric symptoms lessen with appropriate gender-affirming medical and surgical care (Aldridge et al., 2020 ; Almazan and Keuroghlian; 2021; Bauer et al., 2015 ; Grannis et al., 2021 ) and with interventions that lessen discrimination and minority stress (Bauer et al., 2015 ; Heylens, Verroken et al., 2014 ; McDowell et al., 2020 ).…”

Suicide and Self-Harm Prevention and Intervention in LGBTQIA+ Youth: Current Research and Future Directions

“…Of note, several confounding factors co-occur with the presence of a GSA (e.g., larger schools, more experienced teachers; Baams et al, 2018). Additionally, state-level policies banning insurance policies from gender-based discrimination were associated with decreased suicidality in transgender and genderdiverse people (McDowell et al, 2020). Finally, indicating the importance of federal, LGBTQIA+-affirming policies, same-sex marriage policies have been associated with an estimated 134,446 fewer suicide attempts per year among high school students, with this effect driven by LGBQ+ students (Raifman et al, 2017).…”